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MECH (11-1347)53600 Avenida Madero 11-1347 P.O. BOX 1504 78-495 CALLE TAMPICO. LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description Property Zoning: Application valuation: Annlirant 1- 00001347- <_-5.360`0 AAVVENIDA MADERO 774-103-005-20 -000000- MECHANICAL COVE RESIDENTIAL 12000 Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: DON VAN MALSEN + 53600 AVENIDA MADERO LA QUINTA,•CA 92253 VOICE (760) 777-7012 FAX (760) 777-7011 . =PEeT-11 N-S-ff77-7153 ate. j A/21/11 F , Contractor: ~ COOL FLO INC 79469 COUNTRY CLUB DR, #H. BERMUDA DUNES, CA 92203 (76.0)345-6606 Lic. No.: 438781 t LQPERMIT UC CONTRACTOR'S DECLARATION m icensed WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury t under provisions of Chapter 9 (commencing with .. I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of D ision 3 of the Bu ' ss and P ofessionals Code, and my License is in full force and effect. - - I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided ' - Licens ass: C 0 LicenseNo.: 438781 _ for by Section 3700 of the Labor Code, for the performance of the work for which this permit is ntract ..issued. r '. X have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor -I Code, for the performance of the work for which this permit is issued. My workers' compensation OWNER -BUILDER DECLARATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier NORGUARD INS' Policy.Number ' COWC23 9005 following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to I certify that, in the performanc work for which this permit is issued, I shall not employ any ' • construct,.alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the _ person in any manners o tie nine subject to the workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State 'nd agree that, if I s d becom ubject to the workers'. compensation provisions of Section. License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or - 700 of the L or hall rthwith comply with those provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: plicant: ' 1—) I, as owner of the property, or my employees with wages as their sole compensation, will do the. work, and the structure is not intended or offered for sale (Sec. 7044, Business: and Professions Code: The WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who, builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN . improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. ' one year of completion, the owner -builder will have the burden of proving that he or she did not build or .. improve for the purpose of sale.). - APPLICANT ACKNOWLEDGEMENT I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. - IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the . 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application'is made, each person at whose request and for ' pursuant to the Contractors' State License Law.). - whose benefit work is'performed under or pursuant to any permit issued as a result of this application, (_ ) .I am exempt under -Sec. , B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related.to the work being - - _ - performed under or following issuance of this permit. ' Date: Owner: 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of su it, or cessation of work for 180 days will subject CONSTRUCTION LENDING AGENCY permit to cancellation. I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and stat bov information is correct. I agree to comply with all - work for which this permit is issued (Sec. 3097, Civ. C.).. - city and g my ordin nces and state laws relay o buildi onstruction, and hereby authorize representatives of nfy to, n r upon a above-mentio ropert f inspection purposes. Lender's Name: \ _ ate: Si ature (Applicant or gent): Lender's Address: J t LQPERMIT ' - 1 Application Number . . . . . 11-00001347 Permit . . . MECHANICAL Additional desc . Permit Fee- 40.50 Plan Check Fee 10.13 Issue.Date . . . . Valuation 0 Expiration Date 6/18/12 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 " 1.