13-0688 (MECH)P:O. BOX 1504 '414 a
78-495 CALLE TAMPICO
LA QUINTA; CALIFORNIA 92253 BUILDING & SAFETY *DEPARTMENT
BUILDING PERMIT
Application Number:
13-00000688
Property Address:
79390 CALLE PALMETO=
APN:
604-381-013-21 -25953 -
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
9880
Applicant: Architect
'o'or
Engineer:
Vv I.
-----------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and,my License is in full force and effect.
License Class: C20 C36 LicenseNo� 906115_14'
Date: Contractor. .
OWNER -BUILDER DECLARATION - - -
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, .improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State ..
License law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a.civil penalty of not more than five hundred dollars ($500).: !
(_) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, !,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.). '
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
( 1 I am exempt under Sec. ; BAP.C. for this reason
Date: Owner.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penaltyofperjury that there is a construction lending agency for the performance of the
work for which this permit is issued ISec. 3097, Civ. C.I.
Lender's Name:
` Lender's Address:
LQPERMI'I'
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-,7153
Date: 6/03/13
Owner:
LANE WEINMAN
79-390 CALLE PALMETO
.LA QUINTA, CA 92,253
(760)285-8708
Contractor: 0
HYDES.
42949 MADIO 'S E T JUIV 03 2013
INDIO, CA 922 1
(760)360-2202 CITYOF�gQU
Lic. No.: 90 FINdN,rra1NTA
------------------
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier NORGUARD INS Policy Number CEWC356415
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if I should become subject to the worl erg' compensation provisions of Section -
ZZ 3700 of the Labor Code, I shall forth ^ compl ith those provisions.
. Date: �✓, Z�Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE -COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
'
1. Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being -
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of. issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that 1 have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representati4es
of this county to enter upon the above-mentioned property for inspe ti, polir
poses.
Date: e Signature (Applicant or Agent):
' :.Applieation •Number13-00000688'
Permit . . . MECHANICAL 2013
Additional desc -
Permit Fee 71.50 Plan Check Fee
.00
Issue -Date -..Valuation
0
Expiration Date 11/30./13
Qty Unit Charge Per
Extension
`1'.00 35.7500 EA MECH• •FURNACE
35•.75 °.
1.00... 35.7500 EA MECH CONDENSER/COMP
35.75
JNtt-i.ial NVLes and CuuuueiiLs
HVAC'- 16 SEER/78AFUE [2008 ENERGY]
CARBON MONOXIDE'ALARM (S) TO BE
INSTALLED PRIOR. TO FINAL INSPECTION.
.2010 CALIFORNIA BUILDING CODES.
----------------------------------------------------------------------------
Other•Fees BLDG STDS ADMIN (SB14.73)
1.00
PERMIT ISSUANCE M/P/E
90.57
PLAN CHECK; MECHANICAL
47.66
Fee summary Charged Paid Credited
Due
Permit Fee Total 71.50 .00 .00
71.50•
Plan Check Total 00 .00 .00
.00
Other Fee Total 1.39.23 .00 .00
139.23
Grand Total 210.73 .00 00
210:73
LOPEnlff ..
.
Bin #
Petmit.#
Project Address:' 7)
A. P. Number:
Contractor: /
Address:
City, ST, Zip:
City of La Quinta
Building SI Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
,12, Fe, M Q, o Owner's Name:
Address: p/r— 3��Go I
// City, ST' Zip:
4
Project Description: ' 14 %j
III
a]
Telephone:
-
State Lie. # : C7(� " �•
City Lic. #:40
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type:
Occupancy:
P an .
State Lic. #:
Project type (circle one):
New Adi'n Alter Repair' Demo
ep
Name of Contact Person:
Sq. FL: #
Stories: # Units:
Telephone # of Contact Person:
.
Estimated Value of Project: 1`7
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Req'd Recd
TRACKING
Plan Sets
PERMIT FEES
Plan Check submitted
Item
Structural Calcs.
Reviewed, ready for corrections
Amount
Plan Checi Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
•
ConstructIgn
Flood plain plan
Plans resubmitted
Mechanical
Grading. plan
2" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3- Review, ready for corrections/issue
Developer)Snpact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. tlppr
Date of permit issue
School Fees
Total Permir Fees
ij
ji
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations
CF -IR -ALT -HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
79-390 Calle Palmeto La Quinta, CA 92253
City of La Quinta I
Jun 3, 2013
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
IN Furnace
® Indoor Coil
® AFUE 78%
® SEER 13.0
13 COP
[3) HSPF
❑ R 6 (CZ 10-13)•
Served by system
2000 sf
®Setback
If nct already present, must be
® Condensing Unit
[3 EER
[3 Resistance
❑ R 8 CZ 14-15
installed)
❑ Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -IR -ALT -HVAC lbr each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems. -
HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The installer decides what work is being done
and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall
be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this
form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF -6R and registered CF -4R
forms (no hand filled CF-4Rs allowed) are filled out and Sig ned.Beginning October 1, 2010, a registered copy of the CF -IR
and CF -6R shall also be on site for final inspection.
® 1. HVAC Changeout
Required Forms:
. All HVAC Equipment
CF -611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-.4ERS
replaced
CF -4R forms: MECH-21 and (for split systems) MECH-25
. Condenser Coil and /or
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
. Indoor Coil and /or -
CF -4R forms: MECH-21 and (for split systems) MECH-25
. Furnace
•
For Split Systems: Duct leakage < 15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH
V
Exempted from duct leakage testing if: ;'I
[31. Duct system was documented to have been previously sealed and confirmed through HERS verification, or
❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or
❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos
❑ 4. The, system will not be Ducted (ie..Ductless Mini -Split System) (Also Exempt from Refrigerant Charge)
❑ 2. New HVAC System
Required Forms: i.
. Cut in'or Changeout with,CF-6R
forms: MECH-04, MECH-20�HER5 land (for split systems) MECH-22-HERS, and
new ducts: (all new
ducting and all new
MECH=for HH S R J ;l N • �,
MECH-22; MECH-25
CF, -4R for ns:'MECH-20, and (for split system's) and
- --I
equipment) #
// , -, ., ,. x
For Split Systems: Duct leakage.<;6 percent; RC, CCA >_ 350 CFM/ton; FWD,,TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
❑ 3. New Ducts with/or without
Required Forms:
Replacement I
. Includes replacing or installing all new
ducting and/or outdoor condensing unit
CF -611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HER_ S
and/or indoor coil and/or furnace. No or some
CF -4R forms: MECH-20 and (for split systems) MECH,-25
equipment changed.
�1
For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent "
❑ 4. New Ducting over 40 feet
Required Forms:
. Includes adding or replacing more than 40
CF -6R forms: MECH-04, MECH-2I-HERS
linear feet of duct in unconditioned space.
CF -4R forms: MECH-21
For split system or packaged. units: Duct leakage < 15 percent
❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos.,
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
• I certify that this Certificate of Compliance documentation is accurate and complete.
