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11-0988 (MECH)N P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 11-00000988 Property Address: 78723 COMO CT APN: 609-530-018-18 -28457 - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 6350 Applicant: LvwtZiMKsLal/l� Td�/ 4 VOICE (760) 777-7012 FAX (760) 777-7011 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 9/13/11 Owner: MOZZILLO RICHARD D & ANN M 78723 COMO CT LA QUINTA, CA 92253 Contractor: Architect or Engineer: SIMMONS, ADAM 54440 AVENIDA CARRANZA LA QUINTA, CA 92253 (760) 564 -752 5 Lic. No.: 780534 r LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class: C20 icense No.: 780534 Date:�� Contractor: f ilo OWNER -BUILDER DECLARATION I 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 155001.: (_ 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.). (_) 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.). 1 _ 1 I am exempt under Sec. , B.&P.C. for this reason. Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: LQPERMIT 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 STATE FUND Policy Number 000456-2010 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 sho d become subject to the workers' compensation provisions of Section 3700 of the Labor C e I shall forthwith mply with those provisions. Date: C �' 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 bu*Id' onstruction, and reby authorize representatives of this county to enter upon the above-mentioned grope inspection purp s. pate: ,I Signature (Applicant or Agent): Application Number . . . . . 11-00000988 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 33.00 Plan Check Fee 8.25 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 3/11/12 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH APPL REP/ALT/ADD 9.00 1.00 9.0000 EA MECH B/C <=3HP/100K BTU 9.00 ---------------------------------------------------------------------------- Special Notes and Comments HVAC CHANGE OUT - 16.5SEER/80AFUE SPLIT SYSTEM [2008 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2010 CALIFORNIA BUILDING CODES. September*13, 2011 2:45:48 PM AORTEGA ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited ---------------------------------------- Due ----------------- Permit Fee Total 33.00 .00 .00 33.00 Plan Check Total 8.25 .00 .00 8.25 Other Fee Total 1.00 .00 .00 1.00 Grand Total 42.25 .00 .00 42.25 LQPERMIT Simplified Prescriptive Certificate oi Com liance: 2008 R' -#s' ldertpal ,ACAlfertrtlons CF -IR -ALT -HVAC Climate Zones 10 to 15 Sltr Address 7 BnforcemrencAgeaty: Date: Permit* ` Conditioned Floor Equipment Type' List Minimum Efficiency' Duct insulation uirement Area ❑ Packaged Unit 10 Furnace IN AFUE ❑COP Over 40 ft of duos added or O Setback WIndoor Coil MSEER,�� f' E3 HSPF repinoed in unconditioned space Served by system (If naa/ready WC6ndEnsing Unit 0 EERo_ O Resistance 0 R 6 (CZ 10-13) %zlvo sf present, Raw be larwlled) ❑ Other 0 R-9 (CZ 14-11) 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -IR -ALT -HVAC for each system. 2. Minim um. Equtpmew Efflelencics: 1.3• SEER 78% AFUE. 7.7HSPF for typical residential systems. HERS VERIFICATION SUMMARY Listed below aro four HVAC altetatiat Options.lite installer decides what work is being done and picks one of the appropriate Options. Eyh Option lists the HERS measures that must be conducted. A cop of Ilte faints shall be kit an Sita for f d inspection and a copy given to the liomebwobi. At heal, the m4ec for vedites that the work l(atod on this was in W the workwinpleW by the installer. The inspector also verifies 6&6bh appropriate CF -0 and rtgkistddd CP4R fomts (no hand filled C`'1-41ts allowed) are filled out and signed. Beginning October[, 2010 a reabiered copy of the CF -IR and CF4R shall also be on•sltb for mull 116 19 1. HVAC Chan bout red` ormts: • All HVAC Equipment replaced CF -6R forms: H-04, H-2 - and (for split TVM- 25 -HW CF4R forms: MECH- al and for MECH-25 • Condenser Coil and/or CF-01kforms: MECH-21-HERS and (for split systems) MECH- 25 -HERS • Indoor Coil and/or CF4R forms: MECH- 21 and (for split system) MECH-25 • Furnace For Split Systems: Duct leakage < 15 pement; RC, CCA ? 