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13-0594 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description Property Zoning: Application valuation: Applicant: l�v 13-00000594 52505 AVENIDA RUBIO 773-282-013-1 -000000- MECHANICAL COVE RESIDENTIAL 18879 c&'4t 4 4 a" I �../ BUILDII\G R SAFETY DEPARTMENT BUILDING PERMIT Owner: DANIEL TWONEY 52505 AVENIDA RUBIO LA QUINTA, CA 92253 ( Architect or Engineer: LICENSED CONTRACTOR'S' DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and ofessionals Code, and my License is in full force and effect. License Class: CIO C16 C2 Licen 75 4 Date:© b 'Comractor: i ' OWN& -BUIL ER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the i following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the . permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter -9 (commencing with Section 70001 of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for.the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: 1 _ 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 Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.l. (_ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). 1 1 I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.1. Lender's Name: Lender's Address: I Ill 4k LOPE RA1IT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Contractor: PREFERRED PLUMBING/i A/C d P.O. BOX 5120 Q PALM SPRINGS, CA qq23 (760)322-317; MAY G V 3��� Lic. No.: 457554 Date:. 5/08/13 --------------------------------- ---- ----- WORKER'S COMPENSATION DECLARATION I hereby. affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ,'have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier EVEREST NATL Policy Number 7600006445131 I. certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to come subject to the workers' compensation laws of California, and agree that, if I should b o e subject to the workers' pensation provisions of Section 3700 of the Labor Code, It forthwith comp) ith os pro 'ions. Dat—Cif!�APpli WARNING: FAILURE TO SECURE WORKERS' CO SA ION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 1$100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE -LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1.' Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and stale that the above information is correct. ee to comply with all city and county ordinances and state laws relating to building truction, an,der� re au rt a representatives of this county to enter upon the above-mentioned property r ' spection pupos Date;�Signature (Applicant or Agentl. Application Number . . . . . 13-00000594 Permit . . . . . . MECHANICAL Additional desc . Permit Fee 51.00 Plan Check Fee 12.75 Issue Date Valuation . . . . 0 Expiration Date 11/04/13 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 9.0000 EA MECH FURNACE <=100K 18.00. 2.00 9.0000 EA MECH B/C:<=3HP/100K BTU 18.00 ---------------------------------------------------------------------------- Special Notes'and Comments REPLACE (2) 3.5 TON 16SEER/80AFUE SYSTEMS. [2008 ENGERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLE DPRIOR TO FINAL `.INSPECTION. 2010 CALIFORNIA BUILDING CODES. Other Fees . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited Due Permit Fee Total 51.00 .00 .00 51.00 Plan-Check'Total 12.75 .00 .00 12.75 Other Fee Total 1.00 .00 .00 1.00 Grand'Total 64.75 .00 .00 64.75 Bin # Permit # .�.. .:a City of La Quints Building U Safety Division P.O. Box 1504, 78-495 Calle Tampico .':. La Quints, CA 92253 - (760) 777-7012 R. '.t st•Jr 4... .Building Permit Application and Tracking Sheet Project Address:`°.:.­ye., ,�! /%9 U Owner's Name: A P. Number::.. Address: Legal De of phon :;'... ' 'r,' : ,s::'. °:: ... City, ST, Zip �fi 01/w 7,4.. C aZas3 �refer.edConditioning dbii Con etor.Pre.fer..rec Y:P b*mbin • Heatin &Ai Telephone: P % Addiess: PO::.:B.o '.5;;11:0.', Y Project Description: City,ST,Z�pI?alzi►P`rings;...CA,. �226� �r,4� Cfs GON/,i67N5a" Telephone (7317 3MM V_ CO/ 1S State Lie. #: 4;7^5'5`4 Arch.; Ei1gr:; I)eWer ; City Lic. #: S % S> 3, 5� 7,N Address:. City" ST" Zip:.: ,.' •::,;.:,: ..V.. - State-Li pc # .._ % :` `:'; .::. ;'; _`.'_ '' :.. Constriietion Type: Occupancy: ProjecYtype (circle one): New Add'n Alter Repair Demo Name of,Col tact;EeFsom ,.T . �e''h Yews Sq. Ft: #Stories: #Units: Telephone#'o ;ConfactPe son 76,6Z 3 9,2 — 3/73 Estimated Value of Projectg 79 APPLICANT: DO NOT WRITE BELOW THIS LINE # . •$ubrrilttal; `::'.< .