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11-1260 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: .11-00001260 Property Address: 44090 CAMINO AZUL APN: 604-180-010-26 -24517 Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 24000 Td!t 4 4 Q" Applicant: Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT R a FEI";O,�V`l ;I_- r nq CI•c Y OF E.AL WINTA r-!?404C',8 .ls. -------------------------------------------------- L.ICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busines nd Pr ss one s Code, and my License is in full force and effect. Licens ass: C2�0/-)C43 License No.: 276586 ate: �" 6/ ntractor: OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the 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 7000) 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 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.). (_ 1 I, 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.). (_) 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.I. Lender's Name: Lender's Address: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 11/21/11 Owner: PALERMO STEVEN G 44090 CAMINO AZUL LA QUINTA, CA 92253 Contractor: DESERT AIR CONDITIONING, INC. 590 WILLIAMS ROAD PALM SPRINGS, CA 92264 (760)323-3383 LiC. No.: 276586 ------------------ 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. 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 insurance carrier and policy number are: Carrier EVEREST NATL Policy Number 7600007908111 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 become subject to the workers' compensation laws of California, and agree that, if I should come Nect to the workers' compensation provisions of Section 3700 of a Labor Code, hall hw' comply with those provisions. ate:�!� Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($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 state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this coun�D,ignature n the above-mentioned property fo n ec ' oses. te` ' (Applicant or Agent): Application Number . . . . . 11-00001260 Permit . . . MECHANICAL Additional desc . Permit Fee 66.00 Plan Check Fee 16.50 Issue Date Valuation . . 0 Expiration Date 5/19/12 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 9.0000 EA MECH FURNACE <=100K 18.00 2.00 16..5000 EA MECH B/C >3-15HP/>100K-500KBTU 33.00 ---------------------------------------------------------------------------- Special Notes and .Comments REPLACE 2 SPLIT SYSTEMS, FURNACES, INDOOR COILS AND CONDENSERS. 2010 CODES. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited --------------------------------------------------------- Due Permit Fee Total 66.00 .00 .00 66.00 Plan Check Total 16.50 .00 .00 16.50 Other Fee Total 1.00 .00 .00 1.00 Grand Total 83.50 .00 .00 83.50 r LQPERMIT 11/21/2011 10:29 7603238983 DESERT AIR PAGE 04/06 Bind! y df:La Qurnta Petmtt LIQ P 0. km f 504) 78.495 Cage TMplW La Qairaa, G4 92153 - (760) 777-7002 /I Building Permit Applf0thn and Trace Sheet . t aalAddrr i.0 $d QwRat'8 sUe— q er.^ I� 1'. i�mabet: Adm a �. ;�. azo Contrada: fir, 3T, zip: j IAk eA I oS j'j . i �� Tdagltv�: � Telepbone; G.lC Lai% Siete Lia P : •� �b ,�� x.tc. ®; - . Addcem QJA ST, zap: Wephone Stnte Lie. t : Name of coma Pmm, logo o (pm* oae): Naw Add'n Alw Rop* Desna ffMO .^ — Sq i?t is 30oriea fi Untm ®aeon a ► EMmobd VWtw of act: `{ 00 0. APFUCA NTt 00 NOT MM 9t WW VNIS UNE d 8absaltot R",d Plea Ree o TRACKM l mmff ISS Plan ()*a asbaNtEtd Aasoaat swommlCium PAVk W, reed) for eomdlons PllnCbeck3leposst TIM.Ctae C1oAatCos�retltiersoe Pl CeecicBaluoa. Tnte:bl lice. Kate pteked up Court F W4 Oft pus Flare rtsapn;liteA MeehnSerl 6raQfn6 n T! RMm. ready *r corrttoone/t M Blaaria�t sairo�atottor Lkt attar Qnseaer tenon Fhrmb" cnal neva ):tago ptoloed trp SALL HDA. Apprwmi Plaoz srsabmtlmDeA Gradtag m R+ - "" Refw. rm* for ane owvelopar Impct See planulugApprml cturd C omel perm A.LP.P. � Feb. INks. Appr Dote of payett rlsae Sttaoel R� 'Rotel Phm" Fe - CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECli-21 Duct Leakage Test - Existing Duct System (Page 1 of 2) Site Address: 44-090 CAMINO AZUL 1 OF 2, La Quinta CA 92253 Enforcement Agency: Permit !Number: (System 1) City of La Quinta 11-1260 Enter the Duct System Name or Identiflcation/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 required for compliance for alterations and additions in existing dwellings to space conditioning systems and duct systems. Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible and they can be sealed. For a completely new or replacement duct system installed In an existing dwelling, use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. " Duct Leakage Diagnostic Test - existing duct system Select one compliance method from the following four choices. 