12-1457 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT '
BUILDING PERMIT
Application Number: 12-00001457 Owner:
Property Address: 78856 VIA CARMEL JERRY CORT
APN: 646-430-021- - - 78856 VIA CARMEL
Application description: MECHANICAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 6976
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
20/12
Contractor: �,,
Applicant: Architect or Engineer: GENERAL AIR CONDITIONING ,pG
31170 RESERVE DRIVE AJ�'y� O
THOUSAND PALMS, CA 92276 y Q
(760)343-7488
Lic. No.: 686310
-------------------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am I ensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and fessionals Code, and my License is in full force and effect._ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
Lic se Class: C20 License No.: 686310 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
ssued.
Date: !Z12 'L ontractor: 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
NER-BUILDER DECLARATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier ZENITH INS CO Policy Number Z071741502
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of the work fo hich this permit is issued, 1 shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become sub c to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject he workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I shall forthwith ply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by 1
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: D e: 20 �TOSEaCURE
:
(_ 1 1, 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 WARNING: FAIL WORKERSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PELTIES A D CI
NAVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.). APPLICANT ACKNOWLEDGEMENT
(_ 1' I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made, each Person at whose request and for
n urian to the rnritrartnrc' Statn l ir.nnnn i pr.,,), wnuse oenellf work IS peft&MW under or pursuani fo any permit issued as a result of this application,
(_) I am exempt under Sec. , B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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: f• 4,
LQPERMIT
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 essation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above info ation is correct. I agree to comply with all
city and county ordinances and state laws relating to building const r n, and hereby authorize representatives
of th;'p county to enter up the above-mentioned property for inspe i np- ses.
te: Z20 It ignature (Applicant or Agent):
r
LQPERMIT
Application Number . . . . . 12-00001457
Permit
MECHANICAL
Additional desc .
.
Permit Fee . . .
. 40.50
Plan Check Fee
10.13
Issue Date . . .
.
Valuation . . . .
0
Expiration Date
6/18/13
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 9.0000
EA MECH
FURNACE <=100K
9.00
1.00 16.5000
EA MECH
B/C >3-15HP/>100K-500KBTU
16.50
----------------------------------------------------------------------------
Special Notes and
Comments
HVAC CHANGE -OUT:
INSTALL 2 TON HEAT
PUMP/AIR HANDLER.
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
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
78856 VIA CARMEL La Quinta, CA 92253
City of La Quinta
I Dec 20, 2012
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
® Furnace
® AFUE 78%
❑ COP
[3 R 6 (CZ 10-13)
Served by system
® Setback
[3Indoor Coil
®SEER 13.0
®HSPF 7,7
[3 R 8 (CZ 14-15)
2648 sf
If not already present, must be
® Condensing Unit
[3EER
❑ Resistance
installed)
❑ Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -IR -ALT -HVAC fcr each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems.
HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The installer decides what work is being done
and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall
be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this
form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF -6R and registered CF -4R
forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF -111
and CF -6111 shall also be on site for final inspection.
® 1. HVAC Changeout
Required Forms:
. All HVAC Equipment
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
replaced
CF -4R forms: MECH-21 and (for split systems) MECH-25
. Condenser Coil and /or
. Indoor Coil and /or
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
. Furnace
CF -4R forms: MECH-21 and (for split systems) MECH-25
For Split Systems: Duct leakage < 15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH
Exempted from duct leakage testing if:
❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or
❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or
❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos
❑ 4. The system,will not be Ducted (ie., Mini -Split System)•(Also -Exempt from, Refrigerant Charge)
❑ 2. New HVAC System
Required Forms: i' ( J
. Cut im'or Changeout with",CF-6R
ducts:
forms: MECH-04, MECH-20-HERS1and (for split systems) MECH-22-HERS, and '
new (all new
ducting and all new/
MECH725 -HERS ( p y )
CF -4R forms: MECH-20, � d fors lits stems MECH-22 and MECH-25
equipment)
"
For Split Systems: Duct leakage < 6 percent; RC, CCA z 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
❑ 3. New Ducts with/or without
Required Forms:
Replacement
. Includes replacing or installing all new
ducting and/or outdoor condensing unit
CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or indoor coil and/or furnace. No or some
CF -4R forms: MECH-20 and (for split systems) MECH-25
equipment changed.