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of
Compliance.
• I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24, Parts 1 and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the information documented on ather applicable compliance
forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application.
Name: Mark Hyde Signature: Mark Hyde
Company: CERTIFIED'COMFORT SYSTEMS INC Date: ]un 3, 2013 ,
Address: 42-949 MADIO STREET Licer:se: 906115
City/State/Zip: INDIO•/ CA / 92201 Phone: (760) 360-2202
Reg:213-A0033774A-000000000-0000 Registration Date/Time: 2013/06/03 12:57:04 HERS P"-ovicier: CaiCERTS, Inc.
2008 Residential Compliance Forms 11 July 2010
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f
i
u
Reg:213-A0033774A-000000000-0000 Registration Date/Time: 2013/06/03 12:57:04 HERS P"-ovicier: CaiCERTS, Inc.
2008 Residential Compliance Forms 11 July 2010
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INSTALLATION CERTIFICATE CF-6R-MECH-04
Space Conditioning Systems, Ducts and Fans (Page 1 of 2)
Site Address:
79-390 Calle Palmeto, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
:
1) .:
City of La Quinta
13-688
Space Conditioning Systems .
i i
Heating Equipment 1."
Cooling Equipment ., a
t
..r
,
Efficiency
Duct
.3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -1R form.
Equip
:� "
Efficiency
Location
® §110-§113: HVAC equipment is certified by the California Energy Commission.
,
® §150(h): Heating and/or cooling Ioads'calculated in accordance with ASHRAE, SMACNA, or ACCA.
Equip
,
- §112(c). -
ik
(AFUE
(attic,
minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely:in
conditioned space
Type
ti
ARI
# of ,,
etc.)1, 3
crawl-
Heating
Heating =
(package-
CEC Certified Mfr. Name
Reference
Identical
(>=CF -IR
space,
Duct
Load
Capacity
heat pump)
and Model Number
Number2
Systems
value)4
etc.)
R -value
(kBtu/hr)
(kBtu/hr),
Split
american standard
a}
16 SEER--,
y i, -
;- c
r^4 _)_7�
Furnace
aud2c100b9v5vba
4586003
1
.8 AFUE
Attic
R-4.2
80
100 kBtu'
Al
11P,
MJ1
Cooling Equipment ., a
1. If project is new construction, see Footnotes to Standards Table 151-8 and Table 151-C for duct ceiling alternative .>.r
r compliance. - : °r. y° ¢
..r
2. ARI Reference Number can be found by entering the equipment model number at
Efficiency
Duct
.3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -1R form.
Equip
:� "
(SEER
Location
® §110-§113: HVAC equipment is certified by the California Energy Commission.
,
® §150(h): Heating and/or cooling Ioads'calculated in accordance with ASHRAE, SMACNA, or ACCA.
Type -.
-
- §112(c). -
r
and EER)
(attic,
minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely:in
conditioned space
(package
ti
ARI
# of
1, 3
crawl-
Cooling
Cooling '
, heat
CEC Certified Mfr. Name
Reference
Identical
(>=CF -1R
space,
Duct
Load
Capacity
pump)
and Model Number .
Number2
Systems
value)4
etc.)
R -value
(kBtu/hr)
(kBtu/hr)-
Split
j american standard"
a}
16 SEER--,
y i, -
;- c
r^4 _)_7�
A/C fy
4a7a5061e1000a
4586003
) 1
13 EER
Attic
R-4.2 ,
44 q
55 kBtu ;
Al
11P,
MJ1
1. If project is new construction, see Footnotes to Standards Table 151-8 and Table 151-C for duct ceiling alternative .>.r
r compliance. - : °r. y° ¢
..r
2. ARI Reference Number can be found by entering the equipment model number at
http://www.aridirectory.orglarilac.php#
.3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -1R form.
.4. When CF -1R is reference it is also applicable to the CF -1R, CF -IR -AA or CF -IR -ALT
"
ALL BOXES MUST BE CHECKED TO BE A VALID FORM'
® §110-§113: HVAC equipment is certified by the California Energy Commission.
® §150(h): Heating and/or cooling Ioads'calculated in accordance with ASHRAE, SMACNA, or ACCA.
t'
® §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of 'p.
- §112(c). -
r
'® §150(j)2: Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets�i
minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely:in
conditioned space
t
Reg: 213-A0033774A-M0400001A-0000 Registration Date/Time: 2013/06/23 13:57:44 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance FormsE
August 2009
r. "
INSTALLATION CERTIFICATE CF-6R-MECH-04
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
Space Conditioning Systems, Ducts and Fans (Page 2 of 2)
Site Address:
79-390 Calle Palmeto, 'La Quinta CA 92253 (System
Enforcement Agency:
Permit Number: ,
1)
City of La Quinta
13-688
Ducts and Fans ` r
§150(m): Duct and'Fans
❑ 1. All air -distribution system ducts and plenums installed, sealed and insulated to meet the `
requirements of CMC Sections 601, 602, 603, 604, 605 and Standard 6-5; supply -air and return -air
ducts and plenums are insulated to a minimum installed level of R-4.2 or enclosed entirely in ,
conditioned space. Openings shall be sealed with mastic, tape or other duct -closure system that meets. '
` the applicable requirements ofiUL 181, UL 181A, or UL 181B or aerosol sealant that meets the
requirements of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch, the combination
of mastic and either mesh or tape shall be used; and
❑ 1. Building cavities, support platforms for air handlers, and plenums defined or constructed with
materials other than sealed sheet metal, duct board or flexible duct shall not be used for conveying A .
conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities -,
and support, platforms shall not be compressed to cause reductions in the cross-sectional area,of the
ducts.,
❑ 2D. Joints and seams of duct systems and their components shall not be sealed with cloth back -
rubber adhesive duct tapes unless such tape is used in combination with mastic and draw bands.
[37. Exhaust fan systems have back draft or automatic dampers.
❑ 8. Gravity ventilating systems serving conditioned space,have either automatic or readily accessible,
manually operated, dampers. t
❑ Protection of Insulation. Insulation shall be protected from damage, including that due to sunlight,- ,
moisture, equipment maintenance, and wind. Cellular foam insulation shall be protected as above or
painted with,a coating that is water retardant and provides shielding from solar radiation that can cause
degradation of the material.
a ❑ 10. Flexible ducts cannot have porous inner. ores. �.'�-.�•..#
'"DECLARATION STATEMENT a.
. I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. 4 r,
. I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized
representative of the person responsible for construction (responsible person).
. • I certify that the installed features; materials, components, or manufactured devices identified on this certificate (the installation) ,
conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the ,
enforcement agency.
• I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by the enforcement agency that identifies the specific
requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the installation have been met.
