PMT14-01383 City of Menifee Permit No.: PMT14-01383
29714 HAUN RD. Type: Residential Mechanical
4ACCEL% MENIFEE,CA 92586
MENIFEE Date Issued: 05/30/2014
PERMIT
Site Address: 28805 DIJON CT, MENIFEE, CA 92584 Parcel Number: 364-113-020
Construction Cost: $10,000.00
Existing Use: Proposed Use:
Description of REPLACE HVAC SYSTEM
Work:
Owner Contractor
BARBARA WETZEL CLEARVIEW HOME IMPROVEMENTS INC
28805 DIJON COURT 319 E PALM ST SUITE A
MENIFEE, CA 92584 PLACENTIA, CA 92870
Applicant Phone:7147290680 -
CLEARVIEW HOME IMPROVEMENTS INC License Number: 838720
319 E PALM ST SUITE A
PLACENTIA, CA 92870
Fee Description
City Amount f8l
Forced-Air or Gravity-Type.Furnace or Burner 1 149.00
Air Handling/Condensing Units SFR 1 133.00
,Building Permit Issuance 1 27.00
__-
GREEN FEE 1 1.06
$310.00
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications or from preventing builiding operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Menifee.Except as otherwise staled,a permit for construction under which no work is commenced within six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA_Bldg_Permit_Tempiate.rpt Page 1 of 1
City Of Menifee
LICENSED DECLARATION
I hereby affirm under penalty or perjury that I am licensed under provisions of ❑ I, as owner of the property an exclusively contracting with licensed
Chapter 9(commencing with section 7000)of Division 3 of the Business and contractors to construct the project(Section 7044, Business and Professions
Professions Code and my license is in full force and effect. Code:The Contractor's License Law does not apply to an owner of a property
License Class_J5 _License No. 032 7,20 who builds or improves thereon, and who contracts for the projects with a
Expires Signature licensed contractor(s)pursuant to the Contractors State License Law).
WORKERS'COMPENSATI DECLARATION
❑ lam exempt from licensure under the Contractors'Slate License Law for the
❑ I hereby affirm under penalty of perjury one of the following declarations: following reason:
I have and will maintain a certificate of consent of self-insure for workers' By my signature below I acknowledge that, except for my personal residence in
compensation,issued by the Director of Industrial Relations as provided for by which I must have resided for at least one year prior to completion of
Section 3700 of the Labor Code, for the performance of work for which this improvements covered by this permit, I cannot legally sell a structure that I have
permit is issued. built as an owner-building if it has not been constructed in its entirety by licensed
Policy# contractors. I understand that a copy of the applicable law, Section 7044 of the
r I have and will maintain workers' compensation insurance, as required by Business and Professions Code,is available upon request when this application is
'section 3700 of the Labor Code, for the performance of the work for which this submitted or at the following Web site:htto'//www.Ieqinfo.ca.qQv/caIaw.htmI.
permit is issued.My workers'compensation insurance carrier and policy number are:
C eN n lr Property Owner or Authorized Agent Date
Carrier
i
Expires—La- Policy# wCoG3'a 5675
❑ By my Signature below, I certify to each of the following: I am the property
Name of Agent Phone# owner or authorized to act on the property owner's behalf. I have read this
(This section need not be completed if the permit is for application and the information I have provided is correct. I agree to comply
one-hundred dollars($100)or less) with all applicable city and county ordinances and state laws relating to building
construction.I authorize representatives of this city or county to enter the above-
0 1 certify that in the performance of the work for which this permit is issued,I identified property for the inspection purposes.
shall not employ any persons 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 Property Owner or Authorized Agent Date
Code,I shall forthwith comply with those provisions.
