13-0747 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Tiat
"
(e
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
13-00000747
Property Address:
78620 FORBES CIR
APN:
604-221-004-40 -23268
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
8800
Applicant: Architect or Engineer:
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 Code, and my License is in full force and effect.
License Class: C20 license No.: 686310
Date: i 13 Contractor: c, �—
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 (5500).:
(_ 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.).
(_) 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 Licens6 Law.).
( 1 I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPERMIT
Owner:
PUENTE MARIA L
78620 FORBES CIR
LA QUINTA, CA 92253
Contractor:
GENERAL AIR CONDITIONING
31170 RESERVE'DRIVE
THOUSAND PALMS, CA 92276
(760)343-7488
Lic. No.: 686310
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/17/13
-------------------
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 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
33700 of the Labor Code, I shall forthwith comply with those provisions.
Date: Applicant: �'� • '
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.
,pate: 6 17 h Signature (Applicant or Agent):
LQPERMIT
Application Number .. . . . . 13-00000747
Permit MECHANICAL 2013
Additional desc . .
Permit Fee . . . . 71.50 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date 12/14/13
Qty Unit Charge Per
Extension
1.00 35.7500 EA MECH FURNACE
35.75
1.00 35.7500 EA MECH CONDENSER/COMP
35.75
----------------------------------------------------------------------------
Special Notes and Comments
HVAC CHANGE OUT - 13SEER/78AFUE SPLIT
SYSTEM (2008 ENERGY] CARBON MONOXIDE
ALARM(S) TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2010 CALIFORNIA BUILDING
CODES.
June 17, 2013 12:25:16 PM AORTEGA
-
-------------------------------------------------------------
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
Bin #
City of La Quinta
Building & Safety Wston
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
t3
Project Address: "� �(�� j�or-s C -x Le-
Owner's Name:
A. P. Number:
Address: -786-2-0 . ;;cbes
Legal Description:
City, ST, Zip: L C.A ct Z253
Contractor:
?:µM4', k...:n^i::•:.: r•i`i'yryi:.r1r%.
Telephone: ' ✓ � s:,• .r!y z,r x vi<~;<:;:;:
Address: '31k-70 -�t gS clCv a 1. X •
Project Description:
City, ST, Zip: G1 5 CA g2Z7(.
e- `G:t�e .S� mh
G Sc�
Telephone:
State Lic. # : City Lie. #;
Arch., Engr., Designer:
Address:
City,, ST, Zip:
vi%~ :'µ>3:'� Yt3a,`r
Telephone: ;�;_:;Y<!;s:• '�•: �'; �...`.,+
State Lie.
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: it Units..
Telephone # of Contact Person:
Estimated Value of Project: g 00
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
Pians resubmitted
Mechanical
Grading plan
2°" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''d 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
INSTALLATION CERTIFICATE CF-611-MECH-2I-HERS
Duct Leakage Test — Existing Duct System (Page 1 of 2)
Site Address:
78620 FORBES CIRCLE, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
13-0747
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.
Tote: For existing dwellings, a completely new or replacement duct system can also include existing parts o
he original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible
nd they can be sealed. For a completely new or replacement duct system installed in an existing dwelling,
se 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 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 must be attempted, before, utilizing Option 4.), .
Determine. nominal Fan1iFlow using'one ofm.th,e`following three calculation methods." w°
lie
✓ ® Cooling, system method: Size of condenser in Tons 5 - x.400'=, 2000
✓ ting ,of 8 /hr
❑ He system method: 21.7,x. Output Capacity in Thousands= _ CFM
✓ 11 Measured.