1. Measured leakage less than 15% of fan flow 2. Measured leakage to outside less than 10% of Fan Flow 3. Reduce leakage by 60% and conduct smoke and fix all leaks 4. Fix all accessible leaks using smoke and HERS rater verify Note: (One of Options 1, 2, or 3 must be attempted before utilizing Option 4.) Determine nominal Fan Flow using one of the following three calculation methods. Cooling system method: Size of condenser in Tons _ x 400 = _ CFM ✓ Heating system method: 21.7 x _ Output Capacity in Thousands of Btu/hr = _ CFM Measured system airflow using RA3.3 airflow test procedures: _ CFM Option 1 used then: 1 Allowed leakage = Fan Flow— x 0.15 = CFM Actual Leakage = ` CFM Pass if Leakage Actual is less than Allowed Pass Fail Option 2 used then: 2 Allowed leakage = Fan How_ x 0.10 = _ CFM Actual Leakage to outside = _ CFM Pass if Leakage Actual its 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,T,., = Leakage reduction CFM _ ((Leakage reduction _ 1 Initial leakage,_) x 100% Reduction Pass if % Reduction > SO% Pass all 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 Fall Reg: 211-A0060312A-M2100001A-M21A Registration Date/Time: 2011/12/12 15:31:07 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test — Existing Duct System (Page 2 of 2) Site Address: 44-090 CAMINO AZUL I OF 2, La Quinta CA 92253 Enforcement Agency: Permit Number: (system I} City of La Quinta li-IZ60 Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testing, CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing. All supply and return register boots must be sealed to the drywall if smoke test is utilized for compliance — applies to duct leakage compliance option 3 (leakage reduction by 60%) and option 4 (fix all accessible leaks) described above. New duct installations cannot ut0ize building cavities as plenums or platform returns in lieu of ducts. Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct tape to seal leaks at all new duct connections DECLARATION STATEMENT I certlty under penalty at perjury, under the laws at the state of CaUrornia, the information provided on this Farm is true and correct. I am the certified HERS rater who performed the verification services identfied and reported an this certificate (responsible rater). The installed feature, material, component, or manuFactured device requiring HERS verification that is identified w this certificate (the €nstaRation) complies vrith the applicable requirements In Reference Resldenbal Appendices RA2 and RA3 and the requirements specified an tha Certlrlcate(s) or Campliance (CF-IR) approved by the €waI enforcement agency. The in Formation reported on applicable sections of the Installation Certirieate(s) (CF-6R), signed and submitted by the persan(s) responsible for the instaltation conforms to the requirements specified on the Certiflcate(s) of Compliance (CF-IR) approved by the LnForcement agency, builder or Installer information as shown on the Installation Certificate (CF-SR) Company Name: (installing Subcontractor or General Contractor or Builder/Ownerr) DESERT AIR CONDITfONING INC Responsible Person's Name: CSL8 License: Jacqueline Zatiik 276586 HERS Provider Data Registry Information Sample Group * (if applicable): 270776 tested/veriFred dwelling 'J not-tested/verified dwelling in a HERS sample group HERS Rater Information CaICERTS Certificate # CC1-1798609007 HERS Rater Company Name-, Air Solutions of the Desert Responsible Rater's Name: Responsible Rater's Signature: Walter W Neills Waiter W Nidlis Flesponslble Rater's Certifcatran Number w/ this HERS Provider: Date Signed: 12/9/2011 CC2004361 ' Rea: 211-A0060312A-M2100001A-M21A Registration Date/Time: 2011/12/12 15:31:07 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 11/21/2011 10:29 7603238983 DESERT AIR PAGE 05/06 5rtnplifled Prescriptive Certificate of COmpillanceI 20pg Residential H AC'11►tieralluns CG-fa�►i1LT-HYA Climate roues 10 - 15 Site Addre= 44-090 CAMINO AZUL 2 OF 2 L,4 Qulrita, C4 92-25 i=nforc,ameng Age"Permit 47 City of La Qulnta NOV is, 2011 Equipment Typal list Minimum EfFlclenty2 Duct insulation Conditloned Fiaor• ❑ Package Unit requirement Area Thermostat 0 Fumace � AFUE ❑ C4P I Indoor Coil, ® EEER 1S t] 171 HSP� _ ❑ R 6 (CZ 10-13) Served by system EJ Setback ❑ Condensing nsing Unit 13 I:ER Q +tesistan[ae 0 R 8 (CZ 14-1S) _ � sf If n0taireadyPmsenl; must be fns#aliedj I. 1'q+►Ip+rre�.