City Business License#
Date; S�"3(�'" � Applicant;
WARNING: FAILURE O SECURE WORKERS' HAZARDOUS MATERIAL DECLARATION
COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS WILL THE APPLICANT OR FUTURE BUILDING
($100,000), IN ADDITION TO THE COST OF COMPENSATION, ❑YES OCCUPANT HANDLEA HAZARDOUS MATERIAL ORA
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE MIXTURE CONTAINING A HAZARDOUS MATERIAL
LABOR CODE, INTEREST,AND ATTORNEYS FEES Li NO EQUAL TO OR GREATER THAN THE AMOUNTS
CONSTRUCTION LENDING AGENCY SPECIFIED ON THE HAZARDOUS MATERIALS
I hereby affirm that under the penalty of perjury there is a construction lending
INFORMATION GUIDE?
agency for the performance of the work which this permit is issued (Section WILL THE INTENDED USE OF THE BUILDING BY THE
3097 Civil Code) APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE
Lender's Name DYES A PERMIT FOR THE CONSTRUCTION OR MODIFICATION
FROM THE SOUTH COAST AIR QUALITY MANAGEMENT
Lender's Address ❑NO DISTRICT(SCAQMD) SEE PERMITTING CHECKLIST FOR
GUIDE LINES
OWNER BUILDER DECLARATIONS
I hereby affirm under penalty of perjury that I am exempt from the Contractor's PRINT NAME:
License Law for the reason(s)indicated below by the checkmark(s)I have placed ❑YES WILL THE PROPOSED BUILDING OR MODIFIED FACILITY
next to the applicable item(s)(Section 7031.5. Business and Professions Code: BE WITHIN 1000 FEET OF THE OUTER BOUNDARY OF A
Any city or county that requires a permit to construct, alter, improve, demolish, ❑NO SCHOOL?
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 I HAVE READ THE HAZARDOUS MATERIAL
Section 7000)of Division 3 of the Business and Professions Code)or that he or ❑YES INFORMATION GUIDE AND THE SCAQMD PERMITTING
she is exempt from licensure and the basis for the alleged exemption. Any CHECKLIST. I UNDERSTAND MY REQUIREMENTS
violation of Section 7031.5 by any Applicant for a permit subjects the applicant to ❑NO UNDER THE STATE OF CALIFORNIA HEALTH AND SAFETY
a civil penalty of not more than($500).) CODE, SECTOUSIION 2 505ffE 5533fWGD 25534 CONCERNING
HAZAR❑ I, as owner of the property, or my employees with wages as their sole
compensation,will do ( )all of or( )porting of the work, and the structure is PROPERTY OWNER OR AUTHORIZED AGENT
not intended or offered for sale.(Section 7044,Business and Professions Code;
The Contractor's State License Law does not apply to an owner of a property X
who, through employees' or personal effort, builds or improves the property,
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 it was not built or improved for the
purpose of sale).
CITY ll OF MENI E U PLCK No: Permit No:
City of Menifee
29714 Haun Road
Building & Safety Dept. Date: Date:
Menifee, CA 92586
Phone: (951)672-6777 MAY 3 0 2014 Amount: Amou t:
Fax:(951)679-3843 Ck#: Ck#:
Received
Building Combination Permit
To Be Completed ByApplignt
Legal Description: Planning Case: F: L: Rt: R
Property Ad/drres : Assessor's Parcel Number.
ProjectlTenant Name: f- Unit#: Floor
/�a GJ9 F?c
Name: Rhi ng NO _ C47.1- y�/r
ax No.
Property Address: Unit NNNumber i Code
Owner p ' r d G' P
EmallAddress:
Name: Ph ne No Fax No.
oe ee IV 3 6yB8
Applicant Address: d r Unit Number Zip ode
ci. O1�, 0 A/?,tA ./n `� S°S
Email Add re, a
Name: Faz No.