a,y
system. airflow using`RA3.3 airflowtest procedures:CFM
�
Option'1 used then: Y,„,;e ;•f„. w ;;...�-. w
h
1
Allowed leakage = Fan Airflow 060 x 0.15 300 CFM
Actual Leakage= 130 CFM-,
Pass if Actual Leakage is less than Allowed leakage
_pq Pass ❑ Fail
Option 2 used then:,,
2
Allowed leakage = Fan Airflow � x 0.10 = _ CFM
Actual Leakage to outside = s CFM
Pass if Actual leakage to outside is less than Allowed leakage
Pass 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 >= 600/6
Pass 13 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 Fail
own
- o •*11PK AqI
Reg: 213-A0043435A-M2100001A-0000 Registration Date/Time: 2013/07/08 18:42:37 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
rI
INSTALLATION CERTIFICATE CF-611-MECH-2I-HERS
Duct Leakage Test - Existing Duct System (Page 2 of 2)
Site Address:
78620 FORBES CIRCLE, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
13-0747
s
® 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 beysealed to the -drywall if smoke test is utlllzed�4orr,, compliance
- appliesrto duct leakage compliance option 3'(leakage'reducti6in by. 60%) and optior-4�(fix aWaccessible
leaks) described above. -
® New duct Installations -Cannot utilize building cavities asiplenumsor.platform returns in lieu of,ducts. t
''
�' _ tYr$c w`` .ice"
® Mastic and: draw, bands must;be used: in combination.with cloth backed rubb&adhesive ductlape to seal
leaks at all new duct connections ,
DECLARATION STATEMENT
• I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.
• I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized
representative of the person responsible for construction (responsible person).
. I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation)
conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the
enforcement agency.
• I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am
required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also
perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS
rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and
additional checking/testing of other installations in that HERS sample group will be performed at my expense.
• I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by the enforcement agency that identifies the specific
requirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the installation have been met.
• I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the
building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I
understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder
provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data
registry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildings.
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
HARRISON ENTERPRISES INC dba GENERAL AIR CONDITIONING
Responsible Person's Name:
Responsible Person's Signature:
Danielle Garcia
Danielle Garcia
CSLB License:
Date Signed:
16/17/2013
Position With Company (Title):
686310
Is this installation monitored by a Third Party Quality
Name of TPQCP (if applicable):
Control Program (TPQCP)? p Yes ❑ No
Reg: 213-A0043435A-M2100001A-0000 Registration Date/Time: 2013/07/08 18:42:37 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 6)
Site Address: Enforcement Agency: Permit Humber:
78620 FORBES CIRCLE, La Quinta CA 92253 1 City of La Quint a 13-0747
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 Supplv 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 coil in the
® Yes
❑ Yes
❑ Yes
❑ Yes
return plenum and labeled according
❑ No
❑ No
❑ No
❑ No
to Figure.in-Section RA3.2.2.2.2.-
Retufri side ofthe duct system is-.
located entirely with
L7 Yes
D Yes
❑ Yes
❑ Yes
la
space and return iYlow temperature
,
,❑ N -c(
❑"No
❑ No'"-,,
U No
to'be measured; at the return ,grille.
-
5/16 inch (S_tWm):access hole,
2
downstream of evaporative: coil in the
Yes
❑ Yes_
❑ Yes'
❑-Yos
supply plenum and labeled according
❑ No
❑ No
❑ No
❑ No
to Figure in Section RA3.2.2.2.2.
The TMAH Compliance Option should be checked only if it is physically impossible 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 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.gov/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
Reg: 213-A0043435A-M2500001A-0000 Registration Date/Time: 2013/07/08 18:44:43 HERS Provider: CalCERTS, 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:
78620 FORBES CIRCLE, La Quinta CA 92253 City of La Quint a 13-0747
STMS - Sensor on the Evaporator Coil
System Name or
System 1
-T
Identification/Tag
31by
he sensor is factory installed, or field installed according to manufacturer's specifications, or is installed
methods/specifications approved by the Executive Director.
