11-1350 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 11-_0�001350—_,
Property Address: 52970 AVENIDA RUBIO
APN: 773-313-012-15 -000000-
Application description: MECHANICAL
Property Zoning: COVE RESIDENTIAL
Application valuation: 15000
T4iyl 4.4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
DAVID MUELLER
52970 AVENIDA RUIBIO
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/21/11
Date: Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
of La Quinr ta; its officers, agents and employees for. any act oomission 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 state t the ab information is correct. 1 agree to comply with all
��Wq
and state laws relatirI o buil ' g con truction, and hereby authorize representatives
the above-mentioned for ins action purposes.
ture (Applicant or Agent)
Contractor:
Applicant: Architect or Engineer:
COOL FLO INC
79469 COUNTRY CLUB DR, #H
BERMUDA DUNES, CA 92203
(760)345-6606
ILica
No.: 438781
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjur r th I licensed under provisions of Chapter 9 (commencing with -
amnd
I hereby affirm under penalty -of perjury one of the following declarations:,.
Section 700 ) of Division of the B i ss Professionals 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
LicenseCla C20 License No.: 438781
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
3 C radar
issued.
I have and will maintain workers' compensation insurance; as required by Section 3700 of the Labor.
- -
Code, -for the performance of the work for which this permit is issued. My workers' compensation
NER-BUILDER DECLARATION
insurance carrier and poli "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 COWC239005
following reason (Sec: 7031.5, Business and Professions Code: Any'city or county that requires a permit to
_ I certify that; in the.pe orm ce o .the work for which this permit is•issued, I shall not employany
•- construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the "applicant for the
person in any me ers a _bome 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
and agree that, if- d.beco s-'ect•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
that he or she is exempt therefiom and the basis for the alleged exemption. - Any violation of Section 7031.5 by
I 3700 'of the Labor,C a I -shall o h ith comply with those provisions.
M
any applicant for a. permit subjects the applicant to.a civil penalty of not more than five hundred dollars ($500).:
D.a / - plicant: -
1 _ 1 I, as owner of the property, or my employees with wages as,theirsole 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 doesnotapply 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 whodoes 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 of improvement is sold within
SECTION 3706, OF THE LABOR CODE, INTEREST,.AND ATTORNEY'S FEES.
one.yearof 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
1 _ 1 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 orpursuant to any permit issued as a result of this application,
1 _ 1 I am exempt under Sec. , BAP.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
Date: Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
of La Quinr ta; its officers, agents and employees for. any act oomission 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 state t the ab information is correct. 1 agree to comply with all
��Wq
and state laws relatirI o buil ' g con truction, and hereby authorize representatives
the above-mentioned for ins action purposes.
ture (Applicant or Agent)
Application Number . . . . . 11-00001350
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: 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
Bin#
. •., .•,
City. of La Qurnta
Building 8t Safety DNirion..'
P.O. Box 1504, 78-495. Calle Tarlipico . .
La Quinta, CA 92253 760 777-7012.
Building-Permit Application and Tracking Sheet
,
Permit #
J�
Project Address:
d
Owner sNaine: / MVgL.L,F
A. P. Number:
Address:
Legal Description:
,,;City; ST, Zip:
Contractor:
Address:46 1�Pioject
Tele one: a�)�':?;,�SV :�>:bo�';}: •aN�
Description:
City, ST, Zip:&—)2-M
Telephone:StateLic.#City. Lic: #:
Arch., Engr., Designer
Address:
City., ST, Zip:
Telephone:s::.` W A{a.._
.:*�s•:,.' „� �.�•
State Lic. #: ` ' `s`;;'#:::<fo•
Name of Contact Person:
ConstrudionTY Occupancy:
' Project type (circle one): 'New Add'n ter Repair Demo
Sq. Ft.: O
# Stories: !
# Units:
Telephone # of Contact Person:
Estimated Value of Project: Fv��
APPLICANT:
DO, NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structhral Cales.
Reviewed, readyy for corrections
Plan 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
2'" Review, ready for correctionstissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SMI.
