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11-1349 (MECH)P.O. BOX 1504 . 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number. 11:060� Property Address: mg -7'8790 SPYGLASS. HILL DR APN: 770-070-028-6.6 -25389 - Application description:- MECHANICAL Property Zoning: MEDIUM DENSITY RES Application valuation:. 19000 Applicant: Architect or Engineer: 'mow BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: MCBRAYER CHARLES W 23791 FAIR GREENS EAST LAGUNA NIGUEL, CA 92677 sqV30.1vat4s Contractor: f /O COOL FLO INC 79469 COUNTRY CLUB DR,' BERMUDA DUNES, CA 9220- (760)345-6606 Lic..No.: 438781 i VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 12/21/11 21 f ------------------------------------------------------------------- ---- ----------- - - - - - — — -r- - - - - — LIC CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury tha I censed 'under provisions of Chapter.9.(commencing with - Seaio 7000 of Division 3 of the eusin nd P of ssionals Code, and my License is in full force and effect. Licari Class C]20 License No.: 438781 ` tractor: log OWILDER 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 ($500).: 1, 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 contractors) licensed pursuant to the Contractors' State License Law.). (_ 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: L,QPERMIT 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 NORGUARD INS Policy Number COWC239005 _ I certify that, in the perfor a of the work for which this permit is issued, I shall not employ any person in any mann s to become subject to the workers' compensation laws of California, d agree that, if s uld ecome subject to the workers' compensation provisions of Section A bo ode, I all forthwith comply with those provisions. V pplicant: 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 issuanceofsuch permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state th ve information is correct. I agree to comply with all iciy;pun ordinances a state laws relating ildin onstruction, and hereby authorize representatives n o enter up the above -mention prop o inspection purposes. ignature (Applicant or Ag Application Number . . . . 11-00001349 Permit MECHANICAL Additional desc . Permit Fee 66.00, Plan Check Fee 16.50 " Issue Date Valuation 0 Expiration Date. 6118/12 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 HVAC CHANGE -OUT: 2 SYSTEMS, FURNACES, CONDENSERS, INDOOR COILS. 2010 CODES. ------------------------------------------------------------ - - -- other Fees . . . . . BLDG STDS ADMIN (SB1473) -- - -- 1.00 Fee summary Charged Paid Credited --------_------------------=------------ Due ----------------- Permit Fee Total 66.00 .00 .00 .66.0.0. " Plan Check Total 16.50 .00 .00 16.50 Other Fee Total 1.00 .00 .AO 1.00 Grand Total 83.50 .00 .00 83.50 LQPERMIT Sim lifted Prescriptive Certificate of Compliance: 2008 Residential HVACAiterations CF -IR -ALT -HVAC Climate "Zones Site 4ddr�esso ASS EnforcenrentAgerr .1 Date //Permit #: Equipment •Type' List Minimum Eff icicncy' Conditioned Floor Arca Thermostat Nackaged Unit furnace AFUE 1► ndoor Coil EER E Condensing Unit EER OP Q COP— Q l ISPF _ Q Resistance Seined bv system Ian Sf tback fnrn ulreucly present nn sr he insrnlled J Other 1. Equipment Type: Choose the equipment being installed if more than one system use another CF -IR -ALT -HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER. 78%AFUE, 7.7HSPF for typical residential systems. HERS VERIFICATION SUMMARY Listed below are three HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the fornis shall be left on site for final inspection and a copy given to the homeowner. At final. the inspector verifies that the work listed on this form was in fact the work completed by the installer. The inspector also verities that each appropriate CF -6R and registered CF -4R forms (no hand filled Cl--4Rs allowed) are tilled out and signed. Beginning October 1, 2010, a registered copy of the CF -1R and CF -6R shall also be on site for final inspection. 1. HVAC Changeout Required Forms: • All HVAC Equipment CF -6R forms: MECH-04. MECH- 25 -HERS replaced CF -4R forns: MECIA-25 • Condenser Coil and /or • Indoor Coil and /or CF -6R forms: MECH- 25 -HERS CF -4R forms: MECH-25 • Furnace For Split Systems: RC, CCA > 300 CFM/ton, TMAH For Packaged Units: No testing required E12. New HVAC System Required Forms: • Cut in or Changeout with CF -6R forms: MECH-04.. MECH- 25 -HERS new ducts: (all new ducting CF -4R fon-ns: MECH-25 and all new equipment) For Split Systems: RC, CCA > 300 CFM/ton, TMAH. For Packaged Units: No testing required Q 3. New Ducts with Replacement Required Forms: • Includes replacing or installing all new CF -6R forms: MECH-25-HERS ducting and/or outdoor condensing unit CF -4R fornis: MECH-25 and/or�indoor coil and/or furnace. Not all equipment changed. For Split Systems: RC, CCA > 300 CFM/ton, TMAH For Packaged Units: No testing required Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • 1 certih, that this Certificate of Compliance documentation is accurate and complete. • I am eligible under Division 3 of the California Business and Prolessions Code to accept responsibility for the design identified on this Certificate of Compliance. • I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24. Parts 1 and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms. worksheets, calculations. plans and specifications sub n ted to the enforcement agency for approval with the erniit a lie tion. Name:UINDI pff—I III" AN Signature: ConadoL'o A me Date. Addr 141/1 UL, 43$ City/State/Zip: Phone: O 2008 Residenlial Compliance Dorms A9arch 2010 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAIterations CF -I R -ALT -HVAC Climate Zones Site,4ddress: Enforcement Agency: Date- Permit #: 055 W l Equipment Type' List Minimum -fficiency' Conditioned Floor Arca Thermostat Packaged Unit Furnace AFU Indoor CoilLpEE!