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11-1304 (MECH)r P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: C _11-00001304 Property Address: 81080 KINGSTON HEATH APN: 767-490-032- - - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 20038 Applicant: Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Proff ionaI Code, and my License is in full force and effect. License Class: - J1 -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).: (_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure isnot tended or offered for saie (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). (_ 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.). (_) 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 C Owner: JOHN GRAHAM 81080 KINGSTON HEATH LA.QUINTA, CA 92253 Contractor: DESERT AIR CONDITIC 590 WILLIAMS ROAD PALM SPRINGS, CA 92 (760)323-3383 Lic. No.: 276586 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 INC. DEC 2011 cq: t4 Date: 12/07/11 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: _ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier EVEREST NATL Policy Number 7600007908111 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 Cod�all rthwith comply with those provisions. -Date: e _ Applicant: `WARNING: FAILURE TO SECURE JORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. • 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that 1 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 con ruction, and hereby authorize representatives of this county to enter upon the above-mentioned to for i titin rposes. r Date: 12 �� f Signature (Applicant or Agent): Application Number 11-00001304 Permit MECHANICAL Additional desc .' . Permit Fee . . . . 66.00 Plan Check Fee 16.50 Issue Date . . . . Valuation . . . . 0 Expiration Date 6/04/12 Qty Unit Charge Per Extension BASE FEE 15:00 2.00 9.0000 EA MECH FURNACE <=100K 18.00 2.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU 33.00 ---------------------------------------------------------------------------- Special Notes and Comments HVAC CHANGE -OUT: 2 SPLIT SYSTEMS AT GROUND LEVEL. 2010 CODES. -------------- ------------------------------------------------------------- Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged -------------------- Paid Credited -------------------- Due ----------------- Permit Fee Total 66.00 .00 .00 66.00 P1an.Check Total 16.50 ..00 .00 16.50' Other Fee Total 1.00 .00 .00 1.00 Grand Total 83.50 .00 .00 83.50 LQPERMIT Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-iR-ALT-HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 81-080 KINGSTON HEATH•1 .OF 2 La Quinta, CA 92253 City. of La Quinta Nov 30, 2011 - Duct insulation Conditioned Floor Equipment Type1 List Minimum Efficiency? requirement Area Thermostat ❑ Package Unit 0 Furnace Q Indoor Coil 0 AFUE 78% 0 SEER 13.0 ❑ COP ❑ "SPF ❑ R 6 (CZ 10-13) Served by system 0 Setback If not already present must be 0 Condensing Unit DEER ❑ Resistance ❑ R 8 (CZ 14-15) X 00 sf installed) ❑ Other 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -IR -ALT -HVAC for each system. 2. Minimum Equipment EfRdendes: 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 -IR and CF -6R shall also be on site for final inspection. 8 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 -411 forms: MECH-21 and (for split systems) MECH-25 . Condenser Coil and /or . Indoor Coil and /or CF -611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-2S-HERS . Furnace CF -411 forms: MECH-21 and (for spfiit systems) MECH-25 For Split Systems: Duct leakage < 15 percent; RC, CCA 5 300 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. Ductless Mini -Split System) (Also. Exempt from. Refrigerant Charge) ❑ 2. New HVAC System Required Fornns: • Cut in or: Changeout with-- r t d :% s CF -6R forms,: MECH-04, MECH=20-HERS, and (for split systems) MECH-22'-HERS, and new ducts: (all new r , MECH=25 HERS f = ` all new, r ,^ equiduptpment) equipment) ; CF -4R forms: NIECH 20, and (for split systems) MECH-22, and MECH-25 _ 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 ❑ 3. New Ducts with/or without Required Forms: Replacement . Includes replacing or installing all new ducting and/or outdoor condensing unit CF -611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS and/or indoor coil and/or furnace. No or some CF -411 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 dud in unconditioned space. CF -4R forms: MECH-21 For split system or packaged units: Dud leakage < 15 percent ❑ EXCEPTION: Existing dud 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 