For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
❑ 4. New Ducting over 40 feet
Required Forms:
. Includes adding or replacing more than 40
CF -6R forms: MECH-04, MECH-2I-HERS
linear feet of duct in unconditioned space.
CF -4R forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent
❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos.
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
. I certify that this Certificate of Compliance documentation is accurate and complete.
. I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of
Compliance.
. I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24, Parts 1 and 6 of the California Code of Regulations.
. The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance
forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application.
Name: Danielle Garcia Signature: Danielle Garcia
Company: HARRISON ENTERPRISES INC Date: Dec 20, 2012
Address: 31-170 RESERVE DRIVE STE A License: 686310
City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 343-7488
Reg: 212-A0071732A-000000000-0000 Registration Date/Time: 2012/12/20 11:19:24 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010
City of La Quanta
Building 8t Safety Division
P.O. Box 1504, 78.495 Calle Tampico
La Qulnta, CA 92253 - (760) 777-7012
Building Permit Application and. Tracking Sheet
Permit # y
. `
1
Project Address:
. V� ►"
Owner'sName:�)
A. P. Number:
Address: —Itgoap
Legal Description:
Contractor: P^1Telephone:-11
City, ST, Zip: Lsk QU ( (2k "l�
.'1�� } }
Address: M
City, ST, Zip: 7'�
Project Description: 2N
Telephone: s
State Lie. # : 3 L City Lie. C. t"O
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
Construction Type: Occupancy:
...
State Lie. .
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: �p �.(c 64 60,;(S ZNU -Sq. Ft.: 2e�L �Q # Stories: # Units:
Telephone # of Contact Person: '7Co O 3 cl 3 % Estimated
APPLICANT: DO NOT WRITE. BELOW THIS LINE
#
Submittal
Plan Sets
Req'd
Recd
TRACH NG
Plan Check submitted
PERMIT FEES
Item Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading" plan
2"" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up.
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
7rd Review,.ready for corrections/Issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
Schodl Fees
Total Permit Fees
N
d
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21
Duet Leakage Test — Existing Duct System (Page 1 of 2)
Site Address: Enforcement Agency: Permit Number:
78856 VIA CARMEL , La Quinta CA 92253 (System 1) City of La Quinta 12-1457
Enter the Duct System Name or Identification/Tag: System i
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.
Vote: For existing dwellings, a completely new or replacement duct system can also include existing parts of
`he 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,
ise the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. "
Duct Leakaqe Diaqnostic Test - existinq duct system
Select one compliance method from the following four choices.
0 1. Measured leakage less than 15% of fan flow
0 2. Measured leakage to outside less than 10% of Fan Flow
0 3. Reduce leakage by 60% and conduct smoke and fix all leaks
0 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, Fan. Flow using one, of the; following Ahree calculation, methods. -
✓ 0 system method: 6(condenser Tons CFMM ti
Coolie Size in x 400 =
�) �7
21.7"xt_
✓ 0 Heating system method: Output Capacity in Thousands of Btu/hr = _ CFM
0
j procedures:
S
✓ 0 Measured system`airfl using' RA3.3 airflow test; CFM
Option i used then:
1
Allowed leakage = Fan Flow x 0.15 = _ CFM
Actual Leakage = _ CFM
Pass if Leakage Actual is less than Allowed
Pass Fail
Option 2 used then:
2
Allowed leakage = Fan Flow_ x 0.10 = _ CFM
Actual Leakage to outside = _ CFM
Pass if Leakage Actual is less than Allowed
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%
0 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
Q Pass rl Fail
Reg: 212-A0071732A-M2100001A-M21A Registration Date/Time: 2013/01/16 23:34:13 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21
Duct Leakage Test — Existing Duct System (Page 2 of 2)
Site Address: Enforcement Agency: Permit Number:
78856 VIA CARMEL , La Quinta CA 92253 (System 1) City of La Quinta 12-1457
❑ 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 mustibe-sealed•to:the drywall:if-smoke :testds+utilized, for -compliance
— applies'to�duct leakage compliance option 3`(leakage reduction by 60%)'and'optioii(4+(fix a`I,accessible
leaks) � scribed above.