❑ Yes ❑ No I ❑ Yes ❑ No ❑ 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 IThe sensor measures the saturation temperature of the coil within 1.3 degrees F
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Yes to 3, 4, and 5 is a
e
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
STM5 - Sensof on the Condenser Coil
System Name orilSystern
1,
Identification/Tag
6
ITh=is factory installed,�orjfteld installed according�tojmanufacturer's specifications; -or is installed
by/specifications approved by the Executive�pirector: .�' '.a ' ",. „"'',.:#---.- ._
5° .J ; r j,❑,Yes„❑ No It. 11 Yes ,❑ o ._, F ❑Yes ❑ No❑Yes ❑.Nom
The "sensor wirejs[terminatedjwith a>standard mini plug,suitable'forconnection to a digital thermometer.
7
The sensor mim plug"is•accessible,to`°the ins talling,technician an�-the MFRS rater without-chan,gmg`the
airflow through the condenser coil
[]Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
8 The. -sensor measures the saturation temperature of the coil within 1.3 degrees F
i' ❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Yes to 6, 7, and 8isa
e
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
Reg: 213-A0043435A-M2500001A-0000 Registration Date/Time: 2013/07/08 18:44:43 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2013
a
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 6)
Site Address: Enforcement Agency: Permit Number:
78620 FORBES CIRCLE, La Quinta CA 92253 City of La Quint. 13-0747
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 Conditioninq Svstems
System Name or Identification(Tag
System i
'(must be re -calibrated monthly) -
, .
System Location or Area Served
Whole House
6/1/2013
(must be re -calibrated monthly)
_-
Outdoor Unit Serial #
1305108083
Outdoor Unit Make t
GOODMAN
Outdoor Unit Model';
GSX160601
Nominal Cool i ng-lCapacity
5 Tons
Date ofJVerificaEion` ._ `,
6/25'j20130�'
a
p ri+
Calibration'tof D adn stic In truments
Date of RefrigeranVGauge Calibration,. '"
_f $6/1'/2013,F;'. : * ""
'(must be re -calibrated monthly) -
, .
Supply (evaporator leaving) air dry-bulb
Date of - Thermocouple Calibration
6/1/2013
(must be re -calibrated monthly)
_-
temperature (Tsu I db)
45
/
Measured Temperatures (°F)
System Name or Identification%Tag
System 1
Supply (evaporator leaving) air dry-bulb
59
temperature (Tsu I db)
45
Return (evaporator entering) air
84
dry-bulb temperature (Treturn db)
105
Return (evaporator entering) air
61
wet -bulb temperature (Treturn wb)
Evaporator saturation temperature
45
(Teva orator sat)
Condensor saturation temperature
105
(Tcondensor, sat)
Suction line temperature (Tsuction)
63
Liquid Line Temperature (Tliquid)
96
Condenser (entering) air dry-bulb
91
temperature (Tcondenser, db)
0
Reg: 213-A0043435A-M2500001A-0000 Registration Date/Time: 2013/07/08 18:44:43 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2013
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 6)
Site Address: Enforcement Agency: Permit Number:
78620 FORBES CIRCLE, La Quinta CA 92253 City of La Quinta 13-0747
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 1
Calculate: Actual Temperature Split =
25.00
Treturn db - Tsupply, db
Target Temperature Split from Table RA3.2-3
24
using Treturn wb and Treturn db
Calculate difference: Actual Temperature
1
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" Method Calculation is not necessary if actual Cooling Coil Airflow is verified using
one .of the airflow measuremen"t;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.
JJJ
... � �i '..•. A ..�-"'..ems �y �a� ��A..�R �� •
Calculated Minimum Airflow CFM) Nominal Cooling Capac Xg3.00
F . equiremen (ton),
I i
SyStemNarne or3T entif xtion/Taga
_ .A :' !'
