10-0487 (MECH)P.O. BOX. 1504 .
78-495 CALLE TAMPICO _
LA- QUINTA, CALIFORNIA 92253
Application Number:. 10-00000487
Property Address:. 52280 AVENIDA VELASCO
APN: 7737265 -002 -
Application description: MECHANICAL
Property Zoning: COVE RESIDENTIAL
Application valuation: 5500
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760)777-7153
Owner:
LA QUINTA REDEVELOPMENT AGENCY
P O BOX 1504
LA QUINTA, CA 92247.
Date: 6/08/10
U �
Contractor:
Applicant: Architect or Engin BUDGET AIR
:JUN 172010 PO BOX 1066
LA QUINTA, CA 92247.
I /L WCC:' EXEMPT
CITY OF LA QUINTA Li c . No .: C2 0
FINMICE SEPT. '
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (comrimencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. _ I have. and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: ---------- License No.: C20 - for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
/Da/ te: 4 –&1�&,P1l5mactor _ 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
OWNER -B R DECLARATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am ,exempt from the Contractor's State.License Law for the Carrier. EXEMPT - OS 31 1Bolicy Number 796186
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance. of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant. for the person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant.to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or ' . 377000 oftheLabor Code, I shall forthwi t omply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section7031.5.by ,/!�/� /� ,
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: ate: pplicant: r�
1 _ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structureis not intended or offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECT WORKERS' COMPENSATIO COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his ocher own employees, provided that the DOLLARS ($100,000). IN 40DITION-TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN '
improvements are not intended or offered for sale: If, however, the building or improvement is sold within _ SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.). - APPLICANT ACKNOWLEDGEMENT
(_ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. • IMPORTANT Application is hereby made to the Director of Building and Safety for a. permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of. conditions -and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application,
I—) I am exempt under Sec. , B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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 (Sec. 3097, Civ. C.).
Lender's Name:
- Lender's Address: _.
LQPERMIT
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
of this��re
upthe above-mentioned propert for inspection purpo es. '
Date: (Applicant or Agent):
00,
Application Number 10700000487
: Permit. MECHANICAL
Additional desc .
Permit Fee 33:00- Plan Check Fee
•8.25 .
Issue Date Valuation
.0
Expiration Date 12/05/10
Qty Unit Charge Per,
Extension
BASE FEE
15.00
1.00 9.0000 EA MECH FURNACE.<=100K
9.00
1.00 9.0.000.EA MECH B/C <=3.HP/100K BTU
9.00 -
Special Notes and Comments
REMOVE EXISTING.ROOF TOP UNIT AND DUCTS.
INSTALL"NEW SPLIT SYSTEM WITH NEW DUCTS.
- MAYTAG 4 TON 14 SEER SPLIT SYSTEM.
2007 CODES.
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473)
1.00..
Fee summary Charged Paid -Credited
Due
Permit•Fee Total. 33.00 .00. 00
33.00
Plan Check Total 8.25 .00' .0.0
8.25
Other Fee Total 1.00 .00 .00
1.00
Grand Total 42.25 .00 .00
42.25
.. LQPERMIT
05/18/2010 08:49
Site Address
Packaged Unit
Furnace
Indoor Coil
Condensing (fait
7687777011
LA QJINTA BLDG DEPT
A —Ly
O AFUE,"-V/ I a COP Over 40 n of ducts added or
OSEER-_I, n 10 HSPF replaced m unconditioned Spam Served by system
D EER /.3..�C 0 Resistance )dR 6 (CZ/0-13) / ` sf
D R 6 (CZ 14 -IS)
PAGE 01/01
O Setback
flfrror.alnwdy
pMwK *Must be
installed)
I. Egttiptnenr Type: Chasse'be equOmctrt h9&9 installed; Elmore lhatr one system. wr anollserCF--/R-ALT-HYACfor'each sy tm.
