10-0979 (MECH)p.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
10-00000979
Property Address:
54499 TANGLEWOOD G7:_
APN:
775-051-063- -
Application description:
MECHANICAL
Property Zoning:
MEDIUM DENSITY RES
Application valuation:
3000
Applicant:
cUAIV VIC"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
KEMP PAUL F
- 54499 TANGLEWOOD #G7
LA QUINTA, CA 92253
(760)564-3108
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 License No.: 619091
Date: , ��3 ^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 (Seo. 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 70001 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).:
(_ 1 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 ISec. 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 intendedor 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 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State Lirrnsa I.aw 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 I am exempt under Sec. B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY +
I hereby affirm under penalty of perjury 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:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/23/10
1
2 2', 2a�0
C6 fl7/�CF LA iiU4i7g1�7A
_1-
----------------------------- I — — — — — --- — — — — — — — — — — — —
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 SOUTHERN INS CO - Policy Number WSIO02303402
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 workers' compensation provisions of Section
3700 pf Oe Labor Code, I shall forthwith comply with those provisions.
Date: 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 furtli un 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 I 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 representatives
ofthis county to enter upC n ; above-mentioned property for inspection purposes. .
Date: Signature (Applicant or Agent):
Contractor:
Architect or Engineer:
PALOMA AIR CONDITIONING
A�A_
P.O. BOX 3501 I
PALM DESERT, CA 92261
(760)347-1212
Lic. No.:`619091
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 License No.: 619091
Date: , ��3 ^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 (Seo. 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 70001 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).:
(_ 1 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 ISec. 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 intendedor 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 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State Lirrnsa I.aw 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 I am exempt under Sec. B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY +
I hereby affirm under penalty of perjury 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:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/23/10
1
2 2', 2a�0
C6 fl7/�CF LA iiU4i7g1�7A
_1-
----------------------------- I — — — — — --- — — — — — — — — — — — —
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 SOUTHERN INS CO - Policy Number WSIO02303402
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 workers' compensation provisions of Section
3700 pf Oe Labor Code, I shall forthwith comply with those provisions.
Date: 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 furtli un 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 I 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 representatives
ofthis county to enter upC n ; above-mentioned property for inspection purposes. .
Date: Signature (Applicant or Agent):
LQPERMIT
Application Number 10-00000979
Permit . . . . . . MECHANICAL
Additional desc .
Permit Fee 42.00
Plan Check Fee
10.50
Issue Date
Valuation
0•
Expiration Date 3/22/11
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1-00 9.0000 EA MECH
FURNACE <=100K
9.00
1.00 9.0000 EA MECH
APPL REP/ALT/ADD -
9.00
1.00- 9.0000 --EA MECH
B/C-<=3HP/100K BTU
9..00 '
----------------------------------------------------------------------------
Special Notes and Comments
REPLACE HVAC, FURNACE,COIL AND
s
CONDENSER. 2007 CODES.
-- - - - - -- - -------------------------
Other_Fees . . . . . . BLDG STDS ADMIN A SB1473)
--------------
1.00
Fee summary Charged
Paid Credited
Due
-- - - - - - - - - - - - - - ------ - -- - ---
Permit Fee Total''42:00
--- - - - - ------ - - - - ------------
.00 .00
42:00
Plan Check Total 10.50
.00 .00
10.50
Other Fee Total 1.00
.00. ..00
1."00
Grand Total 53.50
.00 .00
53.50
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -1R ALT F VAC
h.. [ Climate Zones 10 to 15 �
Site Addres
5 9 Tait/ fuL wood'
Enforcement Agency:
Date:
Permit A<:
— z /o
Equipment ni et
List Minimum EI'ficienc '
Duct insulation requirement
Conditioned Flair
Area
Thermostat
❑ Packaged Unit
011,176mace
O AFUE O COP
Over 40 ft of ducts added or
a back
144 our Coil
OSEER 7Z O HSPF
replaced in unconditioned space
Served by system
tljnot alrendr
0 -Condensing Unit
O EER O Resistance
O R 6 (CZ 10-1 3)
st'
present. inusrhr
O Other 1
O R 8 (CZ 14-15)
installed)
1. Equipment Type: Choose the et/uipntent being inslulled: if more (hurt one st•stein. use another CF -1 R-ALT-HV,aC jor each .tvstem.