• I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the
building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I
understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder
provides to the building owner at occupancy. ,
r
•
CERTIFIED COMFORT SYSTEMS INC
Responsible Person's Name:
Responsible Person's Signature:
Mark Hyde
Mark Hyde r -
CSLB License:
906115
Date Signed:
6/4/2013
Position With Company (Title):
Reg: 213-A0033774A-M0400001A-0000 Registration Date/Time: 2013/06/23 13:57:44 HERS Provider: CalCERTS, Inc.
2.008 Residential Compliance Forms ' August 2009
This installation certificate is required for compliance for alterations and additions in existing dwellings to F
space conditioning systems and duct systems, r
r
r
Duct Leakage Diagnostic Test - existing duct system
Select one compliance method from the following four choices.
INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS
`
Duct Leakage Test — Existing Duct System (Page 1 of 2)
Site Address:
79-390 Calle Palmeto, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
E 4. Fix all accessible leaks using smoke and HERS rater verify
•
`
4
1�
Cit y of La Quinta
13-688
This installation certificate is required for compliance for alterations and additions in existing dwellings to F
space conditioning systems and duct systems, r
r
r
Duct Leakage Diagnostic Test - existing duct system
Select one compliance method from the following four choices.
`
® 1. Measured leakage less than 15% of fan Flow.
'
2. Measured leakage to outside less than 10% of Fan Flow ` 1
••
r
Duct Leakage Diagnostic Test - existing duct system
Select one compliance method from the following four choices.
`
® 1. Measured leakage less than 15% of fan Flow.
'
2. Measured leakage to outside less than 10% of Fan Flow ` 1
••
3. Reduce leakage by 60% and conduct smoke and fix all leaks
E 4. Fix all accessible leaks using smoke and HERS rater verify
•
`
4
Note: (One of Options 1, 2 or 3 must be attempted. before utilizing Option
_
Determine nominal Fan Flow using one ofrthe following three calculation methods. If/ } f
® Cooling system method: Size of condenser in Tons 15 x 400 = 2000 CFM
* L
✓0 Heating system method: 21.7 x Output Capacity inThousands of Btu/hr = _CFM,
�{r
✓0 Measured system airflow using RA3.3 airflow est procedures:`j CFM
Option 1 used then:,...
1
Allowed leakage = Fan Airflow 2000 x 0.15 ._ 300 CFM ;
Actual Leakage = 190 CFM
+
Pass if Actual Leakage is less than Allowed leakage
Pass Fail
Option 2 used then:
2
Allowed leakage = Fan Airflow _ x 0.10 = — CFM
Actual Leakage to outside = _ CFM
Pass if Actual leakage to outside is less than Allowed leakage
13 Pass Fail
Option 3 used then: '
Initial leakage prior to start of work = _ CFM "
Final leakage after sealing all accessible leaks using smoke test _ _ CFM
3 '
Initial leakage _ - Final leakage . f = Leakage reduction CFM -
((Leakage reduction _/Initial leakage 1 x 100% _ %Reduction
Pass if % Reduction >= 60%
Pass Fail
Option 4 used then:-,
4
All accessible leaks repaired using smoke test. HERS rater must verify (No Sampling).
`
Pass if all accessible leaks have been repaired using smoke
❑ Pass p Fail.
INSTALLATION CERTIFICATE + CF-6R-MECH-2I-HERS
Duct Leakage Test — Existing Duct System (Page 2 of 2)
Site Address:
79-390 Calle Palmeto, La:Quinta CA 92253 (System
Enforcement Agency:
'
Permit Number: '
1)
City of La Quinta
13-688
' , '• a .r ,. `* `,, 1 .+ }. `}} i -f •'} `,ice,. ... - '"+: . -.. - e
f
kr
I@ Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off, r
• during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA
ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may
`be configured to the closed position during duct leakage testing. ° •x: a.:
-— ^,�`�",_.+�€+_.a�-��-.i
. ® All supply- and return'register ;boots,must be„sealed to the drywall if smoke testis utilized for compliancei r -
applies`to duct leakage compliance option 3 (leakage reduction. by 60%) and option 4(fix all accessible „
Teaks) described above,, +�
® New duct installationscannot utilize building cavities aSl,plenums`,or platform' returns in lieu of ducts.
® Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct.tape to'seal{,; 1 r
leaks at all new duct connections �, , _' r
'DECLARATION STATEMENT
{ • I certify under penaltyof perjury, ry, under the laws of the State of California; the information provided on this form is true and correct • v";, , ' i:;
•' I am eligible under -Division 3.of the Business and Professions Code to accept responsibility for construction, or an authorized t-
representative of the person responsible for construction (responsible person). ,
• I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) d''.�
conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the
enforcement agency. { r f ,j
• I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am - • ''
required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also
.perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS
rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and >.
,additional checking/testing of other installations in that HERS sample group will be performed at my expense. , _.
• I reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that identifies the specific r
Y. requirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the installation have been met.
4 • I will ensure that a completed, signed copy of.this Installation Certificate shall be posted, or made available with the
building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I
understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder,_ . r
provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data
registry for multiple orientation alternatives, and beginning October 1;2010, for all low=rise residential buildings. + rr
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) t
CERTIFIED COMFORT SYSTEMS INC
Responsible Person's Name:
Responsible Person's Signature: ,
Mark Hyde _ I -
Mark Hyde '
CSLB License:
Date Signed:
Position With Company (Title):
90611S
6/4/2013
,
Is this installation monitored by a Third Party Quality
Name of TPQCP (if applicable): i.
Control Program (TPQCP)? [3 Yes ❑ No
Reg: 213-A0033774A-M2100001A-0000 Registration Date/Tim e: 2013/06/23 13:58:13} HERS Provider: CalCERTS, Inc.
2008 Residential -Compliance Forms t' j ` March 2010 '
INSTALLATION CERTIFICATE CF-611-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 6)
Site Address: Enforcement Agency: Permit Number:
79-390 Calle Palmeto, La Quinta CA 92253 , City of La Quint a 13-688
a -
Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge,*
verification for compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to
demonstrate compliance with the refrigerant charge verification requirement. TMAH and STMS are not ,
required for compliance when a CID is utilized for compliance. .
As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an
additional form(s) for any additional systems in the dwelling as applicable.
Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement
Sensors (STMS)
Procedures for installing, TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge -
verification is required for compliance, TMAH are also required for compliance, unless the TMAH Compliance
Option is chosen.
STMS are only required for completely new of replacement space -conditioning systems that utilize , •' `
prescriptive compliance method.
TMAH - Access Holes in Supply and Return Plenums of Air Handler '
System Name or Identification/Tag
System 1
System Location or Area Served
Whole House
5/16 inch (8 mm) access hole
1 ,
upstream of evaporative coil in the
® Yes
❑ Yes.
❑ Yes
❑ Yes
return plenum and labeled according
❑ No
❑ No
❑ No
❑ No
to Figure,in Section RA3.2.2.2.2.'.
Return side of the, duct system is".,'
L
`
L
la
located entirely within, conditioned=.