•, . Reg'd Reed TRACKING ° FERNMFEES Plan.Sets:- . ''.: .; Plan Check fliftitted Ite Amount Structfirsl'Caio.. Reviewed, ready for corrections Plai Check Deposit TrussCaics.. Called Contact Person Plar Check Balance E4eigY Calcs.: Pians (licked up Con traction Flood PIR in plan. , Plans-resubmitted Me anlcal Gradingphin' 2"a Review, ready foi-'correctiouVissue Elec trical 5ubc6nta6tor.LIA Called Contact Person Flur thing Grant Deed.' Plans picked up S.M L g.0 A Approval Plans resubmitted Gra ing INHOUSE:- 'nd Revlew, ready for correctionsrssue Dev Loper Impact Fee FlanningApprbval. Called Contact Person AM I.P. Pub. Wks. Appr ' Date of permit issue School Fees Tot Permit Fees - Sim lifted Prescri tive Certificate of Corh fiance: 2008 Residential HVA C Alterations CF -IR -ALT -HVAC Climate Zones 10 to 15 o Cut in or Changeout with new CF -6R forms: MECH-04, MECH-20-HERS;and (for split systems) NIECH-22-HERS, and MECH-25-HERS ducts: (all new ducting and all new equipment) CFVR forms: MECH 20-, and (for split systems)MECH-22, and MECH 25 For Split Systems: Duct leakage < 6 percent; RC, CCA > 350 CFM/ton, FWD, TMAH, SIMS, and either HSPP or PSPP. For Packaged Units: Duct leakage < 6 percent ❑ 3. New Ducts with Replacement Required Forms; ® Includes replacing or installing all new ducting CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS and/or outdoor condensing unit and/or indoor CF -4R forms: MECH-20 and (for split systems) MECH-25 coil and/or furnace. Not all equipment changed. For Split Systems: Duct leakage < 6 percent, RC, CCA >_ 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent ❑ 4. New Ducting over 40 feet Required Forms: o Includes adding or replacing more than 40 linear feet of duct in unconditioned space. CF -6R forms: MECH-04, MECH-21-HERS CF -4R forms: MECH-21 For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos Contractor (Documentation Author's /Responsible Designer's Declaration Statement) o I certify that this Certificate of Compliance documentation is accurate and complete. o I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design idehtified on this Certificate of Compliance. I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance con rm to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations. The design features identified on this Certificate of Compliance are consistent with the inform on documented' on other plica le compliance forms, w s eets, calculations plans and s ecifications submitted to the enforcement agency for approval with ermi ti Name: Te Fr- L_ Signature: Company: Date: Address--- ddress: License: City/State/Zip: _P. 1529=106s, CA- Q ZZ O -3 Phone: '3H30— 5 Zz – 3 oueI auress: -Worement A encs: I Date:. Lb EQ Permit #: Equipment T ' o d boned Floor List Minimum Efficient Duct insulation reguirement Area Thermostat ❑ Packaged Unit Furnace UE rf 56 p Cop Over 40 ft of ducts added or nletback ndoor Coil ondensing Unit EER ❑ HSPF replaced in unconditioned space erv�eA by system VEER ❑Resistance ❑ R 6 (CZ 10-13) sf (If not already must be ❑ Other ❑ R 8 (CZ 14-15) present, installed) L Equipment Type: Choose the equipment being installed,• if more than one system, use another CF -IR -ALT -HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems. HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options: Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fact the work completed by the installer. The inspector also verifies that each appropriate, CF -6R and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and si 012LBeginning October 1, 2010, a registered copy of the, CF-1Rand CF -6R shall also be on site for final inspection. 1. HVAC Changeout Required Forms: ® All HVAC Equipment replaced CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS CF -4R forms: MECH- 21 and fors lits stems MECH-25 ® Condenser Coil and/or ® Indoor Coil and/or CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS e Furnace CF -4R forms: MECH- 21 and (for split systems) MECH-25 For Split Systems: Duct leakage < 15 percent; RC, CCA >_ 300 CFM/ton(Minimum Air Flow Requirement), TMAH For Packaged Units: Duct leakage < 15 percent Exempted from duct leakage testing if: ❑ 1. Duct system was documented'to have been previously sealed and confirmed through HERS verification, or ❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or ❑ 3. Existing ducts stems are constructed, insulated or sealed with asbestos ❑ 2. New HVAC System Required Forms: o Cut in or Changeout with new CF -6R forms: MECH-04, MECH-20-HERS;and (for split systems) NIECH-22-HERS, and MECH-25-HERS ducts: (all new ducting and all new equipment) CFVR forms: MECH 20-, and (for split systems)MECH-22, and MECH 25 For Split Systems: Duct leakage < 6 percent; RC, CCA > 350 CFM/ton, FWD, TMAH, SIMS, and either HSPP or PSPP. For Packaged Units: Duct leakage < 6 percent ❑ 3. New Ducts with Replacement Required Forms; ® Includes replacing or installing all new ducting CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS and/or outdoor condensing unit and/or indoor CF -4R forms: MECH-20 and (for split systems) MECH-25 coil and/or furnace. Not all equipment changed. For Split Systems: Duct leakage < 6 percent, RC, CCA >_ 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent ❑ 4. New Ducting over 40 feet Required Forms: o Includes adding or replacing more than 40 linear feet of duct in unconditioned space. CF -6R forms: MECH-04, MECH-21-HERS CF -4R