300 CFMhon(Minimum Air Flow Regniremodt), TMAH For Packaged Units: Duct leakage < 15 percent Exempted from duct leakage testing if ❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or ❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or ❑ 3. Existing ducts stemsarC or real, wi x ❑ 2. New HVAC .. ,terra Ferns: • Cutin or Chaogeotrt with now CF -611 forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-I1>vAS ducts: (all new ducting all CF4R form: MECII 20-, and (foo split WitH-22, and M$CH 25 new e t For Split Systems: Dtict leakage < 6 percent; RC, CCA 2:350 CFM/ton, FWD, TMAH, SIMS, and either HSPP or PSPP. For Packaged Units: Dud 1 6<6 Mrcent ❑ 3. NEw Ducts with Re lacement Required Forms: • Includes replacing or installing all new ducting CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-2541ERS and/or outdoor condensing unit and/or indoor CF -4R forms: MECH-20 and (for split systems} MECH-25 coil and/or furnace. Not all equipment changed. For Split Systems: Wd leakage < 6 ifet'l:ent, RC, CCA >_ 300 CFM/ton, TMAH For Packaged, Unitsf Dud' 1 e < 6 nt ❑ 4. New Ductin over 40 feet .'PAqdWQ Dorms: • Includes adding or replacing more than 40 CF -6R forms: MECH-04, MECH-21-HERS CF -4R fortes: MECH-21 linear feet of duct in uhconditioned s ce. For split system or packaged unkii Dud leakage < 15 percent ❑ EXCEPTION: Existing duct systems constru insulated or sealed with asbestos: Contractor (Documentation Author's fResponsibCe Designer's Declaration Statement) • t certify that this Certificate of Compliance documentation is accurate and complete. • I am eligibic under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compl "=- I cen ify 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. • ihe.ie.tgn features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance fours, worksheets, calculations, plans ands ifications submitted to the enforcement agency for approval with kation. Name- r Signature: Compare : Date: 1 Add License: tj t3 ' City/StatU7..ip: I-e4t Pitonei'?l9�1 2008 Residential Compliance Forms March 2010 Bin '# Permit # Project Address: _;I'- 7Z 3 City of La Quinta Building u Safety Division ' P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777=7012 Building Permit Application and Tracking Sheet �. D Owner's Name: �L p A. P. Number: Address: 3 z M,a c Legal Description: City, ST, Zip: n,'Z � Lee Contractor: i' ons Telepho Address: (/T Project Description: (AGE City, ST, Zip: L4 (S��` Cip, %'Z 63 Tele ho e: , gg State Lic. # City Lie. C Arch., Engr., Designs: Address: City, ST, Zip: Telephoner Construction Type: Occupancy: l�.v-ni.v.- X.. �:4Pi9 Fir! Project circle one): New Add'n Alter Repair Demo J tYPe ( )- State Lic. #: Name of Contact Person: Sq. FLWOC> # Stories: I # units Telephone # of Contact Person: Estimated Value of Project APPLICANT: DO NOT WRITE BELOW THIS UNE N Submittal Req'd Rec'd TRACMG PERMIT FEES Plan Sets Plan Check submitted Item . Amount Structural Cala. Reviewed, ready for corrections Pian Check Deposit Truss Cala. Called Contact Person Plan Check Balance .Title 24 Cala. Plans picked up Construction Flood plain pian Plaits resubmitted Mechanical Grading plan V Review, ready for correctioos/issuc Eleetriul Subcontactor List Called Contact Person Grant Deed Plans picked up H.O.A. Approval Plans resubmitted IN HOUSE:- ''' Review, ready for correctionshssoe IP4 Planning Approval Called Contact Person Pub. Wks. Appr Date of permit issue r1 School Fees I :J iI Total Permit Fees INSTALLATION CERTIFICATE* CF-6R-MECH-25-HER9 Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: 78723 Como Court, La Quinta CA 92253. 1 City of La Quinta 11-0988 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 p Yes ❑ No 4 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 p Yes ❑ No:: l= 5/36 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.:.. �r;;><, Enter Pass or Faill ✓ 0 'Pass ✓ ❑ Fail ,z STMS : Sensor on._the Evaporator Coil . System Narne,�'or Idia cation/Tag �vfi F� 2 .r System i s i ..' � � .., _. F _. 