C leg/'v:c Me Ne 21
nf4 7 9 -��B
Contractor Address: ,,r "t �+ J' ty� ��' S 4,e Zip Code��7
7 7 mvp J / e `� 60 cl , ✓t L r
Contractors city Business roense o. Cont g is City state of California License No. Classj(pation:
Number of Squares: !S
Square Footage
Description of Work: C 7it q» e Cost 01 Work:
Applicant's Signature Date: jU_C3JG - ly
To;Be Completed By City Staff Only
Indicate As R-Received or N/A-NotApplicable
5 Completes sets of fully dimensioned,drawn to sale plans which include: 1 set of documents which include
❑ Title Sheet ❑ Elevations ❑ Electrical Plan ❑ Goo Tech/Soils Report(on ed only)
❑ Plot/Site Plan ❑ Roof Plan Mechanical Plan ❑ Title 24 Energy(on tI V:x 11)
❑ ❑ Structural Calculations
Foundation Plan ❑ Cross Section ❑ Plumbing Plan ❑ Single Line diagram for elec.services over 400 AMP
❑ Floor Plan ❑ Structural Framing Plan&Details ❑ Shoring Plan I ❑ Sound Report-Residential
Class Code: Indicate New Construction Alteration" Addition' Means/Methods
Work Type: Repair' - Retroflt' Revision to Existing Parmlt' Required? YES NO
Proposed Building Use(s): Existing Building Use(s):
#Buildings: #Units: #Stories: Will the Building Have a Basement?
Y of N
Bldg.Code Occupancy Group Indicate Indicate if YES or NO Indicate all Geo-tech.Haz.Zone
At Project Construction Sprinklered that apply: Coastal Zone
Completion:
Type(s): C IN O YES or NO Noise Zone
Required? Lis[ed on Historic Resources Inventory
CITY PLANNING STAFF ONLY
APPROVALS: Costal Commiss Arch.Review Board Landmark Comm. Planning Comm.Zoning Administrator
Fee Exempt: City Project Elec.Vehicle Charger Landmark Seismic Retront Special Case:altlg_
OfricialA robot
Expedite Project(s): Child Care City Project Green Building Landmark Affordable Housing
For Staff Use Only
Building/Safety 1 Permit Specialist I City Planning I Civil Engineering I EPWM-Admin I Transportation Mgmt, I Rent Control
THANK YOU FOR HELPING US CREATE A BETTER COMMUNITY
STATE OF CALIFORNIA li
RESIDENTIAL ALTERATIONS
CEC-CFIR-ALT Revised 03110 CALIFORNIA ENERGY COMMISSION
Prescriptive Certificate of Compliance: Residential CF-IR-ALT
Residential Alterations Pa e 5 of 7
Project Name: S� ! Climate Zone# #of Stories
O o, -0 e
Building & Safety Dept.
MAY 3 0 2014
HVAC SYSTEMS-HEATING
Minimum 1 Itpaelve(jDuct or Piping Configuration
Heating Equipment Efficiency Distribution Insulation Thermostat (Central,Split,
Type and Ca aci nt2,3 (AFUE or HSPF) Type and Location° R-Value T e S ace,Package or H dronic
�6
1.Indicate Heating Type(Central Furnace, Wall Furnace,Heat pump,Boiler,Electric Resistance,etc)
2.Electric resistance heating is allowed only in Component Package C,or except where electric heating is supplemental(i.e.,if total capacity
<2 KW or 7,000 Btulhr electric heating is controlled by a time-limiting device not exceeding 30 minutes). See§151(b)3 exception.
3.Refer to the HERS Verification section on Page 4 of the CF-IR-ALT Form for additional requirements and check applicable boxes.
4. Indicate Type or Location(Ducts,Hydronic in Floor,Radiators,etc)
HVAC SYSTEMS-COOLING
Minimum
Efficiency Duct or Piping Configuration
Cooling Equipment (SEER/EER or Distribution Insulation Thermostat (Central,Split,
Type and Ca aci U COP) Type and Location' R-Value Type Space,Package or H dronic)
1.Indicate Cooling Type(A/C,Heat pump,Evap. Cooling,etc)
2.Refer to the HERS Verification section on Page 4 of the CF-IR ALT Form for additional requirements and check applicable boxes.
3.Indicate Type or Location Ducts,H dronic in Floor,Radiators,etc.
WATER HEATING
List water heaters and boilersfor both domestic hot water(DHW)heaters and hydronic space heating. Individual dwelling DHW heaters must be
gas or propane fired. Hot water pipe insulation from the DHW heater to the kitchen(s)and on all underground hot water pipes is required in all
component packages in all climate zones.