� Condensing Unit EER 0 COP 0 I ISPF erve by system 0 Resistance sf etback f fnw alrecrrh+presem. naisi be installed)Other 1. Equipment Type: Choose the equipment being installed if more than one system use another CF -1 R -ALT -HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER. 78%AFUE, 7.7HSPF for typical residential systems. HERS VERIFICATION SUMMARY Listed below are three HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final. the inspector verifies that the work listed on this form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF -6R and registered CF -4R fornms (no hand filled C174Rs allowed) are tilled out and signed. Beginning October 1, 2010, a re-istered copy of the CF -1 R and CF -6R shall al4p be on site for final inspection. 1. HVAC Changeout Required Forms: • All HVAC Equipment CF -6R forms: MECH-04. MECH- 25 -HERS replaced CF -4R forms: MECH-25 • Condenser Coil and /or • Indoor Coil and /or CF -6R forms: MECH- 25 -HERS CF -4R forms: MECH-25 • Furnace For Split Systems: RC, CCA >_ 300 CFM/ton, TMAH For Packaged Units: No testing required EJ 2. New HVAC System Required Forms: • Cut in or Changeout with CI ---6R Dorms: MECH-04. MEC H- 25 -HERS new ducts: (all new ducting CF -411 fon-ns: MECI-1-25 Lind all new ec ui nment) For Split Systems: RC, CCA >_ 300 CFM/ton, TMAH. For Packaged Units: No testing required Q 3. New Ducts with Replacement Required Forms: • Includes replacing or installing all new C17-611forms: MfiCH-25-I IERS ducting and/or outdoor condensing unit CF -4R fornms: MECH-25 and/or indoor coil and/or furnace. Not all e uipment changed. For Split Systems: RC, CCA > 300 CFM/ton, TMAH For Packaged Units: No testing required Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • 1 certify that this Certificate of Compliance documentation is accurate and complete. • I am eligible under Division 3 of the Califomia Business and Prolessions Code to accept responsibility for the design identified on this Certificate of Compliance. • I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24. Parts I and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable conmpliance forms. worksheets, calculations. plans and specifications s mitted to forcemeat agency for approval with the permit it a lie tion. Name: Signat c: ConCrN y�OLOO, PWDate: .� ^ Addr License: 4 ig40 City/Statelip:l2b4— CA 417Phone:100 0 EERewe .7,03, 2008 Residential Compliance forms rllarch 2010 Bin # .. City of La Quinta, Building 8T Safety Division P.O. Box 1504, 78-4.95 Calle Tampico, La. Quinta, CA 92253 - (760) 777-7012 . . Building Permit Application and Tracking Sheet Permit # Project Address: ®� G Owner's Name:14d8 A. P. Number: Address: Legal Description: ; City; ST, Zip: ContractorLZL : G �i et.�}::�• �.;:;?�: Tlephone: kf •caW o x>�vy Address: Project Description: City, ST, Zip: -3G d� v� ! Telephone'• State Lic. # : f li5 l Arch., Engr., Designer: v���•�;�;2>:;::�;:s:�>�%��%..�«,.:,- ::;'.v:::< City Lic. #: Address: City, ST, Zip: Telephone: w �::� � � �' •`'�� '-'':"::` M GFS. . �::.: . i • Construction T Occupancy: . Project type (circle one): New Add'n Alter Repair Sq. Ft.6 , # Stories: I # Uni . Demo 2 •N���r��:Si,.�.;;5}.moi .� :.,�,i•.. `�:� State Lica#:;ay �E�t. Name of Contact Person: z1E Telephone # of Contact Person: D 0- � � % Estimated Value of Project: G% 'Doc). APPLICANT: DO NOT WRITE BELOW THIS LINE q Submittal Req'd Recd TRACKING PERMTT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Pian Check Deposit Truss Calcs• Called Contact Person Plan Check Balance Title 24 Coles. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan god Review, ready for correctionsftssue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''' Review, ready for corrections/mue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test -7 Existing Duct System (Page 1 of 2) Site Address: 78-790 Spyglass Hill Drive 2 of 2,•La Quinta CA 92253 Enforcement Agency: r (System 1) 1 ' CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test -7 Existing Duct System (Page 1 of 2) Site Address: 78-790 Spyglass Hill Drive 2 of 2,•La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) 1 ' City of La Quinta 11-1349 Enter the Duct System Name or Identification/Tag: System 2 of 2 Enter the Duct System Location or 'Area Served: Bedroom Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. , is This installation certificate is required for compliance for alterations and additions in existing dwellings to space conditioning systems and duct systems. k 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 Optigns 1, 2, or 3 must be attempted before utilizing Option4..), Determine nominal Far low using one of*th6followingzth'ree calculation methods ,�,*Z T'1` , <� . fi �_ ; k ✓ Cooling system method: Syeize /jof condenser in Tons X3.5" x 400 1400 r`CFM F a{ ` " ^ �ASid°1 .����.,`: � �g. � �5{ r i ;YW, ��t fid'✓'. V Heating 21 7 x t Output Capaaty in Btu/hr rfCF1YM � system method. :Thousands of = - ✓ Measuredf�ystem•airflow 3,`ai:flow;test wCFM,�,; using�RA3 procedures ,� � Option''Vused then... 1 Allowed leakage = Fan Flow 1400' x 0.15 = 210 CFM** Actu_al,Leakage`=; 853 CFM: Pass if Leakage Actual is less than'Allowed Pass . Fail Option 2 used then:',,,,' 1 2 Allowed leakage = Fan Flow 1400 x 0.10 = 140 CFM - Actual Leakage to outside. r CFM Pass if Leakage Actual is less than Allowed Pass Fail Option 3 used then: Initial leakage prior to start of work = _ CFM Final leakage after sealing all accessible leaks using smoke test = _ CFM ' 3 Initial leakage' - Final leakage _ = Leakage reduction' CFM ((Leakage reduction_/ Initial, leakage_) x 100% _ No Reduction Pass if % Reduction > 600/a Pass Fail Option 4 used then: 4 All accessible leaks repaired using smoke. HERS rater must verify (No sampling). No smoke allowed to