forms: MECH-21 For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos Contractor (Documentation Author's /Responsible Designer's Declaration Statement) o I certify that this Certificate of Compliance documentation is accurate and complete. o I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design idehtified on this Certificate of Compliance. I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance con rm to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations. The design features identified on this Certificate of Compliance are consistent with the inform on documented' on other plica le compliance forms, w s eets, calculations plans and s ecifications submitted to the enforcement agency for approval with ermi ti Name: Te Fr- L_ Signature: Company: Date: Address--- ddress: License: City/State/Zip: _P. 1529=106s, CA- Q ZZ O -3 Phone: '3H30— 5 Zz – 3 ,CERTIFICATE'OF FIELD VERIFICATION AND``DIAGNOSTICTESTING ;, CF=4R-MECH-21 Duct:Leaka a Test- Existhn ;DUCt S'' M'. •= Pa e l of 2 Site Address:'- 52505 Avenida Rubio Rancho Mimge•CA'92253. .•: [EhforiiriieritAgency: Rancho'Mirage; city.,,o ! Permit Number: 13-594 Enter the Duct System Name or Identification/Tag: Enter the Duct System' Location or Area Served: Note: Submit one Installation Certificate for each duct.,system that must demonstrate compliance in the dwelling. This installation certificate is requiredfor compliance for alterations and additions,in existing dwellings to space conditioning systems and duct systems. Note: For existing dwellings, .a completely new or,replacemerit. 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 ducts stem Select one compliance, method frof the following four choices. ❑ Option 1. Measured°leakage les's than 15% of Fan'Airflow., at r 700 ❑ Option Zasu�Wd1le�`akage�tWrou�tstdeles_s�anllo�fI a'�n A�rflo . ❑ Option 3. tteduce=leakage<by 60m'ore'VdoaB/duct smokestesCall accessibls e lea 0� ttIt �� ❑ Option 4 -FAM accessible lest verify on 4;) Note: (Opt l�must be attempt�d,b�efo�reu�tihzng Option t s. a ?5447 .�Cy 7!' "Y iAI�$ # �...,g, Y� Determine nominal«F,an Air�flow usri�ng�yyone o the following three calculation methods F w ` ❑ Cooling systerri method Size of condenser m Tons¢x 400r FM; ❑'Heating system, method: 21 7�x. = Heating Output Cap city (ktstuh# n CFM; ❑ Measured system airflow using RA3.3 airflow test procedures: CF h Option 1 used -then: - Allowed leakage= Fan Airflow x 0:15 = CFM 1 Actual leakage= CFM Pass if Actual leakage is•less than Allowed -leakage ❑ Pass ❑ Fail Option 2 used then: Allowed leakage = Fan Airflow x 0.10 = CFM 2 Actual leakage to outside = CFM Pass if Actual'leaka a 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 3 Initial leakage -Final leakage = Leakage reduction . CFM (Leakage reduction /Initial leakage `• ) x 100% = % Reduction,, Pass -if % Reduction > 60% ❑ Pass ❑.Fail Option 4 used then: All accessible leaks repaired using smoke test. HERS rater must verify (No, sampling),. 4 Pass if all accessible leaks have been sealed using Smoke Test ❑ Pass ❑ Fail Registration Number: 313-A0015856A-M2116526A-M21A •`'Registration DatelPme: 06/25/201320:5.6:07 HERS Provider: CBPCA 2008 Residential Compliance Forms August 2009 l CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test — Existing Duct System (Page 2 of.L Site Address: I Enforcement Agency: Permit Number: 52505 Avenida Rubio Rancho Mirage CA 92253 1 Rancho Mirage, City of 13-594 ❑ Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testing, Cyto A duds that u�tlizleoti°jdr�lotlt*datrnpersthat )en only when OA ventilation is required to meet ASH]i 1y �andardr52t2, andjcloseLLw�_ben O veg4lat)j "" not req.tured mmay be cQ.F,' �tp� a closed position during duct leakage'testing. ❑ All su I and return re tster'boi — ots 1qt be sea edlto the 1%--4 `l Isinok test s u i 'zed or com li"cI a lies to PP Y � � g � I . _. _� � J �P , U PP duct leakage compliance option -3 (leakage reduction by 600X and option 4fix all accessible leaks) described above. ❑ New duct installations cannot utilize building cavities as plenums or platform're"turns in lieu of ducts. ❑ Mastic an --�r d draw bands mus be used in co-�mbination with Ic cth backed/rubber�adh�ve-duct tape to seal leaks at all new U4- duct connections. L ��`. DECLARATION STATEMENT rt • I certify under penalty of perjury, under the laws the State,of California, the m�foation providen this form is true and correct. • I am the certified HERS rater who performed the verification services identified and reported on thiscertificate (responsible rater). • The installed feature, material, component, or manufactured device requiring HERS verific tion that is _L -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 -1 R) 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 -h R) approved by the enforcement agency. Builder or Installer information as shown on the Installation Certificate CF-611 Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Preferred