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU 16.50 ------------------------------------------------ Special Notes and Comments HVAC CHANGE -OUT REPLACE FURNACE, CONDENSER, INDOOR COIL. 2010 CODES. --------------------------------------- Other Fees . . . . . . . ... BLDG "STDS ADMIN (SB1473) 1.00 Fee summary Charged` Paid Credited Due - ---------------- ------ ---------- Permit Fee Total 40.50 .00 .00 40.50 Plan Check .Total 10.13 .00 .00 10.13 Other Fee Total 1.00 .00 .00 1.00 Grand -Total 51.63 .00 .00 51.63 LQPERMIT Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC Climate Zones Site Address: Enforcement A;enc it fl f! it ate: Permit #: L•quipntcntTy e' List Minimum Efficiency' Conditioned Floor Area Thermostat LJ Packaged Unit urnace AFU ndoor Coil SEER ondensittg Unit EER 0 COP erve by system HSPF Q Resistance sf Setback Onol already presew. must be installed) Other I. Equipment Tvpe: Choose the equipment being installed if more than one system use another CF- I R -ALT -HVAC fbr each system. 2. Minimum Equipment Efficiencies: 13 SEER. 78%AFUE. 7.711SPF for typical residential systems. HERS VERIFICATION SUMMARY Listed below are three 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 fomt was in fact the work completed by the installer. The inspector also verities that each appropriate CF -6R and registered CF -4R fornis (no hand filled CF-4Rs allowed) are tilled out and signed. Beginning October 1, 2010, a registered copy of the CF4 R and CF -61R shall also be on site for final inspection. Q 1. HVAC Changeout Required Forms: • All HVAC Equipment CF -6R fornis: MECH-04. MECH- 25 -HERS replaced CF -4R forms: MECli-25 • Condenser Coil and /or • Indoor Coil and /or CF -6R fornis: MECH- 25-HEIZS • Furnace CF -4R forms: MECH-25 For Split Systems: RC, CCA = 300 CFM/ton, TMAH For Packaged Units: No testing required _. New HVAC System Required Forms: • Cut in or Changeout with CF -6R forms: MECH-04.. MECH- 25 -HERS new ducts: (all new ducting 1- 1--4R tonus: M ECI-1-25 and all new a uipntent) For Split Systems: RC, CCA > 300 CFM/ton, TMAH. For Packaged Units: No testing required 3. New Ducts with Replacement Required Forms: • Includes replacing or installing all new ducting and/or outdoor condensing unit CF -6R fonts: MECH-25-HERS and/or indoor coil and/or furnace. Not all CF -4R fonts: MECH-25 e ui ment changed. For Split Systems: RC, CCA > 300 CFM/ton, TMAH For Packaged Units: No testing required Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • 1 certify that this Certificate of Compliance documentation is accurate and complete. • 1 am eligible under Division 3 ofthe California Business and Professions Code to accept responsibility for the design identified on this Certificate ofContpliance. ` • 1 certify that the energy features and performance specifications for the design identified on this Certificate of Compliance confonn to the requirements of Title 24, Parts I and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are cons' tent wmm with the information documented on other applicable compliance forms, worksheets. calculations. plans and specifications s fitted to the enforcement agency for approval with the erntit a plicPtion. ` Name: Signa[u CorC6Pu' Date: _ w Addy two LM (Am License: 4,39ILd2V T `t% Phone:h City/State/lip: vvo rcesiaennut i- ompnonce P orms March 2010 Bin #. City of La Quints • . Building 8I• Safety Division P.O.-Box 1504, 78-495 bile Tampico La Quints CA 92253 - (760) 777-7012 ' Building.Permit Application and Tracking Sheet ' Permit # /1 Project Address: 53 Owner's Name: A. P_ Number: Address: Legal Description: >'City, $T, Zip: Project Description: Address City, ST, Zip: 4L)4_ Telephone J 7..7_% 0,47 < t:s?>:;z<z'^ :%c{.>•;>! State Lic. #: ji City Lic. #: '>!" Arch., Engr., Designer: Address: City, ST, Zip: Telephone:,;z Construction Type: Occupancy: K State Lic. #: Project circle one): New Ad 'n Alter Repair Demo Name of Contact Person: Sq. Ft : S60 #Stories: 0 # Uni Telephone # of Contact Person: Estimated Value of Project: ooD APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Pian Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Titre 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan V Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit Issue. School Fees Total Permit Fees ' CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: • . '53%00:•Avenida,Madero , La Quinta CA 92253 City of La Quinta 11-1347 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. , R