09-1199 (MECH)}
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
09-00001199
Property Address:
78465 CALLE FELIPE
APN:
646-192-022- -
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
12000
Ti,ht 4 4 Q"
Applicant: Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 ssionals Code, anVmyse full force and effect.
LicenseClass: C20 C36�� Dense No./ Datl: a'(on, actor:NER-BUILDER DECLI hereby affirm under penalty of perjury that I am exempt from the Conense Law for the
following reason (Sec. 7031.5, Business and Professions Code: Any cirequires 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 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 said (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 improvementis 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, 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.).
(_) 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 (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/20/09
Owner: G�O�
PENNY BILL
78-465 CALLE FELIPE
LA QUINTA, CA 92253
C, A-,
Contractor:
HYDES �3 , el -
77825 WILDCAT STREET ^,rr
PALM DESERT, CA 92211 ., .�
(760)360-2202
Lic. No..:: 906115
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:
Cairier DELOS INS Policy.Number 02DKRM12004084
_ 1 certify that, in the performance of the work for which this permit is issued, 1 shalt not employ any
person in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if oul ecome sub.ect to the workers' compensation provisions of Section
/3700 of the or od I shall for th comply with those provisions.
D '�: Applican
WARNING: FAILURE TO SECURE WOR ERS' OMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL LTIES 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 anJelF&g
that the above inform on i correct. I agree to comply with all
city and county ordinances and state laws [o buil ng construc ' n, hereb horize representatives
of this c un o en[er upon the above-meroperty for ins tDatel ' Signature (Applicant ):
r•
Application Number' . . . . . 09-00001199
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . 33.00
Plan Check Fee
8.25
Issue Date . . . .
Valuation . . .
. 0
Expiration Date 5/19/10
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
-----------------------
--------------
REPLACE HVAC SYSTEM PLUS WATER HEATER 16
SEER.
-------=--------------------------------------------------------------------
Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged
-------------------------------------
Paid Credited
Due
Permit Fee Total 33.00
--------------------
-.00 .40
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
LQPERMIT
CERTIFICATE OF COMPLIANCE: RESIDENTIAL
(Page 1 of 1) CF -111-A
ect Td
Date
. Building Permit #
%-A�VQ)f)"rm<
< a o 6
❑
Project Address
U
01
Documentation Author q
Telephone
Plan Check / Date
CF -4R page 5 of 8
Field Check / Date
Compliance Method (Prescriptive — HVAC and/
Climate Zone
Enforcement Agency Use Only
or Duct System Alteration - § 152(b) IC, D, and E)
HVAC SYSTEMS
Heating Equipment Type Minimum Distribution Type Duct or Piping
Thermostat Type
Configuration
and Capacity (furnace, heat Efficiency and Location (ducts, Insulation
(setback)
(split or ackage)
pump, boiler, etc. (AFUE or HSPF) attiq, etc. R -V lue
❑
Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos?
U
01
Duct systems with less than 40 linear feet of ducts in unconditioned space.
v
CF -6R pages 3 and 8 of 12
CF -4R page 5 of 8
Cooling Equipment Type Minimum Duct Location
and Capacity (A/C, heat Efficiency
M , eva coolin (SEER or EER (attic, etc.)
Duct Insulation Thermostat Type Configuration
R -Value (setback) (split or package)
Exceptions
1
❑
Duct systems that are documented to have been previously sealed as confirmed through field verification and diagnostic
testing in accordance with procedures in the Residential ACM Manual.
2
❑
SEALED DUCTS, REFRIGERANT CHARGE (TXV) AND EER
Before the permit can be finalized, a signed CF -6R Form and CF -4R Form must be provided to the building department for any of the
following compliance requirements that are ✓
✓ Com liance Requirements
Sealed Ducts (Climate Zones 2 and 9-16) - Installer testing and HERS Rater field verification required
TXV (Climate Zones 2 and 8-15) - Installer testing and HERS Rater field verification required'
❑ Refrigerant Charge (Climate Zones 2 and 8-15) - Installer testing and HERS Rater field verification required'
❑ ALTERNTAVE to Duct Testing: High EER as indicated in Table 8-3 of the Residential Compliance Manual (SEE Table.8-3 for
additional requirements and available Compliance Options). - Installer testing and HERS Rater field verification required
The prescriptive requirement for either a refrigerant charge or a TXV does not apply to packaged units.
EXCEPTIONS
If any of the following three exceptions are ✓, the ducts stem is exempt from sealed ducts
#
✓
Exceptions
1
❑
Duct systems that are documented to have been previously sealed as confirmed through field verification and diagnostic
testing in accordance with procedures in the Residential ACM Manual.
