13-0060 (MECH)1
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
13-00000060
Property Address:
53345 EISENHOWER DR
APN:
774-085-018-6 -000000-
Application description:
MECHANICAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
6850
T,&t 4 4 Q"
Applicant: Architect or En in er:
i
c�
------------------
UCENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
1 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 Li o.: 56658
Date: Contractor:
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).: r
(_ 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 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 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 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
Owner:
SATTLER GEORGE
53345 EISENHOWER
LA QUINTA, CA 92253
Contractor:
VIC'S AIR CONDITIONING INC
P.O. BOX 215
THOUSAND PALMS,_CA 92276
(760)343-5033
Lic. No.: 756658
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/17/13
WORKER'S COMPENSATION DECLARATION
OF
1 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: s-
Carrier WILLIAMSBURG IN Policy Number WCMWIL5085285
_ 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 Code, I shall forthwith comply with those provisions.
Date: ^ 5Applicant:
j v
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 ($100,0001. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPUCANT 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, indemnity 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):
Application Number . . . . .
Permit MECHANICAL
Additional desc .
Permit Fee •40.50
Issue Date . . . .
Expiration Date . . 7/16/13
13-00000060
Plan Check Fee . . . 10.13
Valuation . . . . 0
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 9.0000 EA MECH APPL REP/ALT/ADD 9.00
1.00 '16.5000 EA MECH B/C >3-15HP/>100K-500K13TU 16.50
----------------------------------------------------------------------------
Special Notes and Comments
REPLACE EXISTING SPLIT HVAC SYSTEM WITH
NEW SYSTEM CONDENSING UNIT OUTSIDE WITH
AIR HANDLER INSIDE. 2010 CODES.
-------------------------------------------------------------- -------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00
Fee summary Charged Paid Credited Due
---------------------------------------------------------
Permit Fee Total 40.50 .00 .00 40.50
Plan Check Total 10.13 .00 .00 10.13
Other Fee Total 1.00 .00 .00 1.00
Grand Total 51.63 .00 .00 51.63
LQPERMIT
Binl
Permit at
Project Address:
Criy of 'Quinta
BWWng St -Safeiy Division
P.O. Box 1504,78-495 Cage Tampico
La.Quinta, CA 92253 -:(760) 777-7012
Building Permit -Application'and Tracking Sheet
gonirs Name:..
=2
A. P. Number
Legal Description:
Or
City. ST, Zip:
Conwartor.
one'.
Address:
PWD.,;ription:
City, ST, Zip:
Telcphoff' 7-,/e
State Lia r: ZK4
city 1:1,0. 4,
Arch, PAW, Designer
Xr�j 4-F--CT� 6e&ef4o
Addrcs&-
City, ST. Zip:
Telephone:
State Lic. #:
Con Occupancy:
Construction Type:
Project rfpc (circle one): New Add'n. Alter Repair Demo
P"�
Name of Contact Person:
Sq. FL: 9 Stories,.
Telephone 9 of Contact Person:
Estimated Value of Project
APPLICANT: DO NOT WRITE BELOW THIS LINE
ff
Submittal
Roqld
Rccld
TRACMG PERMIT FEES --
Plan Sett
Plan Check submitted item Amount
Structural Otics.
Reviewed, ready Car corrections ?Ian CtLcck Deposit.
Truss Calts.
Called Contact Person Plan Check Ualan -t.
Title 24 Calm
Plans picked up Constracdom
F1004 plain plan
Plans resubmitt.ed. ?&Ch2alCRl
Grading plan
2," Review, ready for corcution&rusue Electrical
Subcostactor List
Calm Contact Person Plumbing
Grant Deed
Plans picked up SALL
LLO-A- Approval
Pleas resubmitted Grading
IN HOUSE:-
R,,,,itw. ready for torrcctio nifissuc Developer Impact Fee
Planning Approval
Called Contact Person M.P.P.
Pub. Wks. Appr
Date of permit Issue
School Fees
Total Permit Fees
•
.. . .............
• Site Ad td�ress: � Enforcement agency: Dale: Perm!! #: ,
I Address: �� �/ Lidense:
rC_a/Statc/Zip: f n e��Phone:
1008 Residetrlia! Compliance Forms
w
March 2010
Conditio ----Moor
EquipmentTypet
List Minimum Efficiency' Duct insulation requirement Area Thermostat
O Packaged Unit '
O Fumace
❑ AFUE COP Over 40 ft of ducts added or 0 Setback
O Indoor Coil
OSEER ❑ HSPF replaced in unconditioned space Served by system (If not already
V k. ndensing Unit
O EER 1- ❑ Resis ce O R 6 (CZ 10-l3) sf prcscrtr, must be
installed)
flier
" v O R 8 (CZ 14-15)
l Equipment T}•pe: Choose rhe equipment being installed: if more than ore system. use another CF- I R -ALT -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78%AFUE.-7.7HSPF fartypical residential systems.
HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides what work is being done and
picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for fatal
inspection and a copy given to the homeowner. At final, the inspector verifies that the wort: listed on this form was in fact the work completed by the
installer. The inspector also verifies that each appropriate CF -6R and t:egisteicd CF4R forms (ho hand filled CFARs allowed) etre filled cert and
si ed. Beginning October 1, 2010 a rtillstered copy of the CF -111 and CF -611 dull also be on site for final inspection.
1. HVAC Changeout
Required Forms:
_tf
• All HVAC Equipment replaced
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF -4R forms: MECH- 21 and for split stems MECH-25
• Condenser Coil and /or
• Indoor Coil and /or
CF-61kforms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CFAR forms: MECH- 21 and (for split systems) MECH-25
• Furnace
For Split Systems: Duct leakage < 15 percent; RC, CCA > 300 CFMhon(Minimum Air Flow Requirement), TMAH
For Packaged Units: Duct leakage < 15 percent
Fxempted from duct leakage testing if:
❑ 1 Duct s,. -stem was documented to have been previously sealed and confirmed through 14ERS verification, or
❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or
❑ 3. Existing ducts stems are constructed, insulated or sealed with asbestos
❑ 2. New HVAC System Required Forms:
• Cut in out with new CF -6R fortes: MECH-04, MECH•20-211(for split systems) MECH-22-HERS, and MECH-25-HERS
(a l new d
ducts: (all new ducting end 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, SIMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage <6 percent
O 3, New Ducts with Replacement
RequIred Forms:
• Includes replacing or installing all new ducting
CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor
CF -4R forms: MECH-20 and (for split systems) MECH-25
coil and/or furnace. Not all equipment changod.
For Split Systems: Duct leakage < 6 percent, RC, CCA >: 300 CFM/ton, TMAH
For Packet ed Units: Duct leakage <6 percent
O 4. New Ducting over 40 feet
Required Forms:
• Include: addtn_ or replacing more than 40
CF -6R forms: MECH-04, MECH-2I-HERS CF4R forms: MECH-21
linear feet of duct in unconditioned spa ce.
For split system or packaged units: Duct leakage < 15 percent
❑ EXCEPTION: Existing ducts stems constructed,insulated or sealed with asbestos.
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
• 1 certA, that this Certificate of Compliance documentation is accurate and complete.
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance.
1 cenif< that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to tate requirtareents of Title 2k
!'arts I and h of the California Code of Regulations.
- • ific ae>i;n featu`rrs"idenuf ed on this Ceniftcate of Compliance are consistent with the information. documented on other a e compliance fomu, worksheets.
wiculau s, plans ands specifications submitted to the enforcement enc for oval with the it ica '
Name:
Signature:
Company: Date -
!
I Address: �� �/ Lidense:
rC_a/Statc/Zip: f n e��Phone:
1008 Residetrlia! Compliance Forms
w
March 2010
INSTALLATION CERTIFICATE CF-W-MECH-2I-11ERS
Duct Leakage Test — Existing Duct System (Page 1 of 2
Sit¢ Address: Enforcement Agency: Permit Number:
53345 Eisenhower La Quinta CA 92253 La Quinta, City of
Enter the Duct System Name or Identification/Tag:
Enter the Duct System Location or Area Served:
Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling.
This installation certificate is required for compliance for alterations and additions in existing dwellings to space
conditioning systems and duct systems.
Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of the original
duct system (e.g., register boots, air handler, coil, plenums, etc) if those parts are accessible and they can be sealed. For a
completely new or replacement duct system installed in an existing dwelling, use the Installation Certificate titled "Duct
Leakage Test — Completely New or Replacement Duct System. "
Duct Leakaue Diaunastic Test — Rxistino Duct gvstem
Select one compliance method from the following four choices.
0 Option 1. Measured leakage less than 15% of Fan Airflow.
❑Option 2. eLas.,urr�d le kage; to:outside ess fha W�iltiOr/o;oofLFan,AwPoe r . i. ' n c e
❑ Option 3. Reduce leakage by 60°�/o o mo a and1 smoke-test�"to seal kll accessible. leaks.
t i on
W1fc`ond'u;t
❑ Option . F
�tx all accessible smo r ust�verify...
leaks using*ke,ttest; an � ERSr-ateerm
Note: (Option I musst be a ttempt d befo�.utilizing Option)
Determine nominal Fang ow using'otne ofithe followii gg thr�e calculation methods.