El Yes ''
❑ Yes
❑ Yes
-11 Yes
space and return aiiflow temperature
❑ No
❑ No
❑ Nok
❑ No
to be measured,,A the return grille.
'
5/16 inch (8`mm).access holed
downstream
"
�-
€ s.
2
of evaporative coil in the�,
® Yes
❑ Yes
❑ Yes`•
❑•Y
,
supply plenum and labeled according
"❑ No 6
❑ No •
.❑ No
❑ No
to Figure in Section RA3.2.2.2.2.
The TMAH Compliance Option should be checked only if it is physically impossible to drill the TMAH as
required by Section RA3.2.2.2.2. Using this Compliance Option requires the HVAC installer to annotate on
the HERS Provider's data registry an explanation as to why the TMAH cannot be installed on the system,
and photographs of the equipment on which the TMAH cannot be installed. Use of this Compliance Option_
also requires minimum airflow verification through the direct measurement of airflow per RA3.3
For more information see httl2://www.energy.ca.ciov/title24/2008standards/special case appliance/ - y
TMAH Compliance Option
❑
❑
❑
❑
Yes to 1 and 2, or Yes to la and 2, or
checking the TMAH Compliance_ Option, is
® Pass ', .
❑ Pass
❑ Pass
❑ Pass
a pass. -
❑ Fail
❑ Fail
❑ Fail
❑ Fail
' f Enter Pass or Fail
J
Reg: 213-A0033774A-M2500001A-0000 Registration Date/Time: 2013/06/23 14:01:14 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms ? March 2013
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 6)
Site Address: Enforcement Agency: Permit Number:
79-390 Calle Palmeto, La Quinta CA 92253 City of La Quint a 13-688
STMS . Sensor on the Evaporator Coil '
System Name or
System 1 '.
f
'
..
Identification/Tag'
The sensor is factory installed, or.field installed according to.manufacturer's specifications, or is installed)
by methods/specifications approved by the Executive, Director..,,
❑ Yes ❑ No ' ❑ Yes ❑ No ❑ Yes ❑ No � ❑,Yes `❑ No, "
3
The sensor is factory installed, or field installed according to manufacturer's specifications, or is installed
7
by methods/specifications approved by the Executive Director.
•1 ❑ Yes ❑ No 1 ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
airflow through the condenser coil
sensor wire is terminated with a standard mini plug suitable for connection to a digital thermometer.
JT:he
sensormini plug is accessible to the installing technician and the HERS rater without changing thelow
❑ Yes ❑ No ❑ Yes ❑ No
through the condenser coil
,❑
❑ Yes ❑ No - ❑ Yes ❑ No ❑ Yes No ❑ Yes ❑ No'
5 The sensor measures the saturation temperature of the coil within 1.3 degrees F
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Yes to 3, 4, and 5 is a
❑ N/A
applicable.
-
❑ Pass
pass.-
Enter N/A if STMS are not
® N/A
V❑ N/A. f
❑ N/A
' ' ❑ N/A
applicable.
❑ Pass
❑ Pass
❑Pass =
❑Pass ' '
Otherwise -enter Pass or
❑Fail,
❑Fail
❑Fail
❑Fail
Fail
•
--L �;
• is _ x .
STMS - Sensor on the Condenser Coil , • - , - �� s
System Name or
Identification a
System,i
'
..
6
The sensor is factory installed, or.field installed according to.manufacturer's specifications, or is installed)
by methods/specifications approved by the Executive, Director..,,
❑ Yes ❑ No ' ❑ Yes ❑ No ❑ Yes ❑ No � ❑,Yes `❑ No, "
The sensor wire is,terminated with a standard mini plug suitable for connection to a digital thermometer.,4
7
The sensor, mini"plug is accessible to the installing technician and -the HERS rater without changifig- O'e' '
airflow through the condenser coil
❑ Yes ❑ No ❑ Yes ❑ No - ❑ Yes ❑ No - ❑ Yes ❑ No ;
8. The sensor measures the saturation temperature of the coil within 1.3 degrees F
❑ Yes ❑ No ❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Yes to 6, 7, and 8isa
Enter N/A if STMS are not
❑ N/A ❑ N/A
'
- ❑ N/A
❑ N/A
applicable.
❑ Pass ❑ Pass
^{❑Fail
❑ Pass
❑ Pass
`"13
Otherwise enter Pass or
❑Fail
'
❑Fail
Fail f
Fail
Y
•
--L �;
a: ...7' ^i - Iry f
^.' a �"�
.. 1
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Reg:,213-A0033774A-M2500001A-0000:
Registration_ Date/Time:'
2013/06/23 14:01:14
HERS Provider: Ca10ERTS, Inca
2008 Residential Compliance Forms
"
March 2013
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 6)
Site Address: Enforcement Agency: Permit Number:
79-390 Calle Palmeto, La Quinta CA 92253 City of La Quint a 13-688
Standard Charge Measurement Procedure (for use if outdoor air dry-bulb temperature is 55°F or
above)
Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in
Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using
this form. Attach an additional form(s) for any additional systems in the dwelling as applicable.
• The system should be installed and charged in accordance with the manufacturer's specifications before starting this
procedure.
• The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test.
• If outdoor air dry-bulb temperature is less than 550F, the installer must use the RA3.2.3 Alternate Charge Measurement
Procedure (Weigh -In Charging Method). If the Weigh -In Method is used, the dwelling cannot be included in a sample
>' group for HERS verification compliance.) k, , ' ,
Space Conditioning Systems ~
System Name or Identification/Tag
System 1 ,4
(must belre-calibrated ..-,,�`
monthly)"
Date of Thermocouple Calibration
6/1/2013
System Location or Area Served
Whole House.
Outdoor Unit Serial #
13094t6t2f
Outdoor Unit Make
american
standard
Outdoor Unit Model
4a7a5061e1000a
(Tcondensor, sat)
Nominal. Cooling,Capacity - -
,t.�._S Tons,
Liquid Line Temperature (Tliquid)
94.8 0
[Date_of Verification;
6%4/2013
%
}
temperature (Tcondenser, db)
-Calibration of Diagnostic Instruments ,# � J.
Date of Refrigerant Gauge Calibration
6/1/2013
(must belre-calibrated ..-,,�`
monthly)"
Date of Thermocouple Calibration
6/1/2013
(must be re -calibrated
monthly)
Measured Temperatures (°F)
9
System Name or Identification/Tag
System 1
Supply (evaporator leaving) air dry -bulb -
temperature (Tsu I db)
42.3
Return (evaporator entering) air
dry-bulb temperature (Treturn db) •
104.4
Return (evaporator entering) air
wet -bulb temperature (Treturn wb)
Evaporator saturation temperature
42.3
(Teva orator sat)
Condensor saturation temperature
104.4
(Tcondensor, sat)
Suction line temperature (Tsuction)
66.9
Liquid Line Temperature (Tliquid)
94.8 0
Condenser (entering) air dry-bulb
91.3
temperature (Tcondenser, db)
Reg: 213-A0033774A-M2500001A-0000 Registration Date/Time: 2013/06/23 14:01:14 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2013
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 6)
Site Address: - Enforcement Agency: Permit Number:
79-390 Calle Palmeto, La Quinta CA 92253 City of La Quint a 13-688
Minimum Airflow Requirement
Temperature Split Method Calculations for determining Minimum Airflow Requirement for
Refrigerant Charge Verification. The temperature split method is specified in Reference_ Residential
Appendix RA3.2. # ' y ,• -
System Name or Identification/Tag
System 1•
Calculate: Actual Temperature Split
iii
�
_ �
- � ..