2
❑
Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos?
3
01
Duct systems with less than 40 linear feet of ducts in unconditioned space.
Z Duct alterations are exempt from duct sealing ONLY if they meet Exception 2 above.
SPECIAL FEATURES REQUIRING HERS RATING VERIFICATION
A ✓ indicates which compliance requirements are part of this project and need HERS rater verification
✓
Compliance Requirements
Installer Forms (irapplicable)
HERS Rater Forms (itapplicable)
Duct Sealing
CF -6R pages 3 and 4 of 12
CF -4R page 1 of 8
Thermostatic Expansion Valve (TXV)
CF -6R pages 3 and 5 of 12
CF -4R page 3 of 8
❑ Refrigerant Charge
CF -6R pages 3, 5 and 6 of 12
CF -4R pages 3 and 4 of 8
❑ High EER
CF -6R pages 3 and 8 of 12
CF -4R page 5 of 8
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 1 of 8) CF -4R
Project Address (Bill Penny Residence)
78-465 Calle Felipe / La Quinta, CA
Duct Pressurization Test Results (CFM @ 25 Pa)
Builder or Installer Name
Hyde's Air Conditioning
Builder or Installer Contact
Hyde's Air Conditioning
Telephone
(760) 360-2202
Plan/Permit (Additions or Alterations) Number
Permit #09-119
HERS Rater
Christopher Mcfadden - CHEERS Rater #CCNCM275794
Telephone
760 449-1308
Sample Group Number
(Group #19)
Compliance Method (Prescriptive) (Prescriptive - Package D)
Climate Zone 15
Certifying Signature
Date
12/4/2009
Sample House Number
3 of 7
Firm
CM Energy Consulting
Enter Total Fan Flow in CFM:
HERS Provider
CIHIEIEIRIS
Street Address:
P.O. Box 4655
3
City/State/Zip:
Palm Desert, CA 92261
Copies to: BUILDER, HERS PROVIDER AND BUILDING DEPARTMENT
HERS RATER COMPLIANCE STATEMENT
The house was: ✓ ❑ Tested ✓ ® Approved as part of sample testing, but was not tested
As the HERS rater providing diagnostic testing and field verification, I certify that the house identified on this form complies with
the diagnostic tested compliance requirements as checked ✓ on this form. The HERS rater must check and verify that the new
distribution system is fully ducted and correct tape is used before a CF -4R may be released on every tested building. The HERS
rater must not release the CF -4R until a properly completed and signed CF -6R has been received for the sample and tested
buildings.
1X1 The installer has provided a copy of CF -6R (Installation Certificate).
D1 New ducts are fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts).
PQ New ducts with cloth backed, rubber adhesive duct tape is installed, mastic and draw bands are used in combination with
cloth backed, rubber adhesive duct tape to seal leaks at duct connections.).
✓-❑ MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Procedures for field verification and diagnostic testing of air distribution systems are available in RACM, Appendix RC4.3.
Duct Diagnostic Leakage Testing Results
NEW CONSTRUCTION:
Duct Pressurization Test Results (CFM @ 25 Pa)
Measured
Values
I
Enter Tested Leakage Flow in CFM:
Measured
Fan Flow: Calculated (Nominal: v -'M Cooling ✓ ❑ Heating) or v'2000
2
Enter Total Fan Flow in CFM:
cfm
V/❑
✓
3
Pass if Leakage Percentage < 6% [ 100 x L_(Line # 1) / (Line # 2)]]
❑ Pass ❑ Fail
ALTERATIONS: Duct System and/or HVAC Equipment Change -Out
Enter Tested Leakage Flow in CFM from CF -6R: Pre -Test of Existing Duct System Prior to
4
Duct System Alteration and/or Equipment Change -Out.
Enter Tested Leakage Flow in CFM: Final Test of New Duct System or Altered Duct System
5
for Duct System Alteration and/or Equipment Chan a -Out.