External Tank
Water Heater Type/Fuel Distribution Type Number In Tank Energy Factor or Insulation
Typel (Standard,Recirculating)' System Capacity(gal) Thermal Efficiency R-Value3
1.Indicate Type(Storage Gas,Heat Pump,Instantaneous,etc)
2.Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of§150(n). The Prescriptive requirements do
not allow the installation ofa recirculating water heating system for single dwelling units.
3.The external water heating tank and i es shall be insulated to meet the requirements o 150 ).
SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below.
These items may require written justification and documentation and special verification.
NEW ROOF ASSEMBLY-Radiant Barrier
The radiant barrier requirement of§151 2 does not apply to roof alterations.
Slab Edge(Perimeter)Insulation 0 YES 0 NO
YES:In Climate Zone 16 in Component Packages D,R-7 insulation is required.
Heated Slab Insulation O YES O NO
YES:Slab edge insulation required for all heated slabs in all Climate Zones. See details in Table I I8-A of the standards.
Raised Slab Insulation 0 YES 0 NO
YES:In Climate Zones 1,2, 11, 13, 14&16,R-8 insulation is required;in Climate Zones 12&15,R-4 is required under component Package D.
Registration Number: Registration Date/Time: HERSProvidedt
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:
28805 Dijon Ct., Menifee CA 92584 City of Menifee PMT14-01383
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 Handler
System Name or Identification/Tag System 1
System Location or Area Served Whole House
5/15 inch (8 mm) access hale `
1 upstream of evaporative coil in the ®Yes ❑Yes ❑ Yes ❑Yes ur ;
return plenum and labeled according ❑ No ❑ No ❑ No ❑ No
to Figure_in Section RA3 2.2.2.2.
Returti side of the duct system 1s '
la located entirely with m,conditionEd ❑Yes ❑Yes ❑Yes ' El Yes
spaca;;and return alrfltzW tdm5pe�rature i❑ Na ❑ No ❑ No EI No
to & measured at the retu`rh geille.
5/16 bch
2 downstream of evaporative j(ioll I a ®'Yes ❑Yes ElYec m 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 or the HERS Provider's data registry an
explanation as to why the TMAH cannot be installed or 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.energy.ca.gov/title24/2008staiidards/special case appliance/
TMAH Compliance Option ❑ ❑ ❑ ❑
Yes to 1 and 2, or Yes to la and 2, or
checking the TMAH Compliance Option, is ® Pass ❑ Pass ❑ Pass ❑ Pass
a pass. ❑ Fail ElFall ❑ Fail ❑ Fail
Enter Pass or Fail
Reg: 214-A0044I95A-M2500001A-M25A Registration Date/'P me: 2014/07/07 13:22:59 EERS Provider: Cal CERTS, Inc.
2008 Residential Compliance Forms February 2013
I
+f
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25 !,
Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 6)
Site Address: Enforcement Agency: Permit Number:
28805 Dijon Ct., Menifee CA 92584 City of Menifee PMT14-01383
STMS - Sensor on the Evaporator Coil
System Name or System 1
Identification/Tag
3 The sensor is factory installed, or field installed according to manufacturer's specifications, or is installed
by methods/specifications approved by the Executive Director.
❑Yes ❑ No I ❑Yes ❑ No ❑Yes ❑ No ❑Yes ❑ No
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
airflow through the condenser coil
❑ Yes ❑ No ❑Yes ❑ No ❑Yes ❑ No ❑Yes ❑ No
5 When attached to a digital thermometer, the sensor provides an indication of the saturation temperature
of the coil.