3 '4 'k es ri 9 . �d] No r e The sensor is factory instal ed `or fie'l�d�mstalled accortlmg to manufacturer s p 1 �,rf T,k' d-M+..'N4'i49'$. specifications, or imstalled by methods/specdications approved; by the Executive - 4 s p Yes l?krE a ❑ No . ` The sensor wire is terminated with astandard°mimiplug suitable:forconnecton'to a fIx digitalrthermometer�Th;Egensor mini plug maccessible tothe installing technician and th'e HERS rater withd t'changi' th`e airflow'ah�o.ugh the o dense cr oil 5 ❑ Yes. ❑.No ;The sensor, measures the saturation temperature of the coil within 1.3 degrees F Yes to 3, 4; andf5 isa�pase..Enter N/Q^ if. STMS are not applicable Otherwise: enter Pass ori fail ✓ N/A ✓ El Pass ✓ E] Fail STMS - Sensor on the Condenser itoil System Name or Identification/Tag,. I I System 1 The sensor is factory installed, or field installed according to manufacturer's 6 ❑ Yes ❑ No specifications, or is installed by methods/specifications approved by the Executive _ Director. The sensor.wire is terminated with a standard mini plug suitable for connection to a 7 ❑ Yes ❑ No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 8 1 ❑ Yes I ❑ 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 ✓ 2 N/A ✓ El Pass Pass ✓ ❑F applicable. Otherwise enter Pass or Fail Reg: 211-A0047836A-M2500001A-0000 Registration Date/Time: 2011/09/14 19:56:45 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms IAugust 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HER9 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: 78723 Como Court, La Quinta CA 92253 1 City of La Quinta 11-0988 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. Space Conditioning Systems System Name or Identification/Tag System 1 (must be re -calibrated monthly) System Location or Area Served Whole House f 1' ch 1 , P . �(gqmust;be�re calibrated monthly) ryry,. a ..<,41. Outdoor Unit Serial # E112214527 Outdoor Unit Make ICP Outdoor Unit Model NXA660GCK Nominal Cooling Capacity Btu/hr 60000 Date of Verification ":i 9-13-11 canbration•ot Diagnostic instruments Date bf Refrigerant Gauge Calibration,- 9-1-11' (must be re -calibrated monthly) Date of Thermo ou ` e Calibration p? w f 1' ch 1 , P . �(gqmust;be�re calibrated monthly) ryry,. a ..<,41. r MeasuredTemberatUt4 s((a°F<.)n:,t,? ,.. A21wMr' ,Wxw IWR�L ,.: ......... System Name.or Identification a .f S stem'l rai dry °z �53y� t mperaturep'(Supply pbulb upPlYa db)) Return (evaporator entering) air dry bulb ." 75 temperature, (Treturn b d)> .. Return (evaporator entering)iaiq wet -bulb 62 temperature (T return, " b.. "' Evaporator saturation temperature i% 47 (Tevaporator, sat) Condensor saturation temperature 109 (Tcondensor, sat) Suction line temperature (Tsuction) 52 Liquid Line Temperature (Tliquid) 100 Condenser (entering) air dry-bulb 100 temperature (Tcondenser, db) Reg: 211-A0047836A-M2500001A-0000 Registration Date/Time: 2011/09/14 19:56:45 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-611-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 78723 Como Court, La Quinta CA 92253 1 City of La Quinta 11-0988 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, 22.00 db - Tsupply, db Target Temperature Split from Table RA3.2-3 19.3 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - 2.7 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;5pecifled in Reference Residential Appendix RA3.3. If actual cooling coil airflow is measured, the value must. be. equal to; or greater than the Calculated Minimum Airflow Requirement in the table below. Calculated Minimum Airflow: Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) M System Nam�Ew,id n fication/Ta9 s i ' _ ;r �r { .�,.. y'-ir2�dl� Calcu atedfiMlnlmum Airflgow'Requi�rement�(CFM) j' 'b ,F' 1.M .s ` 9 rpro MeasuredwAii'rflow using RA3 3�procedures . � .. ., ,,...,. �;,.. �. Passes if measuredairflow is"`gre'ater:than or equal to the calculated minimum airflow requirement = Enter. ass or Fail p....,. Superheat Charge Method Calcuiations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering devicesystems. System Name or Identification/Tag• System i 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-A0047836A-M2500001A-0000 Registration Date/Time: 2011/09/14 19:56:45 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 :NSTALLATION CERTIFICATE CF-6R-MECH-25-HER; tefrigerant Charge Verification - Standard Measurement Procedure - (Page 4 of 5 Site Address: Enforcement Agency: Permit Number: 78723 Como Court, La Quinta CA 92253 City of La Quinta 11-0988 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 = 9.0 Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer 9 Calculate difference: 0' Actual Subcooling - Target Subcooling = System passes if difference is between -3°F and +3°F PASS ` Off } Enter Pass or Fail �, r �� 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=:: `. i; 5.0 Tsuction - Tevaporator, sat. ..; Enter allowable superheat:range from manufacturer's specifications (or userange 25 between 4°F and 25°F if manufacturer's.:. specification is not available) System'passactual'superheat is within the-` allowable superheat:rangeX .x PASS' ` Off } ".