System 1
Y ""`��a�
`
*
}}`ZO
Calculated Minimuin•Airflow'Requirenient .A". '
' =.r•
(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.
f. Enter Pass or Fail
.9
Reg: 213-A0043435A-M2500001A-0000 Registration Date/Time: 2013/07/08 18:44:43 HERS Provider: Ca10ERTS, 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:
78620 FORBES CIRCLE, La Quinta CA 92253 1 City of La Quinta 13-0747
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 =
9.0
Tsuction - Teva orator sat
Target Superheat from Table RA3.2-2
7
using Treturn wb and Tcondenser, db
Calculate difference:
18
Actual Superheat - Target Superheat =
PASSr
f
0
System passes if difference is between
-5°F and +5°F
Enter Pass or Fail
PASS
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 =
9.0
Tcondenser, sat - Tli uid
Target Subcooling specified by
7
manufacturer
Calculate difference:
Actual`Subcooling Target
18
System passes if difference is between"
-3°F anis +3°FVA'
PASSr
f
0
specification is not available)
er�Pass or Fail { ---� '
,�lY� i' i oll-4 k, 0 ,d
n ` D'evice"Galcuiations for'Ref�'r Brant"Cta� a Veriffcationi: This " rocedui•e`is"-`re "uired'to l�e��
Meteri g 9 9. ....,.-.. P. q ..
., ., ,_
used, for thermostatic expansion valve'(TXV).and!electronicexpansion'valve (EXV) systems. `
System,Name o" r Identification/Tag
System 1
Calculate: Actual Superheat
Tsuction - Teva orator sat
Enter allowable superheat range from
manufacturer's specifications (or use range
18
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
.
Reg: 213-A0043435A-M2500001A-0000 Registration Date/Time: 2013/07/08 18:44:43 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms March 2013
INSTALLATION CERTIFICATE CF -6R -MEC -H -25 -HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 6 of 6)
Site Address: Enforcement Agency: Permit Number:
78620 FORBES CIRCLE, La Quinta CA 92253 City of La Quinta 13-0747
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:
686310
Date Signed;
6/17/2013
Position With Company (Title):
System meets all refrigerant charge and
Name of TPQCP (if applicable):
Control Program (TPQCP)? 13 Yes ❑ No
airflow requirements.
PASS
Enter Pass or Fail
® 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 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 samplegroup pUtnot checked by a'HEj2S ratersani if'th so e.installation3 faitomeet fheirequir mehts of such
quality assurance checking, the required -corrective actronnd
•a' dditronal'checking/testing of other installations in that
HERS sample group will be perfo*r`med`at my expense rt,r'� • f +- =,
. I reviewed a copy of the Certificate of Compliance (CF iR).form approved by the enforcement agency that identifiiTi the'. -
specific requirementslor the inst6llation3I certify that the requirements detailed on !he CF -1R thot�apply to,,the
have been met., �-.-
. I will ensur..eitthat a completed; signed;-copy,of this I,nstailation Cert-ificate,,shall be posted,,ior made available*.
with the building permit(s):issued for the building, anis made a"vailable fo tFie enforcement agencyifoeall'"'*
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:
686310
Date Signed;
6/17/2013
Position With Company (Title):
Is this installation monitored by a Third Party Quality
Name of TPQCP (if applicable):
Control Program (TPQCP)? 13 Yes ❑ No
Reg: 213-A0043435A-M2500001A-0000 Registration Date/Time: 2013/07/08 18:44:43 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms March 2013
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-21
Duct Leakage Test — Existing Duct System (Page 1 of 2)
Site Address:
78620 FORBES CIRCLE, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
13-0747
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 Diaanostic 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 Optionsj, 2, or 3 must be attempted, beforenutilizing OptionA4 ),,, --
Determine7riorninal Fan Flow using one offthe following three calculation methods: M
✓ ❑ Cooling/ system method: Size of condenser in.Tons x.400 =. CFM' ;• "- -
-.
