12-1439 (MECH)4
P.O. BOX 1504
78-495 CALL TAMPICO
LA •QUINTA, CALIFORNIA 92253
Applicant:
'Architect or Engineer:
PIA
4 ao
BUILDING & SAFETY DEPARTMENT DEC 17 20121
BUILDING PERMIT c17YOFLAQUINTA
FINANCE DEPT.
Owner:
ELSTIEN DONALD M
48340 VIA SOLANA
LA QUINTA, CA 92253
Contractor:
GENERAL AIR CONDITIONING
31170 RESERVE -DRIVE
THOUSAND PALMS, CA 92276
(760)343-7488
Lic. No.:1686310
VOICE (760) 777-701.2
FAX (760) 777-7011
'TIONS (760) 777-7153 `
Date: 12/17/12
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
Application Number:
X12-00001439
Property Address:
48340. VIA SOLANA
APN:
.646 -380 -049 --
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
.7000
Applicant:
'Architect or Engineer:
PIA
4 ao
BUILDING & SAFETY DEPARTMENT DEC 17 20121
BUILDING PERMIT c17YOFLAQUINTA
FINANCE DEPT.
Owner:
ELSTIEN DONALD M
48340 VIA SOLANA
LA QUINTA, CA 92253
Contractor:
GENERAL AIR CONDITIONING
31170 RESERVE -DRIVE
THOUSAND PALMS, CA 92276
(760)343-7488
Lic. No.:1686310
VOICE (760) 777-701.2
FAX (760) 777-7011
'TIONS (760) 777-7153 `
Date: 12/17/12
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
- 1 hereby affirm under penalty of perjury that I am licensed 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 Professionals Code, and =rise 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
Date: h 12— ntractor.� _
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
OWNER -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 for which this permit is issued, I 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 subject 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 to the 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, 1 shall forthwith comply with thoseprovisions.'
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).:
ate: 1Z (� IZ pplicant:-
() I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and,
• the structure is not intendedor offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAI URE TO SECURE WORKERS' COMPENSATION COVERAGE -1S 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 PENALTIES AND CIVIL 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.). -
(_ 1 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.).
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
- Date: Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the .
- work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
" APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permitsubjectto 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, eachagreesto, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being•.
performed under or following issuance of this permit. _
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above information is correct. I, agree to comply with all
city and county ordinances and state laws relating to building construction,,and hereby authorize representatives
of this ounty to enter upon the above-mentioned property for inspection purposes.
ate: IZ �1 «—Si azure (Applicant•or Agentl:�'•Nt�a�� <
n Application Number 12-00001439
Permit . . . MECHANICAL
Additional desc .
Permit Fee 40.50.
Plan Check Fee
10.13
"- Issue Date
- •Valuation
= 0
Expiration Date ." 6/15/13
" 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:'REPLACE 3.5.TON
SYSTEM
FURNACE, CONDENSER & COIL. 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 HVACAIterafions CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Address:
EnforcementAgettey:
Dare:
Permit #:
48340 VIA SOLANA
LA QUINTA B&S
12/17/2012
Conditioned Floor
Equipment Type'
List Minimum Efficiency2
Duct insulation requirement
Area
Thermostat
❑ Packaged Unit
® Furnace
80%
®AFUE 8
❑ cop
Over 40 ft of ducts added or
®Setback
® Indoor Coil
❑SEER
❑ HSPF
replaced in unconditioned space_
Served by system
((fnot already
® Condensing Unit
g
❑ EER
❑ Resistance
O R 6 (CZ 10-13)
000 sf
present, must be
installed
❑ Other
❑ R 8 (CZ 14-I5)
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -IR -AL T -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPFfor 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. Beainninp October 1, 2010 a registered copy of the CF -1R and CF -6R shall also be on site for final inspection.
01. HVAC Changeout
Required Forms:
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
• All HVAC Equipment replaced
CF4R forms: MECH-21 and fors lit stems MECH-25
• Condenser Coil and /or
CF -611 forms: MECH-2I-HERS and (for split systems) MECH-25-HERS
• Indoor Coil and /or
CF4R forms: MECH-21 and (for split systems) MECH-25
• Furnace
For Split Systems: Duct leakage < 15 percent; RC, CCA > 300 CFM/ton(Minimum Air Flow Requirement), TMAH
For Packaged Units: Duct leakage < 15 percent '
Exempted from duct leakage testing if
❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or
O 2. Duct systems with less than 40 linear feet in unconditioned space, or
❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos
13 2. New HVAC System
Required Forms:
• Cut in or Changeout with new
CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
ducts: (all new ductingngnd all
CF4R forms: MECH-20, and (for split systems) MECH-22, and MECH-25
new equipment)
For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
17 3. New Ducts with Replacement
Required Forms:
• Includes replacing or installing a0 new ducting
CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor
CF4R fomes: MECH-20 and (for split systems) MECH-25
coil and/or furnace. Not all equipment changed.