H.OA. Approval
Plans resubmitted
[Grading.
IN HOUSE:-
'1t 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
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAIleralions CF -IR -ALT -HVAC
Climate Zones LIE
S
Sile,4dc/r ss:
EnjorcenientAgenc,: Dat
T77
!fsROAMLIM �M
/ �O /I
Equipment Type List Mininnnn ElTicien' Conditioned Floor Area
Thermostat
1,
-Packaged Unit
.1)(L
Furnace COP
011Coil SEE .Q Q I ISPFFU. d b_v system
Condensing Unit EER R0 Resistance sf (lfnor ah -each'. present. Hurst he installed)
H
Other
I. Equipment Type: Choose the equipment being installed ifmore [han oiie system use another CF -I R -ALT -HVAC for each system.
2. Nlinimum.Equipment F,fficiencies•: 13 SEER. 78%AFUE, 7.7HSPF•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 foris 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 verities that each -appropriate CF -6R and registered CF -4R forms (no
hand f •-4Rs allowed) are tilled out and signed. 13cginning October 1', 2010; a registered copy of the CF -1 R and CF -611 shall
a1wo on site for final ins ection.
1."HVAC Changeout ,
Required Forms:
• All HVAC Equipment
CF -6R loris: MECH-04. MECH- 25 -HERS
replaced
CF -4R fonns: MECH-25
• Condenser Coil and/or
• Indoor Coil and /or
CF -6R fonns:.MEC11- 257HER.S
CF -4R forms: MECH-25
• Furnace
For Split Systems: RC, CCA-->— 300 CFM/ton, TMAH
F r Packaged Units:. No testing required
New HVAC System.,- Required Forms:
• Cut in or Changeout with C'1' -6R forms: MECH-04. MECH- 25 -HERS
new ducts: (all new ducting CF -4R forms: MECI-1-25
and all new equipment).
For Split Systems: RC, CCA >_ 300 CFM/ton,., TMAH.
For•Packaged Units: No testing required
El 3. New Ducts'with Replacement
Required Forms:
• Includes replacing or..installing all newCF-6R
forms: MECH-25-I IERS .
ducting and/or outdoor condensing unit
CF -4R forts: MEC14-25
and/or indoor coil and/or furnace. Not all `
equipment changed.
For Split Systems: RC; CCA > 300 CFM/ton, TMAH
For Packaged Units: No testing re aired
Contiractor (Documentation Author's /Responsible, Designer's Declaration Statement)
• 1 certify that this Certificate ofCompliance-documentation"is accurate and complete,
• 1 am eligible under Division 3 of the California Business acid Professions Code to accept responsibility for the design identified on
this Certificate of Ccirnpliance.
• 1 certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform
to the requirements of Title 24, Parts I and 6 of the California Code of Regulations.
• The design features idenlif ied on this Certificate of Compliance are consistent with'the information documented on other applicable
compliance forms, worksheets. calculations. plans.and specifications sub itted to the enforcement -agency for approval with the
r
eiit a lie tion.
Name:
SiQnatur
Cor���%V � � �..
Date:
Add r dL Jk
License: % `:
s
City/Siatelio:
Phone:
2008 Residential Compliance 1"ornts Murch 2010
CERTIFICATE OF FIELD VERIFICATION &:DhAGNOSTIC TESTING CF-4R-MECH-25
Refrigerant Charge Verification - StandardiMeasurement Procedure: (Page 1 of 5)
Site Address: Enforceriient•Agency: Permit Number:
a52f,97.C-Avenida Rubio La Quinta CA 92253 City of La Quinta 11-1350
Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for
compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to demonstrate compliance with
the refrigerant charge verification requirement. TMAH and STMS are not required for compliance, when a CID is utilized
for compliance.
As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for
any additional systems in the dwelling as applicable.
Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement
Sensors (STMS)
Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is
required for compliance, TMAH are also required for compliance..STMS are only required for completely new or
replacement space -conditioning systems that utilize prescriptive compliance method.
TMAH - Access Holes in Supply and Return Plenums of Air Handler
System Name or Identification/Tag 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
labeled according to Figure in Section RA3.2.2:2.2.