✓ ❑Heating systern 21.7 Capacity Thousands Btu/hr CFM --
method ,x Output m of. = — _
❑ Measuredsystem.aiMow using RA3 3
airflowtest procedures;___ CFM_
��
Option I used then:-� �
1
Allowed leakage = Fan Flow x 0.15 CFM
Actual,Leakage = CFM J
j Pass if Leakage Actual is less than Allowed
Pass Fail
Option 2 used then:'*,
2
Allowed leakage = Fan'Flow x 0.10 = _ CFM
Actual Leakage to outside= r_ CFM
�z Pass if Leakage Actual is less than Allowed
Pass a 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%
Pass 0 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 Fail
Reg: 213-A0043435A-M2100001A-M21A Registration Date/Time: 2013/07/08 19:34:44 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2910
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21
Duct Leakage Test — Existing Duct System (Page 2 of 2)
Site Address:
78620 FORBES CIRCLE, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
13-0747
i�
V '.:.
❑ Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be seziled/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/a`nd. return register`'boots'�must` bo
— applleeid'duct leakage compliance option 3 _
leaks) described above
❑ New duct Installations:cannot utlllze€b ullding:cavltles as plenumsoi platform returns In"lieu of ducts ; ,
11ust Mastic and draw bands m6e used -in_ comb,lnation.'.wlth cloth backed. rubber adhesive duet tape to seal
leaks at all new'duct connections:;,:
DECLARATION STATEMENTI..
• I certify under penalty of perjury, und0the laws of the State of California, the information provided on this form is true and correct.
• I am the certified HERS rater who,performed the verification services identified and reported on this certificate (responsible rater).
• The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the
installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified
on the Certificate(s) of Compliance (CF -1R) approved by the local enforcement agency.
• The information reported on applicable sections of the Installation Certificate(s) (CF -6R), signed and submitted by the person(s)
responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the
enforcement agencv.
pliance
Builder or Installer information as shown on the Installation Certificate (CF -6111)
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): 424667
❑tested/verified dwelling
® not-tested/verified dwelling in
la
HERS sample group
HERS Rater Information CaICERTS Certificate # CC1-1798765243
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: 6/25/2013
CC2006208
Reg: 213-A0043435A-M2100001A-M21A Registration Date/Time: 2013/07/08 19:34:44 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 6)
Site Address: Enforcement Agency: Permit Number:
78620 FORBES CIRCLE, La Quinta CA 92253 City of La Quinta 13-0747
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 Identification/Tag
System 1
System Location or Area Served
Whole House
5/16 inch (8 mm) access hole
1
upstream of evaporative coil in the
❑ Yes
❑ Yes
❑ Yes
❑ Yes
return plenum and labeled according
❑ No
❑ No
❑ No
❑ No
to Figure in"-S<ection RA3.2.2.2.2.
Retufn side of the duct system. is,
located entirely within -conditioned
❑ Yes,y�
ITYes�
[3 Yes,
El Yes
1a
space and return.lairflow temperature
(❑ No7
❑ No r
13No",,_
No
to�be measured"a't the return,grille.
- -
5/16 inch_(&=mm) access hole'
-
2
downstream of evaporative coil in the
❑Yes
❑Yes
❑ Yes=
b Yes
supply plenum and labeled"according
❑ No
❑ No
❑ No
❑ No
to Figure in Section RA3.2.2.2.2.
The TMAH Compliance Option should be checked only if the HERS Rater is able to confirm that it was
physically impossible for,the HVAC 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 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.eneray.ca.ciov/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
Reg: 213-A0043435A-M2500001A-M25A Registration Date/Time: 2013/07/08 19:36:29 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms February 2013
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 6]
Site Address: Enforcement Agency: Permit Number:
78620 FORBES CIRCLE, La Quinta CA 92253 City of La Quinta 1 13-0747
STMS - Sensor on the Evaporator Coil
System Name or
✓
System
t , -_
-
Identification/Tag
3
The sensor is factory installed, or field installed according to manufacturer's specifications, or is installed
by methods/specifications approved by the Executive Director.