Plumbing and Air Conditioning Responsible Person's Name: CSLB License: Patti o'toole 1457554 HERS Provider Data Registry Information Sample Group # (if applicable): ❑ tested/verified dwelling 0 not-tested/verified dwelling 313-0144 in a HERS sample group HERS Rater Information HERS Rater Company Name: John Henry's HERS Responsible Rater's Name Responsible Rater's Signature John D Henry John Henry Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 1095756 6/25/2013 Registration Number: 313-A0015856A-M2116526A-M21A Registration Dale/Time: 06/25/201320:56:07 HERSProvider: CBPCA 2008 Residential Compliance Forms August 2009 CERTIFICATE OF FIELD VERIFIC•AT,ION AND: CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5 Site Address: Enforcement Agency:Permit Number: 52505 Avenida Rubio Rancho Mirage CA 92253 Rancho Mirage, City of Fn94 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 forms) 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. • /f outdoor air dry-bulb is 55 *For below, the installer must use the Alternate Charge Measurement Procedure. SnaCe Conditioning Svstems System Name or Identification/Tag a ', (must be re -calibrated monthly) �Gauge- System Location or Area Served rte; Date of Thermocouple Calibration Outdoor Unit Serial # temperature (Tsu I , db) Outdoor Unit Make Return (evaporator entering) air dry-bulb Outdoor Unit Model temperature (Tretum, db) Nominal Cooling i�kCapacity Brr r�,r `' rt,. CS n, n n D*. rm .se,: "! , a,•nr � Date of Verificat on b 11 --el U U % U 11 b Ans if riU Calibration of Dingnnstic-instruments Date of Refrigerant Calibration a ', (must be re -calibrated monthly) �Gauge- rte; Date of Thermocouple Calibration (must be re -calibrated monthly) temperature (Tsu I , db) Measured TemnP..rntnreS (°F) [ti System Name or Identification/Tag Supply (evaporator leaving) air dry-bulb temperature (Tsu I , db) Return (evaporator entering) air dry-bulb temperature (Tretum, db) Return (evaporator entering) air wet -bulb temperature (Tretum) wb) Evaporator saturation temperature (Teva orator sat) Condensor saturation temperature (Tcondenson sat) Suction line temperature (Tsuction) Liquid Line Temperature (Tliquid) Condenser (entering) air dry-bulb temperature (Tcondenser, db) Registration Number: 313-AO015656A-M25i6524A-M25A 2008 Residential Compliance Forms Registration Date/Time: 06/25/2013 20:54:27 HERS Provider: CaPCA August 2009 CERTIFICATE' OF .FIELD VERIFICATION AND;,DLAGNOSTIC TESTING . CF-4R-MECH-25: Refri e6nt Ctiar`e.:Verification .Standard`iMeasurement Procedure :' (Page 3 of 5 Site Address: -. 52505 Avenida Rubio Rancho Mirage CAc92253,: Enforcement Agency: • Rancho Mirage;' city of Permit Number: 13-594 Minimum Airflow Requirement Temperature Split Method Calculations foi•. determining Minim•um'; Airtlow4Requirement for Refrigerant Charge Verification. The temperature split method is specified in`Reference'Residential Appendix RA3.2. System Name or Identification/Tag 'Calculate: Actual Temperature Split= . Treturn, db - Tsuppiy, db Target Temperature Split from Table RA3.2-3 using Tretum, Wb and Treturn; db -Calculate difference: Actual :rem perature Split— Target Temperature Split'=. Passes if difference is between -4°F and — , +4°F or upon remeasurement; if between -4°F and -10 �fnt+eranss or Fail 1 d 1. • 0f kl an, e Note: TemperaturlMelbodCal ulatc'IT., i en 1 necessary c �,ctual Coolin°� ocl Acr gas vert ted usin one o the jllke ,�,�f�� iso �g ���: ���juA m,%' f Referenee9Resrdentea 3 airflow measurremenaprocedures pec"fed�cn' .9ppendix;RA3 f gctual coo'[cng e'oclaacrpow is measured, the, value must be equal to or g�rjeat r�¢�than the C, alculated rlltn umvAcrflo*Reguirement in the table below. ,u �. ¢ Calculated'Mtminurit Airflow Requirement (CFMs) Nommal Y s i .. Coohtig�Capacton) 300:(cfm/ton) _X System Name or Identification, Tag Calculated Minimum Airflow Requiremeht,(CFM) _ r Measured Airflow using•RA3.3 procedures (CFM) Passes if measured airflow is greater than or equal to the calculated minimum airflow requirement. Enter Passlor Fail Superheat Charge Method Calculations •for. Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems 4 System Name or Ide.ntification/Tag Calculate: Actual, Superheat = Tsuction — Teva orator sat Target Superheat from Table RA3.2-2 using Tretum wb and Tcondenser .db Calculate difference: Actual Superheat — Target. Superheat= System passes if difference is between . -6°F and +6°F Enter Pass:orFail•, Registration Number: 313-AO015856A-M2516524A-M25A Registration Date/Time: 06/25/2013 20:54:27 HERS Provider: CSPCA 2008 Residential Compliance Forms August 2009 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5 Site Address: Enforcement Agency: Permit Number: 52505 Avenida Rubio Rancho Mirage CA 92253 Rancho Mirage, City of 13-594 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 i� p Lei ,r a Calculate: Actual Subcooling = F7 C '+ �U