As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. -- Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement , - ' - Sensors (STMS) _ Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is required for compliance, TMAH are also required for compliance. STMS are only required for completely new or replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in Supply and Return Plenums of Air Handler • . - .w, { System Name or Identification/Tag System 1 System Location or Area Served Whole House 1 V Yes No 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 v Yes No 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum and labeled according to Figure in Section RA3.2.2.2.2. Yes to 1 and2 is a pass., • J, Enter Pass or FailF ✓ ✓ Pass ✓ Fail, STMS Sensoron*the.Evaoorator Coil- System Name"or•;Ident fication/Tag ), !*= '. "System 1 3 Yes No The sensor is factory installed, or field installed -according to manufacturer s specifications, or isinstalled by rn} ethods%specifications approved by the Executive No specifications, or is installed by methods/specifications approved by the Executive Director. l.:rr.". Director. i Yes 'N ,The sensor wire s term inatedfwith a standard mini plug suitable for connection, to a•`< 4 digital thermometer. The sensor mini plug is accessible to the installing technician tJigital thermometer .The sensor:mmrplugsis aeeessible to the.installmg tecK ian' .s • .. z, , and the'HERS'rat6'ithout changing the airflow through the condenser coil 5 Yeses. -w No When attached to a digital thermometer, the sensor provides an indication of the saturation temperature of the coil. saturation temperature of the coil. ' Yes to 31 4, and 5 is a pass. Enter N/A if STMS are not applicable. Otherwise enter Pass or`:'Feil' ✓ ✓ N/A ✓ Pass ✓ Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag System 1 - The sensor is factory installed, or field installed according to manufacturer's 6 Yes No specifications, or is installed by methods/specifications approved by the Executive Director. i The sensor wire is terminated with a standard mini plug suitable for connection to a 7 Yes No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil • 8 Yes No When attached to a digital thermometer, the sensor provides an indication of the saturation temperature of the coil. Yes to 6, 7, and 8 is a pass.'Enter N/A if STMS are not V N/A ✓. Pass ✓ Fail applicable. Otherwise enter Pass or Fail , Reg: 211-A0067288A-M2500001A-M25A Registration Date/Time: 2011/12/29 01:18:05 HERS Provider: CalCERTS, Inc. - 2008 Residential Compliance Forms •f , art d%'; '+ w March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: 53-600 Avenida Madero , La Quinta CA 92253 City of La Quinta 11-1347 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 ti Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. ' • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. • if outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. - Space Conditioning Systems System Name or Identification/Tag System 1 (must be re -calibrated monthly) . System Location or Area Served Whole House '` ,. ' _ $7"' f::#. ,.c: mss, m;r' ,.i. Outdoor Unit Serial # E104110270 ` Outdoor Unit Make Day & Night Outdoor Unit Model IC4648GKd 4 t.r Nominal Cooling Capacity Btu/hr "t ,r 48000 • , Date of Verification `" ` 12/28/11 a,dnorduon or ulagnoscic lnscrumenis . . 11 Date of Refri Brant Gau a Calibration 9 9 11/30/11 (must be re -calibrated monthly) . Date of Thjerfmo oupleCelibration /'a 1%30/31 ^(must-be '` ,. ' rea alibrateti monthly) $7"' f::#. ,.c: mss, m;r' ,.i. k"<i`3 .a l . i '.• ..._"`; i'`.#'. .._ measurea iemperacuresg( .yrz). ,P 4,4F V,: U_v ae:i >r 411,4—K %001.1, • , System Name or Identificahion/Tagg System Supply (eva{orator leaving)`air dry fiulb K53 temperature(Tsu l db),;' PP y. ` Return (evaporatoe. entering) air dry=bulb 76ret temperature'-ff-urn; db) • • , Return (evaporator entering) air wet=;bulb 54 temperature (Treturn, wb) '+ - Evaporator saturation temperature : 43 (Tevaporator, sat) Condensor saturation temperature 83 (Tcondensor, sat) Suction line temperature (Tsuction) 51.3 ti ' r Liquid Line Temperature (Tliquid) 71.8 _ Condenser (entering) air dry-bulb 77 temperature (Tcondenser, condenser, db) _ y • J Reg: 211-A0067288A-M2500001A-M25A Registration Date/Time: 2011/12/29 01:18:05', HERS