2. Mini-- Equywew,BOWendes: 13 SEER, 78% AFM 7.7KSFF fo►rypicad residenaal Systema.
HERS VERMCATION SUMMARY i.isted below are foo* HVAC dwradon Options. The installer decades what wont is being done and
pietas one of the approprkm Options. Eadt Option lists the FIRS teres that trete be conducted. Am" of the fors shall be left on site for final
inspection and a copy Oven to the homeowner. At final, the inspector verifies that the work listed on this fwm was w fita the work completed by the
installer. The inspector also verifies that each apprepriae Cj; 6R end memied CF -411t formes (no hand fillet( CP-4Rs allowod) are filled out and
signed. Beetnaing October 1, 2010. s reebtrnd torr tient• CFJ R mad Vice .t:.n .I— L. — -,.- V-- A&--..�_r.__
I. HVAC Changeoot ReFired Fig:
■ All HVAC Equipment replaced CF -6R forms: MECH-04, MECH 21 -HERS and (for split qM ms) MECW 25-F
Condenser Coil seed /or forms: CF -4R MECH- 21 and for lit MECFF-25
•
• Indoor Coil and/or CF -6R fors: MBCH.2I-HERS and (fin split S SUM) MECR- 25 -HERS
• Furnace CF4R forms: MECH. 21 and (for split syster") MECH.25
For Split Systems: Duct leakage < 15 percept; RC, CCA .--Z 300 CFMhon(Minimunt Air Flow Requitnmtent),
For Packaged Units: Duet leakage < 15 pament
ExernplcJ from duet leakage testing if
1 Uua system %vas documented to have beat previously scaled and cotrfutned through HERS verification. or
❑ 2. Duct sysnOM with less than 40 linear feet in unconditioned space, or
O 3. Existing duct systems are constructed, insulated or sealed with asbestos
2. New HVAC System Required Pojuzw
■ Cut in or Ctcangeout with new CF -6R Entre: MECH.04. MECIt-20-�pS�,,,,�
ducts: (all new ducting snit an CF -4R fmw.- MECH 20-, end for split �w (� split ) M�-22-�S. and MECH-25-HERS
new e i t (for SP - Wjleuts)MECF-22. and MECH 25
For Split Systenw Duct leakage < 6 PC RC, CCA > 350 CFM/tmt, FWD, TMAH, SIMS, and either HSPP or PSPP.
ror Packa cd units: Duct IcWmge < 6 pet colt
O 3. New Ducts with Replacement R Forms:
• Includes replacing or installing all new ducting CF -6R forms: MECH o4. MECH Z"lEL w1d (fpr split systems) MECH-25-HERS
and/or outdoor omtdeusing unit and/or indoor CF -4R forts: MECH Z0 and (for split systeeris) N ECH•23
coil and/or fumace. Not all equipment dmnged.
For Split Systerns: Duct leakage < 6 percent, RC, CCA -2:300 CFM/ton, TMAH
For Packaged Units: Duct le Wow <6 nenxrtt
• Includes adding or replacing mem than 40
linear feet of duct in unconditioned space. IL4R
%rims: MECH-04, MECH-214WM CF4R forms: MECH-21
For split system or packaged omits; Dud leakage < 15 percent
Cl EXCEPTION: Existing dues insulated or settledwicA asbestos
Contractor (Documentation Author's /Responsible Valgttees Declaration Statement)
• 1 certify that (his Certificate of Compliance dowronhtatittn is =clr a and tbmpkl-
• 1 am eligible under Division 3 of the Califon Bush= old rn fmiont Code to acexpt responsibility for the design idaaified on Certificate of Contplianue,
• I certify that rex tmergr (mulumi C and pf Reg tarroe speeiftrat ons for the design identirwd on this Cettiinu tr of Complianra: w men to the requirements of Title 24,
. Paris 1 and 6 of the Catifomia Cede of Regulations.
• 11h design fcaLurts ideaaired on this Certifioatt of Compliance aro consistent with dna infomlation docummW on otter apoicawc co MliMoe forms. wprkshem
calwlarions, plans and I / ' h®uoto submim d to the enrewcmenl for Val with the ieation.