c" p tore Tcondenser, sat — Tli uid —Tev ratorpsat Target Subcooling specified by 11 tt tJ Enter allowable superheat range manufacturer's specifications (or manufacturer Calculate difference: Actual Subcooling — Target Subcooling = System passes if actual.supetheaf the is witlun System passes if difference is between allowable superheat range -4°F and +4°F Enter Pass or Fail 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 orIdenti cation/ iag t , I f lP#i i III i� p Lei ,r a Calculate: Actual,Su erheat — Tsuction F7 C '+ �U c" p tore n n —Tev ratorpsat 11 tt tJ Enter allowable superheat range manufacturer's specifications (or from use range between YF and 2'6°F if manufacturer's s ecification�'is not available System passes if actual.supetheaf the is witlun allowable superheat range Enter Pass or Fail Registration Number: 313-AO015856A-M2516524A-M25A 2008 Residential Compliance Forms Registration Date/Time: 06/25/201320:54:27 HERS Provider: CBFCA August 2UU9 i CERTIFICATE .OF FIELD VERIFICATION AND: DIAGNOSTIC TESTING CF=4R-MECH=25 Refri Brant Char a Verification.-.Standard;•.1VMeasuremeiit'Procedure (Page 5 of 5 Site -Address:_ 52505 Avenida Rubio; : Rancho Mirage CA 92253 EnforceFiment Agency: Rancho Mirage, City of PermiC Number: 137594 Standard Charge Measurement Summary: System shall pass both. refrigerant charge criteria, metering device criteria (if applicable), and in cooling coil airflow criteria based on measurements taken concurrently during system, operation.. Ifcorrective actions were taken, all applicable verification criteria must be re -measured and/or recalculated. System Name or Identification/Tag Patti o'toole 457554 HERS Provider Data Registry Information Sample Group # (if applicable): System meets all refrigerant.charge-and O not=tested/verified dwelling 313-0144 in a HERS sample group airflow requirements. Enter Pass or Fail HERS Rater Company Name: John Henry's HERS Responsible Rater's Name Responsible Rater's Signature if Bu �: x t 'i a `i vG g A e 4 � t tb. r DECLARATION STATEMENT • I certify under penalty of perjury, ud r the laws oftheEStateofCallfornla, the mformat�onprovlded on th1s form 1s true and correct. • I am the certified HERS rater who:,performed^the Venfication'servicesidentified and reported ?on'thls cemficate>(responsible rater). • The installed. feature, material, component, gr manufacfurp ed device. requiring HERS verification that isdidentified on this certificate (the installation) complies with the applicable requirements.inRBference Residential Appendices12A2 and.RA3°and the requirements specified on the Certificate,(s) of Compliance (CF -1 R) approve'd,by; the local enforcement agency • The information reported on applicable sections of the Installation Certificate(s) (CF -6R), signed and submitted by the person(s) responsible for the installation conforms to the requirements'specified on Certificate(s) of Compliance (CF -IR) 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). Preferred Plumbing and Air Conditioning Responsible Person's Name: CSLB License: ,, Patti o'toole 457554 HERS Provider Data Registry Information Sample Group # (if applicable): 0 tested/verifieddwelling O not=tested/verified dwelling 313-0144 in a HERS sample group HERS Rater Information HERS Rater Company Name: John Henry's HERS Responsible Rater's Name Responsible Rater's Signature John D Henry John Henry Responsible Rater's Certification Number w/ this HERS Provider:- , .:Date Signed: 1095756 6/25/2013 .. 313-A0015856A-M2516524A=M25A '06/25/201320:54:27 CBPCA Registration Number: Registration Date/Time: HERS Provider: 2008 Residential Compliance Forms August 2009 Enter the Duct System Name or Identification/Tag: Enter the Duct System Location or Area Served: Note: Submit one Installation'Cert fcate for each duct system.1hat 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. .: Duct Leakage Diagnostic Test — exikin ducts stem Select one compliance method from•the following four choices. ❑ Option 1. Measured leakage less•than 75%o.of•Fan Airflow:' ❑Option,tiasu�rW' akage�t�o�pideless h�gll(0°ofs�'anA�rfl°w _ r•, ❑ Option 3 Reduce leakage`by 60%:or more a ditconduct smoke test$to�seal all acce'sslble leaks �f Kr�i8i on ❑ Option 4F1l.accesslble leaks us►ng smoke test; andFHBRS later must uenfy Note: (Op 1 1 must,be attempte eforelut lizing,®ptlon 4:),,. Determine noml al FanA���flowusingR`one of,�the follow►ng threecalc lat�on methods ` ❑ Cooling system method Sze oficondensein Tons fix', z 40,0 c {� \ d ❑ Heating system method' 21 7 x Heating{Output Capacity (kBtuh) - a� cw, CFM"' ❑ Measured system airflow using 'RA3 3 airflow t'esttprocedures CFM r w = r �3 Optiom•1 used then: F.T Allowed leakage= Fan.AAow x 0:15 = CFM 1 Actual leakage = 'CFM _ Pass if. Actual leaks e.-iis.less than Allowed leaka e ❑ Pass ❑ Fail Option 2 used then: Allowed leakage = Fan.A rflow . 0. 