❑ New duct installations cannot utilize building cavities as plenums or platform returns.in lieu of ducts.-,
❑ Mastic and-draw'bands.must'be used` in'combination'with.cloth backed.rubber:adhesiveAuc�tape to seal d
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 Cue 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 recuirements 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 th> person(s)
responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -1R) apxoved 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)
HARRISON ENTERPRISES INC
Responsible Person's Name:
CSLB License:
Danielle Garcia
1686310
HERS Provider Data Registry Information
Sample Group # (if applicable): 357055
❑ tested/verified dwelling
not-testedle r dwelling in
a HERS sample group
a up
HERS Rater Information CalCERTS Certificate # CC1-1798717609
HERS Rater Company Name:
The Energuy CA LLC
Responsible Rater's Name:
Responsible Rater's Signature:
Ezequiel Moreno
Ezequiel Moreno
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed: 1/16/2013
CC2005795
Reg: 212-A0071732A-M2100001A-M21A Registration Date/Time: 2013/01/16 23:34:13 HERS Prcvider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-2S
Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of S)
Site Address: Enforcement Agency: Permit Number:
78856 VIA CARMEL , La Quinta CA 92253 City of La Quinta 12-1457
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 SIMS 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 Location or Area Served
Whole House
1
❑ Yes
❑ No
5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and
labeled according to Figure in Section RA3.2.2.2.2.
2
❑ Yes
❑ No
5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum
and labeled according to Figure in Section RA3.2.2.2.2.
Yes to 1 and 2 is a pass.
Enter Pass or Fail ✓ ❑ Pass ✓ ❑ Fail
STMS - Sensor.on,the Evaporator Coil woe—_ , �• ...a._
System Name -or Identification/Tag ]
No
The sensor is factory installed, orfieldinstalled according to manufacturer's
by
313
Yes
❑
specifications, or is'installe'd by methods/specifications approved the Executive
��,••-e�,r1
l I f
Director. i I f j
4
/7
❑ Yes
El No
The sensor wire is terminated with a standard mini plug suitable for connection to of
digital thermometer. The sensor is to theinstalling,teiEhnician
7
❑ Yes
❑ No
mini plug accessible
and the HERS rater without changing the airflow through the condenser coil
5
❑ Yes
❑ No
When attached to a digital thermometer, the sensor provides an indication of the
8
❑ Yes
❑ No
saturation temperature of the coil.
Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not
✓ ❑ N/A
✓ ❑ Pass
✓ ❑ Fail
applicable. Otherwise enter Pass or Fail
✓ M N/A
✓ ❑ Pass
✓ ❑ 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
❑ No
When attached to a digital thermometer, the sensor provides an indication of the
saturation temperature of the coil.
Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not
✓ M N/A
✓ ❑ Pass
✓ ❑ Fail
applicable. Otherwise enter Pass or Fail
Reg: 212-A0071732A-M2500001A-M25A Registration Date/Time: 2013/01/16 23:37:15 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-2!
Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5)
Site Address: Enforcement Agency: Permit Number:
78856 VIA CARMEL , La Quinta CA 92253 1 City of La Quinta 12-1457
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 p. ocedure.
• The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test.
• ff outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure.
Space Conditioninq Svstems
System Name or Identification/Tag
System 1
(must be re-calib-ated monthly)
Date of The m couple'Calibration
! +�
System Location or Area Served
Whole House
Outdoor Unit Serial #
-
Outdoor Unit Make
Outdoor Unit Model
Nominal Cooling Capacity Btu/hr
Date of Verification
w-auorazron or uiagnoszic anscrumen[s
Date of Refrigerant Gauge Calibration
System I
(must be re-calib-ated monthly)
Date of The m couple'Calibration
! +�
must be r re calib ated monthly)
measurea i emperazures•(�,r) • i f 1 -- a r -( r %, 1- o
System Name or Identificatiori/Tagf
System I
! l'�
s °F
Supply (evaporator leaving) -air dry -bulb•
-
temperature (Tsupply, db) I
Return (evaporator entering) air dry-bulb
temperature (Treturn, db)
Return (evaporator entering) air wet -bulb
temperature (Treturn, wb)
Evaporator saturation temperature
(Tevaporator, sat)
Condenser saturation temperature
(Tcondensor, sat)
Suction line temperature (Tsuction)
Liquid Line Temperature (Tliquid)
Condenser (entering) air dry-bulb
temperature (Tcondenser, db)
s
Reg: 212-A0071732A-M2500001A-M25A Registration Date/Time: 2013/01/16 23:37:15 HERS PrDvider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5)
Site Address: Enforcement Agency: Permit Number:
78856 VIA CARMEL , La Quinta CA 92253 -7City of La Quinta 12-1457
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 coil airflow is
measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below.
Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton)
System Namefor Iilenitification/Tag
77-7
-7
Calculated Minimum Airflow°Requirement (CFM)
0
Measure'd Airflows ng RA3.3 p ocedures (CFM)
�✓'
j/
d
Passes if measured airflow is greater than or equal
to the calculated minimum airflow requirement.
Enter Pass or Fail
Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used
for fixed orifice metering device systems
System Name or Identification/Tag
Calculate: Actual Superheat =
Tsuction - Tevaporator, 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
0
Reg: 212-A0071732A-M2500001A-M25A Registration Date/Time: 2013/01/16 23:37:15 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-411-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5)
Site Address: Enforcement Agency: Permit Number:
78856 VIA CARMEL , La Quinta CA 92253 1 City of La Quinta 12-1457
Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is recuired to be used
for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems.
System Name or Identification/Tag
Calculate: Actual Subcooling =
Tcondenser, sat - Tliquid
Target Subcooling specified by manufacturer
Calculate difference:
Actual Subcooling - Target Subcooling =
System passes if difference is between
-4°F and +4°F
V 1
!
(
3
I
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
Calculate: Actual Superheat =
Tsuction - Tevaporator, 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'witn
superheat /
V 1
!
(
3
I
allowable ringe I
/
Ent Pass or Fail
f
Reg: 212-A0071732A-M2500001A-M25A Registration Date/Time: 2013/01/16 23:37:15 HERS Pmvider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5)
Site Address: Enforcement Agency: Permit Number:
78856 VIA CARMEL , La Quinta CA 92253 City of La Quinta 12-1457
Standard Charge Measurement Summary:
System shall pass both refrigerant charge criteria, metering device criteria (if applicable), and minimum =ooling 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
1686310
HERS Provider Data Registry Information
Sample Group # (if applicable): 357055
System meets all refrigerant charge and airflow
® not-tested/verified dwelling in
a HERS sample group
requirements.
HERS Rater Company Name:
The Energuy CA LLC
Responsible Rater's Name:
Responsible Rater's Signature:
Enter Pass or Fail
Ezequiel Moreno
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed: 1/16/2013
CC2005795
DECLARATION STATEMENT
• I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.
. I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater).
• The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the
installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified
on the Certificate(s) of Compliance (CF -111) approved by the local enforcement agency.
• 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) epproved by the
enforcement agency.
Builder or Installer information as shown on the Installation Certificate (CF -6R)
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
HARRISON ENTERPRISES INC
Responsible Person's Name:
CSLB License:
Danielle Garcia
1686310
HERS Provider Data Registry Information
Sample Group # (if applicable): 357055
❑tested/verified dwelling
® not-tested/verified dwelling in
a HERS sample group
HERS Rater Information CalCERTS Certificate # CC1-1798717609
HERS Rater Company Name:
The Energuy CA LLC
Responsible Rater's Name:
Responsible Rater's Signature:
Ezequiel Moreno
Ezequiel Moreno
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed: 1/16/2013
CC2005795
Reg: 212-A0071732A-M2500001A-M25A Registration Date/Time: 2013/01/16 23:37:15 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-6R-MECH-04
Space Conditioning Systems, Ducts and Fans (Page 1 of 2)
Site Address: Enforcement Agency: Permit Number:
78856 VIA CARMEL , La Quinta CA 92253 (System 1) 1 City of La Quinta 12-1457
Space Conditioning Systems
Heating Equipment
Equip
Type
(package-
heat pump)
CEC Certified Mfr. Name
and Model Number
ARI
Reference
Number2
# of
Identical
Systems
Efficiency
(AFUE,
etc.)1, 3
(>=CF -1R
value)4
Duct
Location
(attic,
crawl-
space,
etc.)
