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Bin #
City of La Quinta
Building 8T Safety Division
Permit.# P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address:
F` Owner's Name:
A. P. Number:
Address: c
Legal Description: I r F:•"n
City, ST, Zip: R
�'�
Contractor: .�� 2Y >�! ! c j' �l
�1 �a, �o ^ r F • Telephone: �
Address:
K l
City, ST, Zip: Project Description:
/Q C Z c4
Telephone:
State Lic. # : q dr, City Lic. #: '{
Arch., Engr., Designer
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
State Lic. #: p �'
Project type (circle one): New Add'n Alter Repair Demo
Name of ContactPerson:
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person:
# Submittal
Plan Sets
Structural Calcs.
Truss Calcs.
Energy Calcs.
Flood plain plan
Grading. plan
Subcontactor List
Grant Deed
tELOA- Approval
HOUSE:anning Approval
Pub. Wks. Appr
School Fees
Total Permit Fees
Estimated Value of project: -,-2—
APPLICANT: DO NOT WRITE BELOW
THIS LINE
Req'd Recd TRACKING
PERIMT FEES
Plan Check submitted
q1tewAmount
ready for correctionsan
Check Deposit
Called Contact Person
EReviewed,
Plan Check Balance
Plans picked up
Construction
Plans resubmitted
Mechanical
2°d Review, ready for correctionsrissue
Electrical
Called Contact Person
Plumbing
Plans picked up
SALI.
Plans resubmitted
Grading
3N Review, ready for corrections/issue
Developer Impact Fee
Called Contact Person
A.I P.P.
Date of permit issue
Total Permit Fees
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:Permit
#:
56-635 Riviera La Quinta, CA 92253
City of La Quinta
May 1, 2013
Duct insulation
Conditioned Floor
Equipment Type1
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
® Furnace
® Indoor Coil
® AFUE 78%
® SEER 13.0
❑ COP
❑ HSPF
❑ R 6 (CZ 10-13)
Served by system
® Setback
If not already present, must be
® Condensing Unit
[3EER
[3 Resistance
[3 R 8 (CZ 14-15)
1400 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 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-611 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
CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
. Indoor Coil and /or
CF-4R 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
r
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 I Required Forms:
. Cut in or Changeout with CF-6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-22-HERS, and
new ducts: (all new
MECH-25-HERS
ducting and all new CF-4R forms: MECH-20, and (for split systems) MECH-22, and MECH-25
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
❑ 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: Mark Hyde Signature: Mark Hyde
Company: CERTIFIED COMFORT SYSTEMS INC Date: May 1, 2013
Address: 42-949 MADIO STREET I License: 906115
City/State/Zip: INDIO / CA / 92201 Phone: (760) 360-2202
Reg: 213-A0026057A-000000000-0000 Registration Date/Time: 2013/05/01 13:28:08 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010
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:
56-635 Riviera, La Quinta CA 92253 (System 1) City of La Quinta 13-560
Enter the Duct System Name or Identification/Tag: System 1
Enter the Duct System Location or Area Served: Whole House
Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the
dwelling.
This installation certificate is required for compliance for alterations and additions in existing dwellings to
space conditioning systems and duct systems.
Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of
the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible
and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling,
use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. "
Duct Leakage 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.
✓ ❑ Cooling system method: Size of condenser in Tons _ x 400 = _ CFM
✓ ❑ Heating system method: 21.7 x _Output Capacity in Thousands of Btu/hr = _ CFM
✓ ❑ Measured system airflow using RA3.3 airflow test procedures: CFM
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 _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% = a/o Reduction
Pass if % Reduction >= 60%
❑ Pass rl Fail
Option 4 used then:
4
All accessible leaks repaired using smoke test. HERS rater must verify (No sampling).