�,
Name: M2 V _ A"'LQV e, Z. S'PaIUM: r I I.,., a !))-�it..n
-ti° I'
2008 Residenrial Compliance Forms March 2010
1Dl a (U L--�
BUDGET-AIR
HEATING AND AIR-CONDITIONING
(760)899-1606 1 1 ' - l -7 -? aX
Lic. 4796186
Proposal
Bill Tot ON of La Ouinta Date June 3• 2010
Address: P.O. Box 1.504 / 78495 Calle Tampico . La Quints. CA 92247=1504
Job name and address: . 52280 Avenida Velasco
La Quinta, CA 92253
Budget Air offers to install:
1. One 4 ton 14 seer Maytag air-conditioning split system.
Installation includes` installing all new R-6 ductwork, run
necessary gas line to new unit, necessary refrigerant
lines, pvc condensation line, & flue pipe.
Also i»cluded in price is removal & disposal of existing rooftop
unit, & required ITERS testing.
Total': , $ 5,500.--
Buyer f Seller
L.o 61.1/ 2010
Date Date
l'd LL9 L-LLL-09L ,,zenbz8A N'9 f d l 6:170 0l CO unf
PURCHASE ORDER
CITY OF LA QUINTA
P.O. BOX 1504, LA QUINTA, CA 92247
(760) 777-7000
f
TO
78-495 Calle Tampico, La Quinta, CA 92253 (760) 777-7000
Z450 Ave. La Fonda, La Quints, CA 92253 (760) 564-0096
160 Francis Hack Lane, La Quints, CA 92253 (760) 777-7075
OR NAME and ADDRESS:
BUDGET -AIR
P.O. Bax 1066
La Quinta, P 92253
(760)gs�;cel 1: 899-1606 FAX: 717-1877
NO- 01403
IMPORTANT
Show above Purchase
Order number on all
shipping containers and
correspondence. '
This order Is subject to
the terms and conditions
shown on the face hereof.
e VAN I zm-�.1ne
1 ✓c (F(� i F Vendor Number:
DATE 6-7-10
DATE DELIVERY REQUIRED
F.O.B. POINT
TERMS
REM
r
QUANTITY
REQUIRED
QUANTITY
RECEIVED
UNIT
DESCRIPTION
WAREHOUSE
STOCK NUMBER
UNIT PRICE
AMOUNT
Speedy AC & Heating
$7,800.00
INSTALLATION OF Al ONDITIONING SPLIT
t ARRZA AIR
$5,500.00
SYSTEM PER ATTACHED PROPOSAL AT:
f
52-280 Ave. Velasco - Home Foreclosure
Rehabilitatisd Proi3
SALES TAX -0-
D. AakoO° """ '""� �,�„
....�,
Prepared By Department Director or AuthorizeVerson TOTAL $5,500.00
INSTRUCTIONS TO VENDOR
1t Submit all invoices in DUPLICATE and mail to the attention of the Finance Dept. P.O. Box 1504, La Quints, CA 92247 I
2, Separate Invoice must be submitted for each purchase order. r r t
3 Delivery must be prepaid to destination Indicated unless otherwise stated. A }
PURCHASE ORDER EXCEEDING $999.99 IS NOT VALID Signature Date
UNLESS SIGNED BY THE FINANCE DEPARTMENT
DEPARTMENT USE ONLY
ion 3.12.240 of the La Quinta Municipal Code states that purchase orders in an amount greater than $2,501 and less than $25,000 require 31Mormal bids.
If the amount of this Purchase Order is between $2,501 to $25.000 please list ft 3 vendors contracted and the price quoted.
VENDOR
PRICE QUOTE
ITEMS
ACCOUNT NUMBERS
AMOUNT
TOTAL
BUDGET -AIR
401-1833-551.45-01
$5,500.00
Speedy AC & Heating
$7,800.00
t ARRZA AIR
$9,246.00
�, VENDOR - WHITE FINANCE - YFI I OW PI mr.wmzimr . mute ncoevn¢ur nrov nn� nc.v.....
Bin #
City of La Quinta
Bullding 8L Safety Dt&on
P.O. Box 1504, 78-495 Calle Tampico
La Qulnta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # Qi
v
Project Address:
Owner's Name:
A. P. Number:
Address:
Legal Description:
Contractor: QU-( ef—,41
City, ST, Zip:
Telephone:
Project Description:
Address: Q !� MU9
City, ST, Zip: Qu Ar7A U -e 57- T
Telephone -7
State Lic. # : City Lia #: /0 9 7 r (� I . N S P1
Arch., Engr., Designer.
AZO -W U CTC .