Duct
R -value
Heat.ng
Locd
(kBtu,'hr)
Heating
Capacity
(kBtu/hr)
Split
Furnace
GOODMAN
GSZ130241
5439791
1
(SEER
Attic
47 kBtu
Type
and EER)
(attic,
(package
ARI
# of
1, 3
crawl-
Cooing
Cooling
heat
CEC Certified Mfr. Name
Reference
Identical
(>=CF-iR
space,
Duct
Load
Capacity
pump)
and Model Number
Number2
Systems
value)4
etc.)
R -value
(kBtL./hr)
(kBtu/hr)
Split
GOODMAN
13 SEER
Lamina caulpmenr
1. 1r project is new construction, see footnotes to Standards Table 151-6 and Table 151-C for duct ceilirg alternative
compliance.
2. ARI Reference Number can be found by entering the equipment model number at
http://www.aridirectory.orglarilac.php#
3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -1R form.
4. When CF -1R is reference it is also applicable to the CF -1R, CF -1R -AA or CF -IR -ALT
ALL BOXES MUST BE CHECKED TO BE A VALID FORM
® §110-§113: HVAC equipment is certified by the California Energy Commission.
® §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, o- ACCA.
® §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of
§112(c).
® §150(j)2: Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets
minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entir=ely in
conditioned space.
Reg: 212-A0071732A-M0400001A-0000 Registration Date/Time: 2012/12/21 18:55:32 HERS P_ovider: CalCERTS, Inc.
2008 Residential Compliance Forms August 2009
Efficiency
Duct
Equip
(SEER
Location
Type
and EER)
(attic,
(package
ARI
# of
1, 3
crawl-
Cooing
Cooling
heat
CEC Certified Mfr. Name
Reference
Identical
(>=CF-iR
space,
Duct
Load
Capacity
pump)
and Model Number
Number2
Systems
value)4
etc.)
R -value
(kBtL./hr)
(kBtu/hr)
Split
GOODMAN
13 SEER
A/C
GSZ130241
_
1
11 EER
Attic
24:
2 Tons
1. 1r project is new construction, see footnotes to Standards Table 151-6 and Table 151-C for duct ceilirg alternative
compliance.
2. ARI Reference Number can be found by entering the equipment model number at
http://www.aridirectory.orglarilac.php#
3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -1R form.
4. When CF -1R is reference it is also applicable to the CF -1R, CF -1R -AA or CF -IR -ALT
ALL BOXES MUST BE CHECKED TO BE A VALID FORM
® §110-§113: HVAC equipment is certified by the California Energy Commission.
® §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, o- ACCA.
® §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of
§112(c).
® §150(j)2: Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets
minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entir=ely in
conditioned space.
Reg: 212-A0071732A-M0400001A-0000 Registration Date/Time: 2012/12/21 18:55:32 HERS P_ovider: CalCERTS, Inc.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-6R-MECH-04
Space Conditioning Systems, Ducts and Fans (Page 2 of 2)
Site Address: Enforcement Agency: Permit Number:
78856 VIA CARMEL , La Quinta CA 92253 (System 1) 1 City of La Quinta 12-1457
Ducts and Fans
§.150(m): Duct and Fans
® 1. All air -distribution system ducts and plenums installed, sealed and insulated to meet the
requirements of CMC Sections 601, 602, 603, 604, 605 and Standard 6-5; supply -air and return -air
ducts and plenums are insulated to a minimum installed level of R-4.2 or enclosed entirely in
conditioned space. Openings shall be sealed with mastic, tape or other duct -closure system that meets
the applicable requirements of UL 181, UL 181A, or UL 181B or aerosol sealant that meets the
requirements of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch, the combination
of mastic and either mesh or tape shall be used; and
® 1. Building cavities, support platforms for air handlers, and plenums defined or constructed with
materials other than sealed sheet metal, duct board or flexible duct shall not be used for conveying
conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities
and support platforms shall not be compressed to cause reductions in the cross-sectional area of the
ducts.