leak from system. Including ducts, plenums, air handler and door panel. Pass if all accessible leaks have been repaired using smoke Pass Fail Reg: 211-A0067286A-M2100001A-M21A Registration Date/Time: 2011/12/29 01:05:05 :HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 Outside air (OA) ducts for C en Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off durind 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 lf,smoke test Is`utlllzed for compliance - appliesto duct leakage .compllance option 3 (leakage reduction` yy 60%)`•and 6p66n541(fix aIi,accessible leaks) described above5; 1 New duct;lnstallations cannot utlhze building cavltles asfplen'ums or4platform returns In lieu of ducts , V Mastic and draw°bands must.b::etused-in;,.combinatlon"with cloth°backed rubber adhesive duct�tape to seal leaks at all new duct connections..': ,: DECLARATION STATEMENTt'"=-„ 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 wfioIp"mIeirformed 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. . A 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 agencv. Builder or Installer information as shown on the Installation Certificate (CF -6111) CERTIFICATE OF FIELD VERIFICATION'& DIAGNOSTIC TESTING CF-4R-MECH-21 COOL-FLO INC Responsible Person's Name: CSLB License: Duct Leakage Test - Existing Duct System (Page 2 of 2) 1438781 ' f Site Address: '78-790 Spyglass Hill Drive -2 of 2,'La Quinta CA 92253 Enforcement Agency: City of La Quinta Permit Number: 11-1349 (System 1) HERS sample group HERS Rater Information CalCERTS Certificate # CC1-1798618085 HERS Rater Company Name: Air Solutions of the Desert Responsible Rater's Name_ : Responsible Rater's Signature: Outside air (OA) ducts for C en Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off durind 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 lf,smoke test Is`utlllzed for compliance - appliesto duct leakage .compllance option 3 (leakage reduction` yy 60%)`•and 6p66n541(fix aIi,accessible leaks) described above5; 1 New duct;lnstallations cannot utlhze building cavltles asfplen'ums or4platform returns In lieu of ducts , V Mastic and draw°bands must.b::etused-in;,.combinatlon"with cloth°backed rubber adhesive duct�tape to seal leaks at all new duct connections..': ,: DECLARATION STATEMENTt'"=-„ 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 wfioIp"mIeirformed 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. . A 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 agencv. Builder or Installer information as shown on the Installation Certificate (CF -6111) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) ' COOL-FLO INC Responsible Person's Name: CSLB License: MICHAEL MANGAN 1438781 ' HERS Provider Data Registry Information Sample Group # (if applicable): N/A J tested/verified dwelling not-tested/verified dwelling in la HERS sample group HERS Rater Information CalCERTS Certificate # CC1-1798618085 HERS Rater Company Name: Air Solutions of the Desert Responsible Rater's Name_ : Responsible Rater's Signature: Walter W Nellis Walter W Nellis, Responsible Rater's Certification Number wl this HERS Provider: Date Signed: 12/28/2011 CC2004361 t Reg: 211-A0067286A-M2100001A-M21A,� Registration Date/Time: 2011/12/29 01:05:05 HERS Provider: Ca10ERTS, Inc. 2008 Residential -Compliance Formsi March 2010 INSTALLATION CERTIFICATE* CF-6R-MECH-25-HERS Refrigerant Charge Verification = Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number:. 78-790 Spyglass Hill Drivf2 of 2 'La Quinta CA 922531 City of La Quinta 11-1349 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. I 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 2 of 2 Yes System Location or Area Served Bedroom 6 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 ' INSTALLATION CERTIFICATE* CF-6R-MECH-25-HERS Refrigerant Charge Verification = Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number:. 78-790 Spyglass Hill Drivf2 of 2 'La Quinta CA 922531 City of La Quinta 11-1349 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. I 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 2 of 2 Yes System Location or Area Served Bedroom 6 1 Yes No 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 ✓ Yes No } 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply.plenum and labeled according to Figure in Section RA3.2.2.2.2. Yes to 1. and 2 is a pass. j .; : Enter Pass or Fail ✓ ✓ Pass ✓ Fail STMS - Sensorsonkthe Evaporator Coil System Nam&or Identification/Tag ; 'System 2 of;2*•.'r. ��, •,. ,,r,, 3 Yes No jThe sensor is factory installed, orfield°installed acco"riling to'mahufacturer.'sK _ specifications, or is installed by methods/specifications approved by the Executive 6 " No Director. it.`s - .`;`�I`. �t 4 i YesNo The sensor wi"re is terminated Witha standard mini plug suitable for connection to of digital thecm`ometer'The._sensor mirn;plu.g is accessible tortheFinstallmg�techrnaari `,�� and th&HERS"raterxwithout changing theairflow:through the condenser coil 5 Yes No The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 3 4, and 5 is a`pass. Enter N/A if STMS are not applicable.. Otherwise enter Pass or�Fail ✓ ✓ N/A ✓ Pass ✓ Fail STMS - Sensor on the Condenser.Coil System Name or Identification/Tag System 2 of 2 The sensor is factory installed, or field installed according to manufacturer's 6 Yes No specifications, oris 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 ✓ ✓ N/A ✓ PassFV Fail applicable. Otherwise enter Pass or Fail W y Reg: 211-A0067286A-M2500001A-0000" Registration Date/Time: 2011/12/29 00:40:01 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms,. August 2009 f � f INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification'- Standard Measurement Procedure (Page 2 of 5) Site Address: I Enforcement Agency: Permit Number: 78-790 Spyglass Hill Drive 2 of 2, La Quinta CA 922531 City of La Quinta 11-1349 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. r • 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 2 of 2 (must be re -calibrated monthly) System Location or Area Served Bedroom c 11/30/,,II N� 4 t e. InusGbe re calibrated monthly); . Outdoor Unit Serial # a E113011274 Y Outdoor Unit Make ' Day & night s Outdoor Unit Model ICXA642GKA ` Nominal Cooling Capacity Btu/hr t 42000 Date of Verification �:, . y . r, F 12/28/11 Y i. 1 Calibration of Diagnostic Instruments . Date of Refrigerant Gauge'Calibration' 11/30/11 (must be re -calibrated monthly) - r�` �S r Date of Thermocouple Calibration c 11/30/,,II N� 4 t e. InusGbe re calibrated monthly); . Supply (evaporator leaving)?asr dry. -bulb =K- . Measured Temperatures' ;'(,F). .a+ �. '`.. '.. .,_� . ' _.. 