2
Yes
No k�
`.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 l and.2 is a pass. ;(y�`,...
Enter Pass or Fail ✓ ✓Pass ✓ Fail
STMS - Sensor,onithe,:Evaporator`Coif ....
System Na a oA6Tiie6tifcation/Tag ;'System
" ..:
1101 yx
3
'
Yes
No
kThe sensor is faetory�insta11e-d or�eld installed accortling,to manufactu"vers
speuf cations, or is msYalled by method%specificatwnfs approved by the Executive
� i
Dl,rector
4
N,,es
a;
No
Thesensorwire'is terminatedwastantlardmini plugsuitable forconnectionto a
dgital�ttiermomete The ensor�rnplugisfaceess blame fo'thnstallmgitechmeian .,
-andithe HERS=..rater without hanging the;airflow'through.the condenser coil
5
Yes
_ ,,.,
No
When attachedto a digital thermometer, the sensor provides an indication of the
,aturation temperature of the coil.
Yes to 3 4,'and=5 is a pass :Enter N/Q if STMS are not
applicable Otherwise enter -Pass or Fail::
✓ ✓ N/A
✓ Pass
✓ Fail.
STMS - Sensor on the CondenserCoil
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.
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-A0067566A-M2500001A-M25A Registration Date/Time: 2011/12/29 01:43:16 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC;,TESTING CF-4R-MECH-25
Refrigerant Charge Verification:= Standard'Mea'surement,-Procedure z (Page 2 of 5]
Site Address: Enforcement Agency: Permit Number:
52-970 Avenida Rubio, La Quinta .CA 92253 -City of La Quinta 11-1350'
Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F)
Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential
Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for
any additional systems in the dwelling as applicable.
• The system should be installed.and charged in accordance with the manufacturer's specifications before starting this procedure.
• The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test.
• if outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure.
Soace Conditionina Svstems
System Name or Identification/Tag
System 1
(must be re -calibrated monthly)
Date of Thermocouple] Calibration' .
"R Si/30/�11
System Location or Area Served
Whole House
Outdoor Unit Serial #
WIG1210356
c
, W, ..
`�'
Outdoor Unit Make
York
Outdoor Unit Model
YZH04811CA
Nominal Cooling Capacity Btu/hr. ,
48000
Date of Verification
12/28/11
Calibration of Diagnostic Instruments
Date of Refrigerant Gauge Calibration
11/30/11
(must be re -calibrated monthly)
Date of Thermocouple] Calibration' .
"R Si/30/�11
(mustbere calibrated monthly)
Measure"dt,TemDeratures�(>IWF�), ,. .. '# ;;..
Nwfl
System Name or Idenbfica I n/Tag ;£
MM
System 1�
. .
Supply (evaporatorleavm airdrybulb
9)�
i�
z48, -
c
, W, ..
`�'
temperature (TsuNPPy, db)
Return (evaporator entering) airdry`I ulb
temperature°n( returndb)
68
1
Return (evaporator entering)°':air wetnbulb
T
50
temperature
P ( return, wb!_,`�`>�.',;.:.�;�:
Evaporator saturation temperature's '
34
(Tevaporator, sat)
Condensor saturation temperature
77
(Tcondensor, sat)
Suction line temperature (Tsuction)
43.5
Liquid Line Temperature (Tliquid)
76.6
Condenser (entering) air dry-bulb
76
temperature (Tcondenser, db)
Reg: 211-A0067566A-M2500001A-M25A Registration Date/Time: 2011/12/29 01:43:16 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE. CF-411-MECH-2S
Refrigerant Charge Verification - Standard`•Measurem3r .(Page `3 of 5)
Site Address: Enforcement Agency: PermiYNumber:
52-970 Avenida Rubio, La Quinta CA 92253 City of La Quinta 11-1350
Minimum Airflnw Renuirement
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,
20.00
db - Tsupply, db
Target Temperature Split from Table RA3.2-3
20.9
using Treturn, wb and Treturn, db
Calculate difference: Actual Temperature Split -
-0.9
Target Temperature Split =
Passes if difference is between -4°F and +4°F or,
upon remeasurement, if between -4°F and
PASS
-100°F
Enter Pass or Fail
Note: Temperature Split Metho&Calei lation is not necessary if actual Cooling Coil Airflow is verified using one of the
airflow measurement procediires.speci ed in Reference Residential Appendix RA3.3. If actual cooling coil airflow is
measured, the value must:be equa`lfo or greater than the Calculated Minimum Airflow Requirement in the table below.
r.