O Cooling system method: Size of condenser in Tons s.e�,,x 400 = 14004G�F1VI
❑ Heating system method: 21.7x:--]\, Heating Output Capacity (kBtuh ,�- .. �'/CFM
❑ Measured system airflow RA3.3 airflow test CFM
using procedures:
Option 1 used then:
Allowed leakage = Fan Airflow 1400 x 0.15 = 210 CFM
1
Actual leakage= 168 CFM
Pass if Actual leakage is less than Allowed leakage
El Pass ❑ Fail
Option 2 used then:
Allowed leakage = Fan Airflow x 0.10 = CFM
2
Actual leakage to outside = 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 > 60%
❑Pass [--]Fail
Option 4 used then:
All accessible leaks repaired using smoke test. HERS rater must verify (No sampling).
4
Pass if all accessible leaks have been sealed using Smoke Test
❑Pass ❑Fail
Registration Number: 313-A0014097A-M2114157A-0000
Registration Date/Time: 01/24/201319:09:47 HERS Provider: CBPCA
INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS
Duct Leakage Test — Existing Duct System (Page 2 of 2
Siti Address: Enforcement Agency: Permit Number:
53345 Eisenhower La Quinta CA 92253 La Quinta, City of
3 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.
0 All supp`ly aria red
duct leakages'' o>lan
0 New duct4installati
3 Mastic and draw bands must
duct connections.
DECLARATIOWSTATEM
• I certify under penalty of
under the -laws of the State of6a mia,.the i
• I am eligible under Division 3 ofthe Bu§iness and Professions Code to accept responsibility
representative of the person responsible for construction (responsible person=_"'1'
• I certify that the installed features, materials, components, or(manufactured devices identifie
conforms to all applicable codes and regulations, anAhe�installation is consistent with the p
enforcement agency.
Iiance — applies to
-scribed above.
is
duct tape to seal leaks at all new
true and correct.
installation)
pproved by the
• 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 -1 R) form approved by the enforcement agency that identifies the specific
requirements for the installation. I certify that the requirements detailed on the CF -I R 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)
Vic's Air Conditioning
Responsible Person's Name:
Responsible Person's Signature:
octaviano Victoria
octaviano Victoria
CSLB License:
Date Signed:
Position With Company (Title):
756658
11/24/2013
Is this installation monitored by a Third Party Quality Control
Name of TPQCP (if applicable):
Program (TPQCP)? OYes ONo
Registration Number: 313-AO014097A-M2114157A-0000 Registration Date/Time: 01/24/201319:09:47 HERS Provider: CBPCA
'rY �
WE
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-21
Duct Leakage Test — Existing Duct System (Page 1 of 2
Site Address: Enforcement Agency: Permit Number:
53345 Eisenhower La Quinta CA 92253 La Quinta, City of
Enter the Duct System Name or Identification/Tag:
Enter the Duct System Location or Area Served:
Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling.
This installation certificate is required for compliance for alterations and additions in existing dwellings to space
conditioning systems and duct systems.
Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of the original
duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible and they can be sealed. For a
completely new or replacement duct system installed in an existing dwelling, use the Installation Certificate titled "Duct
Leakage Test — Completely New or Replacement Duct System. "
Duct Leakage Diagnostic Test — existing duct system
Select one compliance method from the following four choices.
El Option 1. Measured leakage less than 15% of Fan Airflow.
❑ Option 2 NleasuLr d l 1-0takage to outside le%ssthan,00%ofL,Fan A flo~w��, '
accessibPe leaks..❑
❑ Option 3. ReduceI eak g by 60° o ormo a a`ndconduct smoky test}to se
4ixal�all
Option all accessible leaks using?smoke test; and HERS -rater must -verify..
\1-1,
Note: (Option 1 must b'ee ttempt d befo�.utilizing Option 4 )�
Determine nominal Fan Airflow using one of}the following three calculation methods.
El Cooling system method: Siz W condense in Tons 3.50,.� 400 = 1400.00 J '"&M
ElHeating system method: 21.74-x_ .Af ating Output Capacity (kBtuh .-,"CFM
❑ Measured system airflow using RA3.3 airflow to st pro tledures: CFM
Option 1 used then: .......... ...... " —
Allowed leakage = Fan Airflow 1400.00 x 0.15 = 210.00 CFM
I
Actual leakage = 168.00 CFM
Pass if Actual leakage is less than Allowed leakage
El Pass ❑ Fail
Option 2 used then:
Allowed leakage = Fan Airflow x 0.10 = CFM
2
Actual leakage to outside = 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 > 60%
❑ Pass ❑ Fail
Option 4 used then:
All accessible leaks repaired using smoke test. HERS rater must verify (No sampling).