• -. �
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 6)
Site Address: - Enforcement Agency: Permit Number:
79-390 Calle Palmeto, La Quinta CA 92253 City of La Quint a 13-688
Minimum Airflow Requirement
Temperature Split Method Calculations for determining Minimum Airflow Requirement for
Refrigerant Charge Verification. The temperature split method is specified in Reference_ Residential
Appendix RA3.2. # ' y ,• -
System Name or Identification/Tag
System 1•
Calculate: Actual Temperature Split
Treturn db - Tsupply, db
Target Temperature Split from Table RA3.2-3
�I
using Treturn wb and Treturn db
Calculate difference: Actual Temperature
`
Split - Target Temperature Split =
Passes if difference is between -3°F and
+3°F or, upon remeasurement, if between
-3°F and -100°F . " ' .
-
,
Enter Pass or Fail
Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using. .
one of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual_
cooling coil airflow is measured, the_value must be equal to'or greater than the Calculated Minimum Airflow
Requirement in the table below.
= X1300'
Calculated Minimum Airflow Requirement (CFM) Nominal Cooling Capacity:(ton)
(cfm/ton)
System -Name oop4dentification/Tag\
,,� System'1/
Calculated Minimum Airflow' Requirement
1500
(CFM) . 4
_
Measured Airflow using RA3.3 procedures
1605
'
(CFM)
Measurement Method,.'
"Flow'Hood
f
Passes if measured airflow is greater than or
a
equal to the calculated minimum airflow
PASS
requirement.
•" �'
�'
Enter Pass or Fail
'
- _. ,�• i _ ' ^Ill - �' } - — .. • • ' ,1.,,
` •' T ` r ��e•a. F + `�, '�-1.. �� - • , .� ! - ` - l r= ';`rte .. t , * t ,v�.
ts
Reg: 213-A0033774A-M2500001A-0000 Registration Date/Time:'2013/06/23 14:01:14 HERS PrOvider:'CalCERTS, Inc.
r 2008 Residential Compliance Forms r March 2013
r
Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is
required to be used for fixed orifice metering device systems
System Name or Identification/Tag
System 1
;
Calculate: Actual Superheat =
9.6
,
Tsuction - Teva orator sat
Target Superheat from Table RA3.2-2
10
r
'
using Treturn wb and Tcondenser, db
4 to 25
s
Calculate difference:
0.4
r
Actual Superheat- Target Superheat =
+
`.
" -^v.
passes if difference is between
G
q•i
7-5'and+5°F
f _
L
= Enter Pass or Fail
'
Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is ,
required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems.
System Name or Identification/Tag.
System 1.
Calculate: Actual Subcooling =
9.6
Tcondenser, sat - Tli uid
2 " `
10
r
'
Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is ,
required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems.
System Name or Identification/Tag.
System 1.
Calculate: Actual Subcooling =
9.6
Tcondenser, sat - Tli uid
Target Subcooling specified by i
10
r
'
manufacturer
4 to 25
s
Calculate difference:.
Actual Subcooling-*Target Subcooling, f
0.4
r
System passes if difference is between
!
PASS
`.
" -^v.
-3°F and +30F. .'
G
q•i
J Enter Pass or Fail
• l
L
Metering Device Calculations for Refrigerant Charge Verification. This procedure is'requiredto be,iz
used for thermostatic expansion ivalve (TXV) and electronic expansion valve (EXV) systems.
System Name or Identification/Tag
System 1
Calculate: -Actual Superheat =
24.6
Tsuction - Teva orator sat
Enter allowable superheat range from
F
r
a.
manufacturer's specifications (or use range
4 to 25
between 4°F and 25°F if manufacturer's
specification is not available)
System passes if actual superheat is within
the allowable superheat range .
PASS
Enter Pass or Fail
'
..
L
' Reg: 213-A0033774A-M2500001A=0000 Registration Date/Time: 2013/06/23 14:01:14 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms F March 2013
r
F
r
..
L
' Reg: 213-A0033774A-M2500001A=0000 Registration Date/Time: 2013/06/23 14:01:14 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms F March 2013
�u
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 6 of 6)
Site Address: Enforcement Agency: Permit Number:
79-390 Calle Palmeto, La Quinta CA 92253 City of La Quinta 13-688
Standard Charge Measurement Summary:
System shall pass both refrigerant charge criteria, metering device criteria (if applicable), and minimum
cooling coil airflow criteria based on measurements taken concurrently during system operation. If
corrective actions were taken, all applicable verification criteria must be re -measured and/or recalculated.
System Name or Identification/Tag
System 1
CSLB License:
906115
Date Signed:
6/4/2013
Position With Company (Title):
System meets all refrigerant charge and
Name of TPQCP (if applicable):
Control Program (TPQCP)? ❑ Yes ❑ No
airflow requirements.
PASS
Enter Pass or Fail
.
® Residential Appendix RA3.2.2 requires that if the outdoor temperature is between 55°F and 65°F the -
return air dry bulb temperature shall be maintained above 70°F during the Standard Charge Measurement
Procedure. The signature of the Responsible Person in the declaration statement below certifies this ti
requirement has been met for all applicable system verifications reported on this certificate.
DECLARATION STATEMENT ,lil -
. I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true
and correct.
. I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an
authorized representative of the person responsible for construction (responsible person).
. I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the
installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and
specifications approved by the enforcement agency.
. I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies
defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS
provider representatives will also perform quality assurance checking of installations, including those approved as part.
of a sample group but not checked by a HERS rater; and'if those installations fail,to'meet the requirements of such
quality assurance checking, -the required corrective action and additional checking/testing of other installations in that
HERS sample group will be performed at my expense./ J I 7 I .
. I reviewed a copy of the Certificate of Compliance (CF -1R) form approved'by the enforcement agency that identifies the - -
specific requirements for the installation. I certify that the requirements detailed on�the CF -IR that apply to the- s "
installation have been met. J x.
. I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available,,,, y
with the building permit(s) issued for the building, and made available to the enforcement agency'for all
applicable inspections. I understand that a signed copy of this Installation Certificate is required to be ;
included with the documentation the builder provides to the building owner at occupancy. I will ensure that
all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives, and.
beqinninq October 1, 2010, for all low-rise residential buildings.