Pass if all accessible leaks have been repaired using smoke
Pass Fail
Reg: 213-A0026057A-M2100001A-M21A Registration Date/Time: 2013/06/08 18:00:08 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:
56-635 Riviera, La Quinta CA 92253 (System 1) City of La Quinta 13-560
❑ 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 utilized for compliance
— applies to duct leakage compliance option 3 (leakage reduction by 60%) and option 4 (fix all accessible
leaks) described 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 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 -SR) 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 -6R)
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
CERTIFIED COMFORT SYSTEMS INC
Responsible Person's Name:
CSLB License:
Mark Hyde
1906115
HERS Provider Data Registry Information
Sample Group # (if applicable): 418085
❑ tested/verified dwelling
® not-tested/verified dwelling in
a HERS sample group
HERS Rater Information CalCERTS Certificate # CCi-1798751787
HERS Rater Company Name:
Desert H.E.R.S. Raters
Responsible Rater's Name:
Responsible Rater's Signature:
Michael Hyde
Michael Hyde
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed: 5/30/2013
CC2005602
Reg: 213-A0026057A-M2100001A-M21A Registration Date/Time: 2013/06/08 18:00:08 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 1 of 6)
Site Address: Enforcement Agency: Permit Number:
56-635 Riviera, La Quinta CA 92253 City of La Q 1 13-560
Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge
verification for compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to
demonstrate compliance with the refrigerant charge verification requirement. TMAH and STMS are not
required for compliance, when a CID is utilized for compliance.
As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an
additional form(s) for any additional systems in the dwelling as applicable.
Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement
Sensors (STMS)
Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge
verification is required for compliance, TMAH are also required for compliance, unless the TMAH Compliance
Option is chosen.
STMS are only required for completely new or replacement space -conditioning systems that utilize
prescriptive compliance method.
TMAH - Access Holes in Supply and Return Plenums of Air Handier
System Name or Identification/Tag
System 1
System Location or Area Served
Whole House
5/16 inch (8 mm) access hole
1
upstream of evaporative coil in the
❑ Yes
❑ Yes
❑ Yes
❑ Yes
return plenum and labeled according
❑ No
❑ No
❑ No
❑ No
to Figure in Section RA3.2.2.2.2.
Return side of the duct system is
is
located entirely within conditioned
❑ Yes
❑ Yes
❑ Yes
❑ Yes
space and return airflow temperature
❑ No
❑ No
❑ No
❑ No
to be measured at the return grille.
5/16 inch (8 mm) access hole
2
downstream of evaporative coil in the
❑ Yes
❑ Yes
❑ Yes
❑ Yes
supply plenum and labeled according
❑ No
❑ No
❑ No
❑ No
to Figure in Section RA3.2.2.2.2.
The TMAH Compliance Option should be checked only if the HERS Rater is able to confirm that it was
physically impossible for the HVAC Installer to drill the TMAH as required by Section RA3.2.2.2.2. Using this
Compliance Option requires the HVAC installer to annotate on the HERS Provider's data registry an
explanation as to why the TMAH cannot be installed on the system, and photographs of the equipment on
which the TMAH cannot be installed. Use of this Compliance Option also requires minimum airflow
verification through the direct measurement of airflow per RA3.3. For more information see
htto://www.eneroy.ca.nov/titie2-,117008standar(i5/5uecial case app d1jM/
TMAH Compliance Option
❑
❑
❑
❑
Yes to 1 and 2, or Yes to is and 2, or
checking the TMAH Compliance Option, is
❑ Pass
❑ Pass
❑ Pass
❑ Pass
a pass.
❑ Fail
❑ Fail
❑ Fail
❑ Fail
Enter Pass or Fail
Reg: 213-A0026057A-M2500001A-M25A Registration Date/Time: 2013/06/08 18:02:39 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms February 2013
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 6)
Site Address: =1 Enforcement Agency:Permit Number:
56-635 Riviera, La Quinta CA 92253 City of La Quinta 13-560
STMS - Sensor on the Evaporator Coil
System Name or
System 1
Identification/Tag
Identification/Tag
e sensor is factory instailed, or field installed according to manufacturer's specifications, or is installed
Tbyimethods/specifications approved by the Executive Director.
The sensor is factory installed, or field installed according to manufacturer's specifications, or is installed
3
by methods/specifications approved by the Executive Director.
❑ Yes ❑ No I ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
7
The sensor wire is terminated with a standard mini plug suitable for connection to a digital thermometer.