2. Minimum Equipment Efficiencies: l3 SEER. 78% AFUE. 7.7HSPF for spiral residential sitctenu.
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 he conducted. A copy of' the forms shall be left on site fo.r final
inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this farm was in fact the work completer, by the
installer. The inspector also verifies that each appropriate CF -6R and registered CF -4R forms (no hand tilled CF-4Rs allowed) are filled out and
si fined. 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 replaced
C17-611forms: MECH-04.. MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF-411forms: MECH- 21 and fors lits stems) MECH-25
• Condenser Coil and/or
• Indoor Coil and /or
CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS
• Furnace
CF -4R forms: MECH- 21 and (for split systems) MECH-25
For Split Systems: Duct leakage < '15 percent; RC, CCA >_ 300 CFM/ton(Minimum Air Flow Requirement), TMAH
For Packaged Units: Duct leakage < 15 percent
Exempted from duct leakage testing if:
O I. Duct system was documented to have been previously sealedand confirmed through HERS verification, or
O 2. Duct systems with less than 40 linear feet in unconditioned space, or
O 3. Existing ducts stems are constructed, insulated or sealed with asbestos
❑ 2. New HVAC System
Required Forms:
• Cut in or Changeout with new
ducts: (all new ducting and all
CF -611 forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS. and MECH-25-HERS
new equipment)
CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25
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 Replacement
Required Forms:
• Includes replacing or installing all new ducting
CF -611 forms: MECH-04. MECH-20-HERS.and (for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor
CF -411 forms: MECH-20 and (for split systems) MECH-25
coil and/or furnace. Not all equipment changed.
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 replacing more than 40
linear feet of ductt in unconditioned space.
CF -611 forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent
O 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 Cali fomia Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance.
• 1 certify that the energy features and performance specifications for the design identified Certificate
on this of Compliance conform to the requirements of Ti; le 1_4,
Pans I and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, work_heets.
calculations, plans and specifications submitted to
the enforcement agency for approval with the permit application.
Name: CV A K/ if Signature:
Date:
D
Address:
n /� (Q License:
17/
V `-[to,/-Phone:
1—citState/Zip:
r
.7
y/* O y �
7MR Aoci,lonrinl i'n n, ntin oro F•n rmc
Ititn ret, �ntn
Bin #
City of La Quinta
Btn7ding & Safety Division
Permtt # P.O. Box 1504, 78-495 Caffe Tampico
La Qufnta, CA 92253 - (760) 777-7012
Building Permit Application and TrackingSheet
Project Address: �}
LOU/6 ad Owner's Name: Paul EOKAI
A. P. Number if
Address:GVqv
Legal Description:
City, ST, Zip:
Contractor: D/b ( a rc
Address:
City, ST, Zip:
Telephone:
Stag Lic. # : (o (9.0q
Arch., E.rtgr., Designer:
Ad*=:
City, ST, Zip:
Telephone:
State Lk. #: .
Name OfContad Person:
Telephone # of Contact person:
# Submittal R,
Plan Sets
Structural Calcs.
Truss Calm.
Title 24 Cale &
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
Project Description:
lej C a 9Z2ngj
V
Total Permit Fees
Construction Type:.
Occupancy:
R-
PrOjed type (circle one): New Add'n Alter Repair Demo
Sq. FL:
# Stories:
#Units:
Estimated Value of Project
S 000
APPLICANT:
DO NOT WRITE BELOW THIS LINE
Recd
TRACKING
PERMIT FEES
Plan Cheek submitted
Item Amount
Reviewed, ready for corrections
Plan Check Deposit
Called Contact Person
Plan Cheek Balance
Plans picked up
Construction
Plans resubmitted
Mechanical
2" Review, ready for eorrectionvissue
Electrical
Called Contact Person
Plumbing
Plana picked up
S.M.L
Plans resubmitted
Gmdlag
Review, ready for eorrectionsfusuc
Developer Impact Fee
Called Contact Person
A.LP.P.
Date of permit issue
Total Permit Fees
r
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-21
Duct Leakage Test — Existing Duct System _ (Page 1 of 2)
Site.Address:
54499 TANGLEWOOD; LalQuinta CA 92253 (System
Enforcement Agency:
;
Permit Number:
1) -
City of La Quinta
10=979 '
Enter the.Duct System Name. or Identification/Tag: System 1
Enter the Duct System Location or Area Served: Whole House
Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the
dwelling. ,
This installation certificate is required for compliance for alterations and additions in existing dwellings
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 existing dwelling,
use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. "
Duct Leakage Diaanostic Test - existina duct system
Select one compliance method from the following four choices.
a 1. Measured leakage less than •15% of fan flow
F
❑ 2. Measured leakage to outside than 10% of Fan Flow
Inc.