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
CERTIFIED COMFORT SYSTEMS INC
Responsible Person's Name:
Responsible Person's Signature:
Mark Hyde
Mark Hyde
CSLB License:
906115
Date Signed:
6/4/2013
Position With Company (Title):
Is this installation monitored by a Third Party Quality
Name of TPQCP (if applicable):
Control Program (TPQCP)? ❑ Yes ❑ No
Reg: 213-A0033774A-M2500001A-0000 Registration Date/Time: 2013/06/23 14:01:14 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2013
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4111-MECH-21
Duct Leakage Test - Existing Duct System (Page 1 of 2)
Site Address:
79-390 Calle Palmeto, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
13-688
Enter the Duct System Name or Identification/Tag: System i
Enter the Duct System Location or Area Served: Whole House
Note: Submit one Installation Certificate for each duct system that must demonstrate compl_ance in the
dwelling.
This installation certificate is required for compliance for alterations and additions in existing dwellings to
space conditioning systems and duct systems.
Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of
the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible
and they can be sealed. For a completely new or replacement duct system installed in an exsting dwelling,
use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Cuct System. "
Duct Leakage Diagnostic Test - existing duct system
Select one compliance method from the following four choices.
❑ 1. Measured leakage less than 15% of fan Flow
❑ 2. Measured leakage to outside less than 10% of Fan Flow
❑ 3. Reduce leakage by 60% and conduct smoke and fix all leaks
❑ 4. Fix all accessible leaks using smoke and HERS rater verify
Note: (One of Options 1, 2, or 3 must -be attemptedhbefore,utilizing Option. ;4.),•
Determine nominal Fan' Flow using one ofthe`following three calculation method' Ar
44. Y .. y , f4 J. �. > ,
.k `.
✓ ElCooling system method: Size of condenser in Tons x 400 = CFM '^
,
>ti
✓ ❑ Heaa�ting,system meethod: 21.7-,x' Output Capacity in Thousands of Btu/hr = CFM
, ri x'
�
TV
.',I!.
✓ ❑ Measuredsystem airflow5usmg RA3 3.airflow test procedures.1 CFM. . +�6�.`•>
W --
f
"49
Optionl•used then:
1
- an Flow i` x 0 15 = _ CFM
Allowed leakage - F0.15
Actual Leakage '_ _CFM
j- Pass if Leakage Actual is less than Allowed
Pass Fail
Option 2 used then:
2
Allowed leakage = Fan Flow 1 x 0.10 = _CFM
Actual Leakage to outside = _ CFM
Pass if Leakage Actual is less than Allowed
Pass Fail
Option 3 used then:
Initial leakage prior to start of work = _ CFM
Final leakage after sealing all accessible leaks using smoke test = _ CFM
3
Initial leakage _ - Final leakage _ = Leakage reduction _ CFM
((Leakage reduction _ / Initial leakage _) x 100% _ % Reduction
Pass if % Reduction >= 60%
Pass Fail
Option 4 used then:
4
All accessible leaks repaired using smoke test. HERS rater must verify (No sampling).
Pass if all accessible leaks have been repaired using smokell
! Pass Fail
0—
Reg: 213-A0033774A-M2100001A-M21A Registration Date/Time: 2013/06/27 11:23:21 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
If
�S t-
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING
CF 4R MECH 21
Duct Leakage Test — Existing Duct System
(Page 2 of 2)
Site Address:
79-390 Calle Palmeto, La Quinta CA 92253 (System
Enforcement Agency:
City of La Quinta
Permit Number:
13-688
1)
Sample Group # (if applicable): 423188 JEteste
_
t
❑ Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off 3
during duct leakage testing. CFI'OA ducts that utilize controlled motorized dampers, that open only when.O.A ,
ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may `j
be configured to the closed position •during duct leakage testing. ,
"71
❑ All supply and return register bootsfrinust be,sealed?'to the drywall if,srnoke test+is utilized fbrrcompliance
— appllesfto;duct leakage complianceFoption 3 (leakage reductlon'by 60%) and option 4z(fix all accessible •,
leaks) described above.,01W.
❑ New duet;inst�al�lationscannot+utilize.';building cavities as:plenumplatform.returns.fn lieu;of ducts
❑ Mastic and draw bands must beused nicombination.with cloth`backed rubber adhesive duct tape to seal ,
leaks at all new duct connections:'
DECLARATION STATEMENTI..
. I certify under penalty of perjury, under the laws of the State of Calif)rnia, the information provided on this form is =rue and correct.'..
. I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater).
. The installed feature, material, component, or manufactured device requiring HERS verification that is Identified on this certificate (the -
installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified -
-on the Certificate(s) of Compliance (CF -1R) approved by the local enforcement agency. .
. The information reported on applicable sections of the Installation Certificate(s) (CF -6R), signed and submitted by the person(s) `; r
responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -1R) a -)proved by the '
enforcement agency. I r
Builder or Installer information as shown on the Installation Certificate (CF -6R)
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) ;
CERTIFIED COMFORT SYSTEMS INC j
Responsible Person's Name:
CSLB License:
Mark Hyde
1906115
HERS Provider Data Registry Information
Sample Group # (if applicable): 423188 JEteste
d/verified dwelling
nt-tested/ve-ified dwelling in
PaHEORS
sample group
HERS Rater Information CalCERTS Certificate # CC1-1798761759
HERS Rater Company Name: -
Desert H.E.R.S. Raters'
Responsible Rater's Name:
Responsible Rater's Signature:
Michael Hyde
Michael Hyde «
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed: 6/12/2013
CC2005602
I
Reg: 213-A0033774A-M2100001A-M21A Registration Date/Time:'2013/06/27 11:23:21 HERS Provider: CalCERTS,`Inc.
2008 Residential Compliance Forms March 2010
i
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 6)
Site Address: Enforcement Agency: Permit Number:
79-390 Calle Palmeto, La Quinta CA 92253 City of La Quinta 1 13-688
Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrige-ant charge
verification for compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) shou:d be used to
demonstrate compliance with the refrigerant charge verification requirement. TMAH and STMS are not
required for compliance, when a CID is utilized for compliance.
As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an
additional form(s) for any additional systems in the dwelling as applicable.
Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement
Sensors (STMS)
Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge
verification is required for compliance, TMAH are also required for compliance; unless the TMAH Compliance
Option is chosen.
STMS are only required for completely new or replacement space -conditioning systems that utilize
prescriptive compliance method.
TMAH - Access Holes in Supply and Return Plenums of Air Handler
System Name or Identification/Tag
System 1
System Location or Area Served
Whole House
5/16 inch (8 mm) access hole
1
upstream of evaporative coil in the
❑ Yes
❑ Yes
❑ Yes
❑ Yes
return plenum and labeled according
❑ No
❑ No
❑ No
❑ No
to Figure;in Section RA3.2.T2:2.2. ":
%�T-WN
,�
Returnxside of the duct system is , ;;
la
located; entirely withimconditioned"
r ,.
space and return airflow temperature
❑ Ye's
❑ No
❑+Yes:
s
t t❑ No`
1* ❑ Yes.;.