4
Pass if all accessible leaks have been sealed using Smoke Test
❑ Pass ❑ Fail
Registration Number: 313-A0014097A-M2114157A-M21 A Registration Date/Time: 01124/2013 19:11:56
HERS Provider: CBPCA
I . . . . , I-
a^
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-21
Duct Leakage Test — Existing Duct System (Page 2 of 2)
Site Address: Enforcement Agency: Permit Number:
53345 Eisenhower La Quinta CA 92253 La Quinta, City of
El Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct
leakage testing-. CF41 0 ducts that liz# Azed operon, o�nLy wten Oventilation is required to
meet ASR AE S�andard G2_ 2,tandjclgse wheni0_A°,venttlat�onits no`�`'req.utred °rnay bet'feonfgured3to�the closed position
during duct leakage`testing." 4
El All supply and retur�register boots mus�gbesealedjtg the drywaL ��f smoke xeststilizedforcompliance applies to
duct leakage compliance option 3 (leakag�,reduction by 60%).,and option 4L x all accessible leaks) described above.
El New duct installations cannotlutilize ,buiuil�ding cavities as plenums or platform returns in lieu of ducts.
El Mastic and draw ba� must be used.i� n combination with oth backed rubber a ive,du'cftap to�seal leaks at all new
duct connections,--,„---"..*'
DECLARATION STATEMENT
• I certify under penalty of perjury., -under the laws.ofthe State,of Califomek�the information provided,orrthis form is true and correct.
• 1 am the certified HERS rater who performed the verification services identified and reported on this gertificate (responsible rater).
• The installed feature, material, component, or manufactured device requiring HERS verification. hat is,identifed_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 -I R) 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 -1 R) 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)
Vic's Air Conditioning
Responsible Person's Name:
CSLB License:
octaviano Victoria
756658
HERS Provider Data Registry Information
Sample Group # (if applicable):
El tested/verified dwelling
❑ not-tested/verified dwelling
in a HERS sample group
HERS Rater Information
HERS Rater Company Name:
MLC Home Performance
Responsible Rater's Name
Responsible Rater's Signature
Tom Bachus
Tom Bachus
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed:
1095794
1/24/2013
Registration Number: 313-A0014097A-M2114157A-M21A Registration Date/Time: 01/24/201319:11:56 HERSProvider: CBPCA
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5
t Number:
53345 Eisenhower La Quinta CA 92253 La Quinta, City of Site Address: Enforcement Agency: Permi
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 requiredfor compliance, when a CID is utilized
for compliance.
As many as 4 systems in the dwelling can be documentedfor compliance using this form. Attach an additional form(s) for
any additional systems in the dwelling as applicable.
Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement Sensors (STMS)
Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification
is required for compliance, TMAH are also required for compliance. STMS are only required for completely new or
replacement space -conditioning systems that utilize prescriptive compliance method.
TMAH - Access Holes in Supply and Return Plenums of Air Handler
System Name or Identification/Tag
S stem 1 r
System 1
System Location or Area Served
whole House
The''senso'r is factory installed, or field%ins�talled according to manufacturer's
3
❑Yes
1
❑ es
ON
5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and
Director.
A o *
�,Cyt,Iab�eledtacc�o�rdingto-Figure,iii
,. � ., ;;
SpctionRAw3�:22;,2 2
The sensor wire is terminated with a standard mini plug suitable for connection to a
1
10'4i'9 Vi£:li4A
2}�►y�'""t� i�� � >C �r� �w.aiw Oa' �w�ry
5/16 mch (8 mm�} access hole downstream of e' �aporattve coil 1n the supply plenum
2
❑Yesro--
IONo
--I Im A n �
and (labeledwaccordiwglto'F gu%e tr Sectkon R 3 2A2-2 2?�y� %0jg% y
q
Yes to 1 and 2 is a pass.
�„ ' _
Enter Pass or Fail
� � t .,, �� tie w E.
✓ I] Pass
�r
_✓ ❑ Fail
NY
STMS -Sensor on the Evaporator Coil
System Name. or Identification/Tag
S stem 1 r
The sensor is factory installed, or field installed according to manufacturer's
The''senso'r is factory installed, or field%ins�talled according to manufacturer's
3
❑Yes
❑No
specifications ,or is installed by methods/specifications'app ed by the Executive
Director.
The sensor wire is terminated with a standard mini plug suitable for connection to a
The sensor wire is terminated with a standard minAplug suitablefor connection to a
4
❑Yes
❑No
digital thermometer: The sensor mini plug is accessible.to_the'installing technician and
the HERS rater without changing the airflow through the condenser coil
the HERS rater without changing the airflow through the condenser coil
5
❑Yes
❑No
The sensor measures the saturation temperature of the coil within 1.3 degrees F
Yes to 3, 4, and 5 is a pass. Enter
El N/A
✓ ❑ Pass
✓ ❑ Fail
N/A if STMS are not applicable. Otherwise enter Pass or Fail
STMS - Sensor on the Condenser Coil
System Name or Identification/Tag
System 1
The sensor is factory installed, or field installed according to manufacturer's
6
❑Yes
❑No
specifications, or is installed by methods/specifications approved by the Executive
Director.