❑ 3. Reduce leakage by 60% and conduct smoke and fix all leaks
•, _ti.. A.
❑ 4?:Fix all accessible leaks using smoke and HERS rater verify
March
Note: (One of Options„1, 2, or 3 must be attempted„before,utilizing Option,: )z•
Determine ribminal F66TIow using one of4the following three calculation metho +t}
8 Cooling system method: Size of condenser in Tonsy 5 = x 400'=�
[_20,00
✓
ElHeating system method 21.7 x 77 Output Capaaty in -Thousands of Bhr _ CFM
❑ Measured:s _stem airflow usin RA3:3 airFlow',test rocedures: _'CFM 4
Option 1 -used then: •
1
Allowed leakage - Fan Flow 2000 x 0.15 = 300 CFM
Actual Leakage"` 288 CFM.
l '
Pass if Leakage Actual is less than Allowed
0 Pass Fail
Option 2 used then: N, -
2
Allowed leakage = Fan Flow••_.x 0.10 = _ CFM
Actual Leakage to outsidei= 7• --`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 t x 100% _ % Reduction
' Pass if %Reduction > 60%
,; Pass Fail
Option 4 used then:
4
All accessible leaks repaired using smoke. HERS rater must verify (No sampling). No smoke
.
allowed to leak from system. Including ducts, plenums, air handler and door panel. • .
Pass if all accessible leaks have been repaired using smoke
.'El Pass Fail
Reg:
210-A0021434A-000000000-M21A
F
HERS Provider: CalCERTS,
Inc.
2008
Reg:
210-A0021434A-000000000-M21A
Registration Date/Time: 2010/10/26! 00:45:14
HERS Provider: CalCERTS,
Inc.
2008
Residential Compliance Forms
t{�
March
2010
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21
Duct Leakage Test - Existing Duct System .(Page 2 of 2)
Site Address:-
54499 TANGLEWOOD, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number: '
1)-
City of La Quinta
10-979 ,
9 Outside a CA)'ducts•for' Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off
during duct leakage testing. CFIOA ducts that utilize controlled motorized dampers, that open only when OA
ventilation is�requ red to meet ASHRAE Standard 62 2,xand)close�when OA ventilationAs notirequired, may .
be configured to the closed position during.duct leakage testings { :'
® All supply and return register boots, must be sealedAtothe dry�wb�Vas
ll #f.smoke'test is utilized for compliance - -.
- applies 6o duct leak ge compliance option 3 (leakage'reduction by 60%)'and option 4 (fix all,accessible
'leaks) described above: f y sI , `•.
jj fid .}:' •Ke3} .
1 f' 'b Qd '*
0 New duct installations`cannot utilize.::building cavities,:as'plenumson platform:returns;in lieu o'f ducts.
y.
® Mastic and draw bands must be used m combination with cloth backed rubber adhesive duct tape to seal
leaks at'all new" duct connections'
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 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 -111) 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) .
responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the .
enforcement agency.
Builder or Installer information as shown on the Installation Certificate (CF -6R)
Company Name: (Installing Subcontractor or Genera_ I Contractor or Builder/Owner)
PALOMA AIR CONDITIONING
Responsible Person's Name:
CSLB License:
HERMAN PAREDES
1619091
HERS Provider Data Registry Information
Sam le Group # if applicable): 176845
P P (iftested/verified
dwelling
❑ not-tested/verified dwelling in
a HERS sample group
HERS Rater Information CalCERTS Certificate # CC1-1798517427
HERS Rater Company Name: ,
All About Air
Responsible Rater's Name: -
Responsible Rater's Signature:
Roman Diaz -
Roman Diaz -
Responsible Rater's Certification Number w/ -this HERS Provider:
Date Signed: 10/18_ /2010 ,
CC2004535
Reg: 210-A0021434A-000000000-M21A ` Registration Date/Time: 2010/10/26'00:45:14 HERS -Provider: CalCERTS, Inc.
2008 Residential Compliance Forms r March 2010
. � f
J '
• � J
.7
44
+
� r
Reg: 210-A0021434A-000000000-M21A Registration Date/Time: 2010/10/26 00:45:14 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5)
Site Address: Enforcement Agency: Permit Number:
54499 TANGLEWOOD, La Quinta CA 92253 City of La Quinta 10-979
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. 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
/Ta9
System 1 -
System Location or Area Served
Whole House
1
0 Yes
❑ No
0/1,
5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and
labeled according to Figure in Section RA3.2.2.2.2.
2
0 Yes,
11 No i
5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum
and labeled according to Figure in'Section RA3.2.2.2.2.
Yes to,-1-and_2 is a pass. .:;:•
Enter Pass or Fail ✓ 2 Pass ✓ ❑ Fail
STMS = Sensor,onzthe,Evaporator Coil
System Narrie•or;Iderit'ification/Tag
t j ,�=System i "~~: f s�•� `ilk ti~" 'i + re
3
❑ :Yes
p No
The sensor is facto st
installed, or2field.inalled according to manufacturers
`scifications, or is installed;by methods/specifications'approved by the Execut vi e
pe
❑ Yes
r i
/
Directot. h� (' f <__ .,*- "w+f �t'b+�`�► .i
Director.
The sensorrire is terminated with a standard mini plug', suitable for. connection to a
4
Yes
YesiF+►,No
X..�"
digital thermometer The sensor. mirn`plug is accessible to the instatlingFtecFinician
❑ Yes
❑ No
- _
and,the'HERS'.rater:.with6ut changing the airflow through the condenser coil
5
❑Yes -
❑ No
When attached to a digital thermometer, the sensor provides an indication of the
saturation temperature of the coil.
Yes to 3,'4 'and 5 is a pass. Enter N/A if STMS are not
`✓ 0 N/A
✓ ❑ Pass
✓ [IFail
applicable. Otherwise enter; Pass or Fail
saturation temperature of the coil. ' `
Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not
STMS - Sensor on the Condenser Coil
System Name or Identification/Tag I System 1 I -I I';
The sensor is factory installed, or field installed according to manufacturer's
6
❑ Yes
❑ No
specifications, or installed by methods/specifications approved by the Executive
Director.
The sensor wire is terminated with a standard mini plug suitable for connection to a
7
❑ Yes
❑ No
digital thermometer. The sensor mini plug is accessible to the installing technician
and the HERS rater without changing the airflow through the condenser coil
8
❑ Yes
❑ No'
When attached to a digital thermometer, the sensor provides an indication of the
saturation temperature of the coil. ' `
Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not
V N/A-
✓ ❑ Pass
✓ ❑ Fail
applicable. Otherwise enter Pass or Fail
__:__T
Reg: 210-A0021434A-000000000-M25A Registration Date/Time: 20.10/1.0/26,00:50:56 HERS Provider: CalCERTS,•Inc.
2008 Residential Compliance Forms March 2010
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING ,CF-411-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5)
Site Address: Enforcement Agency: Permit Number:
54499 TANGLEWOOD, La Quinta CA 92253 City of La Quinta 10-979 •
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 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 is 55°F or below, the installer must use the Alternate Charge Measurement Procedure.
Space Conditioning Systems
System Name or Identification/Tag
System 1
(must be re -calibrated monthly)
System Location or Area Served
Whole House
10/17/2010
(must be recalibrated monthly)
10, :. • vti►
Outdoor Unit Serial #
1001716971'
Outdoor Unit Make
AMANA
S.
Outdoor Unit Model
ASX160601AC
Nominal Cooling Capacity Btu/hr�
60000.
Supply
,
Date of Verification's
10/18/2010
Calibration of Diagnostic Instruments
Date of Refrigerant Gauge Calibration,;;
10/17/2010
(must be re -calibrated monthly)
System Name or Identificafionf-fag'System
Date of ThermocoupletCalibration
10/17/2010
(must be recalibrated monthly)
10, :. • vti►
( N • �.l?
;i4
Measured :Temperatures}(',°F) w A4i# vq_:
System Name or Identificafionf-fag'System
(evaporator leavin ')'air dry;bulb
temperature (Tsupply, db)
Return (evaporator entering) air.dry-bulb
80
temperature`(T)
return,
Supply
,
Return (evaporator entering) air wet -bulb
66
temperature (Treturn, wb)
Evaporator saturation temperature,i;'
47
Reg: 210-A0021434A-000000000-M25A Registration Date/Time: 2010/10/26 00:50:56'.,HERS Provider: CalCERTS, Inc.
2008 Residential Compliance`Forms March 2010
(evaporator leavin ')'air dry;bulb
temperature (Tsupply, db)
Return (evaporator entering) air.dry-bulb
80
temperature`(T)
return,
,
Return (evaporator entering) air wet -bulb
66
temperature (Treturn, wb)
Evaporator saturation temperature,i;'
47
(Tevaporator, sat)
Condensor saturation temperature
11.0
(Tcondensor, sat)
Suction line temperature (Tsuction)
66
Liquid Line Temperature (Tliquid)
98 +
Condenser (entering) air dry-bulb
temperature (Tcondenser,'db)'
V-
Reg: 210-A0021434A-000000000-M25A Registration Date/Time: 2010/10/26 00:50:56'.,HERS Provider: CalCERTS, Inc.
