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13-0257 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 13-00000257 Property Address: 45215 SUNBROOK LN ' APN: 604-302-002-13 -23995 - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 8000 Applicant: Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT ��------••�")� iD --------------------------------------------------- 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 andPro fals Code, and my License is in full force and effect. / License Class: C20 License No.: 489046 Data:.> `i3 Contractor: rV 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 buildsorimproves thereon, and who does the work himself or herself through his or her ownemployees, 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.)" (_ I 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. , 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 (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: LQPERMIT VOICE (760) 777-7012 FAX (160) 777-7011 INSPECTIONS (760) 777-7153 Owner: LJ - MOORE DANIEL F , 5 *NOT ON FILE®13 UNKNOWN, CA 99999 1 CI -Y OF LAQUINT A. HNANce to) Contractor: ESSER AIR.CONDITIONING & HTG P.O. BOX 1636 CATHEDRAL CITY,.CA 92235 (760)324-0550 Lic. No.: 489046 ------------------ 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 i d. .. ave 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 CASTLEPOINT NTL Policy Number WSLTHPE90140303 k, 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 of theLabo�()RKFRS'COMPENSATION tohwith comply with those. provisions. ,J /r Date7./*Applicant: WARNING: FAILURE TO SECUR COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 1$100,0001. IN ADDITION TO THE COST OF CO MPENSATION,'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 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 county to enter upon the above-mentioned proprty for inspection purposes. Date: i S Signature (Applicant'or Agent . el Application Number 13-00000257 4 Permit . . . MECHANICAL Additional desc.. Permit Fee 40.50 Plan Check Fee 10.13 Issue Date . . . Valuation 0 - Expiration, Date 9/07/13 . Qty Unit Charge Per Extension a• 4 •. '. - - BASE FEE 15.00 ' 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU 16.50 ---------------------------------------------------------------------------- Special Notes and Comments ' HVAC AND CONDENSOR CHANGE OUT. 2010 CODES. ---------------------------------------------------------------------------- Other Fees `. •. . ... BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited ----- Due ----------------- Permit Fee Total 40.50 .00 .00 40.50 Plan Check Total 10.13 .00 .00 10.13 Other Fee Total 1.00 .00 .00 1.00 ' Grand Total 51.63" .00 .00 51.63 Prescriptive Certificate of Compliance: Residential CF -IR -ALT Residential Alterations Pae 1 of 5 Project Name: Climate Zone # # of Stories Moore, Dan General Information Site Address: 45215 Sunbrook Ln La Quinta CA 92532 Enforcement Agency: La Quinta,City of Date: 3/11/2013 Building Type El Single Family ❑ Multi Family Circle the Front•Orientation: N,Q S, W, or degrees Conditioned Floor Area (CFA): 1600: Project Type: DAlterations E] Envelope ❑Fenestration ❑Roof ❑HVAC - or T 66°� ! _ and Size orOt� actoi''umr' Rfe. aliie� Replacement or Change Out ❑ Duct Replacement El Water Heater NOTE: This form is not to be used for Newly Constructed Buildings or Additions ' Insulation Values For Opaque Surfaces (for Furring use the Mass and Furring Strips Construction table below) ; Assembly Alteration i , []Opening of framed cavity alone— Alterations that involve the opening of the framed cavity of a wbl1, ceiling, or floor must install the mandatory minimum insulation value per §150 for the altered assembly. Fill in Columns A —C and enter mandatory insulation value in Column H. ❑ Replacement of entire assembly — Replacement of an entire wall, ceiling, or floor assembly requires the installation of Component Package- D insulation values in Table 151-C. Fill in Columns A —J Opaque Surface Details For the furred e2ftioned of Mass Walls see Furring Strips Construction Table below. A B C DE F 'G A I J Pro sed' Note Standard Values From JA4 Table Tag/ Framing ° T)Lcknessl a� �; Framed • Continuous Assemb�atlte`� q..► + t S�ps�c �,� 1 A J�4 )? ( C vity ttbr� JA4 Proposed Assembly Assembly ID - or T 66°� ! _ and Size orOt� actoi''umr' Rfe. aliie� Cell Values U-factor9 in Furring Space from Reference Joint A Dpendix Table 4.3.5 4.3.6 43.7 1, =A0;-•=' f r �.a %0 m- m r • L O Note: For jarred asseinblies,`&counnng for Co ¢I ' ation-R vahie, see :�'dge4JA4 3 ani!0 1: For°calculating furred walls use the Mous and . Furri Construction table below 1. For Tagl1D indicate" the identification' name A4 matches the bidlding plans 1. Indicate the AssemblyName or Roo e�tr W�ls {Floors Slobs C awl S Doors d. i� icate the FrameF Size: For type: flGeilt .. pace type and Wood, Metal, Metal Buildings, Mass, enderd' Zac4N2x6 or isvee JA4for otherpZ ae ' aassembltes 4.: F wble fram, 3. Enter the thickness for mass in inches or Spring between framing members enter, 16�"or74'OC; or Otherifor a!1 other sembly description �" such as Concrete Sandwich Panel, Spandrel Panel, Logs St aw Bale Panel and etc.... ? 