The sensor wire is terminated with a standard mini plug suitable for connection to a
7
❑Yes
❑No
digital thermometer. The sensor mini plug is accessible to the installing technician and
the HERS rater without changing the airflow through the condenser coil
8
❑Yes
ONO
The sensor measures the saturation temperature of the coil within 1.3 degrees F
Yes to 6, 7, and 8 is a pass. Enter
✓ El N/A
✓ ❑ Pass
✓ ❑ Fail
N/A if STMS are not applicable. Otherwise enter Pass or Fail
Registration Number: 313-A0014097A-M2514156A-M25A Registration Date/Time: 01 /24/2013 19:09:03 HERS Provider: CBPCA
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-WCH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5
Site•Address: Enforcement Agency:Permit Number:
53345 Eisenhower La Quinta CA 92253 La Quinta, City of 7
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 is 55 'For below, the installer must use the Alternate Charge Measurement Procedure.
Soace Conditioning Svstems
System Name or Identification/Tag
System 1
be
J r.
System Location or Area Served
Whole House
L�,.�-
1/1/2013
�(�t
(
Outdoor Unit Serial #
11204YKL2F
50.00
Outdoor Unit Make
TRANE
Outdoor Unit Model
4TTWB4042E1000AB
71.00
Nominal Cooling Capacity Btu/hr•
aft ll it0jolk rpWW a 4
42000.00 ;e
:r a ar IF anF^Ava
nw,ras,�w r�►ev+�,
A► sw►,w..r�.
K V %0 9 It .It.r 411A �
Date of Verification1/24/2013
"". ``r. `r"`_ i' `
�. N IMA 9 5 9
.
.•, .a.i: ltk.,:,:w..w
IG er g' � �
1�., . **.W. t A%,
1"M If � tai
,w,..0.'; .W. A .4
, *A"
Calibration of Diaannstie=lnctrumentc
Date of Refrigera4t Gauge,Calibration
/1/2013
be
J r.
(must re -calibrated monthly)
Date of Thetmocoti ple Cal brat otn
L�,.�-
1/1/2013
�(�t
(
be erre-calibrated monthly)
temperature (Tsu I , db)
50.00
Measured Temperatures (°F1 A
System Name or Identification/Tag
Systed1
Supply (evaporator leaving) air dry-bulb
L�,.�-
temperature (Tsu I , db)
50.00
Return (evaporator entering) air dry-bulb
temperature (Treturn, db)
71.00
Return (evaporator entering) air wet -bulb
temtemperature (Treturn,
P ( returns wb)
Evaporator saturation temperature
(Teva orator sat)
77.00
Condensor saturation temperature
(Tcondensor, sat)
68.00
Suction line temperature (Tsuction)
94.00
Liquid Line Temperature (Tliquid)
57.00
Condenser (entering) air dry-bulb
temtemperature (Tcondenser,
P ( condenser db)
Registration Number: 313-Ao014097A-M2514156A-M25A Registration Date/Time: 01124/2013 19:09:03 HERS Provider: CBPCA
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5
Site Address: Enforcement Agency: Permit Number:
53345 Eisenhower La Quinta CA 92253 La Quinta, City of
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 =
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 + 'l,i'�Eff r� �a1ss or Fail
-
or
' i
ial I
Note: Temperature" plii1 A4i?thod Calculation ismotrnecessary ffactual GoolingiGoilAirflow..is verified using one of the
.� 3 ._ �* tf. Ir: tt t e . k v w fie.. j i a�1r 1. M l- ji! 0
airflow measurement proceduresspecified Tn Reference Restdenttalpp"endix"RA3'W/f dctua�cooltng cot airflow is
measured, the value must e a qua to o4gr-eaterthan=the Calculated Minimum=Airflow Requirement in the table below.
Calculated�Minimu Air oRe uirement CFM = Nominal Conlin "Ca acity)(aon) X_300,cfm/ton
System Name or Idenof ton/Tag
S stem 1
Calculated Minimum Airflow
Ll
Requirement (CFM)
Measured Airflow using RA3.3
1145.00
procedures (CFM)
Passes if measured airflow is greater than
or equal to the calculated minimum
Pass
airflow requirement. Enter Pass or Fail
Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for
fixed orifice metering device systems
System Name or Identification/Tag
System 1
Calculate: Actual Superheat =
Tsuction — Teva orator- sat
Target Superheat from Table RA3.2-2
using Treturn wb and Tcondenser, db
Calculate difference:
Actual Superheat — Target Superheat =
System passes if difference is between
-6°F and +6°F Enter Pass or Fail
Registration Number: 313-A0014097A-M2514156A-M25A Registration Date/Time: 01!24!2013 19:09:03 HERS Provider: CBPCA
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5
Site Address: Enforcement Agency:Permit Number:
53345 Eisenhower La Quinta CA 92253 La Quinta, City of
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
Parformance
Calculate: Actual Subcooling =
q'
ud o
Tcondenser, Sat — Tli uid
11.00
Target Subcooling specified by
Enter allowable superheat -range from,.
manufacturer
10.00
manufacturer's specifications (or use range
between 3°F and 2�6'F if�manufacturer's
s ecificationis not available) ��
3.00 26.00
Calculate difference:
1.00
System passes if actuaLsuperrheat' is within
Actual Subcooling —Target Subcooling =
the allowable superheat range"
Pass
System passes if difference is between
Pass
Enter Pass or Fail.