# ilp , the e+piTFparr o belnp insZa!l�rY; iF rrrare Manlone2. affnkr�urrrf/++a+ �w 23 SEER, 7SY5 ►SFtlE 7.7ff$PF IIIsxsl�m, use ano#�r Cr-7k ALT-HVAC rw sy�lem. >!yp►C31 �SYdEhHsl.. HERS YEiEiFxGATI fJ1Y SUMMARY Lid beiow are FOUR HVAC attaraxiors �ptivns. The Insralier decides whdt work is being done and picks one of tht! appropriate Options. Each Option lists the HERS measures ti rat must be condurt�, A be left on site for final Insp�ion and a COPY given io the homeowner. At III ur the Inspector verifl that the V 0 listed the m tsh Il form Was in fact the • work completed by Ire installer. The inspe[#or Oise verll9es that each appropriate CF-6R and registered CF-4R his farms (no hand file" CF-4Rs allowed) ana filled out and signed -Beginning Ewb*er L, 2,30P MoistenedF-6 copy the registered cF- and Cr--SR shall also be an site rer final inspawan. a 1. HVAC Chang�ut Required Forms; • All FNAC Equipme sit CF-fiR farms: MECH-04, MFCH-21-HERS and (far split systems) MECH-25-HERS replaced CF-4R farms: MECH-2] and (for split systems} MECH-25 . Condenser Cv;i and Jar CF-SR farms: MECH-04 ■ Indoor Coil and /cir , MECH-21-HERS and (for split systems) MECH-25-HERS • Furnace CF-40, farms_ MECH-21 and (far split systems) MECH-25 For Spilt SyStemy; Duct leakage < 15 percent; RC, TEA S 300 CFM/ton (Minimum Air Flaw ReQuiref`ient), fMI{H Exempted From dule ct akage testing if: 11 1. Duct system was docurr► rated tb have been previously sealed and Confirmed through HERS 5'erffication, or D 2. Duct systems with less than 40 linear feet In uncondltiouad space, or ❑ 3. Existing duct systems are constructed, insulated or sealed Witt[ asbestos 4. Th terr1twill not be Ducted (le. DWCkiess14 lit e ❑ 2. fQ ,, AC Syltasm Requl flil7rls: s: y.xentpLf gQfatrty�aarge) . Cut in" Changes"t wi MECH-04 new difis (all new �? . M ' IgaMEF25rd r lit ME �5. (t5 E': '� sP s1! } CF1 MFRS, ilnd ductir4� all netiM�!" �•- _ �j,. t: pr{}b r +� fUr; M "s CH-2 M equi k +• r ! CH for t ECFI-25 } <.. s , -. For Split l] S'yaettts: Duet leakage <'6 petM'it; RC. CiCA' $ !Sib CFi+E/tdTr, , AH, S, and ci'lfrnr HSPP or P5PP, Ivor Packaged Unlibc Duct leakage < 6 percent L-J:3. New duets Mithfor without Required Forms: Replacement . Includes replacing qr installing all new ducting and/or outdoor condensing unit C'F-6111 farms: MECH-04, MECH-20-HER.,s, and fors h: and/or Indoor coil emd/or furnace. No or some CF-4R forms; MECH-20 and for lit ( H systems) MECH-z5-HERS equipment change(}. ( split systems) MECH-25 For Split S ems: Duct leakage < 6 percent; RC. Ca � 300 CFM/ton, TMAH For Packaged Units: DUCt leakage < 6 percent ❑ 4. New DUCH"g Over 40 feet EC-F-GR ired Forrt[isp • Includes adding or replacing more than 40 fcrrns: M£CM_D4, MECH-21-HERS linear feet of duet in unconditloned space, farms: MECH-21 For split system or Packaged units: Duct leakage < 15 percent 0 EXCEMON: Existing duct systems Mn$tructed, insulated or sealed with asbestos. Contractor (Documl:ntatian Author's ifte9ponaible, Designer's Dec[ara Von Statementj . t Certify that this Certikate of Camollancv datumehWon is accrete and complete. . i am rllgfhie under Division 3 of She California Busincss and CompflanCr, Ru'essiOn,S Code to accept responsibility for the design IderMed on this Certificate of cemfy • i Quirt that the cram 2y Part es and G aform rMM Vectf scans for the da{g>n ld-Wfled do this CCftt Ent of Carn}�}ten[e �tfO�Tn to the r hir de meats t res I i?r Parts a and d of the �llfamia Cade of Regufapona The s, W6 r features ldt:r,tlRed on this tcMfitate of COmpllg� are onsfstent with the information dommented on Other appticahte eomollanLe forms, worluheets, tairulgucm, plaits and WccEiicattvr* submftteri to the enfvrcernent Blame: Jacqueline Z3tKik�Yf� alrpa[ with the pCrmR appllcetlon. Signature: =4rripany: blr5ERT Allt CONCYiIit]hlltu[; 7tur• / 922fa4 --- Y' Phone. Reg: 212-AOa6o3l3A-fiDog006o-0000 Registrat.iOn Date/Time: 2011/11/18 1a:16;01 93RS Pro--- 2008 Residential COltipliance I:orm� vxder: 17II10ERTl3, Inc. July 201a 11/21/2011 10:29 7603238983 DESERT AIR PAGE 06/06 rMhqhyann r•�••R•. rr�icanprrve Ger'tiffrate of Carripl1ance; 20D8 Resldef�tfalfl{fAC+�I[ierat rrs CF,1R-ALT-fIiYAate 20neis 3LU - 152. Address-90 CAMINO AZUL 1 OF 2 is QuirTta, C A 92253 IEnftw cement Agency: D Permit 0: City of La Quinta Nov 18, 201ment T"I List Minirnum EftiCariry2 Duct i reme on ConditArea Floorckage Unit+'er{uit'�emertt Area T1lcrrrr45tat rnace AFUE .8U9s ❑ COPdoor Coil Rl SEER 20.6 ❑ HSPF R 6 (CZ 10-13)Served by systern M Setback ROJ ndensing UnK ❑ EER C7 Resistance R S (CZ 14-15) ff riot alreedY present, must be her slalled�orm IP►+rant Type: +_l+ooV the eq'+�+ent b Jn9llrs�r f If more than erne l n Parl'nrFfl,RMlencics:13SCR, 7S9f, 7.7NSPP for s1 n+ar+otfrer CF-sk ,aLr-hlvq r_ s mty iml reskier,t�:sr,yWjrss. 