4. Based on the Climate Zone; enter the Standard U factor frot i Tab%151-B, C or D for each different rise bly Na e�-ortype. . 5. Enter the Table number that closely resembles the proposed assembly. ^ 6. Enter the R -value that is being installed in the wall cavity or between the framing; otherwise, enter "0". 7. Enter the Continuous Insulation R -value for the proposed assembly, otherwise, enter "0". 8. Enter the row and column of the U factor value based on Column F Table Number and enter the Assembly U factor in Column J 9. The Proposed Assembly U factor, Column J, must be equal to or less than the Standard U factor in Column E to comply. Furring Strips Construction Table for Mass Walls Onl A B_ C D •E F I G I H I J I K L M Proposed Properties of Masonry and Concrete Added Interior or Exterior, Insulation Walls From Reference in Furring Space from Reference Joint A Dpendix Table 4.3.5 4.3.6 43.7 Joint Appendix Table 4.3.13 r • L O >' G .� Lu . c U (mayy > U 'm C T �F- h- m , > O FinalAssembly Mass Nameor JA4 Table 42 1. v . o 7 3 E m°y Ass6b T Nambe > :�Thickness' U -factor r Co mment Registration Number: 313-AO014592A-000000000-0000 Registration Date/Time: 03/11 /2013 10:36:58 HERS Provider: CBPCA 2008 Residential Compliance Forms F August 2009 j j Prescriptive Certificate of Compliance: Residential CF -IR -ALT. Residential Alterations age 2 of 5 Project Name: Climate Zone # # of Stories Moore, Dan 15 1 ass and Furring Strips Construction(footnotes) 1. Indicate the type of assembly to include; Hollow Unit Masonry Walls, Solid Unit Masonry, Solid Concrete Walls, Etc. Additional assemblies can befound Reference Joint Appendix JA4. 2. This is the U -Factor based on the thickness of the assembly in inches. The R -value of the insulation to be added on the interior or exterior of the assembly. ' 4. The Calculated R- Value is the R -value of the furred out section of the assembly. -6.7he Final Assembly is calculated using Equation 4-2 or Equation 4-4of the Reference Joint Appendix JA4. The equation is the inverse of Column added to Column L Column K is the inverse from column J. 7. Insert the calculated U- actor value on to the Opaque Surface Details in Column J FENESTRATION PROPOSED AREAS ❑ Replacing window alone— Replacement windows shall meet the U -Factor and SHGC Value requirements. of Component Package Din Table'151-C. The Tota! Fenestration and West facing Area requirements are not applicable. ❑ Adding 50ft2 or less of window area — Newly installed windows shall meet the U -Factor and SHGC Value requirements of Component Package D in Table 151-C. ❑ Adding more than 50ft2 of window area — Newly installed windows shall meet the U -Factor and SHGC Value and the Fenestration Area requirements of Component Package D in Table 151-C. Complete the Altered Fenestration Allowed Area Table on Page 2 of the CF -IR -ALT �. ese � � ��i a Tie �,�,0� � Fenestration Can� ateL+I Ips; �t n NFRC or. Default (Window, Glass.Dooror3 G sSputh, West ,(ft) X-factor2.33� SHGCz :° Values �t). W acxor 5501 - a' n A B .- C D E F G 1. Fenestration area is the area of total glazed product (i,e glass plus framme). NExceptton 'Whelea door a less than -50%, the fenestration area may be the glass area plus a "2 inc7t fr' arc 2. Enter Component Package D Requirements Table C value from in l51 ! 3. Actual fenestration products installed and as indicated m CF -6R -ENV Form shall be equivalent to or have a°lower.Ufaetor and/or a lower SHGC CF value than that specified on the -IR ALT Form.. 4. Submit a completed WS -3R Form if a reduced SHGC is calculated with exterior shading. 5. Ifapplicable at this stage enter "NFRC " or NFRC Certified windows or are CEC "Default " valuesfound in Table 116-A or B. ALTERED FENESTRATION ALLOWED AREAS (Complete if more than SOft2 of fenestration is added) ' A B .- C D E F G Allowed - Existing Fenestration Total Area CFA of Entire %of Fenestration Area Fenestration Allowed Proposed Areae Dwelling CFA Area Removed Area Added A x (E -D) + C Total Fenestration Area (ft) .20 . > West Fenestration Area (Required In .05 > CZ's 2,4&7-15) .1- 1. West Fenestration Area includes west -sloping skylights and any skylights with a pitch less than 1:12. 2. West facing glazing area removed cannot be "counted" twice. " In order to distribute the west glazing area removed to the other orientations, input the west glazing area removed in the Total Fenestration Area row, column D. 3. Include the Proposed Area of the West facing fenestration in both Area columns below. 