❑ No
-,r_
❑ Yes
No
tofbe "measured�at the return#grille.
" M ,,`
knn...
8 mm)'aecess hole.1.
of`evaporativecoil'inthe
4.t_.
2
15/1'6,i'hclh
downstream
❑es,
❑ Yes
, •- ❑Yes
❑'Yes
supply plenum and labeled 'according
❑ No
❑ No
❑ No
❑ No
to Figure .in -Section RA3.2.2.2.2.
The TMAH Compliance Option should be checked only if the HERS Rater is able to confirm that it was
physically impossible for the HVAC Installer to drill the TMAH as required by Section RA3.2.2.2.2. Using this
Compliance Option requires the HVAC installer to annotate on the HERS Provider's data registry an
explanation as to why the TMAH cannot be installed on the system, and photographs of the equipment on
which the TMAH cannot be installed. Use of this Compliance Option also requires minimum a"ow
verification through the direct measurement of airflow per RA3.3. For more information see
http://www.enerav.ca.aov/title24/2008standards/special case appliance/
TMAH Compliance Option
❑.
p
❑
❑
Yes to 1 and 2, or Yes to la and 2, or
checking the TMAH Compliance Option, is
E3 Pass
❑ Pass
❑ Pass
❑ Pass
a pass.
❑ Fail
❑ Fail
❑ Fail
❑ Fail
Enter Pass or Fail
0
Reg: 213-A0033774A-M2500001A-M25A Registration Date/Time: 2013/06/27 11:25:43 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms February 2013
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 6)
Site Address: Enforcement Agency: Permit Mumber:
79-390 Calle Palmeto, La Quinta CA 92253 City of La Quinta 1 13-688
STMS - Sensor on the Evaporator Coil
System Name or
Identification/Tag
Ir
3
The sensor is factory installed, or field installed according to manufacturer's specifications, or is installed
by methods/specifications approved by the Executive Director.
❑ Yes ❑ No I ❑ Yes ❑ No ❑ Yes ❑ No 7 Yes ❑ No
i .PP a
The sensor wire is terminated with a standard mini plug suitable for connection to a digital thermometer.
4
The sensor mini plug is accessible to the installing technician and the HERS rater without changing the
7
airflow through the condenser coil
❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No T ❑ Yes ❑ No
5
When attached to a digital thermometer, the sensor provides an indication of the saturation temperature
8
of the coil.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Yes to 3, 4, and 5 is a
❑ Yes ❑ No
Yes to 6, 7, and 8 is a
pass.
Enter N/A if STMS are not
❑ N/A
❑ N/A
❑ N/A
❑ N/A
applicable.
❑ Pass
❑ Pass
❑ Pass
❑ Pass
Otherwise enter Pass or
❑ Fail
❑ Fail
❑ Fail
❑ Fail
Fail
s
STMS - Sensor on the Condenser Coil
System Name!�6r'
Identification/TagSYstem
Ir
6
The sensor is factory,iristalledMor field installed1according tolmanufacturer's specificafions, or is installed
b methods s ecifications a rovedib the Executive. birector:�,`.k 2''
Y / P Y �� Vii: �.I.�i
i .PP a
w s T, ,❑ Yes; ❑ No f r v ❑ Yes1 O`No ,'; ❑Yes. l7 No , �,❑ :Yes ❑,Nof fir'°
.
The sensor�wire'islterminated with a'r5tanda�d mini'plugisuitatile for connection to a digitalahermometer f
7
The sensor mini plug is accessible to the installing iechnician-and the HERS rater without ganging the
airflow through.,the condenser coil
![:]Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
8
When attached to a digital thermometer, the sensor provides an indication of the saturation temperature
of the coil. I
❑ Yes ❑ No
❑ Yes ❑ No
[]Yes ❑ No
❑ Yes ❑ No
Yes to 6, 7, and 8 is a
pass.
Enter N/A if STMS are not
❑ N/A
❑ Pass
❑ N/A
❑ Pass
❑ N/A
❑ Pass
❑ N/A
❑ Pass
applicable.
Otherwise enter Pass or
❑ Fail
❑ Fail
❑ Fail
❑ Fail
Fail
t
No
P
Reg: 213-A0033774A-M2500001A-M25A Registration Date/Time: 2013/06/27 11:25:43 HERS Prcvider: CalCERTS, Inc.
2008 Residential Compliance Forms February 2013
•'I
System 1
Calibrate ni of Diagnostic Instruments
,
r
I
Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F) ,
Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in
Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for cor7pliance using i
this form. Attach an additional form(s) for any additional systems in the dwelling as applicable.
• The system should be installed and charged in accordance with the manufacturer's speciFcations before starting this
procedure.
• The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge tes=..
• If outdoor air dry-bulb temperature is less than 55°F the installer must use the RA3.2.3 Alternate Charge Measurement
Procedure (Weigh -In Charging Method). If the Weigh -In Method is used, the dwelling"cannot be included in a sample
group for HERS verification compliance.)
Space Conditioning Systems ! '
System Name or Identification/Tag •
System 1
Calibrate ni of Diagnostic Instruments
,
r
System Location or Area Served
Whole House
{
(must be re -calibrated monthly)
Outdoor Unit Serial #
j
Outdoor Unit Make `
Outdoor Unit Model
�
n
Nominal Cooling Capacity
I
Date of Verf ationyr.�
:MO p A.Wt iii f<, `-11*0 •��ib'iir. ` 9b"` _a7+,:'F' -''.
al^•EC ," . ""k a , ,
Calibrate ni of Diagnostic Instruments
,
r
R•*•%•j. �;•ie, cta_ .w.
Date of Refrigerant Gaugel
•ys t
i X j Vo N� 11 . - . — - = .
VIS 0
Ali, P�
Calibration
al^•EC ," . ""k a , ,
'(must be re-calib�afed mon;1thly)
t-
Supply (evaporator leaving) air dry-bulb
Date of Thermoc uo ple Calibration
{
(must be re -calibrated monthly)
temperature (Tsu I db)
14
Measured Temperatures (°F)
System Name or Identification/Tag
System 1
Supply (evaporator leaving) air dry-bulb
4
temperature (Tsu I db)
14
Return (evaporator entering) air
dry-bulb temperature (Treturn db)
Return (evaporator entering) air
I
wet -bulb temperature (Treturn wb)
Evaporator saturation temperature
(Teva orator sat)
Condensor saturation temperature
(Tcondensor, sat)
,
Suction line temperature (Tsuction)
i.
Liquid Line Temperature (Tliquid)
'
Condenser (entering) air dry-bulb
temperature (Tcondenser, db)
.,
t
_Reg: 213-A0033774A-M2500001A-M25A Registration Date/Time: 2013/06/27 11:25:43 HERS Prcvider: CalCERTS, Inc.