® 2D. Joints and seams of duct systems and their components shall not be sealed with cloth back
rubber adhesive duct tapes unless such tape is used in combination with mastic and draw bands.
® 7. Exhaust fan systems have back draft or automatic dampers.
® 8. Gravity ventilating systems serving conditioned space have either automatic or readily accessible,
manually operated dampers.
® Protection of Insulation. Insulation shall be protected from damage, including that due to sunlight,
moisture, equipment maintenance, and wind. Cellular foam insulation shall be protected as above or
painted with a coating that is water retardant and provides shielding from solar radiation that can cause
degradation of the material.
® 10. Flexible ducts cannot have porous inner cores.
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 reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that identifies the specific
requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the installation have been met.
• I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the
building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I
understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder
provides to the building owner at occupancy.
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
HARRISON ENTERPRISES INC
Responsible Person's Name:
Responsible Person's Signature:
Danielle Garcia
Danielle Garcia
CSLB License:
686310
Date Signed:
11/20/2012
Position With Company (Title):
Reg: 212-A0071732A-M0400001A-0000 Registration Date/Time: 2012/12/21 18:55:32 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS
Duct Leakage Test — Existing Duct System (Page 1 of 2)
Site Address: Enforcement Agency: Permit Number:
78856 VIA CARMEL , La Quinta CA 92253 (System 1) 1 City of La Quinta 12-1457
=nter the Duct System Name or Identification/Tag: System 1
=nter the Duct System Location or Area Served: Whole House
Vote: Submit one Installation Certificate for each duct system that must demonstrate compliance in the
swelling.
phis installation certificate is required for compliance for alterations and additions in existing dwellings to
;pace conditioning systems and duct systems.
Vote: For existing dwellings, a completely new or replacement duct system can also include existing parts of
-he original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible
ind they can be sealed. For a completely new or replacement duct system installed in an existing dwelling,
ise the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement D-Ict 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 Fan,Flow using one of the:following, three, calculation, methods. �. .
-1® Cooling system method: Size of condenser in Tons .�!_ x 400 = 800, CFM
P ,IV
✓ 13Heating system method:'21.7f Output Capacity in Thousands Btu/hr =
of _CFM
0
✓
❑ Measured system airflow using RA3.3 airflow test, procedures: CFM ,! /( 1 _•' f
Option•l,used then: (- - ` \ -.+'t: r � �
-
`800
1
Allowed leakage = Fan Airflow x 0.15 = 120 CFM
1
Actual Leakage = 85 CFM
Pass if Actual Leakage is less than Allowed leakage
a Pass Fail
Option 2 used then:
2
Allowed leakage = Fan Airflow _ x 0.10 = _ CFM
Actual Leakage to outside = CFM
Pass if Actual leakage to outside is less than Allowed leakage
Pass El 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:
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
OR
Reg: 212-A0071732A-M2100001A-0000 Registration Date/Time: 2012/12/21 18:57:49 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-611-NECH-2I-HERS
Duct Leakage Test - Existing Duct System (Page 2 of 2)
Site Address: Enforcement Agency: Permit Number:
78856 VIA CARMEL , La Quinta CA 92253 (System 1) 1 City of La Quinta 12-1457
® Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off
during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA
ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may
be configured to the closed position during duct leakage testing.