4. To meet compliance, the Proposed Area must be less than orequal to the Tota! Allowed Area for BOTH the Total and West Fenestration Areas. t Registration Number: 313-A0014592A-000000000-0000 RegistrationDate/Time: 03/11/201310:36:58 HERSProvider: CBPCA 2008 Residential Compliance Forms August 2009 Prescriptive Certificate of Compliance: Residential CF -IR -ALT Residential Alterations Page 3 of 5 Project Name: .. Climate Zone # # of Stories Moore, Dan 15 ' 1 ROOFING PRODUCTS (COOL ROOFS) §1511912 • . When the area of exterior roof surface to be replaced exceeds more than 50% of the existing roof area, or more than 1,000 fl=, whichever is less, the new roofing area must meet the roofing product "Cool Roof' requirements of §152(b)1Hi, 152(b)1Hii, or,152(b)IHdi. . ' Check applicable alternative or exception below if the roof alteration is exempt from the roofing product "Cool Roof' requirements. Note: If airy one of the alternatives or exception -below is checked, the Aged Solar Reflectance and Thermal Emittance requirements for roofing products in §118(1) are not applicable. Do not fill table below. ❑ Cool Roofs Not Required in Climate Zones 1-12, 14, and 16 with a Low Sloped. Less or 2:12 pitch. ❑Cool Roofs Not Required in Climate Zones 1 through 9 and -16 with a Steep -,Sloped Roofs (pitch greater than 2:12) and product unit weight less , .than 51b/ft 2. Alternatives to §152(b)1Hi and §152(b)Hii, Steep -slope roof (pitch >2:12) ❑ Insulation with a thermal resistance of at least 0.85 hrft •°F/Btu or at least a 3/4 inch air -space is added to the roof deck, over an attic; or ❑ Existing ducts in the attic are insulated and sealed according to § 151(f)10; or . ❑ In climate zones 10, 12 and 13, with 1 ftp of free ventilation area of attic ventilation for every 150 112 of attic floor area, and where at least 30 percent of the free ventilation area is within 2 feet vertical distance of the roof ridge; or ❑ - Building has at least R-30 ceiling insulation; or - ❑ 'Budding has radiant ba err the attic meeting th ui is of § 151(02Perforlrr%lance ❑ Building has n nuc wtrplerniui ❑ In climate zones 10, IJ,.13, and. 4, R-3 or greater roof deck insulation ve vented atttitic. ,/ - �+► *� /� Exception to §I52(b)IHua I ow -slopes- oof (pitm <_ * n r c o r A s o a i o n , L, ❑ • -Building has no ducts,in heett c r A r. _ ,Other Exceptions "d ❑ Roofing area cove by building-ultegr t4-- photavo] ttatp panels and -soler thermal paneJs.ate exempt from the below Cool Roof criteria. ❑ Roof constructions that`hive, thermal massover°)he rooftnembiane with atileast 2S.lb./ft2 is ex - Cfrom,tlte below Cool Roof criteria. Note: If no CRRC-1 1"abel'is-avar7abley is'cor ipliance method cannotbe us� use the`Performance Ap frbach to s ow ootnpliance, otherwise, , 'Products Check the applicable box below if Exem ffe &the Roofm °`Cdo'IR oof' A ire Y rgoQf Scope ' sProduct.Weight # t P od_uct >'a.' ged-SotaL x 'Tliertual ' CRRC Product ID Number <2:12 > 2 12' f < Slb/ftz >rSlWftz`Reflectagce34 !E "' ce SRI 11 01 El ❑ ❑ ❑ ❑ ❑4 ❑ ❑ ❑ ❑ ❑4 ❑ ❑ ❑ o ❑4 1. The CRRC Product ID Number can be obtained from the Cool Roof Rating Council's Rated Product Directory at www.coolroofs.orY/products/search.�hp 2. Indicate the type of product is being used for the roof top, i.e. single -ply roof, asphalt roof, metal roof, etc. 3. /fthe Aged Reflectance is not available in the Cool Roof Rating Council's Rated Product Directory then use the Initial Reflectance value from the same directory and use the equation (0.2+0.7(pinirial — 0.2) to obtain a calculated aged value. Where p is the Initial Solar Reflectance. . 4. Check box if the Aged Reflectance is a calculated value using the equation above. Calculate the SR/ value by using the SRI- Worksheet at h_itp://www.enerpv.ca.govIntle24/and enter the resulting value in the SRI Column above and attach atopy of the SRI- Worksheet to the CF -IR To apply Liquid Field Applied Coatings, the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage recommended by the coatings manufacturer and meet minimum performance requirements listed in §118(i)4. Select the applicable coating: ❑.Aluminum -Pigmented Asphalt RoofCoating A 11 Cement -Based Roof Coating 13 Other Registration Number: 313-Ao014592A-000000000-0000 RegistrationDatell'ime: 03)11/2013'10:36:58 HERS Provider: CBPCA 2008 Residential Compliance Forms August 2009 i . gas or propane fired, and may-no1 ese d 5�0 galio4s. Ha water pipe;insulatton from t DHW heater to the.ki ehen(s):and :on all underground - he Minimum Duct or Piping - Configuration Heating Equipment Efficiency Distribution Insulation Thermostat (Central, Split, Prescriptive Certificate of Compliance: Residential CF -IR -ALT Residential Alterations71 Pa �e 4 of 5 Project Name: Climate Zone # # of Stories Moore; Dan 15 1 - HVAC SYSTEMS - HEATING R _ gas or propane fired, and may-no1 ese d 5�0 galio4s. Ha water pipe;insulatton from t DHW heater to the.ki ehen(s):and :on all underground - he Minimum Duct or Piping - Configuration Heating Equipment Efficiency Distribution Insulation Thermostat (Central, Split, T and Capacity2 3 AFUE of HSPF T and Location° . R -Value Type Space, Package or H dromic Furnace, 36000 AFUE Ducted, SetBack Split. r br . 