❑ Yes ❑ No ❑ Yes ❑ No ❑ 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 saturaticn 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
❑ N/A
applicable.
❑ Pass
❑ Pass
❑ Pass
❑ Pass
Otherwise enter Pass or
❑ Fail
❑ Fail
❑ Fail
❑ Fail
Fail
STMS - Sensor on the Condenser Coil
System Name or
✓
System
t , -_
-
IdentificaEion/Tag a
6
The sensor is factoTiRstalled, or field installed' according to' manufacturer's specifications, or is installed
by methods/specifications approved by the Executive:Director. /
F, ❑ Yes ❑ Noll ❑ Yes' ❑ No ❑ Yes ❑ No ❑ Yes ❑ No r
The sensoe'wire is terminated with a standard mini plug suitable for connection to"a digital thermometer.
7
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
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 8isa
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
Reg: 213-A0043435A-M2500001A-M25A Registration Date/Time: 2013/07/08 19:36:29 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms February 2013
:NSTALLATION CERTIFICATE CF-4R-MECH-2!
tefrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 6
Site Address: Enforcement Agency: Permit Number:
78620 FORBES CIRCLE, La Quinta CA 92253 City of La Quinta 13-0747
Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F)
Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in
Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using
this form. Attach an additional form(s) for any additional systems in the dwelling as applicable.
• The system should be installed and charged in accordance with the manufacturer's specifications before starting this
procedure.
• The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test.
• If outdoor air dry-bulb 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.)
Suace Conditioninq Svstems
System Name or Identification/Tag
System 1
System Location or Area Served
Whole House
Outdoor Unit Serial #
Outdoor Unit Make
Outdoor Unit Model
Nominal Cooling Capacity
Date of V,,&ification h
Calibration ofDiagnostic Instrumen
Date of Refrigerant Gauge Calibrationu'''
Date of Thermocouple Calibration
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-A0043435A-M2500001A-M25A Registration Date/Time: 2013/07/08 19:36:29 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms February 2013
INSTALLATION CERTIFICATE CF-4R-MECH-2'
Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 61
Site Address: Enforcement Agency: Permit Number:
78620 FORBES CIRCLE, La Quinta CA 92253 City of La Qui nta 13-0747
Minimum Airflow Requirement
Temperature Split Method Calculations for determining Minimum Airflow Requirement for
Refrigerant Charge Verification. The temperature split method is specified in Reference Residential
Appendix RA3.2.
System Name or Identification/Tag
Calculate: Actual Temperature Split = Treturn,
db - Tsupply, db
Target Temperature Split from Table RA3.2-3
using Treturn wb and Treturn db
Calculate difference: Actual Temperature Split -
Target Temperature Split =
Passes if difference is between -4°F and +4°F
or, upon remeasurement, if between -4°F and
-100°F
Enter Pass or Fail
Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using
one of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual
cooling coif airflow is measured, the value must be equal to or greater than the -Calculated
Minimum Airflow Requirement in the table below.
Calculated Minimum Airflow eq lrement (CFM) min
Noal Coolmg;Capacity (ton) X 300
(cfm/tonjif F �.
System :NameoIdfica
entition/Tag
y
Calculated Minimum'Airflow Requirement
(CFM) -�-""
Measured Airflow.using RA3.3 procedures
(CFM)
Measurement MethodA.
Passes if measured airflow is greater than or
equal to the calculated minimum airflow
requirement.
Enter Pass or Fail
■
Reg: 213-A0043435A-M2500001A-M25A Registration Date/Time: 2013/07/08 19:36:29 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms February 2013
INSTALLATION CERTIFICATE CF-4R-MECH-2!
tefrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 6'
Site Address: Enforcement Agency: Permit Number:
78620 FORBES CIRCLE, La Quinta CA 92253 City of La Quinta 1 13-0747
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.
Al .,.