-4°F and +4°F Enter Pass or Fail
Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for
thermostatic expansion valve XV) and electronic expansion valve (EXV) systems.
/TXV)
System Nam"- iold6fitificaticd,v I� v:K.�1� agia ,
feffi
� M' d in
Parformance
Calculate: ActuualxSuperheat —
N F7
q'
ud o
Tsuction — Teva orator -sat
Enter allowable superheat -range from,.
manufacturer's specifications (or use range
between 3°F and 2�6'F if�manufacturer's
s ecificationis not available) ��
3.00 26.00
t
System passes if actuaLsuperrheat' is within
the allowable superheat range"
Pass
Enter Pass or Fail.
Registration Number: 313-AO014097A-M2514156A-M25A
Registration Date/Time: 01 /24/2013 19:09:03 HERS Provider: CSPCA
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5
Site Address: Enforcement Agency: Permit Number:
53345 Eisenhower La Quinta CA 92253 La Quinta, City of
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
756658
HERS Provider Data Registry Information
Sample Group # (if applicable):
System meets all refrigerant charge and
Pass
in a HERS sample group
airflow requirements. Enter Pass or Fail
HERS Rater Company Name:
MLC Home Performance
Responsible Rater's Name
Responsible Rater's Signature
r � i W1 or
F� C Oint.-O.CtOM.-P hi
5
DECLARATION STATEMENT ;�..
• I certify under penalty of perjury, under thelawss of tof
he StateofCaa ifomia the�inf ip vided 2onth.form is true and correct.
• [ am the certified HERS rater who performed the verification) services identified and reported on this ertificate (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 requireine�nts in Reference Residential Appendices R:A2 and RA3 na d the requirements
specified on the Certificate(s) of Compliance (CF -1 R) approved by the local enforcement agency.
• The information reported on applicable sections of the Installation Certificate(s) (CF -6R), signed and submitted by the person(s)
responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the
enforcement agency.
Builder or Installer information as shown on the Installation Certificate CF-611
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
Vic's Air Conditioning
Responsible Person's Name:
CSLB License:
octaviano Victoria
756658
HERS Provider Data Registry Information
Sample Group # (if applicable):
0 tested/verified dwelling
TO not-tested/verified dwelling
in a HERS sample group
HERS Rater Information
HERS Rater Company Name:
MLC Home Performance
Responsible Rater's Name
Responsible Rater's Signature
Tom Bachus
Tom Bachus
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed:
1095794
1/24/2013
Registration Number: 313-AGOI4097A-M2514156A-M25A Registration Date/Time: 01 /24/2013 19:09:03 HERS Provider: CBPCA
°INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5
Site Address: Enforcement Agency: Permit Number:
53345 Eisenhower La Quinta CA 92253 La Quinta, City of
Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for
compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to demonstrate compliance with
the refrigerant charge verification requirement. TMAH and STMS are not required for compliance, when a CID is utilized
for compliance.
As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for
any additional systems in the dwelling as applicable.
Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement Sensors (STMS)
Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification
is required for compliance, TMAH are also required for compliance. STMS are only required for completely new or
replacement space -conditioning systems that utilize prescriptive compliance method.
TMAH - Access Holes in Supply and Return Plenums of Air Handler
System Name or Identification/Tag
System 1
System 1
System Location or Area Served
Whole House
6
❑Yes
❑No
1
❑ es
❑No i
PIabeled�accord�
5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and
r
=Figre inSetionRA2*w24.%nol%
ngto 322.
2
sr Wf� IYI
OYes--
✓
i W W IYh td YYl'ti
� ❑No
Jy' ! YiJ YI Fir W! �9L ii b! a tr ail' Yf dd Lw V 1W V * Mli % M W Mid ?3
S/�l6}�r ch �8rm accesslho4l down�trea of evaporativeicoil m�the supply plenum
�and(I*abFel' edrZL6o P g tnmi ure n Sect gn�R:;,4rR L!2� ,
r.
Yes to 1 and -2 is a pass. ---�
The sensor is factory installed, or fielAnstalled according t_o.manufacturer's
ter, _.Enter Pass or Fail ✓ ❑ Pass ✓ ❑ Fail
V V
STMS - Sensor on the Evaporator Coil,,, \.-11
.� !fig
System 1
i.