1. Indicate Heating Type (Central Furnace, Wall Furnace, Heat pump, Boiler, Electric Resistance, etc) 2. Electric resistance heating is allowed only in Component Package C, or except where electric heating is supplemental (i.e., if total capacity < 2 KW or 7,000 Btu/hr electric heating is controlled by a.time-limiting device not exceeding 30 minutes). See §151(b)3 exception.- xception.-3. 3.Refer to the HERS Verification section on Page 4 of the CF -1 R -ALT Form for additional requirements and check applicable boxes 4. indicate Type or Location (Ducts, Hydronic in Floor, Radiators, etc.) HVAC SYSTEMS - COOLING t Minimum 1. Indicate Type (Storage Gas, Heat Pump, Instantaneous, etc.) Efficiency .'Duct or Piping , Configuration Cooling Equipment (SEER/EER or Distribution Insulation Thermostat (Central, Split, T and Ca aci i2 COP T and Location R -Value T Space, Package or H dronic AirConditioner.46 ,t. _' SEER._ Ducted, �+ SetBack Split _lf-.i U11U1111911 r- c 1. Indicate Cooling Type (A%C'HeaYp*npEv p ,Cooling etce� 2. Refer to the HERSF'ertficahonection,�oa Page �j�the��-7r3_nfo/Eaialer�� jrboxes. 3. /ndicate T or Location Ducts ` tuc•tis .loor iators, etc. F'.[. , ! :} :f'": :7F ti'ti'iu f.; sd11d-P.'¢'"7. E. zolC '.'.:. A-%1 WATER HEATING List water heaters aric boilers for balk domesttr hot Ovate (DHFF� heaters and'io&ioiiic� pace heating. IAndividual dWellingPHW heaters must be gas or propane fired, and may-no1 ese d 5�0 galio4s. Ha water pipe;insulatton from t DHW heater to the.ki ehen(s):and :on all underground - he hot water pipes is required in all com neat in alfclimate zones • f:;y ,^ Water Heater T /Fuel }pe Type' ;, Distribution T ype Standard, Recrnculatin Z ' Numbei`In :",) S stem �• �`°i` 1 Tanit Capacity al ( ) ° b a Energy Factoror '� 4.ThermahEfficren External Tank Insulation R-Value3 r br . 1. Indicate Type (Storage Gas, Heat Pump, Instantaneous, etc.) 2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of §150(n). The Prescriptive requirements do not allow the installation of a recirculating water heating system for single dwelling units. 3. Tire external water heating tank and pipes shall be insulated to meet the requirements o 150 ' . SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below. These items may require written "esti tcation and documentation and special verification. NEW ROOF ASSEMBLY - Radiant Barrier The radiant barrier requirement of §151(f)2 does not apply to roof alterations. Slab Edge (Perimeter) Insulation [3 YES i3 NO , YES: In Climate Zone. 16 in Component Packages D, R-7 insulation is required. Heated Slab Insulation 0 YES 13 NO YES: Slab edge insulation required for all heated slabs in all Climate Zones. See details in Table 118-A of the standards. Raised Slab Insulation LIVES El NO YES: In Climate Zones 1, 2, 11, 13, 14 & 16, R-8 insulation is required; in Climate Zones 12 & 15, R-4 is required under component Package D. Thermal Mass To obtain Compliance Credit for the installation of thermal mass, use the Performance Approach. r' Registration Number: 313-A0014592A-000000000-0000 RegistrationDate/Time: 03/11/201310:36:58 HERSProvider: CBPCA 2008 Residential Compliance Forms August 2009 Bin.# Cray. oF Lel QU(htd Building 8r Safety Division Pemilt # P.O. Box 1504,78-495 CaOe Tampico La.Quinta, CA 92253 - (760) 777-7012 1 Building Permit Appllcatlon and Tracking Sheet Project Address: S'- /4 8 A O b Jr—AJ Owner's Name: . D%1N. /NOC�Q� A P. Number. Address: e,eS Z♦ S SUN6R OOIc Z-4A)x Legal Description: Contractor. E.MR Q rruC. City, ST, Zip: �� j?� , C+� Gf2�ZS Telephone: _ ¢09— 2 /97 & � a Address: 6'65 BAN FLDg- Q R g c. Project Description: �PLs4C S /6' . City, sr; zip:CA?ti L)RR,t. Gr SEE A7 - Telephone' -16t) -32--A - 05-5'O Telephone:-162-x•32-A-Os5'O wQ Lic, #; State Lic. Arch., Engr•, Designer Address: City, ST, Zip: Telephone: Statc Lia #: Name of Contact Person: M/CAA-ri- Construction Type: &W C Occupancy: Project type (circle one): New Add'n ter Repair Demo Sq. Ft.: # Stories: M. Units: Telephone # of Contact Person: z4p -0590 Estimated. Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Ree'd TRACMG PERMIT FEES Plan Sets Plan Check submitted Item Amount S"darai Cates. Reviewed, ready for corrections Plan Check Deposit. . Truss Cala. Called Contact Person Pian Cheek Balance. Title 24 Cal& Plans picked up Construction Flood plain plan Pians resubmitted Mechanical Grading plan 2`! Review, ready for correctionemue Electrical Subeontaetor List Called Contact Person Plumbing Great Deed Plans picked up SMI. ILO.A. Approval Plans resubmitted Grading IN HOUSE:- '^ Review; ready for correctionsfissae Developer Impact Fee Planning Approval Called Contact Person AXP.Y. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test – Existing Duct System (Page 1 of 2) Site Address: Enforcement Agency: Permit Number: Registration Number: ___________________________ Registration Date/Time: __________________ HERS Provider: ____________ 2008 Residential Compliance Forms August 2009 Enter the Duct System Name or Identification/Tag: Enter the Duct System Location or Area Served: 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 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 existing dwelling, use the Installation Certificate titled "Duct Leakage Test – Completely New or Replacement Duct System." Duct Leakage Diagnostic Test – existing duct system Select one compliance method from the following four choices.  Option 1. Measured leakage less than 15% of Fan Airflow.  Option 2. Measured leakage to outside less than 10% of Fan Airflow.  Option 3. Reduce leakage by 60% or more, and conduct smoke test to seal all accessible leaks.  Option 4. Fix all accessible leaks using smoke test, and HERS rater must verify. Note: (Option 1 must be attempted before utilizing Option 4) Determine nominal Fan Airflow using one of the following three calculation methods.  Cooling system method: Size of condenser in Tons x 400 = CFM  Heating system method: 21.7 x Heating Output Capacity (kBtuh) = CFM  Measured system airflow using RA3.3 airflow test procedures: CFM 1 Option 1 used then: Allowed leakage = Fan Airflow x 0.15 = CFM Actual leakage = CFM Pass if Actual leakage is less than Allowed leakage  Pass  Fail 2 Option 2 used then: Allowed leakage = Fan Airflow x 0.10 = CFM Actual leakage to outside = CFM Pass if Actual leakage to outside is less than Allowed leakage  Pass  Fail 3 Option 3 used then: Initial leakage prior to start of work= CFM Final leakage after sealing all accessible leaks using smoke test = CFM Initial leakage - Final leakage = Leakage reduction CFM (Leakage reduction / Initial leakage ) x 100% = % Reduction Pass if % Reduction > 60%  Pass  Fail 4 Option 4 used then: All accessible leaks repaired using smoke test. HERS rater must verify (No sampling). Pass if all accessible leaks have been sealed using Smoke Test  Pass  Fail 45215 Sunbrook Ln La Quinta CA 92532 La Quinta, City of 4.50 1800.00 4 1800.00 270.00 203.00 4 313-A0014592A-M2114755A-M21A 03/14/2013 10:00:03 CBPCA 4 Esser Air Conditining Lydia Garcia 489046 4 MLC Home Performance Tom Bachus Tom Bachus 1095794 3/14/2013 45215 Sunbrook Ln La Quinta CA 92532 La Quinta, City of 313-A0014592A-M2114755A-M21A 03/14/2013 10:00:03 CBPCA 4 4 4 4 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test – Existing Duct System (Page 2 of 2) Site Address: Enforcement Agency: Permit Number: Registration Number: ___________________________ Registration Date/Time: __________________ HERS Provider: ____________ 2008 Residential Compliance Forms August 2009  Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off 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.  All supply and return register boots must be sealed to the drywall if smoke test is utilized for compliance – applies to duct leakage compliance option 3 (leakage reduction by 60%) and option 4 (fix all accessible leaks) described above.  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 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-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-1R) 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) Responsible Person's Name: CSLB License: HERS Provider Data Registry Information Sample Group # (if applicable):  tested/verified dwelling  not-tested/verified dwelling in a HERS sample group HERS Rater Information HERS Rater Company Name: Responsible Rater's Name Responsible Rater's Signature Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: Registration Number: ___________________________ Registration Date/Time: __________________ HERS Provider: ____________ 2008 Residential Compliance Forms August 2009 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/Tag System Location or Area Served 1 Yes No 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 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 1 and 2 is a pass. Enter Pass or Fail   Pass   Fail STMS - Sensor on the Evaporator Coil System Name or Identification/Tag 3 Yes No The sensor is factory installed, or field installed according to manufacturer's specifications, or is installed by methods/specifications approved by the Executive Director. 