10 -` CFM 2. Actual leakage to outside = CFM. Pass if.Actual leaks e'.to outside;:is less -than Allowed leaks e,. ❑ Pass ❑ Fail Option 3 used then: Initial leakage prior to start of work= CFM Final leakage after sealing all accessible leaks using smoke test = CFM 3 :.:. Initial leakage -Final leakage = Leakage reduction CFM (Leakage reduction / Initial leakage ) x 100% = %q Reduction `' Pass'if % Reduction > 60% ❑ Pass ❑ Fail Option 4 used then: All accessible leaks'repaired using -smoke test. HERS rater must verify (No sampling). 4 - ' Pass�if all accessible leaks.have'been sealed`usin :Smoke Test' ❑Pass ❑Fail Registration Number: 313-A0015859A-M2116545A-M21A 'Registration Date/Time: 06/25/2013 20:56:07: yERSPrgvider:. 'CBPCA 2008 Residential Compliance Forms August 2009 V CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test — Existing Duct System (Page 2 of 2 Site Address: I Enforcement Agency: Permit Number: 52505 Avenida Rubio Rancho Mirage CA 92253 1 Rancho Mirage, City of 13-594 ❑ Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testing C) O ducts that utili controlled motorized dampers, that open only when OA ventilation is required to rt I t>ili, ! � rt' t+r` rN►C► meet ASHR�E: andard 2r2,and]close Wlidj ,QA,ver�t laUon is not regtured m y be c�onfi ednto,the closed position during duct leakage testing; ,. _—_ I rsrC rl�" i ^�!`� *Vin!++ � r'Ci' /� at +'� � r I�h R� ❑ All supply and return registerlboots t�15"st�be ealed,�to the drywall Rsmoky=testYzts ut' tzed for cy t�pltanca applies to duct leakage compliance option13 (leakage reduction by 60%) -and option 4 fix all accessible leaks) described above. I 5-, � lr' ❑ New duct installations cannot utilize building cavities i; plenums orYc <pldtfortn retu s in lieu of ducts. th' - w % ❑ Mastic and draw bands must be used ri� n combination w th cloth backe .rubber adhesive duct tape to�seal leaks at all new duct connections.-------,/ � - f DECLARATION STATEMENT. er a"--- • I certify under penalty of penury .under the laws_ofthe Stateof California, thefo anon providemthrs form is true and correct. L- • I am the certified 14ERS rater who performed the verification services identified and reported on this, certificate (responsible rater). • The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -IR) approved by the local enforcement agency. • The information reported on applicable sections of the Installation Certificate(s) (CF -6R), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -IR) 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) Preferred Plumbing and Air Conditioning Responsible Person's Name: CSLB License: Patti o'toole 1457554 HERS Provider Data Registry Information Sample Group # (if applicable): ❑ tested/verified dwelling O not-tested/verified dwelling 313-0144 in a HERS sample group HERS Rater Information HERS Rater Company Name: John Henry's HERS Responsible Rater's Name Responsible Rater's Signature John D Henry John Henry Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 1095756 6/25/2013 Registration Number: 313-A0015859A-M2116545A-M21A Registration Date/Time: 06/25/201320:56:07 HER Provider. CBPCA 2008 Residential Compliance Forms August 2009 f CERTIFICATE OF.FIELD VERIFICATtON AND DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification . Standard:Measuremenf;Procedure .(Page 1 of 5 Site Address: EMfU"c tient Agency: Permit Number: 52505 Avenida Rubio Rancho Mirage CA 92253- . Rancho Mirage City of•" '; 13=594.` Note: If installation of a Charge. Indicator Display (CID) is utilized as an alteMative'to.refrigerant charge verification for compliance, a MECH-24'Certificate finstead'of this MECH=25 Certificate) `should be used'to demonstrate compliance with the refrigerant charge verification requirement: TAY 41I andSTMS are,not requiredfor;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 TMA H are specified iii Reference Residential Apperidd RA 3.2.' If refrigerant charge verification is required for compliance, .TMAH are also required for compliance. STMS. are only.required for completely new or replacement space-conditioningsystems that utilize prescriptive compliance method. TMAH -Access Holes in Supply -and Return Plenums of,Air Handler, System Name or Identification/Tag 3 _ r4-1 IWE ,. .; x x System Location or Area Served `"-'=-,rte'•. :. a t ID�af�"'aa�'sr, y a < � •� �• fr - fir-, -' * ,[�'.s aK'•� C '�:z se ,.sM: ' � The sensor �s iTctory installed v'o field ,installeduaccordrn to manufacturer s �. ;" ' .,�.g'�� 3 1 ONo specifications;lor,is installed by ethods/specificattons�approvedbylthe Executive m ° lic,, 5/1 6inch (8,rpm) access hole upstr6.n of evaporative coil in the return plenum and IabeledVa ccording�tq Figu„re:in SectioQjR A3 422 2kv*Aft 2 vw,qiutt ❑Yes r= w M UAW. 10 0 W p QKR DNo .. Fn ".w t� �d 5/1611c (8 mm} access hole downstream of evapora iv coil�ip the supply plenum ;W...o,TFdGCc M'g u.emc.t_i�on .l,��242an3 Yes to 1ra ❑Yes . ❑ Fail STMS - Se=.t '.the Evanora or it ` } W. ^ raa System Nam e�orfica/Tg 3 _ r4-1 IWE ,. .; x x `"-'=-,rte'•. :. a t ID�af�"'aa�'sr, y a < � •� �• fr - fir-, -' * ,[�'.s aK'•� C '�:z se ,.sM: ' � The sensor �s iTctory installed v'o field ,installeduaccordrn to manufacturer s �. ;" ' .,�.g'�� 3 ❑Yes ONo specifications;lor,is installed by ethods/specificattons�approvedbylthe Executive specifications, or is installed by methods/specifications approved by the Executive :'Tvector.