11ERYFiCAT7'bH SiiMIMARY Llsxed betaw are FOUR HVAC aikeraHnn options. The Installer decides what work is bei>hgdone cks one Gf them appropriate pptiups. Each Option BM the HERS muasurQS that rt7ust he conducted. A hatc*W of the forms shall form on Site €vr f real inspection and a Dopy given to the h0itreowner. At Final, the insPeCtor venfm that time work listed on th15 forms s In d fired fork W allowed) anmPkned by a filled Installer. and $; inspector � for also verifies that each ai�Prapri�' CF-6R and registered CF 4k and CF-6R Shan Olga be an � for e- �r 9 el;rlr'r'I'�'➢ o�ubf+r 1, (ilfl, a feglstCred copjr of the CF-1R �Gti4n. 1. HVAC Changeout Required Porms: . All HVAC Equlpi7ie nt CF-6R 150r1ris: MirCH-p4, MECH-21-HEk5 end (far suit systems] MECH-ZS PIERS replaced CF-4R fonts,: MECfi-2X and (far split system) . Condenser Cofi 31I far MECH-25 ■ indoor Coll and /or CF-GR forms: MECH-04, MECH-21-HERS and (for spilt systems) MECH-25-HERS ■ Furnace CF-411 forms: MECH-21 and (for split systems) MECH-25 For Spff systems Duct leakage a 15 percent; RC, CtJ1 S 300 CFM F:QP-. n.•i /tQlt (Minimum Air Royy RegUirin7ent), TTMAH Exempted frorn duct leafage teSbng If: • r CD I. Duct systein was documented to have been prevfeusly sealed and confirmed through HERS verification, or LI 2. Duct systems with less than 40 Linear feet In Unconditioned space, or ❑ 3. Existing du•:t systems are Constructed, insulated or sealed vgmfth asbmos © 4. The systwr;,,Viif not be Ducte {ie, rct! Mlral tt 5alstenam}, Aasa,ze�,Re#dgerarit Gdarge} 0 2. NeW PWAC SyAtem Raquia d FFDICrrrs: }- ■ Cut In, k Changeorrt wi new ; {ail nely MECH-04, M^'IiE1tS. r du i sy9 'rrrs) MECILNV] IERS, and all new K F 752'ks le equiprfgt �'' .¢.r r' Fo M>rCN ZIi, a (for sprit S ryiimsjECH- MEC�1�25 P .�� -err i i:rr r. ' r, For Split �f9temxi: ipuct ieakags pe>+11pryt; RC, CCA'� 350 CFIMItwi, FWb, TINAH, STMS, and efther'!iS!'A or PSPP. Far Packaged Units; Duct leakage r 6 percent q 3. New Dtis#s wfl�r/Or without RequMred Forms: Replacement • Includes replacing 4r installing all new ducting and/or outdoor condensing unit CF-6R forms: MECH-04, MECH-20-HERS, and fors lit and/or indoor oofl a1p►d/or furnace. No or some CF-4R forums: MECH-20 and far { f� systems) MECH-ZS-HERS equipment changed. ( split systems) MECN-25 For Split Systems: Duct leakage < 6 pert:ent; RC. CCA r 300 CFM/ton, TMAH For Pa�aged Units;; Duct leakage C 6 percent 12 4. New Ducking arver 40 feet Required Farms: . Includes ad f ng or repfacirig more than 40 CF-6R forrrrs: MECH-04, MEC}t-2i-fi£RS linear feet pf dud hi unaanditloned spaci�. CF--4R forms: MECH-21 For split frys.#em or Paged unfft; Duct leakage s 15 percent © EXCEMON: Fx}sting duct ygs#erns Constructed, insulate or sealed with asbestos. ContraCt4t UmquUmcint3tion Author's Ilta>gpOhaible Designer's deciar&tlm, 9iatGmerrt) . I certify that this Cemllrgtn of Cgmpllanm documentation is amA-ate and [omfldete. • I am 11J)"c'Wlfile under division 3 of the Cafifarrria Busfne� ate} PrtYF laps Code to accent reswnsibfilty for the design Identffred on this CerEl Mte 0f C4mpil$rrde, . I certify that the energY features and Gzrfarmancr reGulrements of Title 24, Parts 1 and 6 & the C�alifamiia Code rnfs for the desiulMon&gn Identified tm this E COrripllarme ivrrferm to the • The deM;n featums ldenrlrted on this Csrtipcat- of CompilanC are�c'OnslsterK with the infetmabon dac2mwrftd on Rthrrr a foams, worksheets, cairuradons, plans and sPer�ftcations submitted to the � ppiiW6ie cvmpllanCe Nance: ]aCqueline Zabikmcnt agency for approval with the permit application. Sfgnature: 7�like Pik Company: DESERT RII~: CQN12IiIdT'fING i1VC: Addreccs; 590 wI LYAMS _'A Dates: Nov 18, 20ZA City/5ta6;�p: PALM 5Pkx1VG5 I CAI 9?254 LaCense: 276586 - RCg: 212-A0060312A-00000000-0000 Ttegr„=tiratiOzl Dace/Time; 2011 ],1 16 2008 Femidentia,l CompZiancr_ gorm� / f 48:14:20 HERB Pra"ider: CaJCMra, InC, July 2010 CERTIFICATE OF FIELD VERIFICATION a DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: I Enforcement Agency: Permit Number: 44-090 CAMINO AZUL 1 OF 2, La Quinta CA 92253 1 City of La Quinta 11-1260 Note: If installation efa Charge Indicator Display (CrD) is utilized as an alternative to refrigerant charge verification for compliance, a MECH-24 Certifcate (Instead of this MECH-25 Certificate) should be used to demonstrate compliance with the refrigerant charge verfcarion requirement. TMAH and S7MS are not required for compliance, when a CU) 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 ResidentialAppendix RA3.2. If refrigerant charge verification is required far compliance, TMAH are also required for compliance. 