4
The sensor mini plug is accessible to the installing technician and the HERS rater without changing the
❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
airflow through the condenser coil
❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
[]Yes ❑ No
When attached to a digital thermometer, the sensor provides an indication of the saturation temperature
S
of the coil.
Yes to 6, 7, and 8 is a
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes In No
Yes to 3, 4, and 5 is a
❑ N/A
❑ N/A
Enter N/A if STMS are not ❑ Pass
❑ Pass
pass.
❑ N/A
❑ N/A
❑ N/A
❑ N/A
Enter N/A if STMS are not
❑ Pass
❑ Pass
❑ Pass
❑ Pass
applicable.
❑ Fail
❑ Fail
❑ Fail
❑ Fail
Otherwise enter Pass or
Fail
STMS - Sensor on the Condenser Coil
System Name or
System 1
Identification/Tag
e sensor is factory instailed, or field installed according to manufacturer's specifications, or is installed
Tbyimethods/specifications approved by the Executive Director.
❑ Yes ❑ No 1 ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
The sensor wire is terminated with a standard mini plug suitable for connection to a digital thermometer.
7
The sensor mini plug is accessible to the installing technician and the HERS rater without changing the
airflow through the condenser coil
❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
When attached to a digital thermometer, the sensor provides an indication of the saturation temperature
8 of the coil.
[]Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
Yes to 6, 7, and 8 is a
pass. ❑ N/A
❑ N/A
❑ N/A
❑ N/A
Enter N/A if STMS are not ❑ Pass
❑ Pass
❑ Pass
❑ Pass
applicable. ❑ Fail
❑ Fail
❑ Fail
❑ Fail
Otherwise enter Pass or
Fail
Reg: 213-A0026057A-M2500001A-M25A Registration Date/Time: 2013/06/08 18:02:39 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms February 2013
INSTALLATION CERTIFICATE CF-411-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 6)
Site Address: Enforcement Agency: Permit Number:
56-635 Riviera, La Quinta CA 92253 City of La Quinta 13-560
Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F)
Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in
Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using
this form. Attach an additional form(s) for any additional systems in the dwelling as applicable.
• The system should be installed and charged in accordance with the manufacturer's specifications before starting this
procedure.
• The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test.
• If outdoor air dry-bulb temperature is less than 55°F, the installer must use the RA3.2.3 Alternate Charge Measurement
Procedure (Weigh -In Charging Method). If the Weigh -In Method is used, the dwelling cannot be included in a sample
group for HERS verification compliance.)
Space Conditioning Systems
System Name or Identification/Tag System 1
System Location or Area Served Whole House
Outdoor Unit Serial #
Outdoor Unit Make
Outdoor Unit Model
Nominal Cooling Capacity
Date of Verification
Calibration of Diagnostic Instruments
Date of Refrigerant Gauge Calibration (must be re -calibrated monthly)
Date of Thermocouple Calibration (must be re -calibrated monthly)
Measured Temperatures (°F)
System Name or Identification/Tag
System 1
Supply (evaporator leaving) air dry-bulb
temperature (Tsu I . db)
Return (evaporator entering) air
dry-bulb temperature (Treturn, db)
Return (evaporator entering) air
wet -bulb temperature (Treturn wb)
Evaporator saturation temperature
(Teva orator sat)
Condensor saturation temperature
(Tcondensor, sat)
Suction line temperature (Tsuction)
Liquid Line Temperature (Tliquid)
Condenser (entering) air dry-bulb
temperature (Tcondenser, db)
Reg: 213-A0026057A-M2500001A-M25A Registration Date/Time: 2013/06/08 18:02:39 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms February 2013
INSTALLATION CERTIFICATE CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 6)
Site Address: Enforcement Agency: Permit Number:
56-635 Riviera, La Quinta CA 92253 City of La Quinta 1 13-560
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 - Tsu ply, 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 Identification/Tag
Calculated Minimum Airflow Requirement
(CFM)
Measured Airflow using RA3.3 procedures
(CFM)
Measurement Method
Passes if measured airflow is greater than or
equal to the calculated minimum airflow
requirement.