Provider: CalCERTS, Inc.' 2008 Residential Compliance~ Forms ," - ._•r_ March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-2S Refrigerant Charge Verification - Standard Measurement Procedure. (Page 3 of S) Site Address: Enforcement Agency: Permit Number: 53-600 Avenida Madero , La Quinta CA 92253 City of La Quinta 11-1347 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,' 23.00 db - Tsupply, db Target Temperature Split from Table RA3.2-3 23.4 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - -0.4 Target Temperature Split = , Passes if difference is between -4°F and +4°F or, , upon remeasurement, if between =4°F and ' PASS t. -100°F a V 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 orIdentification/Tag`X, r• ` s„f r Calculated Minimum Airflow Requirement (CFM) ••> aef L. ...r. !e-x+•" ' :a d114h +?. , P' • a P , AW Measured AirFlow usrng RA33 procedures (CF,M) r , Passes if measured airflow is great&,than or equal to the calculated minimum airflow - n requirement--" '.. 11` Enter;Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag" ' Calculate: Actual Superheat = Tsuction - Tevaporator, sat Target Superheat from Table RA3.2-2 using Treturn, wb and Tcondenser,'db Calculate difference: Actual Superheat - Target Superheat = System passes if difference is between -6°F and r+ 6°F i Enter Pass or Fail a L Reg: 211-A0067288A-M2500001A-M25A Registration Date/Time: 2011/12/29,01:18:05 : HERS Provider: Ca10ERTS, Inc., 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 53-600 Avenida Madero , La Quinta CA 92253 1 City of La Quinta 11-1347 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 = 11.2 Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer 12 Calculate difference: -0.8 - Actual Subcooling - Target Subcooling = System passes if difference is between PASS>' a' " ,. -4°F and +4°F PASS r1 i Enter Pass or Fail Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag;: F System 1 Calculate: Actual Superheat= 4"rte Tsuction - Tevaporator, 8.3 sat' Enter allowable superheat range frdm. .. manufacturers specifications (or usF range 8.3 ' between 3°F and 26°F if manufacturer's specification is not available) System paSS&s if actual superheatAMithiWfhe r allowable superheat range", PASS>' a' " ,. :EntessorFa l r1 i i !o r a 7- • :fir a a • b.-. $ ata 't}... ! ... 34 Reg: 211-A0067288A-M2500001A-M25A `Registration Date/Time: 2011/12/29 01:18:05•, HERS Provider: CalCERTS,•Inc. 2008 Residential Compliance Forms; March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-2S Refrigerant Charge Verification - Standard Measurement Procedure (Page S of S) Site Address: Enforcement Agency: Permit Number: 53-600 Avenida Madero , La Quinta CA 92253 City of La Quinta 11-1347 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 1438781 HERS Provider Data Registry Information Sample Group # (if applicable): N/A System meets all refrigerant charge and airflow not-tested/verified dwelling in la HERS sample group requirements. PASS Air Solutions of the Desert Responsible Rater's Name: Responsible Rater's Signature: Enter Pass or Fail Walter W Nellis Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 12/28/2011 CC2004361 a DECLARATION STATEMENTS ?' . 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, co"mp 6nent, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified , on the Certificate(s) of Compliance (CF -1R) approved by the local enforcement agency. . The information reported on applicable sections of the Installation Certificate(s) (CF -611), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -IR) approved by the , ' enforcement agency. r Builder or Installer information as shown on the Installation Certificate (CF -6111) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) COOL-FLO INC Responsible Person's Name: CSLB License: MICHAEL MANGAN 1438781 HERS Provider Data Registry Information Sample Group # (if applicable): N/A tested/verified dwelling not-tested/verified dwelling in la HERS sample group HERS Rater Information CalCERTS Certificate # CCl-1798618087 HERS Rater Company Name: Air Solutions of the Desert Responsible Rater's Name: Responsible Rater's Signature: Walter W Nellis Walter W Nellis Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 12/28/2011 CC2004361 Reg: 211-A0067288A-M2500001A-M25A Registration