13-0702 (MECH)i�
P.O. BOX'1504
78-495 CALLS TAMPICO01
LA QUINTA, CALIFORNIA 92253
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 13-00000702
Property Address: 81189 DESERT SAGE CT
APN: 764-270-999-149 -300234-
Application description: MECHANICAL
Property Zoning: MEDIUM HIGH DENSITY RES rApplication valuation: 7445 0 4 1013
Applicant: Architect or Engineer:P UA QUINTA
NCE DEPT.
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Cade, and my License is in full force and effect. .
License lass: C20 License No.: 686310
Date - Convacim�Cit�t.�,�Z+
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).:
(_ 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 ISec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who 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:
I-OPGRA1IT
Owner:
DAN AND CAROL BECKER
81189 DESERT SAGE COURT
LA QUINTA, CA 92253
11 0AL AIR CONDITIONING
0. RESERVE DRIVE
O SAND PALMS,.CA 92276
76 )343-7488
LiC- No.: 686310
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/04/13
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ 1 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.
P!=' 1I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
�.I Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier ZENITH INS CO Policy Number Z071741502
_ 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 the Labor
rCCode,
I shall forthwith comply with those provisions.
Appliceant
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST,AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1 . Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that 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 property for inspection purposes.,,
Date, Signature (Applicant or Agent):
�r7�
Application Number . . . . . 13-00000702
Permit . . . MECHANICAL 2013
Additional desc .
Permit Fee 71.50 Plan Check Fee
.00
Issue Date . . . . Valuation
0
Expiration Date 12./01/13
Qty Unit Charge Per
Extension
.1.00 35.7 500 EA MECH FURNACE
35.75
1.00 35.7500 EA MECH CONDENSER/COMP
35.75
--------------------------------------------------------------
Special Notes and Comments
--------------
HVAC CHANGE OUT (1) 5 TON SYSTEM
15SEER/781AFUE [2008 ENERGY] CARBON
MONOXIDE ALARM(S) TO BE INSTALLED PRIOR
TO FINAL INSPECTION. 2010 CALIFORNIA
BUILDING CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
PERMIT ISSUANCE M/P/E
90.57
PLAN CHECK, MECHANICAL
47.66
Fee summary. Charged Paid Credited
-------------------------------------------------------=-
Due
Permit Fee Total 71.50 .00 .00
71.50
Plan Check Total .00 .00 .00
.00
Other Fee Total 139.23 .00 .00
139.23
Grand Total 210.73 .00 .00
210.73
LQPF_Rn11T
Y
J
Bin.# Qty Of La QUlhtd
Building a Safety Division
Permit # P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 -:(760) 777-7012
Building Permit -Application and Tracking Sheet
Project Address: g� Owner's Name:.
A. P. Number.
Address: $) )? Ci beSex-*
Legal Description:
City, ST, Zip: Lo, Quy,� 2.
Contmetor: Gex\t✓r ; CcPiNa\Air%V-%\UDQ
Telephone:
Address: )-7O exv
e-
Project Description:
City, ST, Zip:
o -k Q22-71.
lcLce— S� - t_ 11 D1L 3i V
Telephone: 7(o0-34 )_1439
(:�cr ce—
State Lic. # : ICIZ6-13l O
Arch., Engr., Designer.
City Lic. #;
Address.
City, ST, Zip.
Telephone:
State Lic. #:
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Ft.: # Stories: Ut►its:
Name of Contact Person:--F#Sq.
Telephone # of Contact Person:
Estimated Value of Project: 411.5 00
APPLICANT: DO NOT WRITE BELOW THIS UNE
o
Submittal
Plan Sets
Req'd
Reed
TRACIONG PERMIT FEES
Plan Cheek submitted Item Amount
Structural Cafes.
Reviewed, ready for corrections Plan Check Deposit.
Truss Cates.
Called Contact Person Plan Cbcck Balance
Title 24 Cates.
Plans picked up Construction
Flood plain plan
Plans resubmitted Mechamw
Grading plan
Z'` Review, ready for correctionsiissue Electrical
Subcontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up S.M.L
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
''' Review; ready for corrections/issue Developer Impact Fee
Planning Approval
Called Contact Person A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
r
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR A.LT-HVAC
Climate zones 10 to is
Site Address:
RMIq
Enforcemet Agetcy:
e;
a
3
Permit #:
_c
CI
Conditioned Floor
Equipment T e'
List Minimum Efficiency '
Duct insulation requirement
Area
Thermostat
Packaged Unit
Furnace
IS AFLIE %8 ).
0 COP
Over 40 ft of ducts added or
2 Setback
Indoor Coil
SEER
HSPF
8
re laced in unconditioned space
R (CZ 10-13)
Served by system
sf
(Ifnot already
present, must be
Condensing Unit
g
EER
Resistance
8
R 8 (CZ 14-I5)
installed)
Other
1. Equoment Type: Choose the equipment being installer!: if snore than one system, use another CF -IR -ALT -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems.
HERS VFAMCATION 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
signed. Beginning October 1, 2010, a copy of the CF -_1R and CF -6R shall also be on site for final ins on.