For Split Systems: Duct leakage < 6 percent, RC, CCA >_ 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
17 4. New Ducting over 40 feet
Required Forms:
• Includes adding or replacing more than 40
CF -6R forms: MECH-04, MECH-2I-HERS CF -411 forms: MECH-21
linear feet of duct in unconditioned
For split system or packaged units: Duct leakage < 15 percent
❑ EXCEPTION: Existing duct s 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.
• 1 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 arc consistent with the infornmtion documented on other applicable compliance forms, worksheets,
calculations, plans and specifications submitted to the enforcement agcncy for approval with the permit application.
Name: STEVE SCHNIERER Signature:
Company. GENERAL AIR CONDITIONING & HEATING
Date: 12/17/2012
Address'31170 RESERVE DRIVE
31170
License -
City/State/Zip: THOUSAND PALMS, CA 92276
Phone: 760-343-7488
2008 Residential Compliance Forms July 2010
Bin. #
'
Permit #
IV;,. `'
ProjectAddressi qg3qp U iS
City o Ld Quin
Building a Safety Division
P.O. Box 1504,76-495 Calle Tampico
La.Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Owner'sNa/m�er
-
A. P. Number .
2
Address: I 5
Q
Legal Description:
City, ST, Zip: �. C
Contractor: C-1, a Telephone:=
Address:
Project Description: 3
City, ST, Zip:
Telephone:
P
State Lic. # :i
1
I Arch., Engr., Designer .
t`' ;y
s�
city tic. #;
'
'
Address:
City', ST, Zip:
_
Telephone:v;
State Lie. #:
Name of Contact Person:,
a v
�.
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# StoriesC
# Units:
Telephone # of Contact Person:
Estimated Value of Project: c
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
,
Req'd
Recd
TRAC MG
PERMIT FEES
Plan Sets
Plan Check submitted
Item
-Amount'
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit, .
Truss Cates.
Called Contact Person
Pian Check Balance
+
Tide 24 Cake.
Plans picked up .
Construction ' • ^
Flood plain plan
Pians resubmitted .' .
Mechanical
Grading plan
2a° Review, ready for corrections issue
Electrical
Snbcostactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
IM ROUSE:-
''" Review; ready for correetionslissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit Issue
School Fees
"
Total Permit Fees
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21
Duct Leakage Test — Existing Duct System (Page 1 of 2)
Site Address: Enforcement Agency: Permit Number:
48340 VIA SOLANA, La Quinta CA 92253 (System 1) City of La Quint a 12-1439
This installation certificate is required for compliance for alterations and additions in
space conditioning systems and duct systems.
ellings to
Note: For existing dwellings, a.completely new or replacement duct system can also include existing parts of
the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible
and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling,
use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. "
Duct Leakage Diagnostic Test - existing duct system
Select one compliance method from the following four choices.
® 1. Measured leakage less than 15% of fan flow
❑ 2. Measured leakage to outside 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.
V ® Cooling system method: Size of condenser in Tons X3:5 x.400 1400. CFM a
-
✓ 13 Heating system method 21.7'x Output Capacity in Thousands of,Btu/hr = CFM
_ 4 a �
❑Measured "procedures: '
r
systemairflow using RA3 3;airflow test
:.* CFM'`',,; h
Option: 1- then:.* x
:<
1
Allowed leakage .Fan Flow 1400 x 0.15 = 210 CFM
Actual Leakage = 206 CFM.
Pass if Leakage Actual is less than Allowed
.IM
Pass Fail
Option 2 used then:
2
Allbwed 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 _/ nitiai leakage ) x 100% _ 0/h Reduction
Pass if % Reduction >= 60%
a
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 a Fail
L
Reg: 212-A0072303A-M2100001A-M21A Registration Date/Time: 2013/01/02 21:24:38 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:
48340 VIA SOLANA, La Quinta CA 92253 (System 1) City of La Quinta 12-1439
® 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 seale&to the drywall•if smoke. test• is: utilized for. compliance
- applies to,duct leakage compliance,o`ption 3�(leakage.rea'uction�by 60%)'and optiom4r(fix all;'accessibl'
leaks) described above.