❑Yes ❑ No ❑Yes ❑ No ❑Yes ❑ No ❑Yes ❑ No
Yes to 3, 4, and 5 is a
pass. IS N/A ❑ N/A ❑ N/A ❑ N/A
Enter N/A if STMS are not q Pass ❑ Pass ❑ Pass ❑ Pass
applicable. ❑ Fail ❑ Fail ❑ Fail ❑ Fail
Otherwise enter Pass or
Fail
STMS - Sensor on the Condenser Coil
System Name or 5yste'`r`ti 1
Identification/Tag -
6 The sensor is factory installed; or'f:eld installed according to manufacturer s specificatrons or is installed
by methods/speaffcations app rgv'ed;by the Ex6d tiva` irecCor--
❑1?erx,-❑ No. ,,.4;.pYes' q �jt ... ❑Yes b No J:i .C :Yes" C7 No
The sensor wire is terminat'ed witha;=s[andartl'rmrn'ii'plug's'u"it2'ae for'GonnecEion to a'`digiEal thermbmeter."
7 The sensor mini plug is accessible to the installing technician and the HERS rater without changing the
airflow through the condenser coil
I El Yes ❑ No ❑Yes ❑ No ❑Yes ❑ No ❑Yes ❑ No
8 When attached to a digital thermometer, the sensor provides an indication of the saturation temperature
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 p pass ❑ Pass ❑ Pass ❑ Pass
applicable. ❑ Fail ❑ Fail ❑ Fail ❑ Fail
Otherwise enter Pass or
Fail
Reg: 214-A00441.98A-M2500001A-M25A Registration Date/Time: 2014/07/07 13:22:59 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms February 201.3
INSTALLATION CERTIFICATE CF-411-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 6)
Site Address: Enforcement Agency: Permit Number:
28805 Dijon Ct., Menifee CA 92584 City of Menifee PMT14-01383
Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 550F)
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 i
System Location or Area Served Whole House
Outdoor Unit Serial # 13493JF72F
Outdoor Unit Make American
Standard
Outdoor Unit Model 4A7A6061H1
I
t
Nominal Cooling Capacity 5 Tons
Date of Venficat on; ''06[09/2014 '
Cahbratrtin of D1agn:,ost�c I'nstrutuents
Date of Refrigerant'Gauge Calibrations,f--y' 106/01/2014 (must be re calibrated monthly)
Date of Thermocouple Calibration 06/O1/2014 (must be re-calibrated monthly)
Measured Temperatures (OF)
System Name or Identification/Tag System 1
Supply (evaporator leaving) air dry-bulb 51.4
temperature (Tsupply, db)
Return (evaporator entering) air 71.3
dry-bulb temperature (Treturn db)
Return (evaporator entering) air 84.3
wet-bulb temperature (Treturn wb)
Evaporator saturation temperature 39.2
(Teva orator sat)
Condenser saturation temperature 87.4
(Tcondensor, sat)
Suction line temperature (Tsuction) 51.5
Liquid Line Temperature (Tliquid) 76.6
Condenser (entering) air dry-bulb 79.1
temperature (Tcondenser, db)
Reg: 214-A0044198A-M2500001A-M25A Registration Date/Time: 2014/07/07 13:22:59 EERS 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:
28805 Dijon Ct., Menifee CA 92584 City of Menifee PMT14-01383
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 = 19.90
Treturn db - TsupQly, db
Target Temperature Split from Table RA3.2-3 20.0
using Treturn wb and Treturn db
Calculate difference: Actual Temperature -0.1
Split - Target Temperature Split =
Passes if difference is between -40F and
+4°F or, upon remeasurement, if between PASS
-40F and -1000F
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.Requi'rement(CFM):= Nor it Cooling Capacity (ton) X 300
(cfm/toriJy
System Nop epr Identification/Tay s
.a
Calculated Minimum Airflow Requirement
(CFM)
Measured Airflow using RA3.3procedures
(CFM)
Measurement Method
Passes if measured airflow is greater than or
equal to the calculated minimum airflow
requirement.
Enter Pass or Fail
Reg: 214-A0044198A-M2500001A-M25A. Registration Date/Time: 2014/07/07 13:22:59 HERS Provider: CalCERTS, Inc.