- Director... Thesensor w�reas terNmnated with a standard mimpluguitablee'for connection 4 ❑Yes • fix:.' to a ❑No digital thermometer The sensor inmi plug ►s accessible �torthe•mstallingtechnician and 7 ❑Yes the HERS rater without changing the airflow thr.0li, e condenser_`coil 5 ❑Yes ONo • The sensor measures'the saturation temperature of the;coil within 1.3 degrees F Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not applicable. Otherwise enter Pass or Fail ✓ ❑ N/A .% ❑Pass " ✓ ❑Fail STMS - Sencnr an the (nnrtensPr ('nil System Name or Identification/Tag The sensor is factory installed, or field installed according to manufacturer's 6 ❑Yes ❑No specifications, or is installed by methods/specifications approved by the Executive Director... The sensor wire is terminated •with a standard mini plug suitable for. connection to a 7 ❑Yes ❑No digital thermometer.: The sensor mini plug is accessible to the installing technician and the1HERS rater without changing the:airflow through the 'condenser coil 8 ❑Yes ❑No The sensor measures the saturation temperature of the coil)vithin 1.3 degrees F 6, 7, and 8 is a pass: Enter FN/ASTMS are not applicable. Otherwise enter Pass or Fail ✓ ❑ N/A ✓ 0 Pass ✓ ❑ Fail Registration Number: 313-A0015859A-M2516534A-M25A ' Registration Date/Time: 06/25/2013 20:54:28 . HERS Provider: CeaCA 2008 Residential Compliance Forms August 2009 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5 Site Address: Enforcement Agency: Permit Number: 52505 Avenida Rubio Rancho Mirage CA 92253 Rancho Mirage, City of 13-594 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55 °F) Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. • If outdoor air dry-bulb is 55 *For below, the installer must use the Alternate Charge Measurement Procedure. Snace Conditioning Svstems System Name or Identification/Tag (must be re -calibrated monthly) � ��� �. System Location or Area Served Date of Thermocouple Calibratlo�nt musbe re -calibrated monthly) Outdoor Unit Serial # temperature (Tsu I , db) Outdoor Unit Make Return (evaporator entering) air dry-bulb Outdoor Unit Model temperature (Tretum, db) Nominal Cooling Capacity Btu/hr;,, - s r r 2t"i ' • t Mir .. ,nQ l U tl I1 a U a u t Date of Verification_ X11 19%4 1Ja UU li t tl li %ty a 11 1 Ib ) � f-- 1 1 %6vu U UU 1Wk4A6u *Q)a. . rlac �,u ►la 11 Calibration of Ding so tic-1nctruments Date of Refrigerari`Gauge,Calibtation (must be re -calibrated monthly) � ��� �. i Date of Thermocouple Calibratlo�nt musbe re -calibrated monthly) temperature (Tsu I , db) Measured Temneratures t°Fl — -- System Name or Identification/Tag —_ I I _� � ��� ( C� i Supply (evaporator leaving) air dry-bulb temperature (Tsu I , db) Return (evaporator entering) air dry-bulb temperature (Tretum, db) Return (evaporator entering) air wet -bulb temperature (Tretum, wb) Evaporator saturation temperature (Teva orator, sat) Condensor saturation temperature (Tcondensor, sat) Suction line temperature (Tsuction) Liquid Line Temperature (Tliquid) Condenser (entering) air dry-bulb temperature (Tcondenser, db) Registration Number: 313-Ao015859A-M2516534A-M25A 2008 Residential Compliance Forms Registration Date/Time: 06/25/2013 20:54:28 HERS Provider: c6PCA August 2009 CERTIFICATE .OF=FIELD;VERIFICATION AND •DIAGNOSTIC TESTING' CF-4R-MECH-25 -Refri erant Char a Verification_- Standard_Measurert ent,Pi-oced:u.re. ''` " (Page 3 o 5 Site Address:'-.EiiforcementAgency: z Permit Number: 52505 Avenida Rubio. Rancho Mirage CA 92253 Rancho, Mirage, City. of 13-594 Minimum°Airflow.Re uiremeot. Temperature Split Method Calculations for determining Minimum Airflow, Requirement_. for Refrigerant Charge Verification. The temperature split method is.sp6cified.in Reference Residential Appendix RA3.2. System Name or Identification/Tag Calculate: Actual Temperature Split ,= Tretum, db - Tsupply, db Target Temperature Split from Table RA3.2-3 using Tretum, Wb and Tretum, db Calculate difference: Actual Temperature Split — Target Temperature Split = Passes if difference is: between -4°F and +4°F or, upon remeasurement; if between -4°F and -I'001 F �:� .. _ p . 6;�a0ssFatl ,i : _ Note: Tem eraM g S 'ht Method Calc la to t �n t�necessa i pactual Coolin'� oal Air w,is cert ie°d usin one o the p �� ',4 " �*� tl �R +nt�'f j P f '1€�I t" g f airflow measuremerttsprocedures specified m Reference stdentta ppendtz RA3 3 f actual cob"ling coil airflow is measured th' alue muse equal to or greater�than Zhe Calculated Mmtinum Atrfloiw Requirement in the table below. 