1. HVAC Changeout
Required Forms:
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
• All HVAC Equipment laced
CF411forms: MECH-21 and fors lit stems) MECH-25
• Condenser Coil and/or
CF -0R forms: MECH-2I-HERS and (for split systems) MECH-25-HERS
• Indoor Coil and /or
CF4R 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 pest
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 duct systems are constructed, insulated or sealed with asbestos
- 2. New HVAC System
Required Forms:
• Cut in or Changeout with new
CF -6R forms: MECII-04, MECI I-20-IIERS,and (for split systems) MECII-22-HERS, and MECI I -25-I IERS
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 Forma:
• 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
CF4R 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
M. New Ducting over 40 feet !!!9717 ed Forms:
• Includes adding or replacing more than 40 CF -6R forms: MECH-04, MECH-2l-HERS CF4R forms: MECH-2I
I
linear feet of duct in unconditioned space.
For splits stem or packaged units: Duct leakage < 15 percent
EXCEPTION: Existing duct astemis constructed, insulated or sealed with asbestos.
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
• I certify that this Catificate of Compliance documcatatiau is accurate and complete.
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance,
• I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24,
Parts 1 and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Comphancc are consistent with the information documented on other applicable compliance forms, workshects,
calculations, plans and specifications submitted to the enforcement agency for vaI with the application.
Name: e>J
Signature: r^' '
J ----�
Company:
�hC �
Date: y
Address: �1
License:
City/State/Zip: �h _:P4 S C� (�-ZZ7�O
Phone: —AoO- 3i3-7ga8
2008 Residential Compliance Forms July 2010
IN.- TALLATION CERTIFICATE CF-6R-MECH-2I-HERS
Duct Leakage Test — Existing Duct System (Page 1 of 2)
Site Address:
81189 DESERT SAGE CT, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1�
City of La Quinta
13-702
Enter the Duct System Name or Identification/Tag: System 1
Enter the Duct System .Location or Area Served: Whole House
Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the
dwelling.
This installation certificate is required for compliance for alterations and additions in existing dwellings 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 Diaqnostic Test - existinq duct system
Select one compliance method from the following four choices.
® 1. Measured leakage less than 15% of fan flow
❑ 2. Measured leakage to outside less than 10% of Fan Flow
❑ 3. Reduce leakage by 60% and conduct smoke and fix all leaks
❑ 4. Fix all accessible leaks using smoke and HERS rater verify
Note: (One of Options 1, 2 or 3 mus tbe attempted,before: utilizing, Option 4.-)� vYt
Determine nominal Fan Flow using one of,the`following three calculation methods. i' �' {
coenser in Tons l 5 - x 400 2000 CFM
✓ ® Cooling system method: Size ofnd
✓ ❑ Output Capacity Thousands of Btu/hr CFM
Heating system method 21.7x in =
'.CFM'
sured,system '.CFMi
V Me airflow using RA3.3 airflow .test procedures;
Option 1 used then:
1
Allowed leakage = Fan Airflow � 2000 x 0.15 = 300 CFM
Actual Leakage= 175 CFM
Pass if Actual Leakage is less than Allowed leakage
® Pass ❑ Fail
Option 2 used then:
2
Allowed leakage = Fan Airflow x 0.10 = _ CFM
Actual Leakage to outside = _ CFM
Pass if Actual leakage to outside is less than Allowed leakage
13 Pass Q Fail
Option 3 used then:
Initial leakage prior to start of work = _ CFM
Final leakage after sealing all accessible leaks using smoke test = _ CFM
3
Initial leakage _ - Final leakage _ = Leakage reduction _ CFM
((Leakage reduction _ / Initial leakage _) x 100% _ % Reduction
Pass if % Reduction >= 60%
E3 Pass Fail
Option 4 used then:
4
All accessible leaks repaired using smoke test. HERS rater must verify (No Sampling).
Pass if all accessible leaks have been repaired using smoke
C1 Pass Fail
2
Reg: 213-A0034857A-M2100001A-0000 Registration Date/Time: 2013/07/02 00:23:54 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INITALLATION CERTIFICATE CF-6R-MECH-2I-HERS
Duct Leakage Test — Existing Duct System (Page 2 of 2)
Site Address:
81189 DESERT SAGE CT, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
13-702
® 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 sealedtto theldrywall;If smoke is utilized for; compliance
- applies�to duct leakage compliance,optlon 3 (leakage reduction by 60%)Wand option 4((fix all.accessible
leaks) discribed above.
® New duct,lnstallatlons cannotutlllze building cavities as�plenumsorxplatform reEurns In heu of,ducts
,.
z,M^.�... � .��'.'�'`+��.z!,���. � � •.
® Mastic andld�aw�bands'must'be used16:_66mbination.witfi�clotWbacked 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 -111) form approved by the enforcement agency that identifies the specific
requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the installation have been met.
. I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the
building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I
understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder
Provides to the building owner at occupancy. 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)
HARRISON ENTERPRISES INC dba GENERAL AIR CONDITIONING
Responsible Person's Name:
Responsible Person's Signature:
Danielle Garcia
Danielle Garcia
CSLB License:
Date Signed:
Position With Company (Title):
686310
6/4/2013
Is this installation monitored by a Third Party Quality
Name of TPQCP (if applicable):
Control Program (TPQCP)? ❑ Yes ❑ No
Reg: 213-A0034857A-M2100001A-0000 Registration Date/Time: 2013/07/02 00:23:54 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
RefrigerZi Charge Verification - Standard Measurement Procedure; (Page i of 6)
Site Address: Enforcement Agency: Permit Number:
81189 DESERT SAGE CT, La Quinta CA 92253 City of La Quinta 13-702
Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant• charge
verification for compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should, be used to
demonstrate compliance with the refrigerant charge verification requirement. TMAH and. STMS are not
required for compliance when a CID is utilized for compliance.