Address:
City., ST, Zip:
Telephone:
State Lie. #:
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft:
#Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Reed
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cala.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cala.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
. 2'' Review, ready for corrections/iuue
Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:- -
--
''� Review, ready for correctionsPissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Toro Permit Fees
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-20
Duct Leakage Test - Completely New or Replacement Duct System (Page 1 of 2)
Site Address: Enforcement Agency: Permit Number:
52280 AVE VELASCO, La Quinta CA 92253 (System 1)1 City of La Quinta 10-483
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 certificate is required for compliance for completely new duct systems installed in new dwelling construction, and also
for completely new or replacement duct systems in existing dwellings. 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.
{
Duct Leakage Dia onstic Test - completely new or replacement ducts stem
Enter a value for the Allowed Leakage (CFM) for the duct system leakage verification. The value entered must be the
VLLDCS criteria or one of the three calculated leakage rates described below. ;
Verified Low Leakage Ducts in Conditioned Space (VLLDCS) Compliance Credit. If compliance credit for
Allowed
verified low leakage ducts in conditioned space is shown in the special features section of the CF -111, the
Leakage
leakage to outside test method must be used to verify dud leakage (refer to RA3.1.4.3.4), and 25 CFM must
(CFM)
be entered for Allowed Leakage.
ar
Allowed leakage calculation - (select one calculation method from this section). Use 6% (leakage factor =
a
0.06) for calculations. When utilizing Low Leakage Air Handler (LLAH) credit, the allowed duct leakage may be
specified by the CF -111 to be less than 6%, in which case the user-specified leakage rate must be used in the
calculations below. For example, if the user-specified leakage (specified as a,percentage of fan airflow) is
reported on the CF -1R as 3%,_then use aleakage factor of 0.03 in the calculations below.
Q Cooling systeethod:.
Nominal capacity- of condenser in Tons 4 x 400 x leakage factor = 96 CFM
+
❑ Heating
s' yste�hod:
21.7 x Output Capacity in Thousands of Btu/hr x /eakageffactor = �•• CFM
El mei airflmethod (RA3 3): ' -
L / rr
Enter measuredfan flow''in,CFM:;;here x-leakagefactor,
Enter value for Actual leakage (CFM) in the right column, from measurement using applicable duct leakage
Actual
Leakage
pressurization test procedure from Reference Residential Appendix RA3.1(CFM @ 25 Pa).
(CFM)
List Actual Leakage from duct leakage test(CFM)
Pass if Actual Leakage is less than Allowed Leakage ❑Pass ❑Fail
For complete replacement of duct systems only, if the 6 percent leakage rate criteria cannot be met, a smoke
test should be performed to verify that the excess leakage is coming only from a pre-existing furnace cabinet
(air handler cabinet), and not from otheraccessib/e portions of the duct system. A HERS rater must verify the
47
installation (No sampling allowed).
List Actual Leakage from smoke test(CFM)
Pass if all accessible leaks (except for existing air handler) are sealed using smoke 0 Pass ❑ Fail
Rea: 210-A0015566A-000000000-M20A Registration Date/Time: 2010/09/08 22:26:30 HERS Provider: Ca10ERTS. Inc.
e
}
ar
a
Rea: 210-A0015566A-000000000-M20A Registration Date/Time: 2010/09/08 22:26:30 HERS Provider: Ca10ERTS. Inc.
e
5
CERTIFICATE OF FIELD VERIFICATION& DIAGNOSTIC TESTING CF-411-MECH-20
Duct Leakage Test - Completely New or Replacement Duct System (Page 2 of 2)
Site Address: Enforcement Agency: Permit Number: -
52280 AVE VELASCO, La Quinta CA 92253 (System 1)1 City,of La Quinta 10-483
. T
POutside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems; shall not be sealed/taped off during duct
akage 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. a
All supply and return register boots must be sealed to the drywall
0 New duct installations cannot utilize building cavities as 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 leaks at ,
duct connections.- If
S� �(J} f C.
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 verificationservices identified and reported on this certificate (responsible rater).
• The.installed featu�e�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 -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 agency.