1141T± IK& !'.• ... Y . �., {C6ni)C.p1AI "51. 6.4Y!45+ST..etCXTtx 29.:. s. •' EYI,a..'MSB7F 1.'sA. . Calculated in Atrfl w Nomin Cooling Capac_ity�(ton) 3.00.(cfm/ton) mu equirement-(CFM) .:X .4 i System Name'or Identification/Tag1 "w firls 0", n x Calculated Minimum Airflow`} Requirement (CFM) Measured Airflow using RA3.3 procedures (CFM) Passes if measured airflow is greater than or equal to the calculated minimum airflow requirement. Enter Pass or Fail Superheat Charge Method Calculaiions,for Refrigerant Charge Verification. This. procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag Calculate: Actual`Superheat = Tsuction — Teva orator sat Target Superheat from Table RA3.2-2 using Treturn wb and Tcondenser, db Calculate'difference: Actual Superheat —Target Superheat = . System passes if difference is between -6°F and +60F Enter Pass or Fail Registration Number: Sia Aoo�sassA-nnzsiss3aA=nnzsA Registration. Date/Time: 06/25/2013 20:54:26 HERS Provider: cePCA 2008 Residential Compliance Forms August 2009 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5 Site Address: Enforcement Agency: Permit Number: 52505 Avenida Rubio Rancho Mirage CA 92253 Rancho Mirage, City of 13-594 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 E i� j tom' una nk Calculate: Actual Subcooling = r � �� ��►► Tcondenser, sat — Tli uid —Tev rator.sat TsuctionU Target Subcooling specified by "1'��kp Enter allowable superheat -range manufacturer Calculate difference: use rang` ' Actual Subcooling — Target Subcooling = between YE and 26°F i�6anufactu` specification not available ,% er"s j a' System passes if difference is between System passes if-actualsupetheai is within `'`� -4°F and +4°F Enter Pass or Fail the allowable superheat range 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 Na fe or dd. t1ttf 1 i� .a g,,,� c:5, E i� j tom' una nk Calculate: Actual -Superheat, _ r � �� ��►► _ �s {}�j —Tev rator.sat TsuctionU Dell; "1'��kp Enter allowable superheat -range from manufacturer's specifications (or use rang` ' between YE and 26°F i�6anufactu` specification not available ,% er"s j a' ,.�� "" �• System passes if-actualsupetheai is within `'`� the allowable superheat range Enter Pass or Frail Registration Number: 313-Ao015659A-M2516534A-M25A 2008 Residential Compliance Forms LJ v Registration Date/Time: 06/25/201320:54:28 HERS Provider: ceacA August 2009 CERTIFICATE•OF FIELD,VERIFICATIOWAND DIAGNOSTIC'T.ESTING '.: CF-4R-MECH-25 Refri 6ipt-Char e.VeriPicatitin Standard`Measu"rement;Pt"rocedure.., ,; , Pa e'5 of 5 Site Address: 52505 Avenida Rubid Rancho Mirag6: 6A 92253 Enforcement Agency: Rancho Mirage,'.City',of Permit Number: 13-594 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 verificatiomcriteria,must be re -measured and/,or..recalculated. System Name or Identification/Tag Patti o'toole 457554 HERS Provider Data Registry Information Sample Group # (if applicable): System meets all.refrigerant charge and m Rot-tested/verified dwelling 313-0144 in a'KRS sample group airflow requirements. Enter Pass or Fail HERS Rater Company Name: John Henry's HERS Responsible Rater'§ Name Responsible Rater's Signature rfo, .'r imeman k 1. DECLARATION STATEMENT':.'f • . I certify under perialty,of perjury, under th laws�of9the State of Callfornia, theginformatlo provld�ed on this forms true and correct. • I am the certified HERS rater who performed the. eedilcahon services identified"and reported on this certlficate�(responsible rater). • The installed feature, material, component ormanufactured device requiring HE verification thatis identlfl�e `.this certificate (the installation) complies with the apphcable requirements iiReference Residential Appendi'c ss 2 and RA3 and the requirements specified:on the Certificate(s) of Compliance (CF -I R).'approved by the local enforcement agency. • The information reported on applicable sections of the Installation Certificate(§) (CF. -6R), signed and submitted by the person(s) responsible for the'instal lation. conforms to the requirements specified on the Curtificate(s) of Compliance (CF -IR) approved by the enforcement agency. Builder or Installer. information as'show.n on the Installation Certificate' CF -6R . Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Preferred Plumbing and Air Conditioning:' Responsible Person's Name:' CSLB License: Patti o'toole 457554 HERS Provider Data Registry Information Sample Group # (if applicable): 0 tested/verified dwelling m Rot-tested/verified dwelling 313-0144 in a'KRS sample group HERS Rater Information HERS Rater Company Name: John Henry's HERS Responsible Rater'§ Name Responsible Rater's Signature John D Henry John Henry. Responsible Rater's Certification Number w/ this HERS Provider: `Date Signed: 1095756 "' 6/25/20:13 313-A0015859A-M2516534A-M25A ' -''06/25/2013 20:54:28 CePCA Registration Number: ,Registration Date/Time: HERS. Provider: 2008 Residential Compliance Forms August 2009