As many as 4 systems in the dwelling can be. documented for compliance using this'form. Attach an
additional form(s) for any additional systems'in the dwelling as applicable.
Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement
Sensors (STMS)
Procedures for installing TMAH are specified in Reference. Residential Appendix RA3.2. If refrigerant charge
verification is required for compliance, TMAH are also required for compliance, unless the TMAH Compliance
Option is chosen.
STMS are only required for completely new or replacement space -conditioning systems that utilize
prescriptive compliance method.
TMAH - Access Holes in Suooly and Return Plenums of Air Handler
System Name or Identification/Tag
System 1
System Location or -Area Served",;
Whole House
5/16 -.inch (8 mm) access hole
1
upstream of evaporative coif in the
®Yes
❑ Yes
❑ Yes
❑ Yes
'return plenum and labeledaccording
❑ No
[3No
[3No
❑ No
to Figure iq -Action RA3.2.2_2 2:•
, _
„ ,
la
Retun?sde`of the_ duct system
s
locatedrentireI within onditioned 14 '
owtemperature
®Y#as
��
p Yes
No�'
❑Yes
❑Yes
space and return i�rfl
ONo®
LL
x❑ No
to be' measureda;ttie return
5/16`rr
e`mch''fm.e cvic° eisascFkole
osmf
Yes
-
YNeos,".'
'
❑❑k
�evap2
label
sd
❑ N0.11 r>
3
❑
AJ
.❑oratiy
NIosuppl"enumnd
.�
to Figure in_ ion RA3.2.2'>2`s2.
The TMAH Compliance, Option should be checked only if it is physically impossible to drill the TMAH as
required'by Section R?,3,2.2.2.2 .Using this Compliance Option requires the HVAC installer to. annotate on
the HERS Provider's data�registry:;;an explanation as to why the TMAH cannot be installed on the system,
and photographs of the equipment on which the TMAH cannot be installed. Use of this Compliance Option
also requires minimum airflow verification through the direct measurement of airflow per RA3.3
For more information see http//www.energy.ca.00v/title24/2008standards/special case appliance/
TMAH Compliance Option ❑
❑
❑
❑
Yes to 1 and 2, or Yes to la and 2, or
checking the TMAH Compliance Option, is ® Pass
❑ Pass
❑ Pass
❑ Pass
a pass. ❑ Fail
❑Fail
❑ Fail
❑ Fail
Enter Pass or Fail
a 0
Reg: 213-A0034857A-M2500001A-0000 Registration Date/Time: 2013/07/02 00:26:09 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms March 2013
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 6)
Site Address: Enforcement Agency: Permit Number:
81189 DESERT SAGE CT, La Quinta CA 92253 1 City of La Quinta 13-702
STMS - Sensor on the Evaporator Coil
System Name or
System 1
Identification/Tag
Identification/Tag
6
The sensor'is factory installedoris ,'ofield .installed omanufactiirer'sspecifications, os installed
3
The sensor is factory installed, or field installed according to manufacturer's specifications, or is installed
..❑Yges`0 No $ r Q Yes' 13xNow, f ": ❑ Yes O No ..,_... "~ El'XesO;No W
by methods/specifications approved by the Executive Director.
❑ Yes ❑ No 1 ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
7
The sensor wire is terminated with a standard mini plug suitable for connection to a digital thermometer.
4
The sensor mini plug is accessible to the installing technician and the HERS rater without changing the
NY ;UYes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
airflow through the condenser coil
❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
5 IThe sensor measures the saturation temperature of the coil within 1.3 degrees F
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Yes to 3, 4, and 5 is a
pass.
Enter N/A if STMS are not
❑ N/A
pass.
Enter N/A if STMS are not
® N/A
❑ N/A
❑ N/A
❑ N/A
applicable.
❑ Pass
❑ Pass
❑ Pass
❑ Pass
Otherwise enter Pass or
❑ Fail
❑ Fail
❑ Fail
❑ Fail
Fail
M
STMS - Sensor' -On the Condenser Coil
System Name or
System 1
Identification/Tag
6
The sensor'is factory installedoris ,'ofield .installed omanufactiirer'sspecifications, os installed
by methods/specifications approved by the Execaccording`auttveDirector
..❑Yges`0 No $ r Q Yes' 13xNow, f ": ❑ Yes O No ..,_... "~ El'XesO;No W
The sensor wirA' is"tei`minat2d�with a sta�nd'ard mini plug citable for connection;: to 6fdigital the�rmom'et&" .
7
The sensor*minifplug?=is a`cc'essible to�the ins talling;techbidan andAWHERS rater without chan.ging�.the.
airflow through the:condenser coil'
NY ;UYes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
8 The' sensor iimeasu'res the saturation temperature of the coil within 1.3 degrees F
j OYes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Q Yes ❑ No
Yes to 6, 7, and 8 is a
pass.