4, j _r ­:i 6 System Name or IdyenytifLcaattion/Tag' , - e nom em 2 of2 Syst2 Supply (evaporator leaving)?asr dry. -bulb =K- 17 k Y temperature (Tsupply, db) s Return (evaporator:entering) air dry-bulb 11 74 temperature ;(Treturn,.db) . Return (evaporator entering) air wet -bulb 53 temperature (Treturn wb) Evaporator saturation temperature, 41 (Tevaporator, sat) Condensor saturation temperature 83 (Tcondensor, sat) Suction line temperature (Tsuction) 54.8 , Liquid Line Temperature (Tliquid) 75.3 Condenser (entering) air dry-bulb temperature (T74• condenser db) Reg: 211-A0067286A-M2500001A-0000 Registration Date/Time: 2011/12/29 00:40:01 HERS Provider: Ca10ERTS,ifInc. 2008 Residential Compliance Forms a August 2009 s Reg: 211-A0067286A-M2500001A-0000 Registration Date/Time: 2011/12/29 00:40:01 HERS Provider: Ca10ERTS,ifInc. 2008 Residential Compliance Forms a August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of, S) Site Address: s Enforcement Agency: Permit Number: 78-790 Spyglass Hill Drive 2 of 2,1a Quinta CA 922531 City of La Quinta 11-1349 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 2 of 2 ! Calculate: Actual Temperature Split = Treturn, 22.00 db - Tsupply, db Target Temperature Split from Table RA3.2-3 22.6 using Treturn, wb and Treturn, db - Calculate difference: Actual Temperature Split - -0.6 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 specified in Reference Residential Appendix RA3.3. If actual cooling coil airflow'is measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below. ' PGj Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) fir+' �'4t' System Name or Identification/Tag ., r � '^f� : � • System 2 of 2* �# " �` s t Calculated Minimum Airflow Regwrement.(CFM) s1 ��-- 1t.p... +d" I.dtt .. .. ' _ MeasuredxAirit flow,using RA3:3 prbcoce.rdures (CFM) a *� f_ai ..aw7w.l. Passes if measured airflow is greaterjhan-ore* `,^ equal to the calculated, minimum airflow requirement,!!,'"'�,;,_ Enter•Pass or Fail ,7; 1 7 Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag System 2 of 2 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-A0067286A-M2500001A-0000 Registration Date/Time: 2011/12/29 00:40:01 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 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 2 of 2 . Calculate: Actual Subcooling = �.� Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer. 9 Calculate difference: 1.3 Actual Subcooling - Target Subcooling = PASS System passes if difference is between =- -3°F and +3°F PASS Enter Pass or Fail Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag System 2 of 2 Calculate: Actual Superheat, Tsuction - Tevaporator, sat 13.8 Enter allowable superheat.range fromg s manufacturer's specifications (or use range 13.8 between 4°F and 250F•if manufacturer's specification is not available) r System passesif actual' superheat is+withindthe allowable superheat range PASS EnterPaor, Fail fA ftss _.: =- yi Vu .� �,r. ..�� ., -ar''t 4 -. - � ..-^�'-<.k'2q• �cr.M..�" �:k ..5:� P�}�`i'•�v; r � r . Reg: 211-A0067286A-M2500001A-0000 Registration Date/Time: 2011/12/29 00:40:01 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 r. yi Vu .� �,r. ..�� ., -ar''t 4 -. - � ..-^�'-<.k'2q• �cr.M..�" �:k ..5:� P�}�`i'•�v; r � r . Reg: 211-A0067286A-M2500001A-0000 Registration Date/Time: 2011/12/29 00:40:01 HERS Provider: Ca10ERTS, 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: I Enforcement Agency: Permit Number: 78-790 Spyglass Hill Drive 2 of 2, La Quinta CA 922531 City of La Quinta• 11-1349 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 2 of 2 CSLB License: 438781 Date Signed: 12/28/2011 Position With Company (Title): System meets all refrigerant charge and airflow Name of TPQCP (if applicable): Control Program (TPQCP)? Yes No requirements. PASS Enter Pass or Fail I DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am eligible under Division 3 of.the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). " . I certify that the installed features,`materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. a . I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. • I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives, and beginninq October 1, 2010, for all low-rise residential buildinas. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) COOL-FLO INC Responsible Person's Name: Responsible Person's Signature: MICHAEL MANGAN MICHAEL MANGAN CSLB License: 438781 Date Signed: 12/28/2011 Position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? Yes No Reg: 211-A0067286A-M2500001A-0000 Registration Date/Time: 2011/12/29 00:40:01 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms, August 2009 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. Th1AH 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 of 2 System Location or Area Served Living area ° 1 ✓ Yes No s 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 ✓ Yes No ' ' 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum. and labeled according. to Figure in Section RA3.2.2.2.2. ` Yes to,l,and 2 is a pass. J,., ;. Enter Pass or Faill ✓ ✓ Pass I ✓ Fail STMS - Sensor,,on the Evaporator.Corl — _ �--•------,.r=te, - .