2008 Residential Coinpli.ance Forms February 2013
INSTALLATION CERTIFICATE CF-411-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 6)
Site Address: Enforcement Agency: Permit Number:
28805 Dijon Ct., Menifee CA 92584 City of Menifee PMT14-01383
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 we and Tcondenser, db
Calculate difference:
Actual Superheat - Target Superheat =
System passes if difference Is between -6°F
and +6°F
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 10.8
Tcondenser, sat- Tli uid ,
Target Subcooling specified by 10.0
manufacturer
Calculate difference;:= -
v OLS
Actual Sucooling - Target Subc{ahng,-`- '
System p'`a`��es if dlfference.is �a�w�egn-. -
-4 F and-+4°F a s;
tF
e'r Pas°s;.gr 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 12.3
Tsuction - Teva orator sat
Enter allowable superheat range from
manufacturer's specifications (or use range 10.0
between 30F and 26°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: 214-A00441.98A-M2500001A-M25A Registration Date/Time: 201.4/07/07 13:22:59 HERS Provider: CalCERTS, Inc.
2008 Residential. Compliance Forms February 2013
INSTALLATION CERTIFICATE CF-4R-MECH-25 al�,
Refrigerant Charge Verification - Standard Measurement Procedure (Page 6 of 6)
Site Address: Enforcement Agency: Permit Number:
28805 Dijon Ct., Menifee CA 92584 City of Menifee PMT14-01383
Standard Charge Measurement Summary:
System shall pass both refrigerant charge criteria, metering device criteria (if applicable), and minimum
cooling coil airflow criteria based on measurements taken concurrently during system operation. If
corrective actions were taken., all applicable verification criteria must be re-measured and/or recalculated.
System Name or Identification/Tag System 1
System meets all refrigerant charge and
airflow requirements. PASS
Enter Pass or Fail
® Residential Appendix RA3,2.2 requires that if the outdoor temperature is between 55OF and 65OF the
return air dry bulb temperature shall be maintained above 70OF 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 RAS 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 l;equlremeCyt specified on the Certificate(s) gf,,Compllance
(CF-1R),approved by the enforcement agency. ::-
Builder_or-Installer information as shown on kktie`Installafl on C&tificab CICF-60-11r.,
Company`Name (Installing Subcontractor or Gap Eral C—dntractgf�br Builder/Ovthet)
CLEARUIEW HOME IMPROVEMENTS INC
Responsible-Persons'Name: m:GSLB.LIpense _. - , _
David Ogden 838720
HERS Provider Data Registry Information
Sample Group # (if applicable): N/A ® tested/verified dwelling ❑ not-tested/verified dwelling
in a HERS sample group
HERS Rater Information CaICERTS Certificate # CCS-1798869569
HERS Rater Company Name:
Omega Energy Consultants, Inc.
Responsible Rater's Name: Responsible Rater's Signature:
Armen Abramian Armen Abramian
Responsible Rater's Certification Number w/this HERS Date Signed: 6/9/2014
Provider:
CC2005750
Reg: 214-A004419BA-M2500001A-M25A Registration Date/Time: 2014/07/07 13:22:59 HERS Provider: Ca10ERTS, inn.
2008 Residential Compliance Forms February 2013
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 6) '�
Site Address: I E nforcement Agency: Permit Number:
28805 Dijon Ct., Menifee CA 92584 City of Me fee PMT14-01383
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 Handler
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 of-the duct system side i$s :'
la located entirely within conditioned ❑Yes ❑ Yes ❑ Yesd ❑Yes
space=and return airf[nw temper�itu re ;�No- O No r ❑ No '" ❑ No
IX
to o;e:measured;at th„e return g'tille.