Enter N/A if STMS are not
❑ N/A
❑ N/A
❑ N/A
❑ N/A
applicable.
❑ Pass
❑ Pass
❑ Pass
❑ Pass
Otherwise enter Pass or
❑. Fail
❑ Fail
❑ Fail
❑ Fail
Fail
tF3
23
Reg: 213-A0034857A-M2500001A-0000 Registration Date/Time: 2013/07/02 00:26:09 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms March 2013
INSTALLAtiTION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 6)
Site Address: Enforcement Agency: Permit Number:
81189 DESERT SAGE CT, La Quinta CA 92253 City of La Quinta 13-702
Standard Charge Measurement Procedure (for use if outdoor air dry-bulb temperature is 55°F or
above)
Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in
Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using
this form. Attach an additional form(s) for any additional systems in the dwelling as applicable.
• The system should be installed and charged in accordance with the manufacturer's specifications before starting this
procedure.
• The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test.
• If outdoor air dry-bulb temperature is less than 55°F, the installer must use the RA3.2.3 Alternate Charge Measurement
Procedure (Weigh -In Charging Method). If the Weigh -In Method is used, the dwelling cannot be included in a sample
group for HERS verification compliance.)
Space Conditioning Systems
System Name or Identification/Tag
System 1
V('m'ust�betre caibrdt'e"d:??
-�"riontily)
.
System Location or Area Served
Whole House
6/1/2013
(must be re -calibrated
::.. ,..
Outdoor Unit Serial #
1913C51725
Outdoor Unit Make
LENNOX
Outdoor'Unit Model
14ACX-059-230-04
(Tcondensor, sat)
Nominal Cooling`Capacity
5 Tons p�
�7y�v�"
'..� is 6
[Date of VerificationP17111
6/18/2013
Condenser (entering) air dry-bulb
��4
Calibration of Diacinostic InstrdMe is l _ :�: �iF
_K k,`��
Date of Refrigerant Gauge Calibation6%1/:2013f
*E
�::•-�
V('m'ust�betre caibrdt'e"d:??
-�"riontily)
.
Supply (evaporator leaving) air dry-bulb
Date of Thermocouple Calibration,: "
6/1/2013
(must be re -calibrated
::.. ,..
temperature (Tsu I db)
monthly)
Measured Temperatures (°F)*
System Name or Identificat'ibn%Tag
System 1
Supply (evaporator leaving) air dry-bulb
55
temperature (Tsu I db)
47
Return (evaporator entering) air
79
dry-bulb temperature (Treturn db)
115
Return (evaporator entering) air
61
wet -bulb temperature (Treturn wb)
Evaporator saturation temperature
47
(Teva orator sat)
Condensor saturation temperature
115
(Tcondensor, sat)
Suction line temperature (Tsuction)
56
Liquid Line Temperature (Tliquid)
109
Condenser (entering) air dry-bulb
100
temperature (Tcondenser, db)
I
Reg: 213-A0034857A-M2500001A-0000 Registration Date/Time: 2013/07/02 00:26:09 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2013
INSTALLATION CERTIFICATE CF-6R-MECH-2S-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 6)
Site Address: Enforcement Agency: Permit Number:
81189 DESERT SAGE CT, La Quinta CA 92253 City of La Quinta 13-702
Minimum Airflow Reauirement
Temperature Split Method Calculations for determining Minimum Airflow Requirement for
Refrigerant Charge Verification. The temperature split method is specified in Reference Residential
Appendix RA3.2.
System Name or Identification/Tag
System 1
Calculate: Actual Temperature Split =
24.00
Treturn db - Tsupply, db
Target Temperature Split from Table RA3.2-3
22
using Treturn wb and Treturn db
Calculate difference: Actual Temperature
2
Split - Target Temperature Split =
Passes if difference is between -3°F and
+3°F or, upon remeasurement, if between
PASS
-3°F and -100°F
Enter Pass or Fail
Note: Temperature Split Methdd'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. .
7.
Calculated,Minimum Airflow Requtremen (CFM) Nominal CoohngFCapacityr(ton) X'1300
(gym/ n)�.
�
System;Name or, Identification/Tag
System<:1.
Calculated MinimumWrflow Reguweement
(CFM)
Measured`Airfldw using RA3.3. procedures
(CFM) l°..
Measurement Method'
Passes if measured airflow is greater than or
equal to the calculated minimum airflow
requirement.
Enter Pass or Fail
Reg: 213-A0034857A-M2500001A-0000 Registration Date/Time: 2013/07/02 00:26:09 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2013
INSTALLATION CERTIFICATE CF-611-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 6)
Site Address: Enforcement Agency: Permit Number:
81189 DESERT SAGE CT, La Quinta CA 92253 City of La Quinta 13Agency:
Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is
required to be used for fixed orifice metering device systems
System Name or Identification/Tag
System 1
Calculate: Actual Superheat =
6.0
Tsuction - Teva orator sat
Target Superheat from Table RA3.2-2
6
using Treturn wb and Tcondenser, db
9
Calculate difference:
'
�f_
Actual Superheat - Target Superheat =
r
iiPAS L^��
y:
z
System passes if difference is between
A
.e
-5°F and +5°F
PASS
Enter Pass or Fail
Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is
required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems.