4 Yes No The sensor wire is terminated with a standard mini plug suitable for connection to a digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 5 Yes No The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not applicable. Otherwise enter Pass or Fail   N/A   Pass   Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag 6 Yes No The sensor is factory installed, or field installed according to manufacturer's specifications, or is installed by methods/specifications approved by the Executive Director. 7 Yes No The sensor wire is terminated with a standard mini plug suitable for connection to a 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 The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not applicable. Otherwise enter Pass or Fail   N/A   Pass   Fail 45215 Sunbrook Ln La Quinta CA 92532 La Quinta, City of 313-A0014592A-M2514754A-M25A 03/14/2013 09:58:49 CBPCA System 1 4 4 4 4 4 System 1 System 1 45215 Sunbrook Ln La Quinta CA 92532 La Quinta, City of 313-A0014592A-M2514754A-M25A 03/14/2013 09:58:49 CBPCA System 1 130652662F TRANE 4TTB4061E1000CA 16.00 System 1 3/13/2013 3/1/2013 3/1/2013 50.00 81.00 31.00 47.00 70.00 76.00 71.00 65.00 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: Registration Number: ___________________________ Registration Date/Time: __________________ HERS Provider: ____________ 2008 Residential Compliance Forms August 2009 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55 oF) 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 Location or Area Served Outdoor Unit Serial # Outdoor Unit Make Outdoor Unit Model Nominal Cooling Capacity Btu/hr Date of Verification Calibration of Diagnostic Instruments Date of Refrigerant Gauge Calibration (must be re-calibrated monthly) Date of Thermocouple Calibration (must be re-calibrated monthly) Measured Temperatures (°F) System Name or Identification/Tag Supply (evaporator leaving) air dry-bulb temperature (Tsupply, db) Return (evaporator entering) air dry-bulb temperature (Treturn, db) Return (evaporator entering) air wet-bulb temperature (Treturn, wb) Evaporator saturation temperature (Tevaporator, sat) Condensor saturation temperature (Tcondensor, sat) Suction line temperature (Tsuction) Liquid Line Temperature (Tliquid) Condenser (entering) air dry-bulb temperature (Tcondenser, db) 45215 Sunbrook Ln La Quinta CA 92532 La Quinta, City of 313-A0014592A-M2514754A-M25A 03/14/2013 09:58:49 CBPCA System 1 21.00 21.40 -0.40 System 1 1050.00 1156.00 Pass System 1 Pass CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: Registration Number: ___________________________ Registration Date/Time: __________________ HERS Provider: ____________ 2008 Residential Compliance Forms August 2009 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. Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) System Name or Identification/Tag Calculated Minimum Airflow Requirement (CFM) Measured Airflow using RA3.3 procedures (CFM) 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 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 Fail 45215 Sunbrook Ln La Quinta CA 92532 La Quinta, City of 313-A0014592A-M2514754A-M25A 03/14/2013 09:58:49 CBPCA System 1 System 1 3.00 - 26.00 11.00 8.00 3.00 Pass 16.00 Pass CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: Registration Number: ___________________________ Registration Date/Time: __________________ HERS Provider: ____________ 2008 Residential Compliance Forms August 2009 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 Calculate: Actual Subcooling = Tcondenser, sat – Tliquid Target Subcooling specified by manufacturer Calculate difference: Actual Subcooling – Target Subcooling = System passes if difference is between -4°F and +4°F 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. Sys tem Name or Identification/Tag Calculate: Actual Superheat = Tsuction – Tevaporator, 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 45215 Sunbrook Ln La Quinta CA 92532 La Quinta, City of 313-A0014592A-M2514754A-M25A 03/14/2013 09:58:49 CBPCA System 1 Pass Esser Air Conditining Lydia Garcia 489046 4 MLC Home Performance Tom Bachus Tom Bachus 1095794 3/14/2013 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: Registration Number: ___________________________ Registration Date/Time: __________________ HERS Provider: ____________ 2008 Residential Compliance Forms August 2009 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 meets all refrigerant charge and airflow requirements. Enter Pass or Fail 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-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 General Contractor or Builder/Owner) Responsible Person's Name: CSLB License: HERS Provider Data Registry Information Sample Group # (if applicable):  tested/verified dwelling  not-tested/verified dwelling in a HERS sample group HERS Rater Information HERS Rater Company Name: Responsible Rater's Name Responsible Rater's Signature Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: INSTALLATION CERTIFICATE CF-6R-MECH-21-HERS Duct Leakage Test – Existing Duct System (Page 1 of 2) Site Address: Enforcement Agency:Permit