Enter Pass or Fail
Reg: 213-A0026057A-M2500001A-M25A Registration Date/Time: 2013/06/08 18:02:39 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms February 2013
INSTALLATION CERTIFICATE CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 6)
Site Address: Enforcement Agency: Permit Number:
56-635 Riviera, La Quinta CA 92253 [City of La Quinta 1 13-560
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 - Teva orator. sat
Target Superheat from Table RA3.2-2 using
Treturn wb and Tcondenser, db
Calculate difference:
Actual Superheat - Target Superheat =
System passes if difference is between -6°F
and +6°F
Enter Pass or Fail li
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 - Tli uid
Target Subcooling specified by manufacturer
Calculate difference:
Actual Subcooling - Target Subcooling =
System passes if difference is between
-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 26°F if manufacturer's
specification is not available)
System passes if actual superheat is within
the allowable superheat range
Enter Pass or Fail
Reg: 213-A0026057A-M2500001A-M25A Registration Date/Time: 2013/06/08 18:02:39 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms February 2013
INSTALLATION CERTIFICATE CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 6 of 6)
Site Address: Enforcement Agency: Permit Number:
56-635 Riviera, La Quinta CA 92253 City of La Quinta 13-560
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
Sample Group # (if applicable): 418085
❑ tested/verified dwelling
® not-tested/verified dwelling
lin
System meets all refrigerant charge and
a HERS sample group
HERS Rater Information Ca10ERTS Certificate # CC1-1798751787
HERS Rater Company Name:
airflow requirements.
Responsible Rater's Name:
Responsible Rater's Signature:
Michael Hyde
Michael Hyde
Enter Pass or Fail
Date Signed: 5/30/2013
�Provider:
CC2005602
❑ Residential Appendix RA3.2.2 requires that if the outdoor temperature is between 55°F and 65°F the
return air dry bulb temperature shall be maintained above 70°F during the Standard Charge Measurement
Procedure. The signature of the Responsible Person in the declaration statement below certifies this
requirement has been met for all applicable system verifications reported on this certificate.
DECLARATION STATEMENT
. I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is
true and correct.
• I am the certified HERS rater who performed the verification services identified and reported on this certificate
(responsible rater).
. The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this
certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and
RA3 and the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the local enforcement
agency.
. The information reported on applicable sections of the Installation Certificate(s) (CF -6R), signed and submitted by the
person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance
(CF -1R) approved by the enforcement agency.
Builder or Installer information as shown on the Installation Certificate (CF -6111)
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
CERTIFIED COMFORT SYSTEMS INC
Responsible Person's Name: CSLB License:
Mark Hyde 1906115
HERS Provider Data Registry Information
Sample Group # (if applicable): 418085
❑ tested/verified dwelling
® not-tested/verified dwelling
lin
a HERS sample group
HERS Rater Information Ca10ERTS Certificate # CC1-1798751787
HERS Rater Company Name:
Desert H.E.R.S. Raters
Responsible Rater's Name:
Responsible Rater's Signature:
Michael Hyde
Michael Hyde
Responsible Rater's Certification Number w/ this HERS
Date Signed: 5/30/2013
�Provider:
CC2005602
Reg: 213-A0026057A-M2500001A-M25A Registration Date/Time: 2013/06/08 18:02:39 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms February 2013
INSTALLATION CERTIFICATE CF-6R-MECH-04
Space Conditioning Systems, Ducts and Fans (Page 1 of 2)
Site Address: Enforcement Agency: Permit Number:
56-635 Riviera, La Quinta CA 92253 (System 1) City of La Quint a 13-560
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
Heating
Load
(kBtu/hr)
Heating
Capacity
(kBtu/hr)
Split
Furnace
american standard
aud1c100a9481ab
1
80 AFUE
I Attic
R-4.2
80
100 kBtu
Cooling Equipment
Equip
Type
(package
heat
pump)
CEC Certified Mfr. Name
and Model Number
ARI
Reference
Number2
# of
Identical
Systems
Efficiency
(SEER
and EER)
1, 3
(>=CF -1R
value)4
Duct
Location
(attic,
crawl-
space,
etc.)