System Name or Identification/Tag
System 1
Calculate: Actual Subcooling =;
6.0
Tcondenser, sat - Tli uid
Target'Subcooling specified by s
6
manufacturer
9
Calculate difference:
Actual'SubcoyfinTarget Subcooling,=
'
�f_
System passes if difference is between°~: `
-3°F and +3°F
r
iiPAS L^��
y:
z
' '�Enter�PasFaril
A
.e
Metering 6-6– Calculations ication. This proce'dure' isirequiredito be? '+
used for thermostatic expansion valve (TXV)"and electronic expansion'valve (EXV) systems.
System...Name or Identification/Tag::
System 1
Calculate: Actual Superheat =
9.0
Tsuction - Teva orator sat
Enter allowable superheat range from
manufacturer's specifications (or use range
9
between 4°F and 25°F if manufacturer's
specification is not available)
System passes if actual superheat is within
the allowable superheat range
PASS
Enter Pass or Fail
D
Reg: 213-A0034857A-M2500001A-0000 Registration Date/Time: 2013/07/02 00:26:09 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2013
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 6 of 6)
Site Address: Enforcement Agency: Permit Number:
81189 DESERT SAGE CT, La Quinta CA 92253 1 City of La Quinta 13-702
Standard Charge Measurement Summary:
System shall pass both refrigerant charge criteria, metering device criteria (if applicable), and minimum
cooling coil airflow criteria based on measurements taken concurrently during system operation. If
corrective actions were taken, all applicable verification criteria must be re -measured and/or recalculated.
System Name or Identification/Tag
System 1
CSLB License:
Date Signed:
Position With Company (Title):
System meets all refrigerant charge and
6/4/2013
Is this installation monitored by a Third Party Quality
Name of TPQCP (if applicable):
airflow requirements.
PASS
Enter Pass or Fail
8 Residential Appendix RA3.2.2 requires that if the outdoor temperature is between 55°F and 65°F the
return air dry bulb temperature shall be maintained above 70°F during the Standard Charge Measurement
Procedure. The signature of the Responsible Person in the declaration statement below certifies this
requirement has been met for all applicable system verifications reported on this certificate.
DECLARATION STATEMENT
. I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true
and correct.
. I am 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 thatra'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�bdt not checkedaby a:VHE,RS; raters and.if;those instaltationszfailCtto ""meet -:the requirements of such
quality assurance checking, the required corrective action and'additional'checking/testing of othei installations in that
HERS sample group will be pegrformedat my expense
. I reviewedta; copy of the3Certificate of Compliance (C�, iR)�fo►m:ap roved by the enforcement agency,that identifies the_.
specific req uirem entssfior he mstallation.I certify thatthe requirements.detailed on the -CF 1R that-applyto theme,
install' tion have een met :8r �-
. I will ensurexttfat iicompleted, sigiied .cop.vbfrt6i Installation Certificate=shall be posted, or.made;availab
with the build ng pe�rri�t(,$) -issued;for'theau�ldmg;,fand„itiade a�iiailable-_fo tfie"enforcenientagency for all
applicable inspections. Funder"stand-that'a�signed'copy ofthis 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`Cer6ficates will come from a HERS provider data registry for multiple orientation alternatives, and
beginning October , 2010, for all`low-rise residential buildings.
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
HARRISON ENTERPRISES INC. dba GENERAL AIR CONDITIONING
Responsible Person's Name: .. -
Responsible Person's Signature:
Danielle Garcia
Danielle Garcia
CSLB License:
Date Signed:
Position With Company (Title):
686310
6/4/2013
Is this installation monitored by a Third Party Quality
Name of TPQCP (if applicable):
Control Program (TPQCP.)? ❑ Yes ❑ No
Reg: 213-A0034857A-M2500001A-0000 Registration Date/Time: 2013/07/02 00:26:09 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms March 2013
r
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21
Duct Leakage Test — Existing Duct System (Page 1 of 2)
Site Address:
81189 DESERT SAGE CT, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
13-702
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.
in existing dwellings to
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.
❑ 1. Measured leakage less than 15% of fan flow
❑ 2. Measured leakage to outside fess than 10% of Fan Flow
❑ 3. Reduce leakage by 60% and conduct smoke and fix all leaks
smoke
❑ 4. Fix all accessible leaks using and HERS rater verify
Note: (One of OptipDsvl, 2, or 3 must be attempted,rbeforeAtilizing Option
Determiny minal,Fa�n Flow using one of�thE followiing tfiree�calculation metfiods
✓ ❑Cooling system method Size oficon eraser in Tons : x 400 L CFM , t"
m acs
?"
✓ ❑ Heatmg..system method,:'21.7
Z .x Output Capacity m Thousands of Btu/hr
✓ ❑ Measured system airflow usirigtRA3 3 airfloru fest procedures +_ CFM " P
Option 1 -used then
1
Allowed leakage = Fan Flow x,0.15 _"CFM "
Actual Leakage =,._ CFM
Pass if Leakage Actual is less than Allowed
Pass Fail
Option 2 used then:N,
2
Allowed leakage = Fan.'Flow : x 0.10 = _ CFM
Actual Leakage to outside"= CFM
Pass if Leakage Actual is less than Allowed
E3 Pass E3 Fail
Option 3 used then:
Initial leakage prior to start of work = CFM
Final leakage after sealing all accessible leaks using smoke test = CFM
3
Initial leakage ^ - Final leakage _ = Leakage reduction CFM
((Leakage reduction_/ Initial leakage x 100% _ % Reduction
Pass if % Reduction >= 60%
0 Pass E3 Fail
Option 4 used then:
4
All accessible leaks repaired using smoke test. HERS rater must verify (No sampling).