�?� �, r �� Reg: 211-A0047836A-M2500001A-0000 Registration Date/Time: 2011/09/14 19:56:45 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms ' August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: 78723 Como Court, La Quinta CA 92253 City of La Quinta 11-0988 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 9/13/2011 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): requirements. PASS Enter Pass or Fail ¢aria", ;i ml - 9 CS za .j, 3 fWW -:C '� �. 7 E.f?..n�,�::*.,, ah kF"'a { p.�.. ... DECLARATION STATEMENT;_ • I certify under penalty of perjury undeF.Ahe laws of the State of California, the information provided on this form is true and correct. • I am eligible under Division:3..-6�tlie:B6 iness and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). • I certify that the installed features,"inaiterials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group'but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. • I reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the installation have been met. •.I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or, made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives; and beginning October 1, 2010, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) ADAM SIMMONS Responsible Person's Name: Responsible Person's Signature: Donna Simmons Donna Simmons CSLB License: Date Signed: Position With Company (Title): 780534 9/13/2011 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No Reg: 211-A0047836A-M2500001A-0000 Registration Date/Time: 2011/09/14 19:56:45 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERE 3uct Leakage Test — Existing Duct System (Page 1 of 2' Site Address: Enforcement Agency: • Permit Number: 78723 Como Court, La Quinta CA 92253' (System 1) 1 City of La Quinta 11-0988 Enter the Duct System Name or Identification/Tag: System 1 Enter the Duct System Location or Area Served: Whole House Vote: Submit one Installation Certificate for each duct system that must demonstrate compliance in the swelling. This installation certificate is required for compliance for alterations and additions in existing dwellings !:1 space conditioning systems and duct systems. dote: For existing dwellings, a completely new or replacement duct system can also include existing parts of he original duct system (e.g., register boots, air handler, coil, plenums; etc.) if those parts are accessible ind they can be sealed. For a completely new or replacement duct system installed in an. existing dwelling, ise 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 Notei,(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 ZOW�„ �:< ✓ Coolmgsystem:method: Size bfondenser in Tons�S x 400 - 2000CFM FIR ✓ Deating systt 'A7241.7 x�Output Capacity m�Thousands of Btu/hr _CFM f ✓ ❑ Measured system airflow r ting?R�A3alowtest procedures: Optionlused Yhen FV 1 AllowedleakageFanAirflow��2000 Actual Leakage'= ; 40 CFM -.-�"� Pass if Actual Leakage is less than Allowed leakage M Pass Fail 0ption.2 usedahen 4M 2 Allowed leakage Fan' Airflow _ x 0.10 = _ CFM Actual Leakage to outside =_<' CFM Pass if Actual leakage to outside is less than Allowed leakage 0 Pass Fail Option 3 used then: Initial leakage prior to start of work = CFM Final leakage after sealing all accessible leaks using smoke test = CFM 3 Initial leakage _ - Final. leakage _ = Leakage reduction _ CFM ((Leakage reduction _ / Initial leakage _) x 100% _ % Reduction Pass if % Reduction > 60% 0 Pass Fail Option 4 used then: 4 All accessible leaks repaired using smoke test. HERS rater must verify (No Sampling). Pass if all accessible leaks have been repaired using smoke Pass Fail Reg: 211-A0047836A-M2100001A-0000 Registration Date/Time: 2011/09/14 19:54:21 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 1_, INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test - Existing Duct System (Page 2 of 2) Site Address: Enforcement Agency: Permit Number: 78723 Como Court, La Quinta CA 92253 (System 1) 1 City of La Quinta 11-0988 0 Outside air (OA) ducts;forCentral Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testing. CFIOA.ducts that utilize controlled motorized dampers, that open only when OA 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. 