Duct
R -value
Cooling
Load
(kBtu/hr)
Cooling
Capacity
(kBtu/hr)
Split
A/C
american standard
4ttb3042d1000ba
1
13 SEER
11 EER
Attic
R-4.2
40
42 kBtu
1. IF project is new construction, see Footnotes to Standards Table 151-B and Table 151-C for duct ceiling alternative
compliance.
2. ARI Reference Number can be found by entering the equipment model number at
http://www.aridirectory. orglari/ac. 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 -IR -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, or 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 entirely in
conditioned space.
Reg: 213-A0026057A-M0400001A-0000 Registration Date/Time: 2013/05/07 20:24:24 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-GR-MECH-04
Space Conditioning Systems, Ducts and Fans (Page 2 of 2)
Site Address: Enforcement Agency: Permit Number:
56-635 Riviera, La Quinta CA 92253 (System 1) City of La Quinta 13-560
Ducts and Fans
§150(m): Duct and Fans
11711. 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
d u cts.
❑ 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.
1110. Flexible ducts cannot have porous inner cores.
DECLARATION STATEMENT
• I certify under penalty of perjury, under the laws of the State of Californla, the Information provided on this form is true and correct.
• I am ellgible 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 spedflc
requirements for the Installation. I certify that the requirements detailed an the CF -1R that apply to the installation have been met.
• I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the
building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I
understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder
provides to the building owner at occupancy.
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
CERTIFIED COMFORT SYSTEMS INC
Responsible Person's Name:
Responsible Person's Signature
Mark Hyde
Mark Hyde
CSLB License: Date Signed:
Position With Company (Title):
906115 5/7/2013
Reg: 213-A0026057A-M0400001A-0000 Registration Date/Time: 2013/05/07 20:24:24 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:
56-635 Riviera, La Quinta CA 92253 (System 1) City of La Quint a 13-560
Enter the Duct System Name or Identification/Tag: System 1
Enter the Duct System Location or Area Served: Whole House
Note; Submit one Installation Certificate for each duct system that must demonstrate compliance in the
dwelling.
This installation certificate is required for compliance for alterations and additions in existing dwellings to
space conditioning systems and duct systems.
Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of
the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible
and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling,
use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. "
Duct Leakage 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.
® Cooling system method: Size of condenser in Tons 3.5 x 400 = 1400 CFM
❑ Heating system method: 21.7 x _ Output Capacity in Thousands of Btu/hr = _ CFM
V ❑ Measured system airflow using RA3.3 airflow test procedures: _ CFM
Option 1 used then:
1
Allowed leakage = Fan Airflow 1400 x 0.15 = 210 CFM
Actual Leakage = 191 CFM
Pass if Actual Leakage is less than Allowed leakage
® 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
p Pass p 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 n 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 0 Fail
Reg: 213-A0026057A-M2100001A-0000 Registration Date/Time: 2013/05/07 17:56:02 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS
Duct Leakage Test — Existing Duct System (Page 2 of 2)
Site Address: Enforcement Agency: Permit Number:
56-635 Riviera, La Quinta CA 92253 (System 1) City of La Quinta 13-560
® 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 tiealed to the drywall if smoke test is utilized for compliance
— applies to duct leakaciie ;x,rnpllance option 3 (ipakage reduction by 60%) and option 4 (fix all accessible
leaks) described above.
® New duct installations cannot utilize building cavities as plenums or platform returns in lieu of ducts.
IN 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 eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized
representative of the person responsible for construction (responsible person).
. I certify that the installed features, materials, components, or manufactured devices Identified on this certificate (the Installation)
conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the
enforcement agency.
• I understand that a HERS rater will check the installation to verify compliance, and that that If such checking identifies defects, I am
required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also
perform quality assurance checking of Installations, including those approved as part of a sample group but not checked by a HERS
rater, and if those Installations fall 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 -IR) form approved by the enforcement agency that identifies the specific
requirements for the installation. I certify that the requirements detalled on the CF -IR that apply to the Installation have been met.