Qilifomia 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: Jacqueline Zabik Signature: JnogwAine ZaWk Company: DESERT AIR CONDITIONING INC Date: Nov 30, 2011 Address: 590 WILLIAMS ROAD License: 276586 City/State/Zip: PALM SPRINGS / CA / 92264 Phone: (760) 323-3383 Reg: 211-A0062146A-00000000-0000 2008 Residential Compliance Forms Registration Date/Time: 2011/11/30 18:14:11 HERS Provider: CalCERTS, Inc. July 2010 Simplified Prescriptive Certificate.of Compliance: 2008 Residential HVAC Alterations- CF-lR-ALT-HVAC ' Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 81-080 KINGSTON HEATH .2 OF 2. La Quinta,. CA 92253 City -of La .Quinta • Nov 30, 2011 Duct insulation Conditioned Floor Equipment Typel List Minimum Efficiency2 requirement Area Thermostat ❑ Package Unit 0 Furnace p Indoor Coil E9 AFUE _78% 0 SEER 13.0 ❑ COP ElHSPF ❑ R 6 (CZ 10-13) Served by system 0 Setback If not already present, must be © Condensing Unit ❑ EER L]Resistance C1R 8 (CZ 14-15) 1600 sf installed) ❑ Other 1. Equipment Type: Choose the equipment being installed, if more than one system, use another CF -IR -ALT -HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF far typical residential systems. HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The installer decides what work is being one 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 -611 and registered CF -4R forms (no hand filled CF -411s allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF -IR and CF -6R shall also be on site for final inspection. R 1. HVAC Changeout Required Forms: • All HVAC Equipment CF -611 forms: MECH-04, MECH=21-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=61k forms: MECH-04, MECH-21-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 FGF PaSkaged UROtSl Duet leakage < 15 ereeRt 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,.- Ductless .Mini -Split System),(Also-Exempt from. . Refrigerant Charge) ❑ 2. New HVAC system Required Forms: • Cut in orChangeout with: ' i - " > f CF 6R forms: MECH-04, MECH-20-HERS, and, (for split systems) MECH 22: -HERS, and new ducts: (all new MECH=25 HERS g an all new CF -4R forms: MECH 20, and (for split systems) MECH-22, and MECH-25 euuii Duct leaka For Split Systems: ge < 6 percti.nt; RC, CCA >_ 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 4.0 CF -6R forms: MECH-04, MECH-2I-HERS linear feet of dud in unconditioned space. CF -4R forms: MECH-21 For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existing dud systems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Dedaration 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: Jacqueline Zabik Signature: Jacqueline Zabik Company: DESERT AIR CONDITIONING INC:. Date: Nov 30, 2011 Address: 590 WILLIAMS ROAD License: 276586 City/State/Zip: PALM SPRINGS/ CA/ 92264 Phone: (760) 323-3383 Reg: 211-A0062147A-00000000-0000 Registration Date/Time: 2011/11/30 18:16:24 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms July 2010 Bin # City of La Quinta 'I BuOdIng ar-Safety Division P.O. Box 1504; 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Per'mit Application and Tracking Sheet Permit # Project Address: 18-0 t,, A. P. Number: Address: Legal Description: I Contractor City, ST, Zip: 1 64 Telephone: Address: City, ST, Zip; 54.06-1v1-5.. Telephone: Ity c*e- Eoc StateLic.11: Lic. Desiger. Address. City, ST, Zip. Telephone: State Lic, Name of Contact Person: Construction 11 . Ype. -/VecA_0ccupancy: Project type (circle one): New Add'n Alter Repair DMI Duro —7— -1 Sq. 1-1: 4 Storier N Units: Telephone 6 of Contact Person: -2, r,)- .211 117 Estimated Value offroject. l APPLICANT: DO NOT MATE BELOW THIS LINE 0 Submittal Rcq'd Reed TRACKING PERMIT FRES Plan Stu I ]Ran Check submit" Item Amount Structural CAICL Reviewed, ready for I corpections — Man clica Deposit 1 Truss Calm Called Contact Person Plan Check Balance. Tide 24 Coics. Plans picked up I Coustru, cdon Flood plain plan Plans resubmitted I Mechanical Grading plan 2" Review, ready for correctionslissue Electrical Subcontattor List CalledCDntact Pcran Plumbing Grant Deed Plans picked up S.M.I. K.O.A. Approval Plans resubmitted I Gmdtug IN H0USF-- Review, ready for, cormetionslissue Developer Impact Fee Planning Approval Called Contact Person AXP.P. Pub. Wks. Appr Date of permit Issue Scbodl Fccs; Total Permit Few J CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: 81-080 KINGSTON HEATH 1 OF 2, La Quinta CA 92253 Enforcement Agency:Permit Number: (System 1) City of La Quinta 11-1304 Enter the Duct System Name or Identific:ation/Tag: System 1 of 2 Enter the Duct System Location or Area Served: Living room 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 cluct 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_i, 2, or 3 mutt be attempted,before.utilizing Option.4.)M�, Determine nominal Fan Flow using one of:the following three calculation methods._er V r r ✓ V Cooling system method: Size of condenser in Tons 15 x 400 =1 2000 CFM _ Heating system me/tho��d: 21.7 x_ Output Capacity in Thousands of Btu/hr = _ CFM -'� - f 1may I-- ✓ Me� ured,system airflow using RA3.3 airflow test procedures: CFM, rJ % vI*�=� Option 1 used then: , 1 Allowed leakage = Fan Flow 2000 x10.15 = 300 CFM Actual. Lea kage = 92,_ CFM ' Pass if Leakage Actual is less than Allowed V 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 > 600/6 Pass Fail Option 4 used then: 4 All accessible leaks repaired using smoke. HERS rater must verify (No sampling). No smoke allowed to leak from system. Including ducts, plenums, air handler and door panel. Pass if all accessible leaks have been repaired using smoke Pass Fail Reg: 211-A0062146A-M2100001A-M21A Registration Date/Time: 2011/12/12 15:31:10 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-21 Duct Leakage Test — Existing Duct System (Page 2 of 2) Site Address: 81-080 KINGSTON HEATH 1 OF 2, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 11-1304 i k %0 Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off duririg duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is requiFed to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may be co `figured to the closed position during duct leakage testing. All supply and rete n register b oo is mud t b ales t the drywallp iftest is utilized f~ compliance — applies'to duct leakage compliance option 3 (leakage reduction by 60%) and option '41 (fix ah'accessible leaks) described abov�fe,. � �✓ i, � � � New duct installations,,cannot utilize building cavities as'plenums or platform returns In lieu of ducts.r V Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct"tape to seal leaks at all new duct connections DECLARATION STATEMENT, • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. . I am 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) 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) DESERT AIR CONDITIONING INC Responsible Person's Name: CSLB License: Jacqueline Zabik 1276586 HERS Provider Data Registry Information Sample Group # (if applicable): 270776 tested/verified dwelling not-tested/verified dwelling in la HERS sample group HERS Rater Information CaICERTS Certificate # CC1-1798611358 HERS Rater Company Name: Air Solutions of the Desert Responsible Rater's Name: Responsible Rater's Signature: Walter W Nellis Walter W Nellis Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 12/9/2011 CC2004361 Reg: 211-A0062146A-M2100001A-M21A Registration Date/Time: 2011/12/12 15:31:10 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: 81-080 KINGSTON HEATH 1 OF 2, La Quinta CA Enforcement Agency: Permit Number: 92253 City of La Quinta 11-1304 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 aye not required for compliance, when a CID is utilized for compliance. j 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. 1 i 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 3 System 1 OF 2 System Location or Area Served ,>No Livingroom 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 o the Evaporator, Coil System Name or Identification/,Tag/ ; System,{i OF 2, 3 Yes ,>No The sensor is factory installed, or field installed according to manufacturer's specifications, or is installed by methods/specificiations.approved by the Executive Yes No specifications, or is installed by methods/specifications approved by the Executive Director. / s Director. 1/ ,/� r A ll;.� �I t , / d..1 " The sensor wire is terminated with a standard mini plug suitable for connection to a ` ✓ �, The sens-or wire is terminated with a standard mini plug suitable,for conneetion',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 8 Yes 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 6, 7, and 8 is a pass. Enter N/A if STMS are not ✓ N/A saturation temperature of the coil. Yes to 3, 4, and 5 is a pass. Enter N/A if STM'. are not ✓ ✓ N/A %01 Pass %01 Fail applicable. Otherwise enter Pass or Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag I System 1 OF 2 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 ✓ N/A ✓ Pass I/ Fail applicable. Otherwise enter Pass or Fail t Reg: 211-A0062146A-M2500001A-M25A Registration Date/Time: 2011/12/12 