0 All supply andoreturn register boots must be, sealed to the drywall if smoke test is utlllzedafor compliance - appliesto,diict-1 akage compllae op on�31e kag duction y6/)a d opt n 4(fiz allaccessible leaks) described above. ,< � -1' 1A, ,x'� New duct56stallatlo s cannoftli illz bullding cav►ties`as pleriums or plaNU tform ret rns In I eu of ducts © Mastic and�dra,.W-ADandsAmusx,be used In combinatlon with cloth backed ubb�er adhesive duct to , e to seal leaks at all`new duct connections% , ���P � DECLARATION STATEMENT • I certify under penalty of perjury; under:the' laws of the State of California, the information provided on this form is true and correct. • I am eligible under Division 1"of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person respongible for construction (responsible person). • I certify that the installed features; .materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • I understand that a,HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. • I reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiDle orientation alternatives, and beginninq October 1, 2010, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) ADAM SIMMONS Responsible Person's Name: Responsible Person's Signature: Donna Simmons Donna Simmons CSLB License: Date Signed: Position With Company (Title): 780534 9/13/2011 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No Reg: 211-A0047836A-M2100001A-0000 Registration Date/Time: 2011/09/14 19:54:21, HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 R L, CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: 78723 Como Court, La Quinta CA 92253 City of La Quinta 11-0988 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 p Yes ❑ No5/16 ❑ Yes 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 p Yes El 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 ....and 2 is a pass.. Enter Pass or Faill ✓ 0 Pass ✓ ❑ Fail STMS =. Sensor..on�the. Evaoorator°Coil---.......:v .. SystemName "or;IdenEifi,cation/Tag 3 �1 �' o, The sensor is factory installed or field installed according tom -anufacturer's . speafications, or is msta;lled by methods/specificationssapproved by the Executive ❑ Yes ❑ No specifications, or is installed by methods/specifications approved by the Executive 02 Director. .<<.�.,, 4 p Yes s p The sensorrwire,i§ tear hinated Wi' standard min plug suitable for connectwnhto a digital'thermometerThesensormimFplu9!s accessible to the installin9techmeian ❑ Yes .. �Y ,and the _HERS rater withd Cchanging th'e airflow.through,the condenser coil 5 ❑ Yeses ❑ No i; When attached to a digital thermometer, the sensor provides an indication of the ❑ Yes ❑ No 5 saturation temperature of the coil. Yes to4 ;and 5 is•a pass. Enter;N/A if STMS are not ✓ 0 N/A ✓ ❑Pass _T ✓ 171Fail applicable. Otherwise enter: Pass or;Fail ✓ E] Pass ✓ ❑Fail applicable. Otherwise enter Pass or Fail L STMS - Sensor on the Condenser Coil System Name or Identification/Tag ' I System 1 The sensor is factory installed, or field installed according to manufacturer's 6 ❑ Yes ❑ No specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 7 ❑ Yes ❑ No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 8 ❑ Yes ❑ No 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 ✓ N/A ✓ E] Pass ✓ ❑Fail applicable. Otherwise enter Pass or Fail Reg: 211-A0047836A-M2500001A-M25A Registration Date/Time: 2011/09/14 20:00:10 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: 78723 Como Court, La Quinta CA 92253 "T City of La Quinta 11-0988 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. Space Conditioning Systems System Name or Identification/Tag System 1 (must be re -calibrated monthly) System Location or Area Served Whole House 9 12 11 m st�be re alibrated month) Outdoor Unit Serial # E112214527 k 4 Outdoor Unit Make ICP Outdoor Unit Model NXA660GCK Nominal Cooling Capacity Btu/hr. '. ; 60000 Date of Verification 1 9-14-11 calibration otUiagnostic instruments . Date of Refrigerant Gauge Calibration::.:;.::::, 9-12-11 (must be re -calibrated monthly) F' Date of Them�iocou Ie CMibration 9 12 11 m st�be re alibrated month) Supply. (eva'porator,leaving),airdry 52... k 4 Measu redgTem peratu res- CtF � ,� ;, �� System Name" or Identific�ayy✓t8�on/�Tyag Systemili F' 161 � .r �... '?•hi s.... ivf s..,: a Supply. (eva'porator,leaving),airdry 52... temperature (Tsupply, db Return eva, ,orator enterin air d . ( p g) ry bulb 75 temperaturej(Treturn, Return (evaporator entering).air'wet=;bulb 62 temperature (Treturn, wb�• . '..,; ; a ` Evaporator saturation temperature: 47 (Tevaporator, sat) Condensor saturation temperature 109 (Tcondensor, sat) Suction line temperature (Tsuction) 52 Liquid Line Temperature (Tliquid) 100 Condenser (entering) air dry-bulb 102 temperature (Tcondenser, db) a Reg: 211-A0047836A-M2500001A-M25A Registration Date/Time: 2011/09/14 20:00:10 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE I I CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 78723 Como Court, La Quinta CA 922.513 City of La Quint a 11-0988 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 I System 1 Calculate: Actual Temperature Split = Tretun, 23.00 db - Tsupply,db Target Temperature Split from Table RA3.2-3 21.3 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - 1.7 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 Method, Calculation is not necessary if actual Cooling Coil Airflow is verified using one of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual cooling coil airflow is measured, the value must.be equdfit"o:or greater than the Calculated Minimum Airflow Requirement in the table below. Calculated Minimum Airflow:Re u,rement CFM Nominal Cooling Capacity ton X.300 cfm/ton System Name or Id ntification/Ta9 a ` ' f"r 4cfirx� , g M. ?.# gt` Calculated'Miniinum Airflow Requirement+(CFM) 'WitMini' -:y✓� •� � c�'14 i � A-,: I W, �F M�l �� , �.Y Measured Airflow uslh RA3 3 rocedures CFM: W E Passes if measured airfliiw is greaterthan ori equal to the calculated minimum:air low requirement: e - EntenPass or Fail Superheat Charge Methodtalcujlations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag Calculate: Actual Superheat = Tsuction - Tevaporator, sat Target Superheat from Table RA3.2-2 using Treturn, wb and Tcondenser, db Calculate difference: Actual Superheat - Target Superheat = System passes if difference is between -6°F and +6°F Enter Pass or Fail Reg: 211-A0047836A-M2500001A-M25A Registration Date/Time: 2011/09/14 20:00:10 HERS Provider: CalCERTS, inc. 2008 Residential Compliance Forms March 2010 :NSTALLATION CERTIFICATE CF-4R-MECH-2! tefrigerant Charge Verification -.Standard Measurement Procedure (Page 4 of 5' Site Address: Enforcement Agency: Permit Number: 78723 Como Court, La Quinta CA 92253 City of La Quinta 11-0988 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 = 9.0 Tcondenser, sat - Tliquid F Target Subcooling specified by manufacture9 Calculate difference: 0 Actual Subcooling - Target Subcooling = System passes if difference is between i ..�.,. -4°F and +4°F i PASS '� ,4. ��' - €`g - � 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 Identification/Tag- System 1 Calculate: Actual Superheat,.=. :,: ;,` 5.0 Tsuction - Tevaporator, sat.. % Enter allowable superheat range from: . manufacturer's specifications (or _uie�gan e' 9 25 6' between 3°F and 26°F if manufacturer,.4s. � specification is not available) ..�.,. System passes4. actual superheatis-withiw hie allowable -superheat range¢ f PASS '� ,4. ��' - €`g - � F . EnterPass�or ��� Fail a 3 x�, ; Reg: 211-A0047836A-M2500001A-M25A Registration Date/Time: 2011/09/14,20:00:10 HERS Provider: CalCERTS, 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: 78723 Como Court, La Quinta CA 92253 City of La Quinta 11-0988 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 n System 1 CSLB License: Donna Simmons System meets all refrigerant charge and airflow 1780534 HERS Provider Data Registry Information• Sample Group # if applicable): N A P P (/ requirements.1 PASS 4, �y HERS sample group Enter Pass or Fail HERS Rater Company Name: Energy Driven Solutions, Inc. �:..: , .?. .. ' DECLARATION.STAT EMENT-1""" . • I certify under penalty.of perjury; uhHder,the laws of the State of California, the information provided on this form is true and correct. P•yY . I am the certified HERS rater who: perfo::rmed the � erification 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 -ilk) 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 