® All supply and -return register boots must :be.sealed •to.the drywall`if.smoke.test.is utilizedtfbr-compliance
- applies to`duct leakage compliance,o'tion 3'(leakage reduction by 60%)=and'option14,(fix all 6ccessible
leaks) de scribed above Jid
J�
® New duct installations cannot utilize building cavities as plenums or platform returns in lie of ducts. ;
® Mastic'and.draw bands must be used -in cbmbination•with cloth backed, rubber,aclhesive._duct tape to seal �o
leaks at all new duct connections - 4'
DECLARATION STATEMENT
• I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is Cue 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 represercatives will also
perform quality assurance checking of installations, including those approved as part of a sample group but not chec:ced 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 1 -ave 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 documertation the builder
provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HEF.S 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
Responsible Person's Name:
Responsible Person's Signature:
Danielle Garcia
Danielle Garcia
CSLB License:
Date Signed:
Position With Company (Title):
686310
11/20/2012
Is this installation monitored by a Third Party Quality
Name of TPQCP (if applicable):
Control Program (TPQCP)? ❑ Yes ❑ No
Reg: 212-A0071732A-M2100001A-0000 Registration Date/Time: 2012/12/21 18:57:49 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE* CF-6R-NECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5)
Site Address: Enforcement Agency: Permit Number:
78856 VIA CARMEL , La Quinta CA 92253 City of La Quinta 12-1457
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 SIMS 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 addi-ional 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 charce 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 Location or Area Served
Whole House
1
® Yes
❑ No
5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and
labeled according to Figure in Section RA3.2.2.2.2.
2
® Yes
❑ No
5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum
and labeled according to Figure in Section RA3.2.2.2.2.
Yes to 1 and 2 is a pass.
Enter Pass or Faill ✓ ® Pass ✓ ❑ Fail
STMS - Sensor on.the Evaporator Coil
System Name,or Identification/Tag-) ! fr System 1 11 1 ' 1 r &I f "
3❑Yes
p No
The sensor is factory installed, or field installed according to manufacturer's
specifications, or is'installed by methods/specifications approved by the Executive
The sensor is factory installed, or field installed according to manufacturer's
6
/ I r
Director. V J i. _. P, .%
specifications, or is installed by methods/specifications approved by the Executive
�J
y) r
The sensor wire is terminated with a.standard mini plug suitable for, connection to a r
4
❑ Yese�j
❑ No/
digital thermometer. The sensor mini plug is accessible to the ins61ing,technician
The sensor wire is terminated with a standard mini plug suitable fon connection to a
7
❑ Yes
and the HERS rater without changing the airflow through the condeser coif
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 if STMS are not
®N/A
✓ [3 Pass
✓ [3Fail
applicable. Otherwise enter Pass or Fail
Yes tc 6, 7, and 8 is a pass. Enter N/A if STMS are not
✓ ® N/A
✓ ❑ Pass
STMS - Sensor on the Condenser Coil
System Name or Identification/Tag I 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 fon connection to a
7
❑ Yes
❑ No
digital thermometer. The sensor mini plug is accessible to the insta ling technician
and the HERS rater without changing the airflow through the condenser coil
8
❑ Yes
1 ❑ No
IThe sensor measures the saturation temperature of the coil within =.3 degrees F
Yes tc 6, 7, and 8 is a pass. Enter N/A if STMS are not
✓ ® N/A
✓ ❑ Pass
✓ ❑Fail
applicable. Otherwise enter Pass or Fail
� 4D
+�
Reg: 212-A0071732A-M2500001A-0000 Registration Date/Time: 2012/12/21 19:09:15 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5)
Site Address: Enforcement Agency: Permit Number:
78856 VIA CARMEL , La Quinta CA 92253 City of La Quinta 12-1457
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 Refe-ence Residential
Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an adyitional 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 p. ocedure.
• The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test.
• If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure.
Space Conditioning Systems
System Name or Identification/Tag
System 1
(must be re-calila-ated monthly)
Date of Thermocouple Calibration
1i/12/12� j �`
System Location or Area Served
Whole House
Outdoor Unit Serial #
1211456992
-
`4' �• ~ -
Outdoor Unit Make
GOODMAN
Outdoor Unit Model
GSZ130241
Nominal Cooling Capacity Btu/hr
24000
Date of Verification
11/12/12
w-anorauon or uiagnosvc; ans[rumenis
Date of Refrigerant Gauge Calibration
11/12/12
(must be re-calila-ated monthly)
Date of Thermocouple Calibration
1i/12/12� j �`
must belre-calibrated monthly)
je
measured i emperatures [ -r t J, J �i J 'r, 1 A, J1
System Name or Identification/Tag'
System i
je
Supply (evaporator leaving) air dry-bulb
37
-
`4' �• ~ -
temperature (Tsupply, db)
Return (evaporator entering) air dry-bulb
59
temperature (Treturn, db)
Return (evaporator entering) air wet -bulb
45
temperature (Treturn, wb)
Evaporator saturation temperature
2�
(Tevaporator, sat)
Condensor saturation temperature
67
(Tcondensor, sat)
Suction line temperature (Tsuction)
32
Liquid Line Temperature (Tliquid)
63
Condenser (entering) air dry-bulb
67
temperature (Tcondenser, db)
s
Reg: 212-A0071732A-M2500001A-0000 Registration Date/Time: 2012/12/21 19:09:15 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5)
Site Address: Enforcement Agency712-1457 Permit Number:
78856 VIA CARMEL , La Quinta CA 92253 City of La Quinta
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,
22.00
db - Tsupply, db
Target Temperature Split from Table RA3.2-3
19.1
using Treturn, wb and Treturn, db
Calculate difference: Actual Temperature Split -
2.9
Target Temperature Split =
Passes if difference is between -3°F and +3°F or,
upon remeasurement, if between -3°F and
PASS
-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 coin airflow is
measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below.
Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm,/ton)
System Name or Identification/Tag %—%/`�,F
77
System
r r
J
Calculated Minimum Airflow Requi ement (CFM)
pjI f- ,J 7
Measured,Airflow. using RA3.3 procedures (CFM)
s--. *.
Passes if measured airflow is greater than or
equal to the calculated minimum airflow
requirement.
Enter Pass or Fail
Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is recuired to be used
for fixed orifice metering device systems
System Name or Identification/Tag
System 1
Calculate: Actual Superheat =
Tsuction - Tevaporator, 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
0
Reg: 212-A0071732A-M2500001A-0000 Registration Date/Time: 2012/12/21 19:09:15 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5)
Site Address: Enforcement Agency: Permit Number:
78856 VIA CARMEL , La Quinta CA 92253 City of La Quinta 12-1457
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
i
Calculate: Actual Subcooling =
4.0
Tcondenser, sat - Tliquid
Target Subcooling specified by manufacturer
4
Calculate difference:
0
Actual Subcooling - Target Subcooling =
System passes if difference is between
-3°F and +3°F
PASS
Enter Pass or Fail
PASS
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
Calculate: Actual Superheat =
5.0
Tsuction - Tevaporator, sat
Enter allowable superheat range from
manufacturer's specifications (or use range
4-25
between 4°F and 25°F if manufacturer's
specification is not available)
System passes.if actual superheat is-withimthe'
7
allowable superheat range
PASS
Enter Pass or Fail
Reg: 212-A0071732A-M2500001A-0000 Registration Date/Time: 2012/12/21 19:09:15 HERS P-ovider: CalCERTS, Inc.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5)
Site Address: Enforcement Agency: Permit Number:
78856 VIA CARMEL , La Quinta CA 92253 1 City of La Quinta 12-1457
Standard Charge Measurement Summary:
System shall pass both refrigerant charge criteria, metering device criteria (if applicable), and minimum :ooling coil
airflow criteria based on measurements taken concurrently during system operation. If corrective actions were taken, all
applicable verification criteria must be re -measured and/or recalculated.
System Name or Identification/Tag
System 1
CSLB License:
Date Signed:
Position With Company (Title):
System meets all refrigerant charge and airflow
11/20/2012
Is this installation monitored by a Third Party Quality
Name of TPQCP (if applicable):
requirements.
PASS
Enter Pass or Fail
DECLARATION STATEMENT
• I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is Prue 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 Mproved by the
enforcement agency.
• I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifim defects, I am
required to take corrective action at my expense. I understand that Energy Commission and HERS provider represertatives will also
perform quality assurance checking of installations, including those approved as part of a sample group but not chedked 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 nave 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 docume.itation 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
Responsible Person's Name:
Responsible Person's Signature:
Danielle Garcia
Danielle Garcia
CSLB License:
Date Signed:
Position With Company (Title):
686310
11/20/2012
Is this installation monitored by a Third Party Quality
Name of TPQCP (if applicable):
Control Program (TPQCP)? ❑ Yes ❑ No
Reg: 212-A0071732A-M2500001A-0000 Registration Date/Time: 2012/12/21 19:09:15 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms August 2009