Builder or Installer information as shown on the Installation Certificate.(CF-6R)"
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) _
BUDGET - AIR `
Responsible Person's Name: -
B License:
JAIME
F79186 i
HERS Provider Data Registry Information
Sample Group # (if applicable): N/A
tested/verified dwelling
❑ not-tested/verified dwelling in
la
HERS sample group
HERS Rater Information CaICERTS Certificate # CC1-1798509403
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: 9/7/2010
CC2004535 •.
J
} {t
' n
Reg: 210-A0015566A-000000000-M20A Registration'Date/Time: 2010/09/08 22:26:30 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms August 2009
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:
52280 AVE VELASCO, La Quinta CA 92253 City of La Quinta 110-483
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 Handier
System Name or Identification/Tag
System 1
System Location or Area Served
Whole House
1
p Yes
❑ No,, •'
f
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
p Yes
❑ No '
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 Land 2 is a pass.
Enter Pass or Faill ✓ 0 Pass ✓ ❑ Fail
R
STMS Sensor„onzthe,Evaporator Coil,.,
System Narrie or Identification/Tag
System 1' `"' ►^"
3
-
([]'Yes
❑ N
The sensor is factory installed, or field installed according to manufacturer.'s _L
specifications, or is'�installed by methods%specifications approved by the Executive
❑ Yes
❑ No
/ f
Director.'-
4
1/Iv
p Yes
�✓ ❑p ,No r
TFie sensor wife is terminated,with a standard mini plug suitable for connection to ar;
.�y'1! J .vF ✓Yt .r .q
digital thermometer The sensor mini plug is accessible to the installirig technician
The sensor wire is terminated with a standard mini plug suitable for connection to a
and the HERS rater without changing the airflow through the condenser coil
5❑Yes--
❑ No
❑ No
When attached to a digital thermometer, the sensor provides an indication of the
-
and the HERS rater without changing the airflow through the condenser coil
saturation temperature of the coil.
Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not
applicable. Otherwise enter Pass or_Fail
✓ 8 N/A
✓ ❑Pass
✓ ❑Fail
r {
STMS - Sensor on the Condenser Coil I
System Name or Identification/Tag System 1
The sensor is factory installed, or field installed according to manufacturer's
6
❑ Yes
❑ No
specifications, or is 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
✓ D N/A
✓ El Piss
✓ ❑Fail
applicable. Otherwise enter Pass or Fail
_
Reg: 210-A0015566A-000000000-M25A Registration Date/Time: 2010/09/08 22:29:43 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:
52280 AVE VELASCO, La Quinta CA 92253 City of La Quinta 1.10-483
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 Svstems
System Name or Identification/Tag
System 1
`tel.;
(must be re -calibrated monthly)
s
System Location or Area Served
Whole House
_ I
.
of Thmcoup rra'on
I � C
Outdoor Unit Serial #
PSD090601457
kr
bDate
must e' re -ca Ii brate dmonthly)
Outdoor Unit Make
MAYTAG
'
Outdoor Unit Model
PSA4BE048K
{
Nominal Cooling Capacity Btu/hr '�
48000
Date of Verification )
f�
9/7/2010
+
caimration oT magnostic instruments i
Date of Refrigerant Gauge Calibration
8/15/2010
`tel.;
(must be re -calibrated monthly)
s
b-41"0 �..�h'i t..i
.� .3 >,..:..,•. ,_F,j
At
E.+1' ¢I�..
of Thmcoup rra'on
I � C
Supply (evaporator leaving)'air dry-bulb ,_ .
8/15/2010j
kr
bDate
must e' re -ca Ii brate dmonthly)
temperature (Tsupply, db)�
Measured Temperaturesl(ff)
System Name or Identification/Tag '
't,".;..
System's.,--'_...
`tel.;
s
b-41"0 �..�h'i t..i
.� .3 >,..:..,•. ,_F,j
"" i.-z�..,. :r
E.+1' ¢I�..
e';' 41G ,.
Supply (evaporator leaving)'air dry-bulb ,_ .