shownlon the Installation Certificate (CF -6111) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) ADAM SIMMONS i Responsible Person's Name: CSLB License: Donna Simmons I 1780534 HERS Provider Data Registry Information• Sample Group # if applicable): N A P P (/ Q tested/verified dwelling ❑ not-tested/verified dwelling in la 4, �y HERS sample group HERS Rater Information CalCERTS Certificate # CC1-1798592316 HERS Rater Company Name: Energy Driven Solutions, Inc. Responsible Rater's Name: Responsible Rater's Signature: David Bricker I bavid Bricker Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 9/14/2011 CC2004131 Reg: 211-A0047836A-M2500001A-M25ARegistration Date/Time: 2011/09/14 20:00:10 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms I March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: Enforcement Agency: Permit Number: 78723 Como Court, La Quinta CA 92253 (System 1) City of La Quinta 11-0988 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 I 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'd educt 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 nominahE n�Flow using o - he of theme followiinn, g three�_callcculation,m�ethods ✓ D Cooling:system method: Si,e of condenser�in°Tons 5 ¢x+400 = a000 CFM a p r r �5 Jt i �w ✓ ❑ Heating system method'` 21 , xP, `itput Capacity in inousands,,of l3tu/hr,IF _CFM ✓ ❑ Measured system airflowusmg'RA33�irflow-testprocedures :. R .,a� .. OpthonQ&,usedFthen 0 Allowed leakage Fan'Flow 2 00 x^0 15 N..3�O0-. CFM -;! - " 1 Actual Leakage — 38 CFM Pass if Leakage Actual is less than Allowed M Pass El Fail Option"2 used then:. � 2 Allowed leakage Fan Flow x 0.10 = _ CFM Actual Leakage to.outeide.==«:CFM Pass if Leakage Actual is less than Allowed 0 Pass Fail Option 3 used then: { `... Initial leakage prior to start of work = CFM Final leakage after sealing all accessible leaks using smoke test = CFM 3 Initial leakage _ - Final leakage _ = Leakage reduction _ CFM ((Leakage reduction _ / Initial leakage x 100% _ % Reduction Pass if % Reduction > 60% Pass Fail Option 4 used then: 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-A0047836A-M2100001A-M21A Registration Date/Time: 2011/09/14 19:58:19 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 J CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test - Existing Duct System (Page 2 of 2) Site Address: Enforcement Agency: Permit Number: 78723 Como Court, La Quinta CA 92253 (System 1) 1 City of La Quinta 11-0988 0 Outside air (OA) ducts for Cer during duct leakage testing. CFI ventilation-is•required-to meet'A be configured to the closed pos.i' 0 All supplyand%return register - applies to,=duct leakage compli leaks) described above. v.. 9 New d' Q1,,installa Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off ducts that utilize controlled motorized dampers, that open only. when OA ,AE Standard 62.2; and close when OA ventilation is not required, may during duct leakage testing. uilding c0itles4s PIE utilizedtforcompliance 44 (fix all accessible X` ns m liewof ducts sof Mastic i3nddraw,bandsmust�beuse�ncombmatlonwlthcloth,backed=rubberadheslveduct tapeto seal;, leaks at all�newduct connections.,..:u.. DECLARATION STATEMENT``' • I certify under penalty of perjuryunder, 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 theapplcable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the local enforcement agency. • The information reported on applicable sections of the Installation Certificate(s) (CF -611), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the enforcement agency. Builder or Installer information as shown on the Installation Certificate (CF -6R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) ADAM SIMMONS Responsible Person's Name: CSLB License: Donna Simmons 1780534 HERS Provider Data Registry Information Sample Group # (if applicable): N/A tested/verified dwelling❑ not-tested/verified dwelling in la HERS sample group HERS Rater Information CaICERTS Certificate # CC1-1798592316 HERS Rater Company Name: Energy Driven Solutions, Inc. Responsible Rater's Name: Responsible Rater's Signature: David Bricker David Bricker Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 9/14/2011 CC2004131 Reg: 211-A0047836A-M2100001A-M21A Registration Date/Time: 2011/09/14 19:58:19 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010