® New duct installations cannot'utlllzebuilding cavities as plenums or. platform returns in.lieu of ducts
® Mastic and=draw bands;mustbe usein combination with cloth backed:rubber-adhesive duct tape to seal
r.
leaks at all new duct connections"., ,.
DECLARATION STATEMENT
• I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.
• I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater).
• The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the
installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified
on the Certificate(s) of Compliance (CF -1R) approved by the local enforcement agency. ,
• The information reported on applicable sections of the Installation Certificate(s) (CF -611), 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 -6111)
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
J.
Responsible Person's Name:
CSLB License:
Danielle Garcia
;a
HERS Provider Data Registry Information
}
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:
48340 VIA SOLANA, La Quinta CA 92253 (System 1) City of La Quinta 12-1439
® 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 seale&to the drywall•if smoke. test• is: utilized for. compliance
- applies to,duct leakage compliance,o`ption 3�(leakage.rea'uction�by 60%)'and optiom4r(fix all;'accessibl'
leaks) described above.
® New duct installations cannot'utlllzebuilding cavities as plenums or. platform returns in.lieu of ducts
® Mastic and=draw bands;mustbe usein combination with cloth backed:rubber-adhesive duct tape to seal
r.
leaks at all new duct connections"., ,.
DECLARATION STATEMENT
• I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.
• I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater).
• The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the
installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified
on the Certificate(s) of Compliance (CF -1R) approved by the local enforcement agency. ,
• The information reported on applicable sections of the Installation Certificate(s) (CF -611), 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 -6111)
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
. t
Reg: 212-A0072303A-M2100001A-M21A Registration Date/Time:-2013/01/02 21:24:38HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms - March 2010 '
HARRISON ENTERPRISES INC
Responsible Person's Name:
CSLB License:
Danielle Garcia
686310
HERS Provider Data Registry Information
Sample Group # (if applicable): 377738
�testecl/,erifiecl dwelling 15HEORS
nt-tested/verified dwelling in
sample group
HERS Rater Information CaICERTS Certificate # CC1-1798718320 ,
HERS Rater Company Name:
Stratz Permit Service
Responsible Rater's Name:
Responsible Rater's Signature:
Garrett Williams
Garrett Williams
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed: 12/19/20.12
CC20062O8
. t
Reg: 212-A0072303A-M2100001A-M21A Registration Date/Time:-2013/01/02 21:24:38HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms - March 2010 '
z
. t
Reg: 212-A0072303A-M2100001A-M21A Registration Date/Time:-2013/01/02 21:24:38HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms - March 2010 '
CERTIFICATE OF FIELD VERIFICATION& DIAGNOSTIC TESTING CF-4R-MECH-2S
Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of S)
Site Address: Enforcement Agency: Permit Number:
48340 VIA SOLANA, La Quinta CA 92253 City of La Quinta 12-1439
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-2S 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 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.
land
2
® Yes
❑ No
5/16 inch (8 mm) access.hole downstream of evaporative coil in the supply,plenum
labeled according to Figure in Section RA3.2.2.2.2.
Yes to 1 and 2 is a pass.
Enter Pass or Faill ✓ I@ Pass ✓ ❑ Fail
STMS - Sensor.on the Evanorator'Coil
System Name or Identification/Tag e. %' System'1
.The sensor is factory, installed, or field installed according to manufacturer's
3
❑.Yes
❑ No
specifications, or is installed by methods/specifications approved by. the Executive
• f.r
Director.
The sensor wire is.terminated with a standard mini plug suitable for connection,to a;
4
Yes -
❑ No
digital therr:hometer. The sensor mini plug'Js accessible to therinstalling technician
,
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
saturation temperature of the coil.
Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not
✓ ®N/A
L
✓ ❑Pass
I
✓ ❑Fail
applicable. Otherwise enter Pass or Fail
I I
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 instalied 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
✓ ® N/A
✓ ❑ Pass
✓ ❑ Fail
applicable. Otherwise enter Pass or Fail
Reg: 212-AO072303A-M2500001A-M25A Registration Date/Time: 2013/01/02 21:26:59" HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5)
Site Address: Enforcement Agency: Permit Number:
48340 VIA SOLANA, La Quinta CA 92253 City of La Quinta 12-1439
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 SS°F or below, the installer must use the Alternate Charge Measurement Procedure.