Date/Time: 2011/12/29 01:18:05 HERS,Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 'd 7. CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-21 Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: 53-600 Avenida Madero La Quinta CA 92253 (System Enforcement Agency: Permit Number: , 1) City of La Quinta 11-1347 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 requirec space conditioning systems and duct ations and additions in existing dwellings to I 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 Optipns 1, 2, or 3 must be attempted, be fore, utilizing Option,,), "Wow - Determine non5inal'F6fi Flow using 6n& ofithefoIlowirig, three'calculation methods ,N! ✓ ✓ Cooling system method: Size of condenser in Tons" x 400'— 1600 CFM'% "" ^ ✓ Heating;system 7-x Output Capacity methodg21 mThousands'A. of Bt hr = CFM-•- `es" ✓ Measuredsystem airflo,NsingRA3 3airFlowtest;procedu CFM . Option i,used then: 1 Allowed leakage — Fan Flow 1600 x 0.15 = 240 CFM. , Actual,Leakage';, 135 CFM y r- -Allowed ' Pass if Leakage Actual is less than Pass Fail Option 2 used then:,, 2 Allowed leakage = Fan Flow " x 0.10 = _ CFM ' I 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' t, ' _ ((Leakage reduction _ / Initial leakage _) x 100% _ /6 Reduction ,. ` Pass if % Reduction > 60% " Pass Fail Option 4 used then: 4 All accessible leaks repaired using smoke. HERS rater must verify (No sampling). No smoke allowed to leak from system. Including ducts, plenums, air handler and door panel. Pass if all accessible leaks have been repaired using smoke Pass Fail Reg: 211-A0067288A-M2100001A-M21A. Registration Date/Time: 2011/12/29 01:16:06. HERS Provider: CalCERTS, Inc.' 2008 Residential Compliance Forms,. March 2010 ,,,/// i .F w In N - • •} : r i t• Y .-t if N••• _• I CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-21 Duct Leakage Test - Existing Duct System (Page 2 of 2) Site Address: 53-600 Avenida Madero La Quinta CA 92253 (System Enforcement Agency: Permit Number: #. , , 1) City of La Quinta 11-1347 V Outside air (OA) ducts for Central Fan Integrated (CFI), ventilation systems, shall not be sealed/taped off Ys' 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 v All supply and re tirn register boots m.ust'be sealed to the"'drywall If,smoke test Is utilized for compliance , - applies to duct leakage compliance option 3 (leakage reduction+by 60%) a' &6` 1 tion 4 (fix all"accessible leaks) described above'" New duInstallatlons cannot utilize bulldln g cavltlesxasplenurns or p ct'latfoem r tUrnsiln Ileu of dts V Mastic and draWbands must be used in -combination wltFi'cloth backed`rubber'adhesive duct'tape to seal leaks at all new duct connections' F DECLARATION STATEMENT,- - . I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. . I am the certified HERS rater who, performed the verification services identified and reported on this certificate (responsible rater). r . The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the local enforcement agency. . The information reported on applicable sections of the Installation Certificate(s) (CF -611), signed and submitted by the person(s) , responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the enforcement agency. Builder or Installer information as shown on the Installation Certificate (CF -6R) _ Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) COOL-FLO INC Responsible Person's Name: CSLB License: MICHAEL MANGAN 1438781 HERS Provider Data Registry Information Sample Group # (if applicable): N/A tested/verified dwelling ted/verified dwelling in FaHEORSsample group HERS Rater Information CalCERTS Certificate # CC1-1798618087 HERS Rater Company Name: Air Solutions of the Desert Responsible Rater's Name: Responsible Rater's Signature:i Walter W Nellis Walter W Nellis Responsible Rater's Certification Number w/ this HERS Provider: Date Signed:,12/28/2011 CC2004361 , • s ' Reg: 211-A0067288A-M2100001A-M21A Registration Date/Time: 2011/12/29 01:16:061• HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March'2010 ` t • ` - '- . i., • .1 /v • '° it 4= . + .. I _- .e•. • r+5 ": •} , r ri Jay ,.' . x 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 Y , 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. _ • - 1. • Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement " Sensors (STMS) Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is required for compliance, TMAH are also required for compliance. STMS are only required for completely new or: replacement space -conditioning systems that utilize prescriptive compliance method. TMAH Access Holes in Supply and Return Plenums of Air Handler System Name or Identification/Tag System 1 , System Location or Area Served - Whole House 1 Yes No 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and 4 labeled according to Figure in Section RA3.2.2.2.2. 