�.:�, System Name;or,Identification/Tag�zf ,,r/� System 1"of;2 '� ;��,� STMS - Sensor on the Condenser: Coil System Name or Identification/Tag;' .• ;. System 1 of 2 3 � ',$-Yes No fhe sensor is f6ctor' installed; orPeld''instalied according to manufacturer s specifications, or isiinstalled by methods/specifications approved by the Executive Yes No f� Director. tc'`; •. 4 yes y No ,The sensor wire is terminated with a standard mini plug suitable for cono'ection'to aO digital`,thermometer. The sensor mplug�is accessible to the installing technician ^� The sensor wire is terminated with a standard mini plug suitable for connection to a ;and'thee''HERS pater without changing the'airflow:through the condenser coil 5 Yes No The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 3, 4- and -5 is a'pass. Enter N/A.if STMS are not applicable: Otherwise enter Pass or Fail i, V ✓ N/A ✓ Pass ✓ Fail STMS - Sensor on the Condenser: Coil System Name or Identification/Tag;' .• ;. System 1 of 2 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 ✓ V N/A ✓ Pass ✓ Fail applicable. Otherwise enter Pass or Fail •r - - Reg: 211-A0067284A-M2500001A-0000• Registration Date/Time: 2011/12/29 00:34:16 HERS Provider: Ca10ERTS,.Inc. 2008 Residential Compliance Forms '1August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency:711-1349 Permit Number: 78-790 Spyglass Hill Drive 1 of 2, La Quinta CA 92253 City of La Quinta Sta'adard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F) s 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 ..I System Name or Identification/Tag System 1 of 2 (must be re -calibrated monthly) _ ...> System Location or Area Served Living area 11/30/li _w, must be re calibrated month) Outdoor Unit Serial # SE112810201 Outdoor Unit Make Day & Night Outdoor Unit Model ICXA642GKA Nominal Cooling Capacity Btu/hr 42000 Date of Verification - �:...4 12/28/11 canDration ot.oiagnostic instruments , Date of Refrigerant`Gauge Calibration?fix; 11/30/11 (must be re -calibrated monthly) _ ...> Supply, (evaporator.leaving)>air dry bulbi � temperature (TSuPPIY, Date of Thermocou ple(Ca li b ration 11/30/li _w, must be re calibrated month) db) � r Measuredffeinperatures (°Fa y .��, s. System Name or Identification/Tag`Syste ��, m 1 2 ". of 'x� Supply, (evaporator.leaving)>air dry bulbi � temperature (TSuPPIY, 52kZ' ag db) � Return (evaporator;entering).air dry=bulb temperatiire'(T73 return db,) - Return (evaporator entering) air w6 -bulb 52 temperature (T return, wb) ".' is Evaporator saturation temperatures • 39 (Tevaporator, sat) Condensor saturation temperature 81 (Tcondensor, sat) Suction line temperature (Tsuction) 50.5 Liquid Line Temperature (Tliquid) 71.4 Condenser (entering) air dry-bulb ' 74.3 temperature (Tcondensor, db) ' Reg: 211-A0067284A-M2500001A-0000 'Registra=ion Date/Time: 2011/12/29 00:34:16 HERS Provider: CalCERTS,jnc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: I Enforcement Agency: Permit Number: 78-790 Spyglass Hill Drive 1 of 2, La Quinta CA 922531 City of La Quinta 11-1349 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 of 2 Calculate: Actual Temperature Split = Treturn, 21.00 db - Tsupply, db ' Target Temperature Split from Table RA3.2-3 22.2 , using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - -1.2 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 specified in Reference Residential Appendix RA3.3. If actual cooling coil airflow is measured, the value must be equal•to or greater than the Calculated Minimum Airflow Requirement in the table below. Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) System Nao •Identif cation/Taga ,-}c[ Sys3tem 1 of 2' ymy.#e# {}yin drt ,_fid "�H 3 •�''_. Calculated Minimum Airfl m w Requireent (CFM) MeasuredArflow usngRA3x3 procedures (CFM " Passes if measured airflow is greatec�than •..�.n .��.; ..�.- equal to the calculated minimum airflow requirement:"'? x ,; . EnterPass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device "systems System Name or Identification/Tag System.1 of 2 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 - f Reg: 211-A0067284A-M2500001A-0000 Registra=ion Date/Time: 2011/12/29 00:34:16 HERS Provider: CalCERTS,'Inc. 2008 Residential Compliance Forms August 2009 N Reg: 211-A0067284A-M2500001A-0000 Registra=ion Date/Time: 2011/12/29 00:34:16 HERS Provider: CalCERTS,'Inc. 2008 Residential Compliance Forms August 2009 N INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: I Enforcement Agency: Permit Number: 78-790 Spyglass Hill Drive 1 of 2,,La Quinta CA 922531 City of La Quinta ` 1 11-1349 This procedure is required to be used Subcooling Charge Method Calculations for Refrigerant Charge Verification. f System Name or Identification/Tag. System i of 2 Calculate: Actual Subcooling = 9.6 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: I Enforcement Agency: Permit Number: 78-790 Spyglass Hill Drive 1 of 2,,La Quinta CA 922531 City of La Quinta ` 1 11-1349 This procedure is required to be used Subcooling Charge Method Calculations for Refrigerant Charge Verification. for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag. System i of 2 Calculate: Actual Subcooling = 9.6 Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer 9 Calculate difference: 0.6 Actual Subcooling - Target Subcooling = System passes if difference is between -3°F and +3°F •' PASS n Enter Pass or Fail b��'�.8 - Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for Al thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. ` System Name or Identification/Tag. ,; .. M , System 1 of 2 Calculate: Actual Superheat;=i: Tsuction - Tevaporator, sat" Enter allowable superheat range from,,' manufacturer's specifications (or use range 11.5 between 4°F and 25°F if manufacturer s specificationisnot