r
5/lfz;:ich (8 mm)-acoess hale ,: 'f
down79trte n of evapialative:coil rn thy' '®tYe`s ❑Yes ❑Yes " ''❑Yes
2 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 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 htto://www energy ca qov/title2412008standardsLs_pecial case ap.-pli�nce
TMAH Compliance Option ❑ ❑ ❑ ❑
Yes to 1 and 2, or Yes to la and 2, or
checking the TMAH Compliance Option, is ® Pass ❑ Pass ❑ Pass ❑ Pass
a pass. ❑ Fail Ell ❑ Fail ❑ Fail
Enter Pass or Fail
Reg: 214-AO044198A-M2500001A-0000 Registration Date/Time: 2014/07/07 13:17e58 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms March 2013
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 6)
Site Address: Enforcement Agency: Permit Number:
28805 Dijon Ct., Menifee CA 92584 City of Men fee PeIT14-01383
STMS - Sensor on the Evaporator Coil
System Name or System I
Identification/Tag
3 The sensor is factory Installed, or field installed according to manufacturer's specifications, or is installed
by methods/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.
4 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
5 IThe sensor measures the saturation temperature of the coil within 1.3 degrees F
❑ Yes ❑ No ❑Yes [] No ❑Yes ❑ No ❑Yes ❑ No
Yes to 3, 4, and 5 is a
pass. M 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 N
System Name or System I
Identification/7s
6 The sensor is factory installed or rield installed according to tnanufacCurer s SpecificatlQns, or is installed
by m�,thosis/speclficati,o ns approved
,by the Executive Directai::'
'.L3 fts ❑ No Yes El Na i' (J Ye _.p No
The serfsor wire is_terminated with a standard mini plug suit4ble fb'r;connectfon to a;digitahthermgrneter�
7 The sensor m(ni plug is accessible to the='installing-tech niciatf and the.HE' rater Without changing`tl�e
airflow through the condenser coil
I El Yes ❑ No ❑Yes ❑ No ❑Yes ❑ No ❑Yes ❑ No
8 IThe sensor measures the saturation temperature of the coil within 1.3 degrees F
a 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 ❑ Fall
Otherwise enter Pass or
Fail
Reg: 214-A0044198A-M2500001A-0000 Registration Date/Time: 2014/07/07 13:17:58 HERS Provider: Cd10ERTS, Tnc.
2008 Residential Compliance Forms March 2013
I
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 6)
Site Address: Enforcement Agency: Permit Number: ,
28805 Dijon Ct., Menifee CA 92584 City of Menifee PMT14-01383
Standard Charge Measurement Procedure (for use if outdoor air dry-bulb temperature is 55OF 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 550F, 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 # 134931F72F
Outdoor Unit Make American
Standard
Outdoor Unit Model 4A7A6061H1
Nominal Cooling,Capacity 5 Tons
Date of Verification
Calibration of Di lc I0l truttients
... ., .:
Date of Refriger6nti'Gau eU'libnation ,0610112014 (must be re-calibrated monthly)'
Date of Thermocouple Calibration 06/01/2014 (must be re-calibrated monthly)
Measured Temperatures (OF).
System Name or Identification/Tag System 1
Supply (evaporator leaving) air dry-bulb 51.4
temperature (Tsu I db)
Return (evaporator entering) air 71.3
dry-bulb temperature (Treturn db)
Return (evaporator entering) air 84.3
wet-bulb temperature (Treturn wb)
Evaporator saturation temperature 39.2
(Teva orator sat)
Condensor saturation temperature 87.4
(Tcondensor, sat)
Suction line temperature (Tsuction) 51.5
Liquid Line Temperature (Tliquid) 76.6
Condenser (entering) air dry-bulb 79.1
temperature (Tcondenser, db)
Reg: 214-A0044198A-M2500001A-0000 Registration Date/Time: 2014/07/07 13:17:58 HENS Provider: cal2ERTS, Inc.
2008 Residential compliance Forms March 2013
{
I
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS 1
Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 6)
Site Address: Enforcement Agency: Permit Number:
28805 Dijon Ct., Menifee CA 92584 City of Menifee PMT14-01383
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 = 19.90
Treturn db - Tsupply, db
Target Temperature Split from Table RA3.2-3
using Treturn wb and Treturn db 20.0
Calculate difference: Actual Temperature
Split - Target Temperature Split = -0.1
Passes if difference is between -30F and
+3°F or, upon remeasurement, if between PASS
-30F and -100OF
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 Req i-remer (CFM)j' Nominal Coo lingc Cap
adity�(tdn) X 300
_
System Nine oC leepficdpon%Tag .. . ;System 1 .