5711S are uniy required for completely new ar replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in Supply and Return Plenums of Air Handler System Name or Identifrcation/Tag System Location or Area Served 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 5116 inch (S 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. Eater Pass or Fail+z Pass ✓ Fail STMS - Sensor on the Evaporator Coil System Name or identification/Tag The sensor is factory Installed, or field Installed according to manufacturer's 3 Yes No specifications, or is installed by methodsJspecifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for mrinec6on to a - 4 Yes No digital thermometer. The sensor mini plug is accessible to the installing techniclan and the HERS rater without changing the airflow through the condenser coif 5 Yes No When attached to a digital thermometer, the sensor provides an indication of the saturation temperature of the coil. Yes to 3, 4, and 5 is a pass_ Enter N/A if STMS are not ✓ NIA ✓ Pass ✓ Fail applicable. Otherwise enter Pass or Fail STMS - Sensor on the Condenser Coil System Name or Identificabon/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 the HERS rater without changing the airflow through the condenser coil Yes No When attached to a digital thermometer, the sensor provides an indication of the P'YIP'llp saturation temperature of the coil_o 5, 7, and 8 is a pass. Enter N/A if STMS are not able. Otherwise enter Pass or Fail v N/A ✓ Pass ✓ Fail Reg. 211-AD060312A-M2500001A-M25A Registration Date/Time: 2011/12/12 15.34:20 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING _ CF-411-14ECN-29 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit ftmbe, 44-090 CAMINO AZUL 1 OF 2, La Quinta CA 92253 City aF La Quanta ] 1-i260 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55'F) PraCedur'eS farle�' ng Refri�reran[ CharSle Using the Standard Charge iKeasurement Prc+Cedure are available in t?eference Resddentral Apperrdlx R43.As many as A systems in the dwelling ri3n be dorUmen[ed for rnmpllanre using Phis Ionia Attarh an addltionai fai m(sj fear any addrtlonal stems In thedwelling as apPlirahle. • Tire system shoulC be Installed and rhargee! in aocgrdante with the marrdtactUrer's sX_Rratorrs iSeR>re starting this procedure. • Tire system must meet minrirrUm airflow requirement3 as preregUislte for a �alld rafrigerarrt rlrarge test. • IF outdarr air dry-4ulb is 55�F ar below the Installer must !rse the Rlterna[e Charge Measurement Procedure. Space Conditioning Systems System Name or Identification/Tag System Location or Area Served Outdoor Unit Serial Outdoor Unit Make Outdoor Unit Model Nominal Coaling Capacity Btu/hr Date of Verification Calibration of Diagnostic Instruments Date of Refrigerant Gauge Calibration (must be re -calibrated monthly) Date of Thennocouple Calibration (must be re -calibrated monthly) Measured Temperatures 1*F1 System Name or Identification/Tag Supply (evaporator leaving) air dry-bulb temperature (Tsvpply, db) Return (evaporator entering) air dry-bulb temperature (Trettrm, db) Return (evaporator entering) air %vet -bulb temperature (Treturn, wb) Evaporator saturation temperature (Tevaporator, sat) Condensor saturation temperature (Tcondensor, sat) Suction lire temperature (Tsurtinn) Liquid Line Temperature (Tliquid) Condenser (entering) air dry-bulb temperature (Tcondenser, db) Reg: 211-A0060312A-M2500001A-M25A Registration Date/Tine: 2011/12/12 15:34:20 FERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-411-FIECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Perm- Humber. 44-090 CAMINO AZUL 1 OF 2, La Quinta CA 92253 City of La Quinta 11-1260 Minimum Airflow Requiremert Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge Verification. The temperature split method is specified in Reference Residential Appendix RA3.2. System Name or Identification/Tag Calculate: Actual Temperature Split = Tretum, db Tsupply, db Target Temperature 'Split from Table RA3.2-3 using Tretum, wb and Treturn, db Calculate difference: Actual Temperature Split - Target Temperature Split = Passes if difference is between -4'F and +4'F or, upon remeasurement, if between -40F and -1000F Enter Pass or Fall Note. Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is veriffed using one of the airflow measurement procedures spired in Reference Residential Appendix RA3_1 If actual cooling roll airflow Is measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below. Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 30D (cfrn/ton) System Name or Identification/Tag Calculated Minimum Airtlow 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 Calculations for Refrigerant Charge Verification. Th1s procedure is required to he used for fixed orifice metering device systems System Name or Identification/Tag Calculate: Actual Superheat = Tsuction - Tevaporator, sat Target Superheat from Table R43.2-2 using Tretum, wb and Tcondenser, dh Calculate difference: Actual Superheat - Target Superheat -= System passes if difference is between -6°F and +6°F Enter Pass or Fail Reg: 211-A0060312A-M2500001A-M25A Registration Date/Time: 2011/12/12 15:34:23 HERS Provider: CalCERTS, Znc_ 2008 Residential Compliance Forms March 2010 CERTIFICATE Refrigerant Charge Verification - Standard Measurement Procedure Site Address: Enforcement Agency: 44-090 CAMINO AZUL 1 OF 2, La Quints CA 92253 City of La Qolnta (Page 4 of 5) Permit Humber: 11-1260 Subcooling Charge t4ethod Calculations for Refrigerant Charge VeAf;cation. This procedure is required to be used for thennostatic expansion valve (T)CV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag Calculate: Actual Subcooling = Tcondenser, sat - Tiiquid Target Subcooling specified by manufacturer Calculate dMrence: Actual Subcooling - Target Subcooling = System passes if difference is between -4'F and +4°F Enter Pass or Fail Rea_ 211-A0060312A-M2500001A-M25A 'Jegistration Date/--ime: 2011/12/'12 15:34:20 HERS provider: Ca1MRTS, Inc. March 2010 2008 Residential Compliance Forms INSTALLATION CERTIFICATE Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of S) Sane Address: I Enforcement Agency: Permit Number: 44-090 CAMIN❑ AZUL 1 OF 2, La Quinta CA 92253 City of La Quints 11-1260 Standard Charge Measurement Summary: System shall pass bath refrigerant charge criteria, metering device criteria (if applicable), and minimum cooling soil airflow criteria teased 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 IdentificationjTag System meets all refrigerant charge and airflow requirements. Fitter Pass or Fail IDECLARATION STATEMENT ■ I certify under penalty of perjury, under'the laws of the State of Caiifomia, the information provided on this form is true and correct. ■ I am the certified HEMS 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 ld and the reguon is certi rate sped hied he installation) complies with the applicable regvimments in Reference Residential Appendices on the Certiflcate(s) of Compliance (CF-IR) approved by the local enforcement agency. ■ The informatlai reported on applicable sections of tite 1�1stallataon Cerdticate(s) (CF-6R), signed and submitted by the person(s) responsible for the installation conforms to the requirements Sped ned on the Certificate(s) of Compliance (CF-1R) approved by the Reg: 211-A0Q6G312A-M2500001A-M25A Registration Date/T_iMe. 2011/12/12 15:34:20 liMS Provider: Calczr<a 1n2 March 016 2008 Residential Coupliance Forms CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test - Existing Duct System (Page 1 of 2) Site Address: 44-090 CAMINO AZUL 2 OF 2, La Quinta CA 92253 Enforcement Agency: Permit Number: {System 1} of La Q City of La uinta 1i-126d Enter the Duct System Name or IdentificationjTag: 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 required for compliance .or 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 tided "Duct Leakage Test - Completely New or Replacement Duct System. " Duct Leakage Diagnostic Test - existing duct system Select one compliance method from the following four choices. 1. Measured leakage less than 15% of fan flow 2. Measured leakage to outside less than 10% of Fan Flow 3. Reduce leakage by 60% and conduct smoke and fix all leaks 4. Fix all accessible leaks using smoke and HERS rater verify Note: (One of Options 1, 2, or 3 must be attempted before utilizing Option 4.) determine nominal Fan Flak using one of the fallowing three calculation methods. V Cooling system method; Size of condenser in Tons _ x 400 = _ CFM Heating system method: 21.7 x Output Capacity in Thousands of Btu/hr = CFM ✓ Measured system airflow using RA3.3 airflow, test proredures: —CFM Option 1 used then: 1 Allowed leakage = Fan Flow _x 0.15 =_CFM Actual Leakage = CFM Pass if Leakage Actual is less than Allowed Pass Fail Option 2 used then: 2 Allowed leakage = Fan Flow_ x 0.10 = _ CFM Actual Leakage to outside = _ CFM Pass if Leakage Actual is less than Allowed Pass Fall Option 3 used then: Initial leakage prior to start of work =_CFM Final leakage after seating all accessible leaks using smoke test = CFM 3 Initial leakage _- Final leakage_ - Leakage reduction CFM ((Leakage reduction _/ Initial leakages x 100% =, 5rn Reduction Pass if 10A Reduction a 6010/c 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-A0060313A-M2100001A-M21A Registration Date/Time: 2011/12/12 15:31;08 HERS Provider: Ca1C=S, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECIH-21 Duct Leakage Test — Existing Duct System (Page 2 of 2} Site Address: 44-090 CAMINO AZUL 2 OF 2, La Quinta CA 92253 Enforcement Agency; City of La Quints Permit Number: 11-1260 (System 1) Outside air (0A) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testing, CFi OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet ASHIRAE Standard 62.2, and close when OA ventilation Is not required, may be configured to the closed position during duct leakage testing. All supply and return register boots must be sealed to the drywall if smoke test is utilized for compliance — applies to duct leakage compliance option 3 (leakage reduction by 600/6) and option 4 (fix all accessible leaks) described above. New duct installations cannot utilize building cavities as plenums or platform returns in lieu of ducts. Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct tape to seal leaks at all new duct connections DECLARATION STATEMENT I cerbfy under penalty of perjury, underthe laws of the state of ralifomia, the information provided on this form is true and correct. t am the tertffied HERS rater who performed the verviication services identified and reported on this certificate (responsible rater). The Installed feature, material, romp anent, or manufactured device requiring HERS Yen Firation that Is Itlentlfled on this tertlrrcate (the installation) complies with the applicable requirements in Reference Residential Appendices RA? and RA3 and the requirements specified on the. Cerdreate(s) of Compliance (CF-1R) approved by the local enforcement agency. The in(urmation reported on applicable sections of the Installation Certihcate(s) ICF-6R), signed and submitted by the persons) responsible for the installation mnfanrrts to ttm requirements spealied on the Certificate(&) of Compliance (CF-1R) approved by the rnfnrrement aoenrv. Builder or Installer information as shown on the Installation Certificate (CF-611) Company Name: (Installing Subcontractor or General Contractor a Builder/Owner) DESERT AIR CONDITIONING INC Responsible Person's Name: CSLB License: Jacqueline 2abik 276586 HERS Provider Data Registry Information Sample Group # (if applicable): 270776 tested/verified dwelling V not-tested/verified dwelling in la HERS sample group HERS Rater Information Ca10ERTS Certificate * CCI-1798609008 HERS Rater Company Name: Air Solutions of the Desert Responsible Rater's Name: I Responsible Rater's Signature: Walter W Nellis Welter W Ndellis Responsible Rater's Certification Number wl this HERS Provider: Bate Signed: 12/9/2011 CC20G4361 Reg_ 211-A0060313A-M2100001A-MZ1A Registration Date/Time- 2011/12/12 15:31-OB HERS Provider: CalCERTS, Inc. March 2010 2D08 Residential Compliance Forms CERTIFICATE OF FIELD VERIFICATION i DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: I Enforcement Agenry: Permit Number: 44-090 CAMINO AZUL 2 OF 2, La Quinta CA 922S3 City of La Qu7nta 11-1260 Note: If installation of a Charge Indicator Display (CID) is utilized as an aftemative to refrlgerant charge verification for compliance, a MEC HI 24 certifrcare (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 dai:umented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as apphcably. 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 of replacement space-cond+tionina systems that utilize prescriptive compliance method. TUAH _ Airs¢ H„t in �unnhr and Return Plenums of Air Handler System Name or IdentificationlTag System Location or Area Served 1 Yes No 5/16 Inch (S mm) access hole upstream of evaporative tail in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 Yes No Si16 inch (6 mm) access hole downstream of evaporative coil in the supply plenum and labeled accarding to Figure in Section PA3.2.2.2.2. Yes to 1 and 2 is a pass. Enter Pass or Fail Pass Fail cruc - conc..r nn *ha Pa nnr fnr rail c mcu _ c..—e -- 14— [`n i-mcar rna Reg: 211-A0060313A-M2500001A-M25A Registratiaa Date/Tisre: 2011/12/12 15:34:21 HERS PYOVider_ CaiCERMarch 2010 2008 Residential Compliance Forms CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING _ CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 55 Site Address: I Enforcement Agency: Permit Number: 44-090 CAMINO AZUL 2 OF 2, to Quinta CA 92253 City of La Qu'i 11-1260 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 Prxedure are available in Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling ran be documented For compliance using this form. Attach an additional form(s) fpr any additianai systems in the dwelling as appllcebfe. • The system should be Installed and charged in accordance with the marwiacturer's spedfkations belore starting this procedure. The system must meet minimum airflow rivairaments as prerequisite for a valid refrigerant charge test If outdoor air dry-bulb Is 551F ar below, the installer must use the Alternate Charge Measurement Procedure. wnaruoniny ay7�r+o�n i Name or Identification/Tag System Location or Area Served Outdoor Unit Serial # Outdoor Unit Make Outdoor Unit Model Nominal Cooling Capacity Btu/hr Date of Verification Instruments Date of Refrigerant Gauge Calibration (must be re -calibrated monthly) Date of Thermocouple Calibration (must be re -calibrated monthly) 11w-�.