Pass if all accessible leaks have been repaired using smoke
Pass E3 Fail
Reg: 213-A0034857A-M2100001A-M21A Registration Date/Time: 2013/07/02 00:51:51 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
CATION & DIAGNOSTIC TESTING CF-411-MECH-21
uct System (Page 2 of 2)
to CA 92253 (System
Enforcement Agency:
City of La Quinta
Permit Number:
13-702
❑ 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.
° `�`�:.. 4'@� ..tet .
❑ All supplysand: return register boots must 'be sealed>to ih--drywall;�if smoke tes�t'is utilized fob=compliance
- applies�to'duct leakage compliance option 3 (leakage reduction by 60%) and option 4VFx�all accessible
leaks described above t'
❑ New duct installations cannot utilfzebuildmg cavities as`plenurns or platform returns in lieu of:ducts
71
[I mastic and draw bands'must _.e se+d"dmcOmbination with`cloth`backedrubber, adhesive duct fape to seal
leaks at all new duct connections:.:'
-N,,
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 -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)
HARRISON ENTERPRISES INC
Responsible Person's Name:
CSLB License:
Danielle Garcia
1686310
HERS Provider Data Registry Information
Sample Group # (if applicable): 422364
❑ tested/verified dwelling
® not-tested/verified dwelling in
la
HERS sample group
HERS Rater Information Ca10ERTS Certificate # CC1-1798762949
HERS Rater Company Name:
Stratz Permit Service
Responsible Rater's Name:
Responsible Rater's Signature:
Garrett Williams
Garrett Williams
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed: 6/18/2013
CC2006208
Reg: 213-A0034857A-M2100001A-M21A Registration Date/Time: 2013/07/02 00:51:51 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
i'
4 '1.
L
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-2S
Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 6)
Site Address: Enforcement Agency: Permit Number:
81189 DESERT SAGE CT, La Quinta CA 92253 City of La Quinta 13-702
Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to, refrigerant charge
verification for compliance, a•MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to
demonstrate compliance with the refrigerant charge verification requirement. TMAH and STMS are not
required for compliance, when a CID is utilized for compliance.
As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an
additional form(s) for any additional systems in the dwelling as applicable.
Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement
Sensors (STMS)
Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge
verification is required for compliance, TMAH are also required for compliance, unless the TMAH Compliance
Option is chosen.
STMS are only required for completely new or replacement space -conditioning systems that utilize
prescriptive compliance method.
TMAH - Access Holes in Supply and Return Plenums of Air Handler
System Name or Identificationo6g
System 1
System Location or Area Served4,:_
Whole House
5/16,•inch._(8 mm) access hole
upstream of"evaporative coll;in the
❑ Yes.
❑ Yes
❑ Yes
❑ Yes
1
4
return plenum and labeled i according
❑ No
❑ No
❑ No
" ❑ No
u
to Figure;�m.'Section RA3.L•2 2 2::.
la
Retufn side of'the duct system
37��' van yr 1 ,""
located entirely within cond do ed
Yes
1� #',i?
O Yes
❑Yes ,
4.
-;E-Yes-..,
S pace and return airflow temperature
®No
0 No'❑
No
O No
tolbemeasuredt heyreturn
sY
4 9C•:e•
5/16nch(8 mm) access�h;ole
sn .�. �.s
,
2
d'own'streamof;�e�aporatiYefcoilin,the
supply plenum and lab eledaccording '
®Yes�Mil,07yes<+
❑'No
❑ No
❑ Yes
❑ No "
❑Yes'
❑ No
to.Fi ure infection RA3.2
The TMAH Co"impliance Option should be checked only if the HERS' Rater is able to confirm that it was
physically' impossible far,.,the HV:QC Installer to drill the TMAH as required by Section RA3.2.2.2.2. Using this
Compliance Option requires the;HVAC.installer to annotate on the HERS Provider's data registry an
explanation as to why the TMAHtannot be installed on the system, and photographs of the equipment on
which the TMAH cannot be installed. Use of•this Compliance Option also requires minimum airflow
verification through the direct measurement of airflow per RA3.3. For more information see
htto://www.eneray.ca.00v/tatle24/2008standards/special case appliance/
TMAH Compliance Option
❑ ❑.
❑
❑
Yes to 1 and 2, or Yes to 1a and 2, or
checking the TMAH Compliance Option, is
❑ Pass ❑ Pass
❑ Pass
❑ Pass
a pass.
❑ Fail ❑ Fail
❑ Fail
❑ Fail
Enter Pass or Fail
Reg: 213-A0034857A-M2500001A-M25A Registration Date/Time: 2013/07/02 00:56:16 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms February 2013
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 6)
Site Address: Enforcement Agency: Permit Number:
81189 DESERT SAGE CT, La Quinta CA 92253 City of La Quinta 1 13-702
STMS - Sensor on the Evaporator Coil
System Name or
a t.