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: 214-A0044198A-M2500001.A-0000 Registration Date/Time: 2014/07/07 13:1.7:58 HERS Provider: Ca10ERTS, inc.
200B Residential Compliance Forms March 2013
I
�i
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 6)
Site Address: Enforcement Agency: Permit Number:
28805 Dijon Ct., Menifee CA 92584 1 City of Menifee PMT14-01383
Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is
required to be used for fixed orifice metering device systems
System Name or Identification/Tag System 1
Calculate: Actual Superheat =
Tsuction - Teva orator sat
Target Superheat from Table RA3.2-2
using Treturn wb and Tcondenser, db
Calculate difference:
Actual Superheat - Target Superheat =
System passes if difference is between
-50F and +5°F
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.
Systen Name or Identification/Tag System 1
Calculate: Actual Subcooling = 10.8
Tcandenser, sat- Tli ud
Target Subcooling specified by '' 10.0
manufacturer
Calculate difference: 0.8
Actual Subcooling - Target Subcp_oling
System passes if difference is between
-30F and 8°F :PASS
j nter,'.P_as5-"or Fail Z
t ,
Metering`Device C'ai'cu -for Refrigerant'JCharge Verification. This procedure is require`3 to b'e -
used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems.
System Name:or.Iaentification/Tag System 1
Calculate: Actual Superheat = " 12.3
Tsuction -Tevalocrator, sat
Enter allowable superheat range from
manufacturer's specifications (or use range 10.0
between 40F and 250F if manufacturer's
specification is not available)
System passes if actual superheat is within
the allowable superheat range PASS
Enter Pass or Fail
Reg: 214-A004419BA-M2500001A-0000 Registration Dave/Time: 2014/09/09 13:19:58 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2013
i
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 6 of 6)
Site Address: I Enforcement Agency: Permit Number:
28805 Dijon Ct., Menifee CA 92584 City of Menifee PMT14-01383
Standard Charge Measurement Summary:
System shall pass both refrigerant charge criteria, metering device criteria (if applicable), and minimum
cooling coil airflow criteria based on measurements taken concurrently during system operation. If
corrective actions were taken, all applicable verification criteria must be re-measured and/or recalculated.
System Name or Identification/Tag System 1
System meets all refrigerant charge and
airflow requirements. PASS
Enter Pass or Fail -
® Residential Appendix RA3.2.2 requires that if the outdoor temperature is between 55OF and 650F the
return air dry bulb temperature shall be maintained above 70OF 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 grouibut not checked by a HERS rater, and;ifthose installations fail oTneet-the',.requ,rements of such
quality assurance checking, the iegmred i€orrective actlphand adclincKal che&nOtesti R, of ath it installations In that
HERS sample yroup will be performed aC.my expense.
. I reviewed a copy of the Certificate 4-Compliance (CFTR)-foYm approv,'ed.by the enforcement agen„djyahat identifies the
speclfiK uirementsfor the insbsllauon I certify thapthe regmremegfs detailed on the,CF-IR thatrap',ly to the
installation have been met
j . I will ensure thate;completed"'signed copy of this:Installatioi 5ft' r ideate 57Ia1[be ps3ted, or 5nad'e available _
with the`bui)ding permit(s)Issued for thelbuilding; and made availatil'e 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 InstallationCertificates 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)
CLEARVIEW HOME IMPROVEMENTS INC
Responsible Peison's Name: Responsible Person's Signature:
David Ogden David Ogden
CSLB License: D5/30/2014ate Signed:
838720 position With Company (Title):
Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable):
Control Program (TPQCP)? ❑Yes ❑ No
Reg: 214-A004419SA-M2500001A-0000 Registration Date/Time: 2014/07/07 13:17:58 TIERS Provider.: Ca10ERTS, Inc.
2008 Residential Compliance Forms March 2013