2 ✓ Yes No 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum No 17he sensor measures the saturation temperature of the coil within 1.3 degrees F Yes tc 3,-4;,and 51s a' -pass. Enter N/A:if STMS are not applicable. Otherwise enter Pass or' Fail and labeled according to Figure in Section RA3.2.2.2.2. Yes to 1 and 2 is a pass. Enter Pass or Fail ✓ ✓ . Pass ✓ , Fail STMS- Sensor on.the Evaporator Coil System'Nameao'r Identification/Tag j .-,,,,! ,,a.. `Systemgl - ` - j :' . ,114 a "Yti, r 3 Yes 1 No;, ; The sensor is factory installed, or,field,i nstalied according to°manufacturer s spe-ifications, or is installed by methods/"specifications'approved by the Executive 4 ;Yes ,, No The sensor were is terminated with a standard miniplug suitable for connectiion'fd a digital`thermo -hdter The,,sensor;mini plug is accessible to the installing,tee an and the HERS ater.without changirig the airflow through the condenser coil 5Yes ' No 17he sensor measures the saturation temperature of the coil within 1.3 degrees F Yes tc 3,-4;,and 51s a' -pass. Enter N/A:if STMS are not applicable. Otherwise enter Pass or' Fail V N/A ✓ Pass ✓ Fail .. ', aFP - • STMS - Sensor on the Condenser -coil . System Name or Identification/Tag I System 1 • The sensor is factory installed, or field installed according to manufacturer's 6 Yes No specifications, or is installed by methods/specifications approved by the Executive . Director. ` The sensor wire is terminated with a standard mini plug suitable for connection to a 7 Yes, No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 8 Yes No IThe sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not V ✓ N/,q ✓ Pass T— ✓ — Fail applicable. Otherwise enter Pass or Fail , T. L r .. Reg: 211-A0067288A-M2500001A-0000 Registration Date/Time: 2011/12/29 00:54:45 HERS Provider:,CalCERTS, Inc. 2008 Residential Compliance Forms _ August 2009 ti • • r .. • r ' ', r. . ' ^ "" t S ,.' l.4 1.- Vit, ., _"` A+ F INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page Site Address: Enforcement Agency: Permit Number: Y X 53-600 Avenida Madero , La Quinta CA 92253 City of La Quinta 11-1347 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 F, ` any additional systems in the dwelling as applicable. ; • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. ' • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. • If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Systems System Name or Identification/Tag System 1 r, r System Location or Area Served Whole House % 130 it ` £" (must be recalibrated monthly) •,}, .. . .:'^` f $ ice. = ` Outdoor Unit Serial # • SE104110270 r Outdoor Unit Make Dat & Night Outdoor Unit Model IC4648GKD ; Nominal Cooling Capacity Btu/hr 48000 temperature (Treturn, wb) ' ; I + Date of Verification f' " 12/28/11 t.anurauun uruiaanustic instruments DateofRefrigerant Gauge Calibration',. 11/30/11 (must be re -calibrated monthly) Date of Thermocou Ie CalibrationV P/ M % 130 it ` £" (must be recalibrated monthly) •,}, .. . .:'^` f $ ice. mt:dbureu> remueratuuC!iA ,r.1 _ 4es; x .& 4 IK.. :, 7 W -0-r, ) .:r V 1 _:, A System Name or Identification/Tad,rJ. System T Supply (evaporator leaving) air dry-bulb-%," pit =z 53 $,1, = ` temperature (TsuPPIY, db) '"• r Return (evaporator entering) air dry-bulb 76 temperature T s' re ; Return (evaporator entering) air wet -bulb 54 temperature (Treturn, wb) ' ; I + Evaporator saturation temperature r 43 (Tevaporator, sat) Condensor saturation temperature 83 (Tcondensor, sat) Suction line temperature (T ) suction 51.3 - 4 , Liquid Line Temperature (Tliquid) 71.8 Condenser (entering) air dry-bulb 77 temperature (Tcondenser, db) Reg: 211-A0067288A-M2500001A-0000 Registration Date/Time: 2011/12/29.00:54:45' HERS Provider: CalCERTS, Inc.