15:34:23 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms j March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: 81-080 KINGSTON HEATH 1 OF 2, La Quinta CA Enforcement Agency: Permit Number: 92253 City of La Quinta 11-1304 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°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Systems System Name or Identification/Tag System i OF 2 --(must,berre-calibrated monthly) Date of ThermocoupleCalibration ji 12/,1/11 System Location or Area Served Livingroom Outdoor Unit Serial # 5811305456 Outdoor Unit Make Lennox Outdoor Unit Model XC21060230 Nominal Cooling Capacity Btu/hr 60000 Date of -Verification 12/9/11 VI ANIOU YIIICIIL9 Date ofo er Refrigant-Gge Calibration au � r, q � � 12 1 li r'�-�.._ / / f --(must,berre-calibrated monthly) Date of ThermocoupleCalibration ji 12/,1/11 (must be re -calibrated monthly) Hca... Cu ■ CIIIYCI OIYI CD l - r 1 d _ I l J _ r. System Name orvIdentification/Tag �. i' _ =System 1 OF 2 Supply (evaporator leaving) air dry-bulb 46 temperature (Tsupply, db) j Return (evaporator entering) air dry-bulb 65 temperature (Treturn, db) Return (evaporator entering) air wet -bulb 50 temperature (Treturn, wb) Evaporator saturation temperature 35 (Tevaporator, sat) Condensor saturation temperature 78 (Tcondensor, sat) Suction line temperature (Tsuction) 58 Liquid Line Temperature (Tliquid) 74 Condenser (entering) air dry-bulb 70 temperature (Tcondenser, db) Reg: 211-A0062146A-M2500001A-M25A Registration Date/Time: 2011/12/12 15:34:23 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: System 1 OF 2 81-080 KINGSTON HEATH 1 OF 2, La Quinta CA Enforcement Agency: Permit Number: 92253 City of La Quinta 11-1304 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 OF 2 Calculate: Actual Temperature Split = Treturn, 19.00 db - Tsupply, db Target Temperature Split from Table RA3.2-3 18 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - 1 Target Temperature Split = Passes if difference is between -4°F and +40l= or, uponremeasurement, if between -4°F and PASS -100° F Enter Pass or Fail 4 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/ f J J or,{ i Calculated Minimum Airflow Requirement (CFM) i 1� t • - - - r" Measured Airflow using RA3.3 procedures (CFM) I Passes if measured airflow is greater than or equal to the calculated minimum aiiflow 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 = stem passes if difference is between -6°F and r+Y6°F Enter Pass or Fail Reg: 211-A0062146A-M2500001A-M25A Registration Date/Time: 2011/12/12 15:34:23 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-2S Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of S) Site Address: System 1 OF 2 81-080 KINGSTON HEATH 1 OF 2, La Quinta CA Enforcement Agency: Permit Number: 92253 City of La Quinta 11-1304 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 OF 2 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 k PASS r -4°F and +4°F PASS 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 OF 2 Calculate: Actual Superheat = 23.0 Tsuction.LTevaporator,- sat Enter allowable superheat range from manufacturer's specifications (or use range 23 between 3°F and 26°F if manufacturer,'s. specification,is not'av`ailable) System passes if actual superheat is within the allowabl superheat range R" k PASS r Enter Pass or t=ail -e Reg: 211-A0062146A-M2500001A-M25A Registration Date/Time: 2011/12/12 15:34:23 HERS Provider: 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: 81-080 KINGSTON HEATH 1 OF 2, La Quinta CA Enforcement Agency: Permit Number: 92253 City of La Quinta 11-1304 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 OF 2 HERS Provider Data Registry Information Sample Group # (if applicable): 270776tested/verified System meets all refrigerant charge and airflow not-tested/verified dwelling in la HERS sample group requirements. PASS Air Solutions of the Desert Responsible Rater's Name: Responsible Rater's Signature: Enter Pass or Fail Walter W Nellis Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 12/9/2011 CC2004361 4 1 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 -SR) 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 -611) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) DESERT AIR CONDITIONING INC Responsible Person's Name: CSLB License: Jacqueline Zabik 7276S86 HERS Provider Data Registry Information Sample Group # (if applicable): 270776tested/verified dwelling not-tested/verified dwelling in la HERS sample group HERS Rater Information CalCERTS Certificate # CC1-1798611358 HERS Rater