System Name,o�ldentifcat /T
Sy" tem
6
❑Yes
❑No
specifications, or is installed by methods/specifications approved by the Executive
Director.
The sensor wire is terminated with a standard mini plug suitable for connection to a
The sensor is factory installed, or fielAnstalled according t_o.manufacturer's
3
❑Yes
❑No Lcificcati�;
or is installed by�methods� /spec�atioris approved by the Executive
T
the HERS rater without changing the airflow through the condenser coil
director. __._, r ("
❑Yes
®No
The sensor measures the saturation temperature of the coil within 1.3 degrees F
The sensor wire is terminated with a standard mini'plug suitt-able,for connection to a
4
❑Yes
❑No
digital thermometer -The sensor mini plug is accessible to -the installing technician and
the HERS rater without changing the airflow through the condenser coil
5
❑Yes
❑No
The sensor measures the saturation temperature of the coil within 1.3 degrees F
Yes to 3, 4, and 5 is a pass. Enter
✓ ❑ N/A
✓ ❑ Pass
✓ ❑ Fail
N/A if STMS are not applicable. Otherwise enter Pass or Fail
STMS - Sensor on the Condenser Coil
System Name or Identification/Tag
System 1
The sensor is factory installed, or field installed according to manufacturer's
6
❑Yes
❑No
specifications, or is installed by methods/specifications approved by the Executive
Director.
The sensor wire is terminated with a standard mini plug suitable for connection to a
7
®Yes
QNo
digital thermometer. The sensor mini plug is accessible to the installing technician and
the HERS rater without changing the airflow through the condenser coil
8
❑Yes
®No
The sensor measures the saturation temperature of the coil within 1.3 degrees F
Yes to 6, 7, and 8 is a pass. Enter
✓ p N/A
✓ ❑ Pass
✓ ❑ Fail
N/A if STMS are not applicable. Otherwise enter Pass or Fail
Registration Number: 313-AO014097A-M2514156A-0000 Registration Date/Time: 01 /24/2013 19:03:58 HERS Provider: CBPCA
INSTALLATION CERTIFICATE CF-61k-MECH-25-11ERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5
Site Address: Enforcement Agency: Permit Number:
53345 Eisenhower La Quinta CA 92253 La Quinta, City of
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 forms) for any additional systems in the dwelling as applicable.
• The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure.
• The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test.
• If outdoor air dry-bulb is 55 V or below, the installer must use the Alternate Charge Measurement Procedure.
Snace Conditioning Svstems
System Name or Identification/Tag
System 1
(must be re -calibrated monthly)
System Location or Area Served
Whole House
1 /1 /2'013 f
(must be: re -calibrated monthly)
Outdoor Unit Serial #
11204YKL2F
50.00
Outdoor Unit Make
TRANE
Outdoor Unit Model
4TTWB4042E10
71.00
Capacity Btu/hr+
Cooling ld
Nominal ►iR''
tt tXAIRkill1('1 s:ft
!t42000idi:00
1:.AIw�t"w*^
��5►f?''�Al�l�tl��'
�f1Am�"��
'w'*"ill- M Y 't 7 W W iB'Yt'YYhb 1Jii`
Date of Verification -
r` ``� �
%W W 11P ` VY W W NO
1/24/2013
6V
iE
n+9�
. � � ("�` w�'■. �r, � � � � ^��► � � �--++els � +_lam mow► � ter+: � � �r � w
Calibration of Diagnostic Instruments4o*_' ►a.: r--- „0 � ---^
Date of Refrigerant Gauge -Calibration
+� v
111,/2013\
(must be re -calibrated monthly)
Date of Thermocouple Calibrattotn
1 /1 /2'013 f
(must be: re -calibrated monthly)
temperature (Tsu I , db)
50.00
Measured Temperatures (°F) {,
System Name or Identification/Tag
System k
r
Supply (evaporator leaving) air dry-bulb
temperature (Tsu I , db)
50.00
Return (evaporator entering) air dry-bulb
tem
temperature T
P ( return, db)
71.00
Return (evaporator entering) air wet -bulb
temperature (Treturn, wb)
65.00
Evaporator saturation temperature
(Teva orator, sat)
74.00
Condensor saturation temperature
(Tcondensor, sat)
51.00
Suction line temperature (Tsuction)
88.00
Liquid Line Temperature (Tliquid)
40.00
Condenser (entering) air dry-bulb
temperature (T condenser db)
65.00
Registration Number: 313-Ao014097A-M2514156A-0000 Registration Date/Time: 01/24/2013 19:03:58 HERS provider: CBPCA
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5
it Number:
53345 Eisenhower La Quinta CA 92253 La Quinta, City of Site Address: Enforcement Agency: Perm
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 =
Treturn, db - Tsupply, db
Target Temperature Split from Table
RA3.2-3 using Tretum, wb and Treturn, db
Calculate difference: Actual Temperature
Split — Target Temperature Split =
Passes if difference is between -3°F and __
t.r�emeasure ent;�i, Between
+3 °F or,and
i0
i�0 � i'
�
5�, c
1 G
-3°F and -100°FrEnt�er Passor Fail
- I a �"
r--- —`t AIF
U x z ai L 41L
� A
Note: Temperature plit Metho^ d Calculatkm smot�he a ry if�actuua! d5olingg 05 1•A flow t v'err- f d�it-0-W 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 than the Calculated�Minimum
AAiirflowyyRequirement in the table below.