S` stem 1
"
Identification/Tag
y:�`
t
Hb
he sensor is factory installed, or field installed according to manufacturer's specifications, or is installed
y methods/specifications approved by the Executive Director.
Yes ❑ No 1 ❑ Yes ❑ Na 1 ❑ Yes ❑ No ❑ Yes ❑ No
The sensor wire is terminated with a standard mini plug suitable for connection to a digital thermometer.
4
The sensor mini plug is accessible to the installing technician and the HERS rater without changing the
airflow through the condenser coil
❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
5
When attached to a digital thermometer, the sensor provides an indication of the saturation temperature
of the coil.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Yes to 3, 4, and 5 is a
pass.
Enter N/A if STMS are not
❑ N/A ❑ N/A ❑ N/A
❑ Pass ❑ Pass ❑ Pass
❑ N/A
❑ Pass
applicable.
Otherwise enter Pass or
pass.
Enter N/A if STMS are not
❑ N/A
❑ N/A
❑ N/A
❑ N/A
applicable.
❑ Pass
❑ Pass
❑ Pass
❑ Pass
Otherwise enter Pass or
❑ Fail
❑ Fail
❑ Fail
❑ Fail
Fail
STMS - Sensor on the Condenser Coil
System Nam&6`f
a t.
S` stem 1
"
IdentificationjTa9
y:�`
t
6
The sensor is factoryjirjstalled; or -,held installedlaccordling to manufacturer's specifications;.or isgN
by methods/specifications approved` by the ExecutiveDirector..#=' 14",1y ,-'
x , ' , � , f/J3 Yps ❑Nod,,. ; ❑Yes;❑4No � �`❑Yes ❑ No $a. ' :❑�Yes
The sensor wieeis.ti2eminatedlwithfarstandard mini°016g suitable fori'connection to 6 d gital,therm'ometee:-7
7
The sensor mini plug is accessible to the installing'technician`and the HERS"rater without'changing the
airflow through the condenser coil
j❑ Yes ❑ No ❑Yes ❑ No EJ Yes ❑ No ❑Yes ❑ No
8
When attached to a digital thermometer, the sensor provides an indication of the saturation temperature
of the coil.
❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
❑ Yes ❑ No
Yes to 6, 7, and 8 is a
pass.
Enter N/A if STMS are not
❑ N/A ❑ N/A ❑ N/A
❑ Pass ❑ Pass ❑ Pass
❑ N/A
❑ Pass
applicable.
Otherwise enter Pass or
❑ Fail ❑ Fail ❑ Fail
❑ Fail
Fail
E
Reg: 213-A0034857A-M2500001A-M25A Registration Date/Time: 2013/07/02 00:56:16 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms February 2013
INSTALLATION CERTIFICATE CF-4R-MECH-2R
Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 6)
Site Address: Enforcement Agency: Permit Number:
81189 DESERT SAGE CT, La Quinta CA 92253 City of La Quinta 1 13-702
Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above SS°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 temperature is less than 55°F the installer must use the RA3.2.3 Alternate Charge Measurement
Procedure (Weigh -In Charging Method). If the Weigh -In Method is used, the dwelling cannot be included in a sample
group for HERS verification compliance.)
Space Conditioning Systems
System Name or Identification/Tag
System 1
(must be re -ca ibrated monthly)
#
..
System Location or Area Served
Whole House
(must be re -calibrated monthly)
Outdoor Unit Serial #
Outdoor Unit Make
Outdoor Unit Model
Nominal Cooling Capacity
Rely,
Date of ,efication
w -
YV
Evaporator saturation temperature
Calibration of Diagnostic _Instruments
Date of Refrigerant Gauge GahtirationhA
` 3
(must be re -ca ibrated monthly)
#
..
Supply (evaporator leaving) air dry-bulb
Date of..,Thermoc ple Calibration
(must be re -calibrated monthly)
Measured Temperatures`:(°F')
System Name or Identification/Tag
System 1
Supply (evaporator leaving) air dry-bulb
temperature (Tsu I db)
Return (evaporator entering) air
dry-bulb temperature (Treturn 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)
Reg: 213-A0034857A-M2500001A-M25A Registration Date/Time: 2013/07/02 00:56:16 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms February 2013
INSTALLATION CERTIFICATE CF-411-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 6)
Site Address!mmm: Enforcement Agency: Permit Number:
81189 DESERT SAGE CT, La Quinta CA 92253 City of La Quinta 1 13-702
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
tf,
Note: Temperature Split MethodCalculation is not necessary if actual Cooling Coil Airflow is verified using
one of. the airflow measurementprocedures 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 Requirementin the table below.
.A ,: ,.
c of
Calculated�Minimum Airflow Requirement (CFM) Nominal Cooling Capacity (ton) X`300
(cfm/ton)+' -
F .'v "y .�..3'r � a r �F� xt: .. s• *, �,1d�:�.ice''
System Namr eodenytfication/Tag
S�,a��'}�
Calculated Minimum`Airflow Requirement ,_.:
(CFM)
Measured Airflow using RA3.3~procedures
(CFM) .'.
Measurement Method
Passes if measured airflow is greater than or
equal to the calculated minimum airflow
requirement.