available)" System,.passesoif,actual superheat iszwithin the allowablesuperheat range` 1 y n ' AP S5 n )'er b��'�.8 - Reg: 211-A0067284A-M2500001A-0000 Registration Date/Time: 2011/12/29 00:34:16 'HERS Provider: Ca10ERTS; Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE Refrigerant Charge Verification - Sta Site Address: 78-790 Spyglass Hill Drive 1 of 2, La QI. A Measurement Procedure Enforcement Agency., CA 922531 City of La Quinta CF-6R-MECH-25-HERS (Page 5 of 5) Permit Number: 11-1349 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 of 2 r• � A c 4 System meets all refrigerant charge and airflow CSLB License: 438781 Date Signed: 12/28/20111 Position With Company (Title): requirements. PASS Control Program (TPQCP)? Yes No Enter Pass or Fail DECLARATION STATEMENT r V., . I certify under penalty of perjury, under..tFie laws of the State of California, the information provided on this form is true and correct. . I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). . I certify that the installed features;`materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. . I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in thatiHERS sample group will be performed at my expense. . Previewed a copy of the Certificate of Compliance (CF -SR) 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 reaistry for multiple orientation alternatives. and beainnino Octoher 1. 2010. for all Inw-rice rPcirlPnfial hidblinnc Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) COOL-FLO INC r Responsible Person's Name: I r• � A c 4 DECLARATION STATEMENT r V., . I certify under penalty of perjury, under..tFie laws of the State of California, the information provided on this form is true and correct. . I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). . I certify that the installed features;`materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. . I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in thatiHERS sample group will be performed at my expense. . Previewed a copy of the Certificate of Compliance (CF -SR) 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 reaistry for multiple orientation alternatives. and beainnino Octoher 1. 2010. for all Inw-rice rPcirlPnfial hidblinnc Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) COOL-FLO INC r Responsible Person's Name: I Responsible Person's Signature: MICHAEL MANGAN MICHAEL MANGAN CSLB License: 438781 Date Signed: 12/28/20111 Position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? Yes No 0 Reg: 211-A0067284A-M2500001A-0000 Registration Date/Time: 2011/12/29 00:34:16 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 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. y 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 of.2� System Location or Area Served I Living area 1 ✓ Yes No ° Wr, 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 V Yes :No _ le - �,, �, 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum and labeled according to Figure in Section RA3.2.2.2.2. Yes to -1 and..2 is a pass.- II_.„ Enter Pass or Fail V ✓ Pass ✓ . Fail STMS= Sensor onithe.Evaporator Coil System Name or Identification/Tag' t4, '" ;System ,of 2 °• 3 ,. Yes No The sensor is factory installed, or field installed according to manufacturer's spec�fications,.or isiinstalled,by method's/specifications approved by�the Executive Yes No �' Director. ' ts�d} `w Director. I • -'(Al ,$�;. �.: 4 Yes° I A I.0 The sensor �w'r're is terminated,with a standard mini,plug suitable f*or�connection�W a * toihecondelnserih-tcoil nician dttFie'HERS '9 Yes atR .. digital thermometer. The sensor mini plug is accessible to the installing technician a rater 9 __ thout chamm�' the9airflow throne h the 5 Yes No "< When attached to a digital thermometer, the sensor provides an indication of the 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 applicable. Otherwise enter,.Pass of Fail: V ✓ N/A ✓ Pass ✓ Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag System 1 of 2 The sensor is factory installed, or field installed according to manufacturer's 6 Yes No specifications, or is installed by methods/specifications approved by the Executive Director. I • The sensor wire is terminated with a standard mini plug suitable for connection to a 7 Yes No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil m 8 Yes No When attached to a digital thermometer, the sensor provides an indication of the saturation temperature of the coil. Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not ✓ V N/A I ✓ Pass ✓ Fail applicable. Otherwise enter,Pass or Fail - • r S -Reg: 211-A0067284A-M2500001A-M25A Registration Date/Time: 2011%12/29 01:01:00 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: I Enforcement Agency: Permit Number: 78-790 Spyglass Hill Drive 1 of 2, La Quinta CA 922531 City of La Quinta 11-1349 1 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 I System 1 of 2 r •-- .yrs - System Location or Area Served Living area re calibrated monthly) Outdoor Unit Serial # l E112810201 * Z -. Outdoor Unit Make Day & Night 4 Outdoor Unit Model ICXA642GKA �. Nominal Cooling Capacity Btu/hr " 42000 Date of Verification _ �: `i. 12/28/11 Calibration of Diagnostic Instruments Date of. Refrigerant Gauge `Calibration 11/30/11 (must be re -calibrated monthly) •-- .yrs .it, f. Date of Thermocouple(CalibratAon(must_be re calibrated monthly) Supply (evaporator leaving') air dry bulb ?i M "'z X52 Measured Temperaturee(IF)%. MT, .... b +<; • ?_ ,Wy System Ny,arre or Identiflcat�on/Tag � -� system 1 of 2, I •-- .yrs .it, f. Supply (evaporator leaving') air dry bulb ?i M "'z X52 * Z -. temperature (TSuPPIY, db) . . Return (evaporator entering) air dry-bulb `(T 73 temperature return'' `db ) ' ':F; ' Return (evaporator entering) air wet=bulb 52 temperature (Treturn, wb� ' J.