• I will ensure that a compieted, signed copy of this Installation Certificate shall be posted, or made available with the
building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I
understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder
provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data
recilstry for multiple orlentation alternatives, and beginning October 1, 2010, for all low-rise residential bulldings.
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
CERTIFIED COMFORT SYSTEMS INC
Responsible Person's Name:
Responsible Person's Signature:
Mark Hyde
Mark Hyde
CSLB License: Date Signed:
Position With Company (Title):
906115 4/23/2013
Is this installation monitored by a Third Party Quality
Name of TPQCP (if applicable):
Control Program (TPQCP)? ❑ Yes ❑ No
Reg: 213-A0026057A-M2100001A-0000 Registration Date/Time: 2013/05/07 17:56:02 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 6)
Site Address: Enforcement Agency: Permit Number:
56-635 Riviera, La Quinta CA 92253 1 City of La Quinta 13-560
Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge
verification for compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to
demonstrate compliance with the refrigerant charge verification requirement. TMAH and STMS are not
required for compliance when a CID is utilized for compliance.
As many as 4 systems In the dwelling can be documented for compliance using this form. Attach an
additional form(s) for any additional systems in the dwelling as applicable.
Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement
Sensors (STMS)
Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge
verification is required for compliance, TMAH are also required for compliance, unless the TMAH Compliance
Option is chosen.
STMS are only required for completely new or replacement space -conditioning systems that utilize
prescriptive compliance method.
TMAH - Access Holes in Supp1Y and Return Plenums of Air Handler
System Name or Identification/Tag
System 1
System Location or Area Served
Whole House
5/16 inch (8 mm) access hole
upstream of evaporative coil in the
® Yes
❑ Yes
Cl Yes
❑ Yes
1
return plenum and labeled according
❑ No
❑ No
❑ No
❑ No
to Figure in Section RA3.2.2.2.2.
Return side of the duct system is
located entirely within conditioned
❑ Yes
❑ Yes
❑ Yes
❑ Yes
1a
space and return airflow temperature
❑ No
❑ No
❑ No
❑ No
to be measured at the return grille.
5/16 inch (8 mm) access hole
downstream of evaporative coil in the
® Yes
❑ Yes
❑ Yes
❑ Yes
2
supply plenum and labeled according
Cl No
❑ No
❑ No
❑ No
to Figure in Section RA3.2.2.2.2.
The TMAH Compliance Option should be checked only if it is physically impossible to drill the TMAH as
required by Section RA3.2.2.2.2. Using this Compliance Option requires the HVAC installer to annotate on
the HERS Provider's data registry an explanation as to why the TMAH cannot be installed on the system,
and photographs of the equipment on which the TMAH cannot be installed. Use of this Compliance Option
also requires minimum airflow verification through the direct measurement of airflow per RA3.3
For more information see httn.1/www.energy.ca.aoyltitle24/2008standardsls ecial case appliance/
TMAH Compliance Option ❑ ❑ ❑ ❑
Yes to 1 and 2, or Yes to la and 2, or
checking the TMAH Compliance Option, is
® Pass
0 Pass
❑ Pass
❑ Pass
a pass.
❑ Fail
❑ Fail
❑ Fail
❑ Fail
Enter Pass or Fail
Reg: 213-A0026057A-M2500001A-0000 Registration Date/Time: 2013/05/07 17:55:12 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2013
STMS - Sensor on the Evaporator Coil
System Name or
System 1
Identification/Tag
The sensor is factory installed, or field installed according to manufacturer's specifications, or is installed
3
by methods/specifications approved by the Executive Director.
TO Yes ❑ No 1 ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
methods/specifications approved by the Executive Director.
The sensor wire is terminated with a standard mini plug suitable for connection to a digital thermometer.
4
The sensor mini plug is accessible to the installing technician and the HERS rater without changing the
7
airflow through the condenser coil
❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
5 IThe sensor measures the saturation temperature of the coil within 1.3 degrees F
❑ Yes ❑ No ❑ Yes ff No ❑ Yes ❑ No ❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Yes to 3, 4, and 5 is a
❑ Yes ❑ No
Yes to 6, 7, and 8 is a
pass.