Space Conditionina Svstems
System Name or Identification/Tag
System 1
(must be re -calibrated monthly)
Date of The`r.mocouple;� Calibration '%
1.2/1/2012
System Location or Area Served
Whole House
y
Outdoor Unit Serial #
1207550522
Outdoor Unit Make
GOODMAN
Outdoor Unit Model
GSX130421BB
Nominal Cooling Capacity Btu/hr
42000
Date of Verification
12/19/2012
v a• I l Ilial u111C11a�
Date of Refrigerant Gauge Calibration
12/1/2012
(must be re -calibrated monthly)
Date of The`r.mocouple;� Calibration '%
1.2/1/2012
(mush be re calibrated monthly)
y
-u- .1' O111w=1aLu1=N l'r:/- ...r - .: I I Ifp "'2 ' 1 . .— c ` ",:: ,,•:
System Name or Identification/Tag
System i
'
� r
Supply (evaporator leaving air dry-bulb r' -,
, .:. .:
45
temperature (T supply, db)
Return (evaporator entering) air dry-bulb
63
temperature (Treturn, db)
Return (evaporator entering) air wet -bulb
52
temperature (Treturn, wb)
Evaporator saturation temperature
37
(Tevaporator, sat)
Condensor saturation temperature
78
(Tcondensor, sat)
Suction line temperature (Tsuction)
59
Liquid Line Temperature (Tliquid)
69
Condenser (entering) air dry-bulb
71
temperature (Tcondenser, db)
5
'
'
� r
Reg: 212-A0072303A-M2500001A-M25A Registration Date/Time: 2013/01/02 21:26:54 HERS Provider: 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:
48340 VIA SOLANA, La Quinta CA 92253 City of La Quinta 12-1439
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
18.00
Target Temperature Split from Table RA3.2-3
17
using Treturn, wb and Treturn, db
Calculate difference: Actual Temperature Split-
1
Target Temperature Split =
Passes if difference is between -4°F and +4°F or,
upon remeasurement, if between -4°F and
PASS
'
-100°F
Enter Pass or Fai
s
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 Name`or.Identification/Tag
Calculated Minimum Airflow Requireinent`(.CFM)
Measured Airflow,using RA3 3 procedures (CFM)
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
+60F
'
Enter Pass or Fail,
Reg: 212-A0072303A-M2500001A-M25A, Registration Date/Time: 2013/01/02 21:'26:59 HERS Provider: Ca10ERTS,'Inc.
2008 Residential•Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5)
Site Address: Enforcement Agency: Permit Number:
48340 VIA SOLANA, La Quinta CA 92253 City of La Quinta 12-1439
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 =
Tcondenser, sat - Tliquid
9.0
Target Subcooling specified by manufacturer
7
Calculate difference:
2
Actual Subcooling - Target Subcooling =
System passes if difference is between
-4°F and +4°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 =
Tsuction - Tevaporator, sat
22 0
Enter allowable superheat range from
manufacturer's specifications (or use range
22
between 3°F and 26°F if manufacturer's
specification is not available)
System passes'f actual superheat is:withinAlle
allowable superheat ren e
P. 9
PASS
-,,Enter`Pass or Fail
x'
INSTALLATION CERTIFICATE CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5)
Site Address: Enforcement Agency: Permit Number:
48340 VIA SOLANA, La Quinta CA 922S3 City of La Quinta 12-1439
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
1686310
HERS Provider Data Registry Information
Sample Group # (if applicable): 377738 -
System meets all refrigerant charge and airflow
❑ not-tested/verified dwelling in
a HERS sample group
requirements.
PASS
Stratz Permit Service
Responsible Rater's Name:
Responsible Rater's Signature:
Enter Pass or Fail
Garrett Williams
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed: 12/19/2012
CC2006208
4
0 .a , iv i.r 'ILF` '�.,-..,•r€ �r"11`
f y 3
!✓ 1 1 A a� a g' J
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 -611), signed and submitted by the person(s)
responsible for the installation conforms to the requirements specified on the Certificates) of Compliance (CF -111) approved by the
enforcement aaencv.
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: ----FCS-LB
License:
Danielle Garcia
1686310
HERS Provider Data Registry Information
Sample Group # (if applicable): 377738 -
® tested/verified dwelling
❑ not-tested/verified dwelling in
a HERS sample group
HERS Rater Information Ca10ERTS Certificate # CC1-1798718320
HERS Rater Company Name: +
Stratz Permit Service
Responsible Rater's Name:
Responsible Rater's Signature:
Garrett Williams
Garrett Williams
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed: 12/19/2012
CC2006208
Reg: 212-A0072303A-M2500001A-M25A Registration Date/Time: 2013/01/02.21:26:54 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms March '2010