• 2008 Residential Compliance Forms August 2009 F INSTALLATION CERTIFICATE CF-611-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number_: 53-600 Avenida Madero , La Quinta CA 92253 1 City of La Quinta 11-1347 Minimum Airflow Requirement r y. ,.s. ` t 1 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, 23.00 db - Tsupply, db ' w Target Temperature Split from Table RA3.2-3 23.4 using Treturn, wb and Treturn, db ' ' Calculate difference: Actual Temperature Split - -0.4 Target Temperature Split = ' Passes if difference is between -3°F and +3°F or, upon remeasurement, if between -3°F and PASS y -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 CFM uirement Re q (CFM) =Nominal Cooling Capacity (ton) X 300 (cfm/ton) ` System Najyme or Idi ratification/Tag Systemic° ` •r p Calculated Minimum Airflow Requirement'{CFM) Y ` r Measured Aiflow using RA3 3 procedures (C,FM) it' Passes if measured': airflow is greater thamor' equal to the calculated minimum airflow requirement.,.'r.,:,; , Enter Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device "systems System Name or Identification/Tag System 1 ' Calculate: Actual Superheat = Tsuction - Tevaporator, sat w Target Superheat from Table RA3.2-2 using Treturn, wb and Tcondenser, db ' Calculate difference: Actual Superheat - Target Superheat = ' System passes if difference is between -5°F and +5°F y Enter Pass or Fail ' ' Reg: 211-A0067288A-M2500001A-0000 Registration Date/Time: 2011/12/2.9 00:54:45 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms `.; August 2009 ' :. Reg: 211-A0067288A-M2500001A-0000 Registration Date/Time: 2011/12/2.9 00:54:45 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms `.; August 2009 t { rF.Ji J 5y 9,, • w 1-' e' aC•'1N/r Vic. +• { INSTALLATION CERTIFICATE I CF-6R-MECH-25-HERS Refrigerant Charge Verification- Standard Measurement Procedure • (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 53-600 Avenida Madero , La Quinta CA 92253 City of La Quinta 11-1347 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 a Calculate: Actual Subcooling = 11.2 J Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer 12 Calculate difference: -0.8 ; > Actual Subcooling - Target Subcooling = System passes if difference is between ° e PASS' -3°F and +30F,.• PASS r t 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 i a Calculate_ Actual Superheat,= , 8.3 suction evaporator, sat` ` Enter allowable superheat range from„' ;• manufacturer's specifications (or use range 8.3 between 4°F and 259E if manufacturer's ; _ specification is not available) System passesif actual superheat is within the allowable superheat range , s= e PASS' EnterPass orFail J,I J 4 r J' 3' AR 41 Reg: 211-A0067288A-M2500001A-0000 -Registration Date/Time: 2011/12/29.00:54:45 HERS Provider: CalCERTS; Inc. 2008 Residential Compliance Forms %, August 2009 w ' S •tom- + *` , i • z . INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS '' '•''.•f i I f- tefrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) `«x' Site Address: Enforcement Agency: Permit Number: 53-600 Avenida Madero , La Quinta CA 92253 City of La Quinta 11-1347 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: , Position With Company (Title): System meets all refrigerant charge and airflow 12/28/2011 Is this installation monitored by a Third Party Quality , requirements. PASS Enter Pass or Fail F t , r' ) r • , , ¢ `•*C d q , ' p ' .e Yc'• L nom+ 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 featums,`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 i 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 buildinas. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) COOL-FLO INC Responsible Person's Name: Responsible Person's Signature: MICHAEL MANGAN MICHAEL MANGAN CSLB License: Date Signed: Position With Company (Title): 438781 12/28/2011 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? Yes No Reg: 211-A0067288A-M2500001A-0000 Registration Date/Time: 2011/12/29 00:54:45 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 i • 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. INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS ?, ; " t '''•, Duct Leakage Test — Existing Duct System (Page 1 of 2) 4:,Fix all accessible leaks using smoke and HERS rater verify