System Name or Identification/Tag
.:; �1. a
Calculate: Actual Superheat =
Enter Pass or Fail'
Tsuction - Teva orator sat
Tsuction - Teva orator sat
Target Superheat from Table RA3.2-2 using
'.-T9p; ;d, ¢ �i. yp y,,�/
Enter allowable superheat range from
Treturn wb and Tcondenser, db
..
i
Calculate difference:
between 3°F and 26°F if manufacturer's
Actual Superheat - Target Superheat =
specification is not available)
System passes if difference is between -6°F
System passes if actual superheat is within
and +6°F
the allowable superheat range
Enter Pass or Fail
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
systems.
Al .,.
System Name or Identification/Tag
.:; �1. a
Calculate: Actual Subcooling =.
Enter Pass or Fail'
Tcondenser, sat - Tli uid ... .
Tsuction - Teva orator sat
Target Subcooling specified by manufacturer
'.-T9p; ;d, ¢ �i. yp y,,�/
Enter allowable superheat range from
Calculate diffe`r'e`nce ?
Actual Subcioling :Target Subcooling',
..
i
System;tpasses if differ nce is between`` `
-4°F a
between 3°F and 26°F if manufacturer's
specification is not available)
Metering Device, Calculations=for Refrigerant Charge Verification. This
procedure is required to be
x
systems.
Al .,.
System Name or Identification/Tag
.:; �1. a
Enter Pass or Fail'
Tsuction - Teva orator sat
��." n �+'�y .a{...Affii. b 3F}. F.�A•dS'..BAn d ..
'.-T9p; ;d, ¢ �i. yp y,,�/
Enter allowable superheat range from
manufacturer's specifications (or use range '
Metering Device, Calculations=for Refrigerant Charge Verification. This
procedure is required to be
used -for -thermostatic expansion valve (TXV) and electronic expansion valve (EXV)
systems.
Al .,.
System Name or Identification/Tag
.:; �1. a
Calculate: Actual Superheat-=
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
Reg: 2i3-A0043435A-M2500001A-M25A Registration Date/Time: 2013/07/08 19:36:29 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms February 2013
I I it
INSTALLATION CERTIFICATE CF-4111-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 6 of 6)
Site Address: Enforcement Agency: Permit Number:
78620 FORBES CIRCLE, La Quinta CA 92253 City of La Qui nta 13-0747
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
68631W -'
HERS Provider -Data Registry Information
Group # (if applicable)#'424667
System meets all refrigerant charge and
®not-tested/verified dwellingSample
lin
N i ..
a HERS sample group
airflow requirements.
HERS Rater Company Name:`'J'
Stratz Permit Service
Responsible Rater's Name:
Responsible Rater's Signature:
Enter Pass or Fail
Garrett Williams
Responsible Rater's Certification Number w/ this HERS
Provider:
Date Signed: 6/25/2013
CC2006208
0 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). 5
. 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.specifiedon 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 -6R), signed and submitted by the
person(s)�responsible for the installationyconformtosthexrequirements-specifiedto�n the,Certificate(s)4of:Compliance
(CF-1R)ra'oorove&` the enforcemesnt 46cY. "%'
Builderjor Installer informationmas shown"ori,thee'Installation;Gertificate (CF -'6R) ti -
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)g
,
HARRISON ENTERPRISESINC _ ` :, `I 1c. "" , f°"i
Responsible Person's Name �kzorf' w
CSLB'Licens6
Danielle Garcia ; "� - _ ° r�;�
68631W -'
HERS Provider -Data Registry Information
Group # (if applicable)#'424667
tested/verified dwelling
®not-tested/verified dwellingSample
lin
N i ..
a HERS sample group
HERS Rater Information,. Ca10ERTS Certificate # CC1-1798765243
HERS Rater Company Name:`'J'
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: 6/25/2013
CC2006208
Reg: 213-A0043435A-M2500001A-M25A Registration Date/Time: 2013/07/08 19:36:29 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms February 2013