2008 Residential Compliance`Forms March 2010
INSTALLATION CERTIFICATE CF-411-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5)
Site Address: Enforcement Agency: Permit Number:
54499 TANGLEWOOD, La Quinta CA.92253 City of La Quinta. •10-979.
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
System 1
Calculate: Actual Temperature Split = Treturn,
20 `
db - Tsupply, db
Target Temperature Split from Table RA3.2-3
19
using Treturn, wb and Treturn, db
-
"
Calculate difference: Actual Temperature Split -.
1
`
Target Temperature Split =
'
Passes if difference is between -4°F and +4°F or,
F
upon remeasurement, if between -4°F and
PASS
-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.
Calculated Minimum Airflow Requirement (CFM) =Nominal Cooling Capacity (ton) X 300 (dm/ton)
System #Name or Ident fi•cation a .:
.115,.
Calculated Minimum Airflow=Requirement (CFM)
s 1•
4
Measured Aiftlow,using RA3.3 procedures (CFM)
'.. �
'? D
f S
r
4`.
� Yi '
� � .;:.:.. ;+ _ w'#+r'; �Fe�.f`� .. � � # r•x
tG.. .Y:•�4+� 'a' :94.t. d''. ^;€',p �n
.; # .:.mqu
,,,yi, . r
T.-
Passes if measured airflow is greater.than or`.
equal to the calculated minimum airflow
requirement:
- - s Enter Pass or Fail,
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
'
Calculate: Actual Superheat = -
Tsuction - Tevaporator, sat
Target Superheat from Table RA3.2-2 using
Treturn, wb and Tcondenser, db
Calculate difference:
Actual Superheat - Target Superheat =
System passes if difference is between -6°F and
F
+6°F
Enter Pass or Fail.
Reg: 210-A0021434A-000000000-M25A Registration Date/Time:,2010/10/26 00:50:56 HERS Provider: CalCERTS, inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-411-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5)
Site Address: Enforcement Agency: Permit Number:
54499 TANGLEWOOD, La Quinta CA 92253 City of La Quinta 10-979 '•
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 =
12
Tcondenser, sat - Tliquid -
21
Target Subcooling specified by manufacturer
10
Enter allowable superheat range from:,
a
Calculate difference:
2
Actual Subcooling - Target Subcooling =
System passes if difference is between
-- �-
—-
'
-4°F and +4°F
PASS
Enter Pass or Fail
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
System 1
Calculate: Actual Superheat:= :,;
21
Tsuction - Tevaporator, sat
Enter allowable superheat range from:,
manufacturer's specifications (or use range
3-26
between 3°F and 26°F if manufacturer's
specification is not_a_vailable)
-- �-
—-
'
System passes if. actual superheat is•within'the
allowable superheat ranges
PASS
y . Enter -Pass or Fail
r� a�..
r P .
.Reg: 210-A0021434A-000000000-M25A Registration Date/Time: 2010/10/26 00:50:56 HERS Provider: CalCERTS, Inc.
2008 Residential,Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5)
Site Address: Enforcement Agency: Permit Number:
54499 TANG LEWOOD, La Quinta CA 92253 City of La Quinta 1 10-979
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
1619091'
-
Sample Group # (if applicable): 176845
System meets all refrigerant charge and airflow
❑ not-tested/verified dwelling in
la
HERS sample group
requirements.
PASS
All About Air
Responsible Rater's Name:
Responsible Rater's Signature:
Enter Pass or Fail
Roman Diaz
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed: 10/18/2010
CC2004535
• i
co
,•?,`,<E,szry..al
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 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 -611), signed and submitted by the person(s) -
responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the
enforcement agencv.
Builder or Installer information as shown on the Installation Certificate (CF -6R)
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
PALOMA AIR CONDITIONING
Responsible Person's Name:
CSLB License:
HERMAN PAREDES
1619091'
HERS Provider Data Registry Information
Sample Group # (if applicable): 176845
tested/verified dwelling
❑ not-tested/verified dwelling in
la
HERS sample group
HERS Rater Information CalCERTS Certificate # CC1-1798517427
HERS Rater Company Name:
All About Air
Responsible Rater's Name:
Responsible Rater's Signature:
Roman Diaz
Roman Diaz
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed: 10/18/2010
CC2004535
Reg: 210-A0021434A-000000000-M25A Registration Date/Time: 2010/10/26 00:50:56 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms March 2010
0