Calculated Minimum Airflow. R'64 e.ment (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton)
orIBentification/Tag
System Namegp
0,02%
Calculated Minimum AirfloRequirem nt (CFM)
a
.a .t.,_
.
'
,,Q#�' fie';
tom.
Measured Airflowusing RA3.3 proced�ugres(C�F�M)
Y `m .;fiXi ✓�e�
Passes if measured,`airflow; is,greaterthan or""
-"
equal to the calculated minimum airflow
requirement`'
"' Enter Pass or Fail
Superheat Charge Method '`Cale`ulations for Refrigerant Charge Verification. This procedure is required to be used
for fixed orifice metering d6ice'sy :i' ' .
System Name or Identification/Tag
Calculate: Actual Superheat =
Tsuction - Tevaporator, sat
Target Superheat from Table RA3.2-2 using
Treturn, wb and Tcondenser, db
Calculate difference:
Actual Superheat - Target Superheat =
System passes if difference is between -6°F and
+6°F
Enter Pass or Fail
Reg: 211-A0067566A-M2500001A-M25A Registration Date/Time: 2011/12/29 01:43:16 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-411-MECH-25
Refrigerant Charge Verification-iStandard,Measurement Procedure: G'`, (Page 4 of 5)
Site Address: Enforcement'Agency: Permit Number:
52-970 Avenida Rubio, La Quinta CA 92253 .;.City..of La Qjinta 11-1350'
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 =
0.4
Tcondenser, sat - Tliquid
Target Subcooling specified by manufacturer
3
Calculate difference:
-2.6
Actual Subcooling - Target Subcooling =
System passes if difference is between
PASS'
K
�r3fs
EnterPass orFail
-4°F and +4°F
PASS
""'
Enter Pass or Fail
.
Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for
thermostatic expansion valve (TXV) and electronic expansion.valve (EXV) systems.
System Name or Identification/Ta'g:. ; .
System 1
Calculate: Actual Superheat.= ,
9.5
Tsuction - Tevaporator,. Sat :
Enter allowable superheat range fror%i
manufacturer's specifications (or use�range
between 3017 and 260F, if`manufactur�ers
9.5
.
specification is navailable)
System passesif actual(superheat is withinfthe'Y
allowable superheat range �1
PASS'
K
�r3fs
EnterPass orFail
�'
� �
""'
.
Reg: 211-A0067566A-M2500001A-M25A Registration Date/Time: 2011/12/29 01:43:16 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-4R-MECH-25
Refrigerant•Charge V6rification "Standatd Measlurement Procedure,' (Page 5 of 5)
Site Address: Enforcement. Agency: : Permit Number:
52-970 Avenida Rubio, La Quinta CA 92253. 7City of La. Quinta 11-1350;1
Standard Charge Measurement Summary:j
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
JCSLB
438781
HERS Provider Data Registry Information
Sample Group # (if applicable): N/A
System meets all refrigerant charge and airflow
not-tested/verified dwelling in
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
"� .
DECLARATIO14: STATEMENTI
• I certify under penalty of perjuryun-_
the laws of the State of California, the information provided on this form is true and correct.
• I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater).
• The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the
installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified
on the Certificate(s) of Compliance (CF -111) approved by the local enforcement agency.
• The information reported on applicable sections of the Installation Certificate(s) (CF -6R); signed and submitted by the person(s)
responsible for the installation conforms to the requirements specified on the Certificate(s)`of Compliance (CF -1R) approved by the
enforcement agency.