116 cfm
Enter Reduction in Leakage for Altered Duct System r(Line # 4) Minus (Line # 5)]
6
(Only if Applicable)
7
Enter Tested Leakage Flow in CFM to Outside (Only if Applicable)
✓ Vol
8
Entire New Duct System - Pass if Leakage Percentage < 6%
❑ Pass ❑ Fail
100 x Line # 5 / Line # 2)11
TEST OR VERIFICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change -Out
✓ ✓
Use one of the following four Test or Verification Standards for compliance:
9
Pass if Leakage Percentage < 15% [100 x ( 116 (Line # 5) / 2000 (Line # 2)]]
5.8%
0 Pass ❑ Fail
10
Pass if Leakage to Outside Percentage < 10% [100 x [_(Line # 7) / (Line # 2)]]
❑ Pass ❑ Fail
Pass if Leakage Reduction Percentage > 60% [100 x r(Line # 6) / (Line # 4)]]
❑ Pass ❑ Fail
11
and Verification by Smoke Test and Visual Inspection
Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection
❑ Pass ❑ Fail
Pass if One of Lines # 9 through # 12 pass
I$1 Pass ❑ Fail
Residential Compliance Forms
December 2005
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 3 of 8) CF -4R
Project Address (Bill Penny Residence)
78-465 Calle Felipe / La Quinta, CA
Builder Name
Hyde's Air Conditioning
Builder Contact
Hyde's Air Conditioning
Telephone
(760) 360-2202
Plan Number
Permit #09-119
HERS Rater
Christopher Mcfadden - CHEERS Rater #CCNCM275794
Telephone
760 449-1308
Sample Group Number
(Group #19)
Compliance Method (Prescriptive) (Prescriptive - Package D)
✓
Climate Zone 15
Certifying Signature
Date
12/4/2009
Sample House Number
3 of 7
Firm
CM Energy Consulting
HERS Provider
CIHIEIEIRIS'
Street Address:
P.O. Box 4655
installation of the specific equipment shall be verified.
City/State/Zip:
Palm Desert, CA 92261
Copies to: BUILDER, HERS PROVIDER AND BUILDING DEPARTMENT
HERS RATER COMPLIANCE STATEMENT
The house was: ✓❑ Tested ✓ ® Approved as part of sample testing, but was not tested
As the HERS rater providing diagnostic testing and field verification, I certify that the house identified on this form complies with
the diagnostic tested compliance requirements as checked on this form.
✓ ® The installer has provided a copy of CF -6R (Installation Certificate).
✓ ® THERMOSTATIC EXPANSION VALVE (TXV)
Procedures for field verification of thermostatic expansion valves are available in RA CM, Appendix R!.
✓ ❑ REFRIGERANT CHARGE MEASUREMENT
Verification for Required Refrigerant Chare for Split System Space Cooling Systems without Thermostatic Expansion Valves
Outdoor Unit Serial #
Location
Outdoor Unit Make
Outdoor Unit Model
Cooling Capacity Btu/hr
Date of Verification
Date of Refrigerant Gauge Calibration (must be checked monthly)
Date of Thermocouple Calibration (must be checked monthly)
Standard Charge Measurement (outdoor air dry-bulb 55 °F and above):
Note: The system should be installed and charged in accordance with the manufacturer's specifications and installer verification
shall be documented on CF -6R before starting this procedure. If outdoor air dry-bulb is below 55 T rater shall use the Alternative
Charge Measure Procedure
Procedures for Determining Refrigerant Charge using the Standard Method are available in RACM, Appendix RD2.
F ❑Yes O No A copy of CF -6R (Installation Certificate) has been provided with refrigerant charge
ci
measurement documented.
Residential Compliance Forms
April 2005
Access is provided for inspection. The procedure shall consist of
✓
N Yes
❑ No
visual verification that the TXV is installed on the system and
®
❑
installation of the specific equipment shall be verified.
Yes is a pass
Pass
Fail
✓ ❑ REFRIGERANT CHARGE MEASUREMENT
Verification for Required Refrigerant Chare for Split System Space Cooling Systems without Thermostatic Expansion Valves
Outdoor Unit Serial #
Location
Outdoor Unit Make
Outdoor Unit Model
Cooling Capacity Btu/hr
Date of Verification
Date of Refrigerant Gauge Calibration (must be checked monthly)
Date of Thermocouple Calibration (must be checked monthly)
Standard Charge Measurement (outdoor air dry-bulb 55 °F and above):
Note: The system should be installed and charged in accordance with the manufacturer's specifications and installer verification
shall be documented on CF -6R before starting this procedure. If outdoor air dry-bulb is below 55 T rater shall use the Alternative
Charge Measure Procedure
Procedures for Determining Refrigerant Charge using the Standard Method are available in RACM, Appendix RD2.
F ❑Yes O No A copy of CF -6R (Installation Certificate) has been provided with refrigerant charge
ci
measurement documented.
Residential Compliance Forms
April 2005
INSTALLATION CERTIFICATE (Page 3 of 12) CF -6R
Site Address (Bill Kelly Residence) Permit Number
78465 Calle Felipe / La Quinta, CA Permit # 09-119
An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (The
information provided on this form is required) After completion of final inspection, a copy must be provided to the building
department (upon request) and the building owner at occupancy, per Section 10-103(a).
HVAC SYSTEMS:
Heating Equipment
Equip Type
(pkg. heat urn
CEC Certified Mfr.
Name and Model
Number
# of
Identical
S stems>_CF-I
Efficiency
(AFUE, etc.)'
R value)
Duct
Location
attic, etc.
Duct or
Piping
R -value
Heating
Load
Btu/hr
Heating
Capacity
Btu/hr
Furnace
American Standard:
1
80% AFUE
Ducts In Attic
R - 8.0
51,840 Btu/h
96,000 Btu/h
Cooling Equipment
Equip Type
(pkg. heat um
CEC Certified Mfr.
Name and Model
Number
# of
Identical
S stems>_CF-IR
Efficiency ,�
(SEER or EER)
value)
Duct
Location
attic, etc.
Duct
R -value
Cooling
Load
Btu/hr
Cooling
Capacity
Btu/hr
Split System A/C
p y
American Standard: 4A7A6060C1000AA
1
16 SEER
Ducts In AtticR
- 8.0
42,400 Btu/h
56,000 Btu/h
1. > symbol reads greater than or equal to what is indicated on the CF -IR value.
Include both SEER and EER if compliance credit for high EER air conditioner is claimed.
✓ & I, the undersigned, verify that equipment listed above is: 1) is the actual equipment installed, 2) equivalent to or
more efficient than that specified in the certificate of compliance (Form CF -1R) submitted for compliance with the
Energy Efficiency Standards for residential buildings, and 3) equipment that meets or exceeds the appropriate
requirements for manufactured devices (from the Appliance Efficiency Regulations or Part 6), where applicable.
Installing S ctor (Co. Name) OR General
Contract (Co me) OR O ner
p� �,✓ t
G`�r� 'damj�,
Signature: _
Date: C� a
ART H( —I/ /
Copies to: BUILDING EPNT, ERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY
Residential Compliance Forms t April 2005
INSTALLATION CERTIFICATE (Page 4 of 12) CF -6R
Site Address (Bill Kelly Residence) Permit Number
78-465 Calle Felipe / La Quinta, CA I Permit # 09-119
INSTALLER COMPLIANCE STATEMENT FOR DUCT LEAKAGE
INSTALLER COMPLIANCE STATEMENT
The building was: ✓ ®Tested at Final ✓ ❑ Tested at Rough -in
INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE FOR NEW DUCTS:
0 Remove at least one supply and one return register, and verify that the spaces between the register boot and the interior finishing
wall are properly sealed.
N If the house rough -in duct leakage test was conducted without an air handler installed, inspect the connection points between the
air handler and the supply and return plenums to verify that the connection points are properly sealed.
N Inspect all joints to ensure that no cloth backed rubber adhesive duct tape is used on new ducts.
✓ ® DUCT LEAKAGE REDUCTION
Procedures for field verification and diagnostic testing ofair distribution systems are available in RA CM, Appendix RC4.3
NEW CONSTRUCTION:
ubctractor ( Name R
�752
Duct Pressurization Test Results (CFM @ 25 Pa)
Measured
Values
1
Enter Tested Leakage Flow in CFM:
Date:
Fan Flow: Calculated (Nominal: ✓ 00 Cooling ✓ ❑ Heating) or ✓ ❑ Measured
Q
2
If Fan Flow is Calculated as 400 cfm/ton x number of tons or as 21.7 cfm/(kBtu/hr) x Heating
2000 cfm
Capacity in Thousands of Btu/hr, enter total calculated or measured fan flow in CFM here:
✓ ✓
3
Pass if Leakage Percentage < 6% for Final or < 4% at Rough -in without air handle:
❑Pass ❑Fail
100 x Line # 1 / Line # 2
ALTERATIONS:
Duct System and/or HVAC Equipment Change -Out
Enter Tested Leakage Flow in CFM from Pre -Test of Existing Duct System Prior to Duct
4
System Alteration and/or Equipment Change -Out.
Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered Duct
116 cfm
5
System for Duct System Alteration and/or Equipment Chan e -Out.
Enter Reduction in Leakage for Altered Duct System
6
Line # 4 Minus Line # 5 —(Only if Applicable)
7
Enter Tested Leakage Flow in CFM to Outside (Only if Applicable)
✓ ✓
Entire New Duct System - Pass if Leakage Percentage < 6% for Final.
❑ Pass 11 Fail
8
100 x Line # 5 / Line # 2)11
TEST OR VERIFICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change-
✓ ✓
Out Use one of the following four Test or Verification Standards for compliance:
9
Pass if Leakage Percentage < 15% [100 x [ 116 (Line # 5) / 2000 (Line # 2)]]
5.8%
1) Pass ❑ Fail
10
Pass if Leakage to Outside Percentage < 10% [100 x r (Line # 7) / (Line # 2)]]
❑ Pass ❑ Fail
Pass if Leakage Reduction Percentage > 60% [ 100 x [—(Line # 6) / (Line # 4)]]
❑ Pass ❑ Fail
11
and Verification by Smoke Test and Visual Inspection
12
Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Ins ection
❑ Pass ❑ Fail
Pass if One of Lines # 9 through # 12 ass
19) Pass ❑ Fail
✓ ®I, the undersigned, verify that the above diagnostic test results were performed in conformance with the requirements for compliance
credit. 1, the undersigned, also certify that the newly installed or retrofit Air -Distribution System Ducts, Plenums and Fans comply with
Mandatory requirements specified in Section 150 (m) of the 2005 Building Energy Efficiency standards.
Installing
ubctractor ( Name R
�752
e 1 Contractor (Co. Name) OR Owner
�i—
Signature:
Date:
Lt
Q
L &"
ARTMENT, HE S RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY
Copies to: BUILDING dp
Residential Compliance Forms December 2005
P
INSTALLATION CERTIFICATE (Page 5 of 12) CF -6R
Site Address (Bill Kelly Residence) Permit Number
78-465 Calle Felipe / la Quinta, CA Permit # 09-119
✓ ® THERMOSTATIC EXPANSION VALVE (TXV)
Procedures for field verification of thermostatic expansion valves are available in RACM, Appendix RI.
Access is provided for inspection. The procedure shall
consist of visual verification that the TXV is installed on
✓ �J Yes ❑ No the system and installation of the specific equipment ® ❑
shall be verified.
Yes is a pass I Pass I Fail
✓ ❑ REFRIGERANT CHARGE MEASUREMENT
Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems without
Thermostatic F.xnansinn Valves
Outdoor Unit Serial #
Location
Outdoor Unit Make
Outdoor Unit Model
Cooling Capacity Btu/hr
Date of Verification
Date of Refrigerant Gauge Calibration (must be checked monthly)
Date of Thermocouple Calibration (must be checked monthly)
Standard Charge Measurement Procedure (outdoor air dry-bulb 55°F and above):
Procedures for Determining Refrigerant Charge using the Standard Method are available in RA CM, Appendix RD2.
Note: The system should be installed and charged in accordance with the manufacturer's specifications before starting this
procedure.
Measured Temneratures
Supply (evaporator leaving) air dry-bulb temperature (Tsupply, db)
OF
Return (evaporator entering) air dry-bulb temperature (Tretum, db)
OF
Return (evaporator entering) air wet -bulb temperature (Treturn, wb)
OF
Evaporator saturation temperature (Tevaporator, sat)
OF
Suction line temperature (Tsuction, db)
OF
Condenser (entering) air dry-bulb temperature (Tcondenser, db)
OF
a erheat Charge Method Calculations for Refrigerant Charge
Actual Superheat = Tsuction, db — Tevaporator, sat OF
Target Superheat (from Table RD -2) OF
Actual Superheat — Target Superheat (System passes if between -5 and +5°F) OF
Temperature Split Method Calculations for Adequate Airflow
Rnlit iMMethnd Cnlrulntinn k not narv.c.cnry if Adanunty Airllnw rradii is tnlewn
Actual Temperature Split = T return, db Tsupply, db
OF
Target Temperature Split (from Table RD3)
OF
Actual Temperature Split Target Temperature Split (System passes if between -
of
3°F and +3°F or, upon remeasurement, if between -3°F and -100°F
Residential Compliance Forms
April 2005
Bin #
City Of La Quinta y
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
l
Project Address:"
Owner's Name:
A. P. Number:
Address: Sa
Legal Description:
City, ST, Zi "•
Telephone:
Contracto
Address:
Project Description:
City, ST, Zip•
Tele h o e:
P
jV�
:#.;.f;
ti 2 -7�
State Lic. I
,f 1,1,
City Lie. '7
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type: occupancy:
Lic. #:
Project type (circle one): New Add'tt Alter Repairair DemoState
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: l t, 0
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 Person
Plumbing
Grant Deed
Plans picked up
S.M.1.
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
Total Permit Fees