Enter Pass or Fail
Reg: 213-A0034857A-M2500001A-M25A Registration Date/Time: 2013/07/02 00:56:16 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms February 2013
INSTALLATION CERTIFICATE CF-411-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 6)
Site Address: Enforcement Agency: Permit Number:
81189 DESERT SAGE CT, La Quinta CA 92253 City of La Quinta 1 13-702
Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is
required to be used for fixed orifice metering device systems
System Name or Identification/Tag
systems.
System Name or Identification/Tag
Calculate: Actual Superheat =
or
Tsuction - Teva orator sat
Calculate: Actual Superheat=f• . `
Wlt
Target Superheat from Table RA3.2-2 using
Tsuction - Teva orator sat
Treturn wb and Tcondenser, db
Enter allowable superheat range from
Calculate difference:
W,",KnA17-
Actual Superheat - Target Superheat =
° ="
w
System passes if difference is between -6°F
specification is not available)
and +6°F
System passes if actual superheat is within
Enter Pass or Fail
the allowable superheat range
Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is
required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems.
System Name or Identification%Tag
systems.
System Name or Identification/Tag
Calculate: Actual Subcooling =1y
or
Tcondenser, sat - Iliquid
Calculate: Actual Superheat=f• . `
Wlt
Target Subcooling specified by manufacturer
Tsuction - Teva orator sat
Enter allowable superheat range from
Calculate difference:1,�
Actual Su6i Qling 'Target Subcool�fig ` `
W,",KnA17-
Systemfpdsses if differen *6�ls Between -t
-4°F and ,
° ="
w
specification is not available)
Metering Device <Calculations..for Refrigerant Charge Verification. This
FailFi-
used -for. thermosekic expansion'.valve (TXV) and electronic expansion valve (EXV)
systems.
System Name or Identification/Tag
.��nter�Pass
or
Calculate: Actual Superheat=f• . `
Wlt
Tsuction - Teva orator sat
Enter allowable superheat range from
Metering Device <Calculations..for Refrigerant Charge Verification. This
procedure is required to be
used -for. thermosekic expansion'.valve (TXV) and electronic expansion valve (EXV)
systems.
System Name or Identification/Tag
Calculate: Actual Superheat=f• . `
Tsuction - Teva orator sat
Enter allowable superheat range from
manufacturer's specifications (or use range
between 3°F and 26°F if manufacturer's
specification is not available)
System passes if actual superheat is within
the allowable superheat range
Enter Pass or Fail
31
0
Reg: 213-A0034857A-M2500001A-M25A Registration Date/Time: 2013/07/02 00:56:16 HERS Provider: CalCERTS, Inc..
2008 Residential Compliance Forms February 2013
INSTALLATION CERTIFICATE CF-4111-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 6 of 6)
Site Address: Enforcement Agency: Permit Number:
81189 DESERT SAGE CT, La Quinta CA 92253 City of La Quinta 13-702
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
Danielle Garcia'~
686310'` `"�*
HERS ProviderkData Registry, Information
System meets all refrigerant charge and
❑ tested/verified dwellin g
® not-tested/verified dwelling
/
lin
KN h .=
airflow requirements.
HERS Rater Information.; CaICERTS Certificate # CC1-1798762949
HERS Rater Company Name:%(,
Stratz Permit Service
Responsible Rater's Name:
Enter Pass or Fail
Garrett Williams
Garrett Williams
Responsible Rater's Certification Number w/ this HERS
Date Signed: 6/18/2013
13 Residential Appendix RA3.2.2 requires that if the outdoor temperature is between 55°F and 65°F the
return air dry bulb temperature shall be maintained above 70°F during the Standard Charge Measurement
Procedure. The signature of the Responsible Person in the declaration statement below certifies this
requirement has been met for all applicable system verifications reported on this certificate.
DECLARATION STATEMENT
• I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is
true and correct.
. I am the certified HERS rater who performed the verification services identified and reported on this certificate
(responsible rater).
. The installed feature, material, component, or manufactured device requiring HERS verification that 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. V
. 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 toithe,requirements-specifiedto_nithe,Certificate(s)iof Compliance
(CF-1R)�approved by the enforcem`ent,a'gency '',>i"_
Builderjor, Installer infor-mationlas'shown'on,,the Installation�Certificate;(CF=6RJ '-4;'
Company Name: (Instelling�Subcontractor or General`Contractortt or,Builder/Owner) " •-. - -
HARRISON ENTERPR-SE5ttINC
Responsible Person's Name ,.,
CSL_B`License5
f°'",
Danielle Garcia'~
686310'` `"�*
HERS ProviderkData Registry, Information
" '
Sample 'Group * I(if applicable) -422364
❑ tested/verified dwellin g
® not-tested/verified dwelling
/
lin
KN h .=
a HERS sample group
HERS Rater Information.; CaICERTS Certificate # CC1-1798762949
HERS Rater Company Name:%(,
Stratz Permit Service
Responsible Rater's Name:
Responsible Rater's Signature:
Garrett Williams
Garrett Williams
Responsible Rater's Certification Number w/ this HERS
Date Signed: 6/18/2013
Provider:
CC2006208
I
Reg: 213-A0034857A-M2500001A-M25A Registration Date/Time: 2013/07/02 00:56:16 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms February 2013