•-�J T__war +F­­ /oCIL System Name or Identification rag Supply (evaporator leaving) air dry-bulb temperature (Tsupply, db) Return (evaporator entering) air dry-bulb temperature (Treturn, db) Return (evaporator entering) air wet -bulb temperature (Treturn, wb) Evaporator saturation temperature (Tevaporator, sat) Condensor saturation temperature (Tcondensor, sat) Suction line temperature (Tsuction) Liquid Line Temperature (Tliquid) Condenser (entering) air dry-bulb temperature (Tpondenser, db) P.eg: 211-A0060313A-M2S00001A-M25A Registration Date/Tine: 2011/12/12 15:34:21 HERS Provider: ca3.ERTS. Inc. Marc` 2010 2005 Residential Compliance Forms Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: IEnforcement Agency: Permit Humber: 44-090 CAMINO AZUL 2 OF 2, La Quinta CA 92253 1 Cky of La Quint -a 11-1260 (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 ldentification/Tag Calculate: Actual Temperature Split = Treturn, db - Tsupply, db Target Temperature Split from Table RA3.2-3 using Tretum, wb and Treturn, dh Calculate difference: Actual Temperature Split - Target Temperature Split = Passes if difference is between -4OF and +40F or, upon remeasurement, if between -41F and -100°F Enter Pass or Fail Note: Temperature Split Method "miatlon is not necessary if actual Cooling Call Airflow is verified using one or the alydow measurement procedures specified in Reference Residential Appendix RA3.3. rfactual cooling coil airflow is measured, the value must.be equal to or greater than the Calculated Minimum Airflow Requirement in the table below. Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) System Name or Identification/Tag Calculated Minimum Airflow Requirement (CFM) Measured Airflow using RA3.3 procedures (CFM) Passes if measured airflow €s greater than or equal to the calculated minimum airflow requirement. Enter Pass or Fail Rea_ 211-AD060313A-M2500001A-M25A Registration Date/Time: 2011/12/12 15:34:21 HERS Provider! CalCERTS,'IInc. 2008 Residential Compliance Forms INSTALLATION CERTIFICATE CF-4R-Mr:CH-25 ltefrigeraEnt Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 44-090 CAMINO AZUL 2 OF 2, La Quinta CA 92253 City of La Quinta 11-1260 Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (Tmi) and electronic expansion valve (EXV) systems. System Name or Identification/Tag Calculate: Actual Subcooling = Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer Calculate difference: Actual Subcooling - Target Subcooling = System passes if difference is between -4°F and +4°F Enter Pass or Fail Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or IdentificationfTag Calculate: Actual Superheat = Tsuction ` Tevaparator, sat Enter allowable superheat range from manufacturer's specifications {or use range between 30F and 26OF if manufacturer's specification is not available) System passes tf actual superheat is within the allowable superheat range Enter Pars or Fai Reg: 211-A0060313A-M2500001A-M25A Registration Elate/TLme: 2012/12/12 15:34:21 HERS Provider: Ca1CFR"_'S, Inc:. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency. Permit Number: 44-090 CAMINO AZUL 2 OF 2, La Quinta CA 92253 City of La Quirtta 11-1260 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 meets all refrigerant charge and airflow requirements. Enter Pass or Fall DECLARATION STATEMENT I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater). . The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF-111) approved by the local enforcement agency. . The information reported an 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-111) approved by the enforcement agencv. Builder or Installer information as shown on the Installation Certificate (CF-6R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) DESERT AIR CONDITIONING INC Responsible person's Name: CSL6 License: Jacqueline 2abiic 276586 HERS Provider Data Registry Information Sample Group 4 (if applicable): 770776 tested/verified dwelling not-tested/verified dwelling in a HERS sample group HERS Rater Information CaICERTS Certificate # CC1-1798609008 HERS Rater Company Name: Air SoIutlnns of the Desert Responsible Rater's Name: Responsible Rater's Signature: Walter W Nellis Walter W Wlis Responsible Rater's Certification Number w/ this HERS ProVIdEY: Date Signed: 12/9/2011 CC2004361 Rea: 211-A0060313A-M2500001A-M25A' Registration Date,/T,iYnec 2011/12/12 15:34-21 HERS Prcvider: CalCERTS, Inc_ 2008 Residential Ccmpliance Forms March 2010