_ _
T'_ ;,,.; r;
-�.
temperature (Tsupply, db)�
Return (evaporator entering) air dry-bulb
87
temperature (Treturn, db) P
Return (evaporator entering) air wet -bulb
70
+
temperature (Treturn, wb) '
Evaporator saturation temperature
52
(Tevaporator, sat)
Condensor saturation temperature
107
(Tcondensor, sat)
Suction line temperature (Tsuction)
69
Liquid Line Temperature.(Tliquid)
96
r
Condenser (entering) air dry-bulb
temperature (Tcondenser, db)
Reg: 210-A0015566A-000000000-M25A I Registration Date/Time: 2010/09/08 22:29:43 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
S
INSTALLATION CERTIFICATE ; CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5)
Site Address: Enforcement Agency: Permit Number:
52280 AVE VELASCO, La Quinta CA 92253 City of La Quinta 10-483
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.
. i
System Name or Identification/Tag
System 1
Calculate: Actual Temperature Split =
19
Treturn, db - Tsupply, db
Target Temperature Split from Table
19.3
RA3.2-3 using Treturn, wb and Treturn, db
Calculate difference: Actual Temperature
Split - Target Temperature Split =
-0.3000000000000007 t
Passes if difference is between -4°F and
+4°F or, upon remeasurement, if between
PASS
-4°F and -100°F
i
Enter Pass or 0aill
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 (cfm/ton)
System Nameor, Ide tifcetion/Tag
F',
Calculated Minimum Airfllow°Requirement
Measured Airflow using RAJ 3procedures
�••
a!lilt
(CFM)• -c r
Passes if measured airflow is greater than
or equal to the calculated minimum"airflow
requirement"
Enter Pass or Fail
Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used e
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 +6°F
Enter Pass or Fai
i
i
Reg: 210-A0015566A-000000000-M25A .w Registration Date/Time: 2010/09/08 22:29:43 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE � CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5)
Site Address: Enforcement Agency: Permit Number:
52280 AVE VELASCO, La Quinta CA 92253 1 City of La Quint a 110-483
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 W
System 1
Calculate: Actual Subcooling =
12
'
Tcondenser, sat - Tliquid
17
i
Target Subcooling specified by manufacturer
10
Calculate difference:
2
Actual Subcooling - Target Subcooling =
3-26
j
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 = • it
17
Tsuction - Tevaporator, sat k
Enter allowable superheat range from
manufacturer's specifications (or use range
3-26
{
between 3°F and 26°F if manufacturer's i,
specification is not available)
System passesrif actual superheat iwithin-the
�=,
allowable superheat range � �
}f Pass or Fail
s PASS
t. , 4.
Uwe,
^Enter
.vx
1
,.i � � E loft p 3L�.` �...w.-: k .-�.-.� .•..•.... a
f
- _ I
r•
F
- I
Reg: 210-A0015566A-000000000-M25A Registration Date/Time: 2010/09/08 22:29:43 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:
52280 AVE VELASCO, La Quinta CA 92253 City of La Quinta 10-483
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
1796186
HERS Provider Data Registry Information
Sample Group # (if applicable): N/A
System meets all refrigerant charge and airflow
-
2010
HERS sample group
requirements.PASS
HERS Rater Company Name: r +
All About Air 4
Responsible Rater's Name:
Responsible Rater's Signature:
Enter Pass or Fail
Roman Diaz r
i
Date Signed: 9/7/2010
CC2004535
'Coll
41
yam• ..:r"'^4 i ,
DECLARATION STATEMENTI'
• 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 -6R), signed and submitted by the person(s)
responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance. (CF -SR) approved by the
enforcement aaencv. 1.
Builder or Installer information as shown on the Installation Certificate (CF -6111)
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
BUDGET - AIR
Responsible Person's Name:
CSLB License:
JAIME
1796186
HERS Provider Data Registry Information
Sample Group # (if applicable): N/A
Q tested/verified dwelling
❑ not-tested/verified dwelling in
la
2010
HERS sample group
HERS Rater Information Ca10ERTS Certificate # CCI -1798509403 .
HERS Rater Company Name: r +
All About Air 4
Responsible Rater's Name:
Responsible Rater's Signature:
Roman Diaz t
Roman Diaz r
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed: 9/7/2010
CC2004535
Reg:
210-A0015566A-000000000-M25A
Registration
Date/Time: 2010/09/08 22:29:43
HERS Provider: Ca10ERTS,
Inc.
2008
Residential Compliance Forms
March
2010