Builder or Installer information as shown on the Installation; Certificate (CF=6R)
Company Name: (Installing Subcontractor or General Contractor of Builder/Owner)
COOL-FLO INC
Responsible Person's Name:
License:
MICHAEL MANGAN
JCSLB
438781
HERS Provider Data Registry Information
Sample Group # (if applicable): N/A
tested/verified dwelling
la
not-tested/verified dwelling in
HERS sample group
HERS Rater Information CaICERTS Certificate # CC1-1798618426
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-A0067566A-M2500001A-M25A Registration Date/Time: 2011/12/29 01:43:16 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms March 2010
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTICJESTING CF-411-MECH-21
Duct Leakage Test — ExistingSDucf System (Page 1 of 2)
Site Address:
52-970 Avenida Rubio, La Quinta CA 92253 (System
Enforcement Agency:
1
Permit Number:
1)
City of La Quinta
11-1350
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 15a/o 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 Options2, or 3 must be attem ted before utilizin 0tion 4.,
Determine nominal"176fifFlow using one "of the.followmg�t--ycalculation methods �
a
✓ J HootmsY stem method; 21 lox ndOuteut Ca fns Q xx 400 = 1600CFM F
in
ea g pacity mThousandsof Btu/hr
y p _CFM
/
Measuredsystern airflowu5ingRA3 3 airflowtest procedures
.
Option'i;i°used then .RKMIM
1
Allowed leakage Fan Flow 1600 x 0 15 240'' CFM
Actual Leakag&.,�� 139 CFM;, ':
;.;._ Pass if Leakage Actual is less than Allowed.
Pass Fail
Option 2 used then ,
2
Allowed leakage = Fan: low k x 0.10 = _ CFM
Actual Leakage to outsid'e,= i W` CFM
Pass if Leakage Actual is less than Allowed
Pass Fail
Option 3 used then:
Initial leakage prior to start of work = _ CFM
Final leakage after sealing all accessible leaks using smoke test = _ CFM
3
Initial leakage _ - Final leakage_ = Leakage reduction CFM
((Leakage reduction _ / Initial leakage _) x 100% = a/o Reduction
Pass if a/o Reduction > 600/a
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-A0067566A-M2100001A-M21A Registration Date/Time: 2011/12/29 01:41:27 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
a
CERTIFICATE OF FIELD- VERIFICATION :& DIAGNOSTIC�TESTING CF-4R-MECH-21
Duct Leakage Test - ExhAii,hg Duct System' "'* ' - Pa
Site Address:
52-970 Avenida Rubio,.La Quinta CA 92253 (System
Enforcement Agency:
City of La Quinta
Permit Number:
11-1350
1)
1438781
HERS Provider Data Registry Information
v Outside air (OA) ducts. for Central Fan Integrated (CFI) ventilation systems, shall, not be sealed/taped off
during duct leakage•testing &1 '664: ducts that utilize controlled motorized dampers, that open only when OA
ventilation is required to meetASHRAE Standard' 62.2, and close when OA ventilation is not required, may
be configured to the closed position during duct leakage testing
All supply�adret�urn.register boots must be sealedtothe drywallif smoketestis�utilized for compliance
— applies to duct leakage compliance option 3 (leakage¢ reduction b.y. 6010) end option 4T(sfix�all accessible
leaks) described above
s,
New duct installations cannot utilize buiidif cavities as plenumsxor pia orm returns Irlklieu 01 crs
V Mastic and'`draw'bands must:be used m com"'binatiorswith.clothMbacked4rubb'e'rfadhesive-duct tape to seal
leaks at all new duct connectionsa
DECLARATION STATEMENT }a
•I certify under penalty of pejpry;4under the laws of the State of California, the information provided on this form is true and correct.
P. . ,..
• I am the certified HERS rater wFioperformed the verification services identified and reported on this certificate (responsible rater).
• The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the
installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified
on the Certificate(s) of Compliance (CF -1R) approved by the local enforcement agency.
• The information reported on applicable sections of the Installation Certificates) (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 -112) approved by the
enforcement agency.