- '_ Evaporator saturation temperature.;'; ' 39 (Tevaporator, sat) Condensor saturation temperature 81 (Tcondensor, sat) - Suction line temperature (Tsuction) 50.5 Liquid Line Temperature (Tliquid) I ! 71.4 Condenser (entering) air dry-bulb „ 74.3 temperature (T condenser db) 4 _ . I • a Reg: 211-A0067284A-M2500001A-M25A - Registration Date/Time: 2011/12/29 01:01:00 HERS Provider: Ca10ERTS, Inc. A 2008 Residential Compliance Forms March 2010 s .it, 4 _ . I • a Reg: 211-A0067284A-M2500001A-M25A - Registration Date/Time: 2011/12/29 01:01:00 HERS Provider: Ca10ERTS, Inc. A 2008 Residential Compliance Forms March 2010 s INSTALLATION CERTIFICATE $ I CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure •(Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 78-790 Spyglass Hill Drive 1 of 2, La Quinta CA 92253 City of La Quinta 1 11-1349 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 of 2 Calculate: Actual Temperature Split = Treturn, 21.00 db - Tsupply, db Target Temperature Split from Table RA3.2-3 22.2 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - -1.2 : 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 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) SystemName or Identification/Tag7, v 0.4t&,- "c:. ...�� Calculated Mi"imum Airflow Requirement (CFM) � 17 b"'� r: Measured'�AirFl�owMu ing 1 'r1_05 Passes if measured airflow is greater .;than or^,Y.: r equal to the calculated minimum airjbw requirement' Enter; Pass or Fail Superheat Charge Method'Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device: `systems <' System Name or Identification/Tag Calculate:, Actual Superheat = Tsuction - Tevaporator, sat Target Superheat from Table RA3.2-2 using Treturn, wb and Tcondenser, db Calculate difference: Actual Superheat - Target Superheat = System passes if difference is between -6°F and +6°F ' Enter Pass or Fail - F . Reg: 211-A0067284A-M2500001A-M25A Registration Date/Time: 2011/12/29 01:01:00 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms "March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: I I Enforcement Agency: Permit Number: 78-790 Spyglass Hill Drive 1 of 2, La Quinta CA 922531 City of La Quinta 11-1349 ` 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 of 2 ' Calculate: Actual Subcooling=, 9.6 Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer 9 Calculate difference: , 0.6 t Actual Subcooling - Target Subcooling = _ System passes if difference is between -----Wit , -4°F and +4°F PASS Enter Pass or Fail Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag.: System 1 of 2 ' Calculate: Actual Superheat= 11.5 T ' suction - T evaporator, sat Enter allowable superheat range fromf manufacturer's specifications (or use range 11.5 t between 3°F and 260F if manufacturer's, `.: _ specification is not available) • �, - -----Wit , System passes1f,actual superheat is hin^'the allowablesuperheat range s � �"i PASS :Enter Pass orfFail ." � I" � ' �, ? r °"i a "`o�• .Y§ �y' �' � p-. . �&� „e e�'a+r ,a.}.... i�;�-a.'"'�5r '`' -F -a� '�- _=w. 3ra+�r: e�-....x . �, ,,••• .. - ��,.`. .. _.. _ 'X{ e , { Reg: 211-A0067284A-M2500001A-M25A., Registration Date/Time: 2011/12/29 01:01:00 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms' March 2010 . 1 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. INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: 78-790 Spyglass Hill Drive 1 of 2, La Quinta CA 92253 City of La Quinta 11-1349 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 of 2 438781 HERS Provider Data Registry Information Sample Group # (if applicable): N/A System meets all refrigerant charge and airflow not-tested/verified dwelling in la HERS sample group requirements. PASS e Responsible Rater's Name: Responsible Rater's Signature: Enter Pass or Fail Walter W Nellis Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 12/28/2011 CC2004361 u 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 -1R) 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. b Builder or Installer information as shown on the Installation Certificate (CF -6R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) COOL-FLO INC Responsible Person's Name: CSLB License: MICHAEL MANGAN 438781 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 # CC1-1798618083 HERS Rater Company Name: Air Solutions of the Desert Responsible Rater's Name: Responsible Rater's Signature: Walter W Nellis Walter W Nellis Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 12/28/2011 CC2004361 Reg: 211-A0067284A-M2500001A-M25A Registration Date/Time: 2011/12/29 01:01:00 HERS Provider: CalCERTS,cInc. 2008 Residential Compliance Forms March 2010 i 0' _ 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 l 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. r Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement Sensors (STMS) Procedures for•instal/ing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification'is � •, c� f. 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 andReturnPlenums of Air Handler System Name or Identification/Tag System.2 of. 211 1' System Location or Area Served I bedroom 1 Yes, No 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 ✓Yes No 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum and labeled according to Figure in Section RA3.2.2.2.2. '• r Yes to, Land _2 is a pass. �, ' Enter Pass or Faill ✓ ✓ Pass ✓ Fail STMS - Sensor onAhe. EvaDorator'C6iI System Name or,.Identification/Ta S stem 2 of 2" ~^ 3 Yes 24kfi 4NN o w The sensor is factoryjmstalled, orfield installed according to manufacturers specifications, or is install"ed by methodsAbecifications approved by the Executive Director.r� 3.,. d .,x_ 4 t s Yest No ,O ry. The sensor wire is terminated with a -standard miniplug suitable for connection to ai ract .e i digital'fhermometer The.sensory'mirn plug is accessible to h'&installing�techniclan and th`e HERS.`rater,without changing the''airflow`through the—con de6s'e-r coil 5Yes;y 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 applicable. Otherwise enter Pass or Fail' ✓ ✓ N/A ✓ Pass ✓ Fail STMS - Sensor on the Condenser Coil ` System Name or Identification/Tag I System 2 of 2 The sensor is factory installed, or field installed according to manufacturer's 6. Yes No specifications, or is installed by methods/specifications approved by the Executive + Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 7 Yes No digital thermometer. The sensor. mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 8 Yes No When attached to a digital thermometer, the sensor provides an indication of the saturation temperature of the coil. Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not V ✓ N/A ✓ Pass ✓ Fail applicable. Otherwise enter Pass or Fail t 1. +r , Reg: 211-A0067286A-M2500001A-M25Ait Registration Date/Time: 2011/12/29 01:07:29 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Formsi March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-25 ! Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address:' I Enforcement Agency: Permit Number: . 78-790 Spyglass Hill Drive 2 of 2, La Quinta CA 92253 ' City of La Quinta 11-1349 Standard Charge Measurement Procedure (for use`if outdoor air dry-bulb is above SS°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 r` System Name or Identification/Tag System 2 of 2 (must be re -calibrated monthly) System Location or Area Served bedroom 1'1/30/11al (must be re -calibrated monthly) Al Outdoor Unit Serial ,# E113011274 = '- '. * 1 . I-=- Outdoor Unit Make Day & night. Outdoor Unit Model ICXA642GKA Nominal Cooling Capacity Btu/hr 42000 Date of Verification i::. `:. 12/28/11 i i, r Calibration of Diagnostic Instruments Date of Refrigerant Gauge Calibration', J; 11/30/11 ,, (must be re -calibrated monthly) Date of Thermocouple, Calibration K 1'1/30/11al (must be re -calibrated monthly) Al Supply (evaporator leaving)'air dry-bulb temperature`(Tsupply, :; x �52� ,f Measuredi7emperatures QF)� "my°t:-�`€�'. �� -- System Name or Identification/Tag) ! System 2 0f,2 Supply (evaporator leaving)'air dry-bulb temperature`(Tsupply, :; x �52� = '- '. * 1 . I-=- db) 10 Return (evaporator=entering) air dry-bulb - ' 74 temperature (Treturn, db)' ,y Return (evaporator entering) air wet=bulb 53 temperature (Treturn, return, wb Evaporator saturation temperature 41 (Tevaporator, sat) Condensor saturation temperature 83 (Tcondensor, sat) t Suction line temperature (Tsuction) q 54.8 Liquid Line Temperature (Tliquid) 75.3 Condenser (entering) air dry-bulb 74.1 temperature (T condenser, db) r. Reg:..211-A0067286A-M2500001A-M25AI Registration Date/Time: 2011/12/29 01:07:29 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms. t March 2010 INSTALLATION CERTIFICATE CF-411-MECH-25 Refrigerant Charge Verification- Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 78-790 Spyglass Hill Drive 2 of 2, La Quinta CA 922531 City of La Quinta 11-1349_ 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 2 of 2 Calculate: Actual Temperature Split = Treturn, 22.00 db - Tsupply, db Target Temperature Split from Table RA3.2-3 '22.6 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - -0.6 ' 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 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) rt System or Identification/Tag 3 � y :. g r_i'it' L.'s'`4' '•:+`.'y - Calculate*d,MMOO inimum Airflow Requirement (CFM)AN '' - Measured Airflow*usng RA3 3 procedwures (CFM) 04 .h:RCQ . ,�?i ..>'osz'akhx•"^�R�F 4 .W r,,,,, Passes if measured airflow is greater than or,,,,,- equal to the calculated minimum airflow - equal requirement w ' _ ` ' EnW* Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag Calculate: Actual Superheat = Tsuction - Tevaporator, sat Target Superheat from Table RA3.2-2 using Treturn, wb and Tcondenser, db Calculate difference: Actual Superheat - Target Superheat = System passes if difference is between -6°F and , +6°F ' Enter Pass or Fail Reg:1211-A0067286A-M2500001A-M25A` Registration Date/Time: 2011/12/29 01:07:29 HERS Provider: Ca10ERTS,pInc. 2008 Residential Compliance Forms � March 2010 T INSTALLATION CERTIFICATE CF-4111-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: , Enforcement Agency: Permit Number: 78-790 Spyglass Hill Drive 2 of 2, La 'Quinta CA 922531 City of La Quinta 11-1349 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 2 of 2 _ Calculate: Actual Subcooling = �.� , Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer 9 Calculate difference: 3 - Actual Subcooling - Target Subcooling = System passes if difference is between m PASS • �.. }� " ,. -4°F and +4°F PASS St,- 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 2 of 2 Calculate: Actual Superheat = 3.: Tsuction - Tevaporator, sat:` 13.8 , Enter allowable superheat range from.-',.' manufacturer's specifications (or use range 13.8 between 3°F and 26°F if manufacturer's specification, is not available) System passes-'if;actual superheat is"within�'the allowable superheat rangejrf., m PASS • �.. }� " ,. .� rEhter Pass on,Fail St,- ^".Y• Y Reg: 211-A0067286A-M2500001A-M25A' Registration Date/Time: 2011/12/29 01:07:29 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: I Enforcement Agency: Permit Number: 78-790 Spyglass Hill Drive 2 of 2, La Quinta CA 922531 City of La Quinta 11-1349 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 2 of 2 1438781 HERS Provider Data Registry Information Sample Group # (if aPPlicable : N/A System meets all refrigerant charge and airflow not-tested/verified dwelling in ' la HERS sample group requirements. PASS Air Solutions of the Desert Responsible Rater's Name: Responsible Rater's Signature: Enter Pass or Fail Walter W Nellis Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 12/28/2011 CC2004361 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 -1R) approