10-0566 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
10-00000566
Property Address:
54425 AVENIDA VALLEJO
APN:
774-244-021-10 -000000-
Application description:
MECHANICAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
11549
T-4wt 4 4 "
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant:. Architect or Engineer:
�1A
------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby aff' m under penalty of perjury that I a lic nsed under provisio s of Chapter 9 (commencing with
Section 70 0) of D vision 3 of t rJ ' ass a r es ionals C • e and m Li ense is in full force and effect.
License Cie s: C2 l / Lic se o.: 45
ate: O tractbcJ
WNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury th o 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).:
(_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.). .
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
( 1 I am exempt under Sec. , BAP.C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under 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 (760) 777-7011
INSPECTIONS (760) 777-7153
�- ate: AP 5/10
Owner: ],[1 COPELAND LINDA SUEL�LLJUN
54-425 AVENIDA VALLEJO;2Q10LA QUINTA, CA 92253
nit;
Contractor:
DCS HEATING/AIR CONDITONNG INC
72078 CORPORATE WAY, #101 "
THOUSAND PALMS, CA 92276
(760)343-5566.
LiC. No.: 595145
------------------
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
_ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier HARTFORD INS Policy Number 72WECLS7131
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 becgrftgjsubject to,",wor�ers' compensation provisions of Section
WARNING:(; FAILURE TO SECURE RK RS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIM NA ENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000)• IN ADDITIOIrrO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES:
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the .
conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and *shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above informati is co r ct. I agree to comply with all
city and county ordinances and state laws9'ui'dJg uctio d h re authorize representatives
oft ' c my en up n the above-meo i ,ctio pu os s.
anature (Applicant
Application Number . . . . . 10-00000566
Permit . . . MECHANICAL
Additional. desc .
Permit Fee . . . . 33.00 Plan Check Fee
8.25
Issue Date Valuation
0
Expiration Date 12/22/10
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 9.0000 EA MECH FURNACE <=100K'
9.00
1.00 9.0000 EA MECH B/C <=3HP/100K BTU
9.00
'. Special Notes and Comments
INSTALL (1) 3 TON 18 SEER HEAT PUMP
SPLIT SYSTEM IN CLOSET. 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 .00
8.25
Other Fee Total 1.00 .00 .00
1.00
Grand Total 42.25 .00 .00
42.25
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAlterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Address:
Enforcement Agency:
Date:
Permit #:
Conditioned Floor
Equipment T el
List Minimum Efficiency Z
Duct insulation requirement
Area
Thqpnostat
❑ Packaged Unit
❑ Furnace
❑AFUE
❑COP
Over 40 ft of ducts added or
Setback
ndoor Coil
❑SEER I F. b0
❑ HSPF
replaced in unconditioned space
S -,ystem
prose already
Condensing Unit
❑ EER 13.00
❑ Resistance
❑ R 6 (CZ 10-13)
❑ R 8 (CZ 14-1 5)
sf
present, must be
installed)
Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1 R -ALT -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems.
HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides what work is being done and
picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final
inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fact the work completed by the
installer. The inspector also verifies that each appropriate CF -6R and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and
sign d. Beginning October 1, 2010, a registered copy of the CF -1R and CF -6R shall also be on site for final inspection.
V. HVAC Changeout
Required Forms:
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
• All HVAC Equipment replaced
CF -4R forms: MECH- 21 and (fors lits stems) MECH-25
• Condenser Coil and/or
CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS
• Indoor Coil and/or
CF -4R forms: MECH- 21 and (for split systems) MECH-25
• Furnace
For Split Systems: Duct leakage < 15 percent; RC, CCA >_ 300 CFM/ton(Minimum Air Flow Requirement), TMAH
For Packaged Units: Duct leakage < 15 percent
Exempted from duct leakage testing if:
❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or
❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or
❑ 3. Existing ducts stems are constructed, insulated or sealed with asbestos
❑ 2. New HVAC System
Required Forms:
• Cut in or Changeout with new
CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
ducts: (all new ducting and all
CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25
new equipment)
For Split Systems: Duct leakage < 6 percent; RC, CCA > 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
❑ 3. New Ducts with Replacement
Required Forms:
• Includes replacing or installing all new ducting
CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor
CF -4R forms: MECH-20 and (for split systems) MECH-25
coil and/or furnace. Not all equipment changed.
For Split Systems: Duct leakage < 6 percent, RC, CCA > 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
❑ 4. New Ducting over 40 feet
Required Forms:
• Includes adding or replacing more than 40
CF -6R forms: MECH-04, MECH-2I-14ERS CF -4R forms: MECH-21
linear feet of duct in unconditioned space.
For split system or packaged units: Duct leakage < 15 percent
❑ EXCEPTION: Existing ducts stems constructed, insulated or sealed with asbestos.
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
• I certify that this Certificate of Compliance documentation is accurate and complete.
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance.
• I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24,
Parts I and 6 of the Califomia Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, worksheets,
calculations, plans and specifications submitted to the enforcement agency for approval with the permit qpplicapn.
Name: 1�1 ., G
cC'.C''�nn''
Signature
/� r �i� J
Company:DCS 44-ew-tn �r) Ar t�(Jl i(�/f7�t � j-"&.
Date:
Address: � /D
License 5/ 5
City/State/Zip:
Phone: —556 to
2008 Residential Compliance Forms March 2010
Bin #
0t/ of La Quinta
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico ;
La Quinta, CA 92253 - (760) 777-7012.
Building Permit Application and Tiacking'Sheet
Permit # - �^
l�
Project Address: aS A ywidfg Va e '
Owner's Name: Linda Co -dan d
A. P. Number:
Address: L/ 2• AytrVda Y tl 11 •
Legal Description:
City, ST, Zip:
Contractor: - fr I' fnC
Telephone: _7Q
Address: -12 S-
Project Description: 3TUn I
Ci ST, Zi .`
ty, Pu n aims C0--)_3-(P
4i'lan 14,&-,4- Purn. S lii- S S�e.YI, ;.
Telephone— . YWO
StateLic.#: City
Arch., Engr., Designer:
3W3 s$21" l W to COnL S
TI
)
iia'- kah U Ize- )-n No sq-
Address:
City., ST, Zip:
�...,�
Construction Type:,i Occupancy:
Tele P hone:
::C+i:':�:::?ji::;i:;:j;:j:::;::•{:r::S is{:;:ji<:j::
State Lic. #:
Project hPa circle one)- Add'n Alt Repair Demo
Name of Contact Person: r4-no-Sq.
Ft�/
# Stories: - # Units:
Telephone # of Contact Person: - j _55(p 1p
Estimated Value of Project: Oa
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
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/issue
Electrical
Subcontactor List
Called Contact PersonPlumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:
'"' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
—r--
`
Total Permit Fees
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-21
Duct Leakage Test - Existing Duct System (Pa e 1 of 2)
Site Address: Enforcement Agency: Permit Number:
54425 Avenida Vallejo,La Quinta,CA92253 City of La Quinta 10-566
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 b
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 ducts 5temjLej:
Select one compliance method from the followingtfo`aZZ�choi'ce 7J
®Option 1. Measured leakage less than 1-1510/0f Fan 1rflpFv
:I��'
Option 2. Measured leakage to outside 1Ss fhanl0% o Tan+�irtlow.
ption 3: Reduce leakage b 60% or mo,Pand conducts oke test t se all accessible leaks.
y
Option 4. Fix_ all accessible leaks using°smoke test, and HERS rate rt verify.
Note: (Option 1 must be attempted bere,.utilizing Option„4)
Determine nominal Fan Airflow using one •of the4followingf three.calculation methods.-
� s
LJ_'ooling system method: Size of condenser in�`Ton /' 400 CFM
N
IIeating system method: 21.7 x Heating Output C pacity.(kBtuh) = CFM
wleasured system airflow using RA3.3 airflow test procedures: CFM
Option 1u sed thenCAirflo
Allowed leakage =C15
—
H
T�
—
CFM
F%K
Actual leakage =P
Pass i
• Actual 1
aka a is les
than Allowed leakage
[7PasEOFail
Option 2 used then:
k
Allowed leakage = Fan Airflow x 0.10 = CFM
2
Actual leakage to outside = CFM
E6asslnail
Pass if Actual leakage to outside is less than'Allowed leakage
Option 3 used then:
Initial leakage prior to start of work= CFM
Final leakage after sealing all accessible leaks using smoke test = CFM
3
Initial leakage - Final leakage = Leakage reduction CFM
(Leakage reduction / Initial leakage } x 100%= % Reduction
Pass if % Reduction > 60%
5assnail
Option 4 used then:
All accessible leaks repaired using smoke test. HERS rater must verify (No sampling).
4
Pass if all accessible leaks have been sealed usin Smoke Test
as ail
Registration Number: 110-9014C8A0-0100-1-MECH21 Registration Date/Time: 07/13/2010 15:30 HERS Provider: CHEERS
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-21
Duct Leakage Test — Existing Duct System s (Page 2 of 2)`
Site Address: Enforcement Agency: Permit Number:
54425 Avenida Vallejo,La Quinta,CA92253 City. of La Quinta 110-566
❑ Outside air (OA) ducts for Central Fan Integrated (CF ventilation systems, shall not be sealed/taped off during duct
leakage testing. CFI OA ducts that utilize controlled nofor�d dampers, .that open only when OA ventilation is required to
meet ASHRAE Standard 62.2, and close when OAkvent;ilafunis not required, may be configured to the closed position
during duct leakage testing. q ',b71;� ,�
❑ All supply and return register boots.f tial] ism ke test is utilized for compliance — applies to
duct leakage compliance option 3 (leaQe-r-eduction,b 60..o)+and option 44*(fix all accessible leaks) described above.
K��l❑ New duct installations cannot utilize�build.4ilies as p entmis or platform returns in lieu of ducts.
❑ Mastic and draw bands must be used`in,combination witi cloth BMZWFfubber adhesive duct tape to seal leaks at all new,
duct connections. ,
DECLARATION STATEMENT �Wsr. '
• I certify under penalty of perjury, under the, 1, o) the to )f•�Cal'iffoom�, the information provided on this form is true and correct.
cation:semces identified and reported on this certificate (responsible rater).
• I am the certified HERS rater who performed theferifi
• The installed feature, material, component, or manufac ed cevic equiring HERS verification that is identified on this certificate
(the installation) complies with the applicable requirements ir. 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 o �a pliabUsectios fthiti e i cafe CF- R), 'gned2nd submitted by the persons)
responsible for the installtton onfore w e exits �pe i e o th a ie( o compliance (CF -1R) approved by the
g Yenforcement a enc .
Builder or Installer informa ''$n-a9-sh'ow !on Q I taft on Ge i ica�e C R
Company Name: (Installing$ubcontrator or Generall Contractor�)r Builder/ wner) I!
DCS Heating & Air Conditioning, Inc.
Responsible Person's Name:
CSLB License: .
Brown
595145
.Buff
HERS Provider Data Registry Information
Sample Group # (if applicable): ested/verified dwelling✓ not-tested/verified dwelling
2 m a HERS sample group
HERS Rater Information
HERS Rater Company Name:
Energy Driven Solutions Inc.
Responsible Rater's Name
Dave .Bricker
Responsible Rater's Signature'
Dave Bricker(Signature on File)
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed:
CCN99380828
7/13/2010
Registration Number: 110-9014C8A0-0100-1-MECH21 Regisi'ation Date/Time: 07/13/2010 15:30 HERS Provider: CHEERS
r
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:
54425 Avenida Vallejo, La Quinta,CA92253 City of La Quinta 10-566
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 forms) 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
3 .
OYes
DO
specifications, oris mstalled by�methods/specifications approved by the Executive
[]No
1
YesOt4o
Director.
5/16 inch 8 mm) access ole u Cream of evaporative coil in t
lab's t accord g tto Fig e in Sect gSRA3.2 2.2.2. he return plenum and. .
2
-01 Yes
Oqo
5�r �,inch (8"nm) cces hol'e�do n tream of evaporative coil in the supply plenum
M , .�.' �.
-or
and'labe�led!an cording toFiigure �m Section RA3.2.2.2.2.
Yes to land 2 is a pass.
LitEn?er�Pass=or Fail ✓ []Pass. ✓ E]Fail
STMS -.Sensor tin the F.vannrntnr
System Name or Identification/Tag . - "
.TZ
Ory ^ VNI
`.
The sensor istfactoryviQni'stalled, orTfield installed according to manufacturer's
3 .
OYes
DO
specifications, oris mstalled by�methods/specifications approved by the Executive
[]No
specifications, or is installed by methods/specifications approved by the Executive
Director.
Director.
The sensor wire is terminated wit
a standard mini plugsuitable "for connection to a
.4 •
QYes
-
�di 'tal Lometer., a semsor
lug is; access le`to the iristalling technician and
'w'
th rater thou c ahggmg;th
air high the condenser coil
5
Eyes
Co -
e"senDr eas es th atic
n t p a e of - coil within 1.3 degrees F
Yes to 3, 4, and 5 is a pass. En r
N/A ✓ Pass
✓ Mail
N/A if STMS are not applicable. Otherwise enter Pass or Fail
.
STMS - Sensor on the Condenser Coil
System Name or Identification/Tag
The sensor is factory installed, or field installed according to manufacturer's
6
ElYes
[]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
UYes
[]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
_J Yes
040
The sensor measures the saturation temperature of the coil within 1.3 degrees F
Yes to 6, 7, and 8 is a pass. Enter
V IM N/A
✓' OPass
✓ OFail .
N/A if STMS are not applicable. Otherwise enter Pass or Fail .
Registration Number: 110-9014C8A0-0100-17MECH25 Registration Date/Time: 07/13/2010 15:30 HERS Provider: CHEERS.
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure h (Page 2 of 5)
Site Address: Enforcement. Agency: Permit Number:
.54425. Avenida Vallejo, La Quinta,CA92253 City Of La Quinta- 10=566
Standard Charge Measurement Procedure (for use if ou-door.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 dwellin€ can be documented for compliance using this form. Attach an
additional form(s) for any additional systems in the dwelling as ap.lieable.
•. The system should be installed and charged in accordance wiE'h 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 SS OF or below, the installer must me the Alternate Charge Measurement Procedure.
Snnee. Cnnditinninv Cvatemc
System Name or Identification/Tag
.(must be re calibrated monthly)
I
System Location or Area Served
Measured Temneratures (0 F) ,!
Outdoor Unit Serial #
4
Outdoor Unit Make
temperature (Tsu I , db) I -
Outdoor Unit Model
Nominal Cooling Capacity Btu/hr
I
t
Date of Verification mss'
!
i n .
.Calibration of Diagnostic Instruments _.. j
Date of Refrigerant Gauge Calibration.
.(must be re calibrated monthly)
Date of Thermocouple Calibration
(must be re -calibrated monthly)
Measured Temneratures (0 F) ,!
System Name or Identification/Tag
Supply (evaporator leaving ar , y 1bu
temperature (Tsu I , db) I -
Return (evaporator enterin air dr b 1
temperature (Tretorn, db)
.Return (evaporator entering) air wet -bulb
,
temperature (Treturn, wb)
Evaporator. saturation temperature
_
(Teva orator, sat)
Condensor saturation temperature
(Tcondensor, sat)
Suction line temperature (Tsuction)
Liquid Line Temperature (Tliquid)
Condenser (entering) air dry-bulb
temperature (Tcondenser, db)
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measu-ement Procedure (Page 3 of 5)
Site Address: Enforcement Agency: Permit Number:
54425 Avenida Vallejo,La Quinta,CA92253 10ty of La. Quinta 10-566
Minimum Airflow Requirement
Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge.
Verification. The temperature split method is specified in Reference Residential Appendix RA3.2..._
System Name or Identification/Tag
System Name or Identification/Tag .
.Calculate: Actual Superheat =
.Calculate: Actual Temperature Split= .
Tsuction — Teva orator sat
Tretum, db - Tsuppjy, db
Target Superheat from Table RA3.2-2
Target Temperature Split from Table
using Tretum wb and Tcondenser, db
RA3.2-3 using Treturn, Wb and Treturn, db
Calculate difference:
Calculate difference: Actual Temperature
t
Actual Superheat= Target Superheat = .
Split.— Target Temperature Split
n�
System passes if difference is between .
Passes if difference is between -4°F and
-60F and+6°F Enter Pass or Fail
+4°F or upon remeasurement, if between
,
-40F and _100°F Enter Pass or Faily
Note: Temperature Split Method Calculation Is not necessapyrf actual Cooling Coil Airflow is verified using one of the,
airflow measurement procedures specified in Re erence Res dential�A endix RA3.3..If actual cooling coil airflow is
be ` i pp�r
Airflow
measured the value must equal to or greater th�an�.the Cedc utlaied Minimum Requirement in the table below.
Calculated Minimum n al
Airflow Requi'm nt (CFVn�'m Cooling apacity (ton) X 300 (cfm/ton)
System Name or Identification/Tag
Calculated Minimum Airflow
Requirement (CFM)
I
:1
Measured Airflow, using 3.3
procedures (CFM)
Passes if measured airflow is greater than.
i
.
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 — Teva orator sat
Target Superheat from Table RA3.2-2
using Tretum wb and Tcondenser, db
Calculate difference:
Actual Superheat= Target Superheat = .
System passes if difference is between .
-60F and+6°F Enter Pass or Fail
Registration Number: 110-9014C8A0-0100-1-MECH25 Registration Date/Time: 07/13/2010 15:30 HERS Provider: CHEERS,
1
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:
54425 Avenida Vallejo,La Quinta,CA92253 City of La Quinta 10=566
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
y
-
Calculate: Actual Subcooling =
Tcondenscr, sat — Tli uid
q"�ATsuction
E ! 1 Il '��
,.
'
Target Subcooling specified by
ll
manufacturer
j �.
r•
Calculate difference:
---
Actual Subcooling —Target Subcooling =
„`
System passes if difference is between
J
-4°F and +40F Enter Pass or Fail
- f
Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for
thermostatic expansion valve (TXV) and electronidZxpans o va5lve (EXV) systems.
System Name or Identification /Tag
y
Calculate: Actual Superheat
—Teva orator sat �<i'
q"�ATsuction
E ! 1 Il '��
i
Enter allowable superheat range from
ll
manufacturer's specifications (or use rang
j �.
r•
0
between 3 F and 260F if manufacturer s+O`--
---
s ecification is not available)
„`
System passes if actual superheat is within
J
the allowable superheat range
.
Enter Pass or Fail
1
a
Registration Number: 110-9014C8A0-0100-1-MECH25 Registration Date/Time: 07/13/2010 15:30 HERS Provider: CHEERS
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measu-ement Procedure t (Page 5 of 5)
Site Address: Enforcement Agency: Permit Number:
54.425 Avenida Vallejo,La Quinta,CA92253 City of, La'Quirita 10=566
Standard Charge Measurement Summary: f
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
a
CSLB License:
System meets all refrigerant charge and
Buff Brown
1595145
-
airflow requirements. Enter Pass or Fail
t
Sample Group # (if applicable):
2
�
•
DECLARATION STATEMENT
• I certify under penalty of perjury,'under the laws of therState o_ 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 com "onent, or man factured device requi ng HERS ve fication th t is identified on this certificate
(the installation) complie�e 1pp i abl q re "tents' in 3e€eeren�'e esBenl A)pe dices RA2 and RA3 and the requirements
specified on the Certifi e(s) of Comp ranee%( F- R) a oved y to - to alm nt ' cy.
• The information reported app 'capbl section of th Ihstallaw o Ce.; fi at -6 • ), sg and submitted by the person(s)
responsible for the installation conf�rms to the requirements s ��ecified on he 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 )r Builder/Owner) '
DCS Heating &.Air Conditioning, Inc..
Responsible Person's Name:
CSLB License:
Buff Brown
1595145
.HERS Provider Data Registry Information
t
Sample Group # (if applicable):
2
tested/verified dwelling
✓ not-tested/verified dwelling
in a HERS sample group
HERS Rater Information
HERS. Rater Company Name:
Energy Driven Solutions Inc.
Responsible Rater's Name
Dave Bricker
Responsible Rater's Signature
Dave Bricker(Signature on File)
.,Responsible
.Responsible Rater's Certification.Number w/ this HERS Provider..
Date Signed:
�
7/13/2010
•
"�
Registration Number: 110-9014C8A0-0100-1-MECH25 Registration Date/Time: 07/13/2010 15:30 HERS Provider: CHEERS