2008 Residential Compliance Forms February 2013
INSTALLATION CERTIFICATE CF-4R-MECH-2!
Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 6)
Site Address: Enforcement Agency: Permit Number.
79-390 Calle Palmeto, La Quinta CA 92253 [City of La Quinta 1 13-688
Minimum Airflow Requirement
Temperature Split Method Calculations for determining Minimum Airflow Requirement for
Refrigerant Charge Verification. The temperature split method is specified in Reference Residential
Appendix RA3.2.
System Name or Identification/Tag
Calculate: Actual Temperature Split = Treturn,
db - Tsupply, db
Target Temperature Split from Table RA3.2-3
using Treturn wb and Treturn db
Calculate difference: Actual Temperature Split -
Target Temperature Split =
Passes if difference is between -4°F and +4°F
or, upon remeasurement, if between -4°F and
-100°F
Enter Pass or Fail
Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using
one of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual
cooling coil airflow is measured,'the value must be equal to or greater than the Calculated
Minimum Airflow Requirement in the table below.
CalculatedrMmimum Airflow Requirement (CFM)`t— Nominal Cooking Capacity (ton) 7I 300/y
(cfm/ n){
14
System Name or Identification%Tai gw:,��
Calculated Minimum Airflow Requirement`
(CFM) I
Measured Airflow using RA3.3 procedures
(CFM) i
Measurement Method
Passes if measured airflow is greater than or
equal to the calculated minimum airflow
requirement.
Enter Pass or Fail
a
Reg: 213-A0033774A-M2500001A-M25A Registration Date/Time: 2013/06/27 11:25:43 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms February 2013
INSTALLATION CERTIFICATE CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 6)
Site Address: Enforcement Agency: Permit Number:
79-390 Calle Palmeto, La Quinta CA 92253 City of La Quinta 1 13-688
Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is
required to be used for fixed orifice metering device systems
System Name or Identification/Tag
systems.
System Name or Identification/Tag
Calculate: Actual Superheat =
Calculate: Actual Superheat =
Tsuction - Teva orator sat
Tsuction - Teva orator sat
Target Superheat from Table RA3.2-2 using
Enter allowable superheat range from
Treturn wb and Tcondenser, db
manufacturer's specifications (or use range
Calculate difference:
between 3°F and 26°F if manufacturer's
Actual Superheat - Target Superheat =
specification is not available)
System passes -if difference is between -6°F
`J
and +6°F
a#
. r`'�4.-- jp
,'�.("'`�
Enter Pass or Fail
Enter Pass or Fail
Subcooling Charge Method .Calculations for Refrigerant Charge Verification. This procedure is
required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems.
System Name or Identification/Tag
systems.
System Name or Identification/Tag
Calculate: Actual Subcooling =
Calculate: Actual Superheat =
Tcondenser, sat - Tli uid '
Tsuction - Teva orator sat
Target Subcooling specified by manufacturer
Enter allowable superheat range from
t
manufacturer's specifications (or use range
Calculate difference:
Actual Suticoolmg -.Target Subegolingr=,
between 3°F and 26°F if manufacturer's
specification is not available)
System passes if difference is betweenr
-4°F and +4°F,
`J
a�
y:JEnterPass'or Fail}.'
a#
. r`'�4.-- jp
,'�.("'`�
; *�'-,.r��r. -,. .��• • � � 3 �....p:�.:.�.t:°�,a+a� ,gyp,-�` '` G.�" t�+
} l r
Metering Device, Calculations for Refrigerant Charge Verification. This
procedure is required to be
used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV)
systems.
System Name or Identification/Tag
Calculate: Actual Superheat =
Tsuction - Teva orator sat
Enter allowable superheat range from
manufacturer's specifications (or use range
between 3°F and 26°F if manufacturer's
specification is not available)
System passes if actual superheat is within
the allowable superheat range
Enter Pass or Fail
Reg: 213-A0033774A-M2500001A-M25A Registration Date/Time: 2013/06/27 11:25:43 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms February 2013
INSTALLATION CERTIFICATE CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 6 of 6)
Site Address: Enforcement Agency: Permit Number:
79-390 Calle Palmeto, La Quinta CA 92253 City of La Quinta 1 13-688
Standard Charge Measurement Summary:
System shall pass both refrigerant charge criteria, metering device criteria (if applicable), and minimum
cooling coil airflow criteria based on measurements taken concurrently during system operation. If
corrective actions were taken, all applicable verification criteria must be re -measured and/or recalculated.
System Name or Identification/Tag
System i
906115`
HERS Provider,Data Registry,"Information
Sample Group # (if applicable)'' 423188
System meets all refrigerant charge and
® not-tested/verified dwelling
in a HERS sampe group
airflow requirements.
HERS Rater Company Name:
Desert H.E.R.S. Raters
Responsible Rater's Name:
Responsible Rater's Signature:
Enter Pass or Fail
Michael Hyde
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed: 6/12/2013
CC2005602
❑ Residential Appendix RA3.2.2 requires that if the outdoor temperature is between 55°F and 65°F the
return air dry bulb temperature shall be maintained above 70°F during the Standard Charge Measurement
Procedure. The signature of the Responsible Person in the declaration statement below certifies this
requirement has been met for all applicable system verifications reported on this certificate.
DECLARATION STATEMENT
. I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is
true and correct.
. I am the certified HERS rater who performed the verification services identified and reported on this certificate
(responsible rater).
. The installed feature, material, component, or manufactured device requiring HERS verification that iE identified on this
certificate (the installation) complies with the applicable requirements in Reference Residential AppenJices RA2 and
RA3 and the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the Iota? enforcement
agency.
. The information reported on applicable sections of the Installation Certificate(s) (CF -6R), signed and Submitted by the
person(s) responsible for the installation cconforms tosthe.requirements-specified,ontthe,Certificate(s)�of Compliance
(CF-1R),,approved'by the enforcementagency.`1 �'+f.��: iA."`';
Builderyor:,:'Installer informationlas1, shown `on the,'Installation Certificate -,(CF -W) ;
Company Name: (Install ng'Subcontractor or General Contractor or,Builder/Owner)
CERTIFIED COMF,ORT�SYS�TEMS INC ,�. _ :• P - •+��{""` '.
Responsil le l?ersori,'s Name „ �'w k
CSLB',License ,�;op:
Mark Hyde '�
906115`
HERS Provider,Data Registry,"Information
Sample Group # (if applicable)'' 423188
❑ tested/verified dwelling
® not-tested/verified dwelling
in a HERS sampe group
HERS Rater Information . CaICERTS Certificate # CC1-1798761759
HERS Rater Company Name:
Desert H.E.R.S. Raters
Responsible Rater's Name:
Responsible Rater's Signature:
Michael Hyde
Michael Hyde
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed: 6/12/2013
CC2005602
B
Reg: 213-A0033774A-M2500003A-M25A Registration Date/Time: 2013/06/27 11:25:43 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms February 2013