Notz: (One of Options 1, 2 or 3 must be attempted beforeutilizing Option.,.,) _ s Site Address: 53-600 Avenida Madero La Quinta'.CA 92253 (System Enforcement Agency: Permit Number: ✓ Heating' system method: 21 7 x 0utput Capacity inThousands of Btu/hr = _CFM. .a - , 1 City of La Quinta 11-1347 Option'1°used them, ,Z t _ E _ ..,-• . a 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_60and conduct smoke and fix all leaks ,R 'j 4:,Fix all accessible leaks using smoke and HERS rater verify Notz: (One of Options 1, 2 or 3 must be attempted beforeutilizing Option.,.,) _ s Determine nominal Fan`,Flow usingone of the'followin three scalculation methods. + r tr o°° 9 s # P ✓ Coolliingr®sgystem method: Size of condense"r in Tons 4 x 400 = 1600 CFM' -. . s k .':i.'.. J . [ } ✓ Heating' system method: 21 7 x 0utput Capacity inThousands of Btu/hr = _CFM. .a - ✓ Measured system airflow usmgRA3 3 airflow test procedures = CFM _ I •. Option'1°used them, ,Z t _ E _ ..,-• . a a :._ _. _. _. 1 Allowed leakage - Fan Airflow 1600 x 0.15 - 240 CFM ' Actual Leakage- 135 CFM;.' ' Pass if Actual Leakage is less than Allowed leakage v Pass Fail. Option 2 used thenar.: - , 2 Allowed leakage = Fan Airflow x . x 0.10 = _ CFM ' Actual Leakage to outside i CFM -Pass •,= N.. if Actual leakage to outside is less than Allowed leakage 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 " • ` z. ' '' 3 Initial leakage _ - Final leakage _ = Leakage reduction _ CFM - ((Leakage reduction_/ Initial leakage 1 x 100% _ % Reduction Pass if.% Reduction > 600/0 Pass Fail Option 4 used then: 4 All accessible leaks repaired using smoke test. HERS rater must verify (No Sampling). Pass if all accessible leaks have been repaired using smoke Pass - Fail 's : Y• 4 Reg: 211-A0067288A-M2100001A-0000 ' Registration Date/Time:-2011/12/29,00-:45:-26',. HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Formsf March 2010 * "` 1 F +'" .- ' •}i,. Vii:. i+ i INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test - Existing Duct System (Page 2 of 2) Site Address: 53-600 Avenida Madero .La Quinta CA 92253 (System Enforcement Agency: Permit Number; , 1) City of La Quinta 11-1347 h' V Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage; testing: CFIOA ducts that utilize controlled motorized dampers, that open only when OA a ventilation is required to meet ASHRAE Standard 62.2, and close when Oventilation is not required, may be' configured to the closed positA ion during duct leakage testing. ' V All supply and.:return register boots most be'sealed7to the ;drywall if smoke test Is utilized for: compliance _. , F - , - applies to. duct leakage_comphance option 3 (leakage reduttion by 60%),an&6ption 4 ('flz all.accesslble leaks) described above X x New ductKlnstallatlons cannot utlhze tiuilding cavities as plenums orplatfornreturns inaieuof dcts' Mastic and:drawhbands must be used in corribination`WitH'cI th-backed rubber adhesive'duet tape to.seal leaks at all new duct connections", r 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 -111) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the installation have been met. . I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. 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) COOL-FLO INC Name of TPQCP (if applicable): Control Program (TPQCP)? Yes No • Reg: 211-A0067288A-M2100001A-0000 •Registration Date/Time: 2011/12/29 00:45:26 HERS Provider:.CalCERTS, Inc. 2008 Residential Compliance Forms ` March 2010 Responsible Person's Name: Responsible Person's Signature: MICHAEL MANGAN MICHAEL MANGAN CSLB License: 438781 Date Signed: 12/28/2011 Position With Company (Title): Ps this installation monitored b y a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? Yes No • Reg: 211-A0067288A-M2100001A-0000 •Registration Date/Time: 2011/12/29 00:45:26 HERS Provider:.CalCERTS, Inc. 2008 Residential Compliance Forms ` March 2010 /V 7-E .5- / L z a &,4, pi /f re 01V,444 f6WR511DkS zo &ASWL STIIDS ENTRY GATE DETIAL AL IfTH CITY OF LA QUIN]h C RA -rc--H BUILDING & SAFETY p APPROVED BY COMMIL"i'JITY DEVELOPMENT DEPARTMENT FAPPROVE RUCTI BY : S DATE FOR CONSTRUCTI 6 OL o/? 'M4 P"' EXHIBIT ORIS CASE NO. O UC7 F I 57. L,4 0 of N -r—A—c-A-9-zz- rs -3; 14 11,4At H, - Z,7- Ob S 57. L,4 0 of N -r—A—c-A-9-zz- rs -3; 14 11,4At H, - Z,7- Ob