,greater
-
A Requirement
Calculated Minimum m flow (CFM) = N� om nal Cooling Cal pac ty too) X� 300 (cfm/ton)
System Name or Identification/Tt g\,'
y�System p11�
i k
Calculated Minimum Airflow
1
Requirement (CFM)
1050:00
Measured Airflow using RA3.3
procedures (CFM)
1145.00
Passes if measured airflow is greater than
Pass
or equal to the calculated minimum
airflow requirement. Enter Pass or Fail
Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for
fixed orifice metering device systems
System Name or Identification/Tag
System 1
Calculate: Actual Superheat =
Tsuction — Teva orator sat
Target Superheat from Table RA3.2-2
using Treturn, wb and Tcondenser> db
Calculate difference:
Actual Superheat — Target Superheat =
System passes if difference is between
-5°F and +5°F Enter Pass or Fail
Registration Number: 313-A0014097A-M2514156A-0000 Registration Date/Time: 01/24/201319:03:58 HERS provider: CBPCA
INSTALLATION CERTIFICATE CF-611-MECH-25-11ERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5
Site Address: Enforcement Agency: Permit Number:
53345 Eisenhower La Quinta CA 92253 La Quinta, City of
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 =
it W Al is
W—W 40
Calculate: fJ.ctual Superheaf ='Wj j
11.00
`- ryluir��
nc
Tcondenser, sat — Tli uid
14.00
.. 444., A Ama% . ,� i
lr.rw �: sw A..rw..
35 Wft A%L W. A&% � ` .s
, AW%
Target Subcooling specified by
10.00
A04 0
i, 1't41r1
1
manufacturer
Calculate difference:
1.00
Actual Subcooling— Target Subcooling=
/--N
/--IN
System passes if difference is between
Pass
-3°F and +3°F Enter Pass or Fail
Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for
thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems.
System Name or Identification/Tag
System 1
Aft A: 0 Op '++ ."Wi a
it W Al is
W—W 40
Calculate: fJ.ctual Superheaf ='Wj j
UI#
`- ryluir��
nc
_...
Tsuction — Teva orator. sat 1�
14.00
.. 444., A Ama% . ,� i
lr.rw �: sw A..rw..
35 Wft A%L W. A&% � ` .s
, AW%
Enter allowable superheat range from ,4sf
* � 4,g' amu:
4-- 0 00
A04 0
i, 1't41r1
1
manufacturer's specifications,('ruse ran�gew
between 4°F and 25°F if manufacturer's
s ecification is n4lavailaffi --j,
/--N
/--IN
System passes if actuaf superheat is within
the allowable perheat,range
Pass
Enter Pass or Fail—
U
Registration Number: 313-AO014097A-M2514156A-0000 Registration Date/Time: 01/24/201319:03:58 NERSProvider: CBPCA
INSTALLATION CERTIFICATE CF-6R-MECH-25-11ERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5
Site Address: Enforcement Agency: Permit Number:
53345 Eisenhower La Quinta CA 92253 La Quinta, City of
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
System meets all refrigerant charge and Pass
airflow requirements. Enter Pass or Fail
alliforni,awl"Idi60-erformoamlice
0n. tract wation
1
N
DECLARATION.STATEMENT
• I certify under penalty of perjury, under tne.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 accejit;responnsi*lit'-or construction,',or anlauthorized
representative of the person responsible for construction (responsible person)R'�-m==
• 1 certify that the installed features, materials, components, orimanufactured devices identifiedion this certifcate (th einstallation)
conforms to all applicable codes and regulations, anhhe 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, 1 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.
• 1 reviewed a copy of the Certificate of Compliance (CF -I R) 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)
Vic's Air Conditioning
Responsible Person's Name:
Responsible Person's Signature:
octaviano Victoria
octaviano Victoria
CSLB License:
Date Signed:
Position With Company (Title):
756658
1/24/2013
President
Is this installation monitored by a Third Party Quality Control
Name of TPQCP (if applicable):
Program (TPQCP)? ❑Yes ✓❑No
Registration Number: 313-Ao014097A-M2514156A-0000 Registration Date/Time: 01/24/201319:03:58 HERSProvider: CBPCA
-A(1 T • 1 l /, 1. n