Company Name: Air Solutions of the Desert Responsible Rater's Name: Responsible Rater's Signature: Walter W Nellis Walter W Nellis Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 12/9/2011 CC2004361 Reg: 211-A0062146A-M2500001A-M25A Registration Date/Time: 2011/12/12 15:34:23 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 1 of 2) Site Address: 81-080 KINGSTON HEATH 2 OF 2, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 11-1304 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 "Dug` Leakage Test - Completely New or Replacement Duct System. " Duct Leakaqe Diagnostic Test - existina 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 109% of Fan Flow 3. Reduce leakage by. 60% and conduct smoke and fix all leaks 4 Fix all accessible le eaks using smoke and HERS rater verify Note: (One of Options_l, 2, or 3 mutt be attempted,before. utiIizing Option:4.), Determin!,nominal Fan Flow using one of;the following three calculation methods.41- ✓ Cooling system method: Size of,cordenser in Tons I x 400 = 1 CFM ,ter � - � ✓ Heating system meth d 21.7 z Capaty in Thousands =Output of Btu/hr = CFM _ N ✓ Measured.syste airflow using RA3.3 airflow test procedurees: CFM, ,�. �, 4j�'f Option 1 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 j 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% _ '/o Reduction Pass if % Reduction > 600/6 Pass Fail Option 4 used then: 4 All accessible leaks repaired using smoke. HERS rater must verify (No sampling). No smoke allowed to leak from system. Including ducts, plenums, air handler and door panel. - - Pass if alil accessible leaks have been repaired using smoke Pass Fail Reg: 211-A0062147A-M2100001A-M21A Registration Date/Time: 2011/12/12 15:31:10 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: 81-080 KINGSTON HEATH 2 OF 2, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 11-1304 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 belsealed to the drywall if smoke test is utilized for compliance — applies'to duct leakage compliance option 3 (leakage reduction by 60%) and option 4i(fix all accessible leaks) described above] r s New i - duct installations cannot utilize building cavities as`plenumskor platform returns in lieu of ducts.; J! Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct tape to seal leaks at all new duct connections DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am 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 -6R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) DESERT AIR CONDITIONING INC Responsible Person's Name:. CSLB License: Jacqueline Zabik 1276586 HERS Provider Data Registry Information Sample Group # (if applicable): 270776 tested/verified dwelling not-tested/verified dwelling in la HERS sample group HERS Rater Information CalCERTS Certificate # CC1-1798611359 HERS Rater Company Name: Air Solutions of the Desert Responsible Rater's Name: Responsible Rater's Signature: Walter W Nellis Walter W Nellis Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 12/9/2011 CC2004361 Reg: 211-A0062147A-M2100001A-M21A Registration Date/Time: 2011/12/12 15:31:10 HERS Provider: 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: 81-080 KINGSTON HEATH 2 OF 2, La Quinta CA Enforcement Agency: Permit Number: 92253 City of La Quinta 11-1304 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 3 System Location or Area Served ,✓/ No The sensor sensor is factory installed, or field installed according to manufacturer's specifications, or is installed by methods/specifications approved'by the Executive 1 Yes No i 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 nand 2'is`a pass. 1 Enter Pass or Faill ✓ Pass I ✓ Fail STMS - Sensor's Evaporator, oil System Name or Identification/.Tag,l i.'/ _ 3 Yes ,✓/ No The sensor sensor is factory installed, or field installed according to manufacturer's specifications, or is installed by methods/specifications approved'by the Executive Yes No specifications, or is installed by methods/specifications approved by the Executive Director. 1 Director. . ✓1 A- + The sensor wire is terminated with a standard mini plug suitable for connection to a 7 Yes The sensor wire is terminated with a standard:mini plug suitable 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 8 Yes and the HEIRS 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 6, 7, and 8 is a pass. Enter N/A if STMS are not✓ j saturation temperature of the coil. Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not V N/A I ✓ Pass T ✓ Fail applicable. Otherwise enter Pass or Fail , STMS - Sensor on the Condenser Coil System Name or Identification/Tag 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✓ N/A T✓ Pass ✓ Fail applicable. Otherwise enter Pass or Fail Reg: 211-A0062147A-M2500001A-M25A Registration Date/Time: 2011/12/12 15:34:23 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: 81-080 KINGSTON HEATH 2 OF 2, La Quinta CA Enforcement Agency: Permit Number: 92253 City of La Quinta 11-1304 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above SS°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 fora valid refrigerant charge test. • If outdoor air dry-bulb is SS°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Systems System Name or Identification/Tag System Location or Area Served Outdoor Unit Serial # Outdoor Unit Make Outdoor Unit Model Nominal Cooling Capacity Btu/hr Date of. Verification ` Calibration of Diannnctir Tnetrumante r Date of Refrigerant`Gauge Calibration... 7 � rte. `-`\ (must be te-calibrated monthly) `" t / S __5 r _ If t , Date of Calibration r / (must be re -calibrated monthly), thermocouple temperature (Tsupply, db) I System Name. orA entificat on/Teg Supply (evaporator leaving) air dry-bulb temperature (Tsupply, db) I Return (evaporator entering) air dry-bulb temperature (Treturn, db) 'a I Return (evaporator entering) air wet -bulb temperature (Treturn, wb) I Evaporator saturation temperature (Tevaporator, sat) Condensor saturation temperature (Tcondensor, sat) Suction line temperature (Tsuction) ` Liquid Line Temperature (Tliquid) Condenser (entering) air dry-bulb temperature (Tcondenser, db) f r Reg: 211-A0062147A-M2500001A-M25A Registration Date/Time: 2011/12/12 15:34:23 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: 81-080 KINGSTON HEATH 2 OF 2, La Quinta CA Enforcement Agency: Permit Number: 92253 City of La Quinta 11-1304 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 Name or Identifcation/Tag r r 1' Calculated Minimum Airflow Requirement (CFM) t Measured'Airfow, s ng 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 +6°F Enter Pass or Fail Reg: 211-A0062147A-M2500001A-M25A Registration Date/Time: 2011/12/12 15:34:23 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: 81-080 KINGSTON HEATH 2 OF 2, La Quinta CA Enforcement Agency: Permit Number: 92253 City of La Quinta 11-1304 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 Calculate: Actual Subcooling =. Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer Calculate difference: Actual Subcooling - Target Subcooling = �`?—' �r-�"i'� P System passes if difference is between �: x -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 (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 260E if manufacturer's., specificationjs,not available) ,z -j �`?—' �r-�"i'� P System passes if actual superheat within the • allowabl superheat range �: x Enter Pass or Fail Reg: 211-A0062147A-M2500001A-M25A Registration Date/Time: 2011/12/12 15:34:23 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 a C INSTALLATION CERTIFICATE CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: 81-080 KINGSTON HEATH 2 OF 2, La Quinta CA Enforcement Agency: Permit Number: 92253 City of La Quinta 11-1304 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 Jacqueline Zabik 1276586 HERS Provider Data Registry Information Sample Group # (if applicable): 270776 System meets all refrigerant charge and airflow not-tested/verified dwelling in la HERS sample group requirements. HERS Rater Company Name: Air Solutions of the Desert Responsible Rater's Name: Responsible Rater's Signature: Enter Pass or Fail Walter W Nellis Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 12/9/2011 CC2004361 1 .. 7-1 r-, I` r f ' 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. • 1 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 off 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 -111) 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) DESERT AIR CONDITIONING INC Responsible Person's Name: CSLB License: Jacqueline Zabik 1276586 HERS Provider Data Registry Information Sample Group # (if applicable): 270776 tested/verified dwelling not-tested/verified dwelling in la HERS sample group HERS Rater Information CaICERTS Certificate # CC1-1798611359 HERS Rater Company Name: Air Solutions of the Desert Responsible Rater's Name: Responsible Rater's Signature: Walter W Nellis Walter W Nellis Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 12/9/2011 CC2004361 Reg: 211-A0062147A-M2500001A-M25A Registration Date/Time: 2011/12/12 15:34:23 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010