Number: Registration Number: ___________________________ Registration Date/Time: __________________ HERS Provider: ____________ 2008 Residential Compliance Forms August 2009 Enter the Duct System Name or Identification/Tag: Enter the Duct System Location or Area Served: 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 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 existing dwelling, use the Installation Certificate titled "Duct Leakage Test – Completely New or Replacement Duct System." Duct Leakage Diagnostic Test – Existing Duct System Select one compliance method from the following four choices. Option 1. Measured leakage less than 15% of Fan Airflow. Option 2. Measured leakage to outside less than 10% of Fan Airflow. Option 3. Reduce leakage by 60% or more, and conduct smoke test to seal all accessible leaks. Option 4. Fix all accessible leaks using smoke test, and HERS rater must verify. Note: (Option 1 must be attempted before utilizing Option 4) Determine nominal Fan Airflow using one of the following three calculation methods. Cooling system method: Size of condenser in Tons x 400 = CFM Heating system method: 21.7 x Heating Output Capacity (kBtuh) = CFM Measured system airflow using RA3.3 airflow test procedures: CFM 1 Option 1 used then: Allowed leakage = Fan Airflow x 0.15 = CFM Actual leakage = CFM Pass if Actual leakage is less than Allowed leakage Pass Fail 2 Option 2 used then: Allowed leakage = Fan Airflow x 0.10 = CFM Actual leakage to outside = CFM Pass if Actual leakage to outside is less than Allowed leakage Pass Fail 3 Option 3 used then: Initial leakage prior to start of work= CFM Final leakage after sealing all accessible leaks using smoke test = CFM Initial leakage - Final leakage = Leakage reduction CFM (Leakage reduction / Initial leakage ) x 100% = % Reduction Pass if % Reduction > 60% Pass Fail 4 Option 4 used then: All accessible leaks repaired using smoke test. HERS rater must verify (No sampling). Pass if all accessible leaks have been sealed using Smoke Test Pass Fail 4.5 1800 1800 270 203 45215 Sunbrook Ln La Quinta CA 92532 La Quinta, City of 313-A0014592A-M2114755A-0000 03/14/2013 09:59:25 CBPCA 4 4 4 45215 Sunbrook Ln La Quinta CA 92532 La Quinta, City of Esser Air Conditining Lydia Garcia 489046 313-A0014592A-M2114755A-0000 03/14/2013 09:59:25 CBPCA Lydia Garcia 3/14/2013 4 4 4 4 4 INSTALLATION CERTIFICATE CF-6R-MECH-21-HERS Duct Leakage Test – Existing Duct System (Page 2 of 2) Site Address: Enforcement Agency:Permit Number: Registration Number: ___________________________ Registration Date/Time: __________________ HERS Provider: ____________ 2008 Residential Compliance Forms August 2009 Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off 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. All supply and return register boots must be sealed to the drywall if smoke test is utilized for compliance – applies to duct leakage compliance option 3 (leakage reduction by 60%) and option 4 (fix all accessible leaks) described above. 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 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 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. • 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-1R 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. 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. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Responsible Person's Name: Responsible Person's Signature: CSLB License: Date Signed: Position With Company (Title): Is this installation monitored by a Third Party Quality Control Program (TPQCP)? Yes No Name of TPQCP (if applicable): INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency:Permit Number: Registration Number: ___________________________ Registration Date/Time: __________________ HERS Provider: ____________ 2008 Residential Compliance Forms August 2009 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/Tag System Location or Area Served 1 Yes No 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 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 1 and 2 is a pass. Enter Pass or Fail 9 Pass 9 Fail STMS - Sensor on the Evaporator Coil System Name or Identification/Tag 3 Yes No The sensor is factory installed, or field installed according to manufacturer's specifications, or is installed by methods/specifications approved by the Executive Director. 4 Yes No The sensor wire is terminated with a standard mini plug suitable for connection to a digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 5 Yes No The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not applicable. Otherwise enter Pass or Fail 9 N/A 9 Pass 9 Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag 6 Yes No The sensor is factory installed, or field installed according to manufacturer's specifications, or is installed by methods/specifications approved by the Executive Director. 7 Yes No The sensor wire is terminated with a standard mini plug suitable for connection to a 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 The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not applicable. Otherwise enter Pass or Fail 9 N/A 9 Pass 9 Fail 45215 Sunbrook Ln La Quinta CA 92532 La Quinta, City of 313-A0014592A-M2514754A-0000 03/14/2013 09:57:07 CBPCA System 1 4 4 4 System 1 4 System 1 4 45215 Sunbrook Ln La Quinta CA 92532 La Quinta, City of 313-A0014592A-M2514754A-0000 03/14/2013 09:57:07 CBPCA System 1 130652662F TRANE 4TTB4061E1000CA 16.00 3/13/2013 3/1/2013 3/1/2013 System 1 50.00 71.00 65.00 31.00 81.00 47.00 70.00 76.00 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency:Permit Number: Registration Number: ___________________________ Registration Date/Time: __________________ HERS Provider: ____________ 2008 Residential Compliance Forms August 2009 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55 oF) 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 Location or Area Served Outdoor Unit Serial # Outdoor Unit Make Outdoor Unit Model Nominal Cooling Capacity Btu/hr Date of Verification Calibration of Diagnostic Instruments Date of Refrigerant Gauge Calibration (must be re-calibrated monthly) Date of Thermocouple Calibration (must be re-calibrated monthly) Measured Temperatures (°F) System Name or Identification/Tag Supply (evaporator leaving) air dry-bulb temperature (Tsupply, db) Return (evaporator entering) air dry-bulb temperature (Treturn, db) Return (evaporator entering) air wet-bulb temperature (Treturn, wb) Evaporator saturation temperature (Tevaporator, sat) Condensor saturation temperature (Tcondensor, sat) Suction line temperature (Tsuction) Liquid Line Temperature (Tliquid) Condenser (entering) air dry-bulb temperature (Tcondenser, db) 45215 Sunbrook Ln La Quinta CA 92532 La Quinta, City of 313-A0014592A-M2514754A-0000 03/14/2013 09:57:07 CBPCA System 1 21.00 21.40 -0.40 Pass System 1 1050.00 1156.00 Pass System 1 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency:Permit Number: Registration Number: ___________________________ Registration Date/Time: __________________ HERS Provider: ____________ 2008 Residential Compliance Forms August 2009 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 -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. Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) System Name or Identification/Tag Calculated Minimum Airflow Requirement (CFM) Measured Airflow using RA3.3 procedures (CFM) 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 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 -5°F and +5°F Enter Pass or Fail 45215 Sunbrook Ln La Quinta CA 92532 La Quinta, City of 313-A0014592A-M2514754A-0000 03/14/2013 09:57:07 CBPCA System 1 11.00 8.00 3.00 Pass System 1 16.00 4.00 - 25.00 Pass INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency:Permit Number: Registration Number: ___________________________ Registration Date/Time: __________________ HERS Provider: ____________ 2008 Residential Compliance Forms August 2009 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 Calculate: Actual Subcooling = Tcondenser, sat – Tliquid Target Subcooling specified by manufacturer Calculate difference: Actual Subcooling – Target Subcooling = System passes if difference is between -3°F and +3°F 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 Calculate: Actual Superheat = Tsuction – Tevaporator, sat Enter allowable superheat range from manufacturer's specifications (or use range between 4°F and 25°F if manufacturer's specification is not available) System passes if actual superheat is within the allowable superheat range Enter Pass or Fail 45215 Sunbrook Ln La Quinta CA 92532 La Quinta, City of 313-A0014592A-M2514754A-0000 03/14/2013 09:57:07 CBPCA Esser Air Conditining Lydia Garcia 489046 3/14/2013 owner Lydia Garcia Pass System 1 4 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency:Permit Number: Registration Number: ___________________________ Registration Date/Time: __________________ HERS Provider: ____________ 2008 Residential Compliance Forms August 2009 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 meets all refrigerant charge and airflow requirements. Enter Pass or Fail 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 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. • 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-1R 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. 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. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Responsible Person's Name: Responsible Person's Signature: CSLB License: Date Signed: Position With Company (Title): Is this installation monitored by a Third Party Quality Control Program (TPQCP)? Yes No Name of TPQCP (if applicable):