Builder or Installer information as shown on the Installation Certificate (CF -6111)
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
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
a HERS sample group
HERS Rater Information CalCERTS Certificate # CCl-17,98618426
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-A0067566A-M2100001A-M21A Registration Date/Time: 2011/12/29 01:41:27 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION. CERTIFICATE CF-6R-MECH-2I-HERS
Duct Leakage Test — Existing Duct System (Page 1 of 2)
Site Address:
52-970 Avenida Rubio, La Quinta CA 92253 (System
Agency:
Permit Number:
1)
City oEnforcementaQui.
City of La Qui
11-1350
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
Ai
3. Reduce leakage by. 60% and conduct smoke and fix all leaks
4..Fix all accessible leaks using smoke and HERS rater verify
Note: (One of Options 1, 2 or 3 mustbe attempted-befoeuilizng...tr. ..4)
Determine �nomafsFa Flow using o�neof thefollowmg tHeecalculation methotls5. ,+
Coolmg',system method. Size of .condenser m Tons x 400... 1600 CFM
✓ Heating:,system 21r7 x, Output CapacityRinThousands Btu/hr CFM
method: of
! �W �
£ ,A
✓ Measured s stern airFlow usinRA3 3 airFlow testP rocedures
Opti oniused then"��,
Allowed leakage Fan Airflow 1600 °'� 15
1
x 0 — .240 CFM'
Actual LeakagepF 139 CFM ,
....... Pass '. _ Pass if Actual Leakage is less than Allowed leakage
Pass Fail
Option 2 used them
2
Allowed leakage Fan>Airflowk_: x 0.10 = _ CFM
Actual Leakage to outside. _ ":.CFM
Pass 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
3
Initial leakage _ - Final leakage _ = Leakage reduction _ CFM,
((Leakage reduction _ / Initial leakage _) x 100% _ % Reduction
Pass if % Reduction > 600/6
Pass Fail
Option 4 used then:
4
All accessible leaks repaired using smoke test. HERS rater must verify (No Sampling).
Pass if all accessible leaks have been repaired using smoke
Pass Fail
Reg: 211-A0067566A-M2100001A-0000 Registration Date/Time: 2011/12/29 01:35:55 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE.; XFf 61R-M,ECH-2I-HERS
Duct Leakage Test — Existing. Duct System '(Page 2 of 2)
Site Address:
52-970 Avenida Rubio, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
11-1350
V Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off
during duct leakage. testing CFI OXclucts that utilize controlled motorized dampers, that open only when OA
ventilation is required to meet ASHRAE Standard 62.4 and close when OA ventilation is not required, may
be configured to the closed position*during duct leakage testing.
All supply and0eturn reglster7boots must�be sealed tomt"It diywall if smoke tests tillze.d for compliance
o SIS E max,
— ap files to duct leakage.. compliance o tion J. leakage reduction by.60 m) -and oo,i' 4 (�6ix all accessible
leaks described above x ;
e�
New duetrnstallatlons cannot u tll¢e building cavltlesas plenums orplatfo"rrn returnsn lieu of;ducts
Mastic an°dgdraw bands mustkbeiused 1n combjnatlon wit Pbothed rubbeK',a,'heslve`''duct tape to seal
leaks at all new duet connectlons� .
DECLARATION STATEMENT
€ tN
. 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 responsible4.or 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 ttie 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
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-A0067566A-M2100001A-0000 Registration Date/Time: 2011/12/29 01:35:55 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION. CERTIFICATE* CF-6R-MECH-25-HERS
Refrigerant Charge Verification - StandardMeasurement.Procedure . (Pagel of 5)
Site Address: Enforcement Agency: Permit Number:
52-970 Avenida Rubio, La Quinta CA 92253 City of La Quinta 11-1350
Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for
compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to demonstrate compliance with
the refrigerant charge verification requirement. TMAH and STMS are not required for compliance, when a CID is utilized
for compliance.
As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for
any additional systems in the dwelling as applicable.
Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement
Sensors (STMS)
Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is
required for compliance, TMAH are also, required for compliance. -STMS are only required for completely new or
replacement space -conditioning systems that utilize prescriptive compliance method.
TMAH - Access Holes in Supply and Return Plenums of Air Handler
System Name or Identification/Tag 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
labeled according to Figure in..Section RA3.2.2.2.2.
2
Yes
No
5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum
and labeled according to Figure, in.Section RA3.2.2.2.2.
Yes to .1 and 2 is a, pass.;
Enter Pass or Faill ✓ V Pass ✓ Fail
r n
STMS-.Sensor on,the:Evaooraf6Moh
System `Nair for Identification/Ta :,
. m. 9
System 1 "
.t (i
Yes
Nod
fhe sensor is factory mstalletl or3field if&EiIIed?a"bdording to rnan'ufacturers
k fi+s..fP "^"3
peafications or is installed by methods/speafications=approved by the Executive
4
Yes
._ '
fVo
- �K-,v
sensor r&Js terminated with�a stdn�dard mini plug su�tablejfor con sect oan to`aW
digital thermometer Thesensorm�ini�plugis accessible to4the install gifechnician
and�the HERS ater�without changmgxthe; airflow,through�ahe�con'denser coil ��� L
1.1
5
Yes
No
cThe sensor`measuees'th6'saturation temperature of the coil within 1.3 degrees F
Yes to 3, , and 5ris,n:k aapass. Enter N/A if STMS are not
applicable :Otherwise ePass or Fail
,/ ✓ N/A
✓ Pass
✓ Fail
STMS - Sensor on the Condenses 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.
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 accessibleto the installing technician
and the HERS rater without changing the,airflow through the condehser coil
8
1 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
✓ ✓ N/A
✓ Pass
✓ Fail
applicable. Otherwise enter Pass or Fail
Reg: 211-A0067566A-M2500001A-0000 Registration Date/Time: 2011/12/29 01:39:35 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-611-MECH-25-HERS
Refrigerant Charge Verification Standard Mea§urement Procedure (Page 2 of 5)
Site Address:'Enforcement Agency: Permit Number:
52-970 Avenida Rubio, La Quinta CA 92253 City of Le Quinta 114350.
Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F)
Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential
Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for
any additional systems in the dwelling as applicable.
• The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure.
• The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test.
• If outdoor air dry-bulb is 55°F or below, the installer musCuse the Alternate Charge Measurement Procedure.
Snace Conditioning Svstems
System Name or Identification/Tag
System 1
(must be re -calibrated monthly)
Date of Therm(jcou"Ple Calibration =
11/30 11 10
,
System Location or Area Served
Whole House
2.7
.
Outdoor Unit Serial #
WIG1210356
Outdoor Unit Make
York ,
Outdoor Unit Model
YZH04811CA
Nominal Cooling Capacity Btu/hr
48000
Date of Verification
12/28/11
caunration orruiagnostic instruments.
...
Date of Refrigerant Gauge Calibration
11/30/11
(must be re -calibrated monthly)
Date of Therm(jcou"Ple Calibration =
11/30 11 10
,
(must be re calibrated monthly)
..e ww
2.7
.
easure .empera ures 4 a:WF VU �JIAP ia�-
4r
System Name or Identification/Tag ,.
System 1"jf
_ {;
. .
m
..e ww
.
Supply (evaporator leaviing)�airtlr bulb
temperature'(TSuPPiY, db) .
..
Return (evaporatoroentering) air drybulb
temperature (T�etu"rn ddb.) Vin•
68
Return (evaporator entering) air wet bulb
50
temperature (Treturn, wO
Evaporator saturation temperatuFe;°`
34
(Tevaporator, sat) ..
Condensor saturation temperature
77
(Tcondensor, sat)
Suction line temperature (Tsuction)
43.5
Liquid Line Temperature (Tliquid)
76.6
Condenser (entering) air dry-bulb
76
temperature (Tcondenser, db)
Reg: 211-A0067566A-M2500001A-0000 Registration Date/Time: 2011/12/29 01:39:35 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-611-MECH-2S-HERS
Refrigerant Charge Verification - Standard °Measurerrient Procedure (Page 3 of S,
Site Address: Enforcement Agency: Pe umber:
52-970 Avenida Rubio, La Quinta CA 92253 City of La Quinta 11-1350,'
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,
26.00
db - Tsupply, db
Target Temperature Split from Table RA3.2-3
20.9
using Treturn, wb and Treturn, db
Calculate difference: Actual Temperature Split -
-0.9
Target Temperature Split =
Passes if difference is between -3°F and +3°F or,
upon remeasurement, if between -3°F and
PASS
-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 in Reference Residential Appendix RA3.3. If actual cooling coil airflow is
measured, the value must tie eqI.ual,'to or greater than the Calculated Minimum Airflow Requirement in the table below.
AM-
Calculated Mlnlmum.Alrflow Regfwri6ment (CFM) = Nominal Cooling Capacity (ton) X 300 (cfmiton)
System Name or Identification/Tag.:Syste
A#Ml
Calculated M rnrrmum Airflow Requirement (CFM)
µ
r. :
"
x
has
MeasuredAPiflow using RA3.3 procedures (CFM)r`
r'
wISM
Passes if measured'pirflow is:greater than orK,�
equal to the calculated minimum airflow
requirement`";
E • ' Enter;Pass or Fail
m:�xa
Superheat Charge Meth od`Calculatioins for Refrigerant Charge Verification. This procedure is required to be used
for fixed orifice metering deviceaysfems
System Name or Identification/Tag
System 1
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 -5°F and
+5°F
Enter Pass or Fail
Reg: 211-A0067566A-M2500001A-0000 Registration Date/Time: 2011/12/29 01:39:35 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-611-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure.. ' (Page 4 of 5)
Site Address: Enforcement Agency: Permit Number:
52-970 Avenida Rubio, La Quinta CA 92253 City of La Quinta 11-1350
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 =
0.4
Tcondenser, sat - Tliquid
Target Subcooling specified by manufacturer
3.
Calculate difference:
-2.6 ;
Actual Subcooling - Target Subcooling =
System passes if difference is between
-3°F and +3°F
PASS
Enter Pass or Fail
-. .;
a
Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for
thermostatic expansion valve (TXV) and electronic expansion.valve (EXV) systems.
System Name or Identification/Tag
System 1
Calculate: Actual Superheat = #
9.5
Tsuction - Tevaporator, sat'``
Enter allowable superheat range from
manufacturer's specifications (or use range
9.5
between 40F'and 25°F if manufacturer.'s
specification is not available)
System passse!rpif4actu l,superheat, s'withm the
allowable ,Su,PerheaE range
,
- Enter PassoFail
-. .;
a
Reg: 211-A0067566A-M2500001A-0000 Registration Date/Time: 2011/12/29 01:39:35 HERS Provider: CalCERTS, inc.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification Standard'Measurement Procedure _ (Page S of S.
Site Address: Enforcement Agency: Permit Number:
52-970 Avenida Rubio, La Quinta CA 92253 City.of La Quinta 11-1350"
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:
Date Signed:
Position With Company (Title):
System meets all refrigerant charge and airflow
12/?8/2011
Is this installation monitored by a Third Party Quality
Name of TPQCP (if applicable):
requirements.
PASS
Enter Pass or Fail
FV
)ECLARATION STATEMENT f
• 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 307,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 featureg,-a'terials, components, or manufactured devices identified on this certificate (theinstallation)
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,'Ancluding 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 th&enforcement agency that identifies the specific
requirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the installation have been met.
• I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the
building permit(s) issued for the building, and made available to tKii'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
reoistry 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
Responsible Person's Name:
Responsible Person's Signature:
MICHAEL MANGAN
MICHAEL MANGAN
CSLB License:
Date Signed:
Position With Company (Title):
438781
12/?8/2011
Is this installation monitored by a Third Party Quality
Name of TPQCP (if applicable):
Control Program (TPQCP)? Yes No
Reg: 211-A0067566A-M2500001A-0000 Registration Date/Time: 2011/12/29 01:39:35 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms August 2009