Enter N/A if STMS are not
® N/A
❑ N/A
❑ N/A
❑ N/A
applicable.
❑ Pass
❑ Pass
❑ Pass
❑ Pass
Otherwise enter Pass or
❑ Fail
❑ Fail
❑ Fail
❑ Fail
Fail
❑ Fail
Fail
STMS - Sensor on the Condenser Coil
System Name or
System 1
Identification/Tag
Tby
he sensor is factory installed, or field installed according to manufacturer's specifications, or is installed
methods/specifications approved by the Executive Director.
❑ Yes ❑ No 13 Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
The sensor wire is terminated with a standard mini plug suitable for connection to a digital thermometer.
7
The sensor mini plug is accessible to the installing technician and the HERS rater without changing the
airflow through the condenser coil
❑ Yes ❑ No ❑ Yes ff No ❑ Yes ❑ No ❑ Yes ❑ No
8 IThe sensor measures the saturation temperature of the coil within 1.3 degrees F
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Yes to 6, 7, and 8 is a
pass.
Enter N/A if STMS are not
13N/A
❑ N/A
13N/A
1:1N/A
applicable.
❑ Pass
❑ Pass
❑ Pass
❑ Pass
Otherwise enter Pass or
❑ Fail
❑ Fail
❑ Fail
❑ Fail
Fail
Reg: 213-A0026057A-M2500001A-0000 Registration Date/Time: 2013/05/07 17:55:12 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2013
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 6)
Site Address: Enforcement Agency: Permit Number:
56-635 Riviera, La Quinta CA 92253 1 City of La Quinta 13-560
Standard Charge Measurement Procedure (for use if outdoor air dry-bulb temperature is 55°F or
above)
Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in
Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using
this form. Attach an additional form(s) for any additional systems in the dwelling as applicable.
• The system should be installed and charged in accordance with the manufacturer's specifications before starting this
procedure.
• The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test.
• If outdoor air dry-bulb temperature is less than 55°F, the installer must use the RA3.2.3 Alternate Charge Measurement
Procedure (Weigh -In Charging Method). If the Weigh -In Method is used, the dwelling cannot be Included in a sample
group for HERS verification compliance.)
Space Conditioning Systems
System Name or Identification/Tag
System 1
(must be re -calibrated
monthly)
Date of Thermocouple Calibration
4/23/2013
System Location or Area Served
Whole House
temperature (Tsu I db)
Outdoor Unit Serial #
13062ypr3f
Return (evaporator entering) air
Outdoor Unit Make
american
standard
dry-bulb temperature (Treturn, db)
Outdoor Unit Model
4ttb3042d1000ab
Nominal Cooling Capacity
3.5 Tons
Date of Verification
4/23/2013
Calibration of Diagnostic Instruments
Date of Refrigerant Gauge Calibration
4/23/2013
(must be re -calibrated
monthly)
Date of Thermocouple Calibration
4/23/2013
(must be re -calibrated
monthly)
Measured Temperatures (°F)
System Name or Identification/Tag
Supply (evaporator leaving) air dry-bulb
System 1
wet -bulb temperature (Treturn wb)
temperature (Tsu I db)
Evaporator saturation temperature
39.4
Return (evaporator entering) air
(Teva orator, sat)
dry-bulb temperature (Treturn, db)
Condensor saturation temperature
101.7
Return (evaporator entering) air
wet -bulb temperature (Treturn wb)
Evaporator saturation temperature
39.4
(Teva orator, sat)
Condensor saturation temperature
101.7
(Tcondensor sat)
Suction line temperature (Tsuction)
63.1
(Liquid Line Temperature (Tliquid)
87.1
Condenser (entering) air dry-bulb
85
temperature (Tcondenser, db)
Reg: 213-A0026057A-M2500001A-0000 Registration Date/Time: 2013/05/07 17:55:12 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2013
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 6)
Site Address: Enforcement Agency: Permit Number:
56-635 Riviera, La Quinta CA 92253 City of La Quinta 13-560
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 - Tsuooly. 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 -3°F and
+3°F or, upon remeasurement, if between
-3°F and -100°F
Enter Pass or Fail
Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using
one of the airflow 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
System 1
Calculated Minimum Airflow Requirement
1050
(CFM)
Measured Airflow using RA3.3 procedures
1295
(CFM)
Measurement Method
Flow Hood
Passes if measured airflow is greater than or
equal to the calculated minimum airflow
PASS
requirement.
Enter Pass or Fail
Reg: 213-A0026057A-M2500001A-0000 Registration Date/Time: 2013/05/07 17:55:12 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2013
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 6)
Site Address: Enforcement Agency: Permit Number:
56-635 Riviera, La Quinta CA 92253 1 City of La Quinta 13-560
Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is
required to be used for fixed orifice metering device systems
System Name or Identification/Tag
System 1
Calculate: Actual Superheat =
14.6
Tsuction - Teva orator sat
Target Superheat from Table RA3.2-2
12
using Treturn wb and Tcondenser, db
4-25
Calculate difference:
2.6
Actual Superheat - Target Superheat =
System passes if difference is between
-5°F and +5°F
PASS
Enter Pass or Fail
Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is
required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems.
System Name or Identification/Tag
System 1
Calculate: Actual Subcooling =
14.6
Tcondenser, sat - Tli uid
Target Subcooling specified by
12
manufacturer
4-25
Calculate difference:
2.6
Actual Subcooling - Target Subcooling =
System passes if difference is between
-3°F and +3°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
Calculate: Actual Superheat =
23.7
Tsuction - Teva orator, 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 within
the allowable superheat range
PASS
Enter Pass or Fail
Reg: 213-A0026057A-M2500001A-0000 Registration Date/Time: 2013/05/07 17:55:12 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2013
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 6 of 6)
Site Address: Enforcement Agency: Permit Number:
56-635 Riviera, La Quinta CA 92253 1 City of La Quinta 13-560
Standard Charge Measurement Summary:
System shall pass both refrigerant charge criteria, metering device criteria (if applicable), and minimum
cooling coil airflow criteria based on measurements taken concurrently during system operation. If
corrective actions were taken, all applicable verification criteria must be re -measured and/or recalculated.
System Name or Identification/Tag
System 1
CSLB License:
906115
Date Signed:
14/23/2013
Position With Company (Title):
System meets all refrigerant charge and
Name of TPQCP (if applicable):
Control Program (TPQCP)? ❑ Yes ❑ No
airflow requirements.
PASS
Enter Pass or Fail
® Residential Appendix RA3.2.2 requires that if the outdoor temperature is between 55°F and 65°F the
return air dry bulb temperature shall be maintained above 70°F during the Standard Charge Measurement
Procedure. The signature of the Responsible Person in the declaration statement below certifies this
requirement has been met for all applicable system verifications reported on this certificate.
DECLARATION STATEMENT
. I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true
and correct.
. I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an
authorized representative of the person responsible for construction (responsible person).
. I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the
installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and
specifications approved by the enforcement agency.
. I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies
defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS
provider representatives will also perform quality assurance checking of installations, including those approved as part
of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such
quality assurance checking, the required corrective action and additional checking/testing of other installations in that
HERS sample group will be performed at my expense.
. I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by the enforcement agency that identifies the
specific requirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the
installation have been met.
. I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available
with the building permit(s) issued for the building, and made available to the enforcement agency for all
applicable inspections. I understand that a signed copy of this Installation Certificate is required to be
included with the documentation the builder provides to the building owner at occupancy. I will ensure that
all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives, and
beginning October 1, 2010, for all low-rise residential buildings.
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
CERTIFIED COMFORT SYSTEMS INC
Responsible Person's Name:
Responsible Person's Signature:
Mark Hyde
Mark Hyde
CSLB License:
906115
Date Signed:
14/23/2013
Position With Company (Title):
Is this installation monitored by a Third Party Quality
Name of TPQCP (if applicable):
Control Program (TPQCP)? ❑ Yes ❑ No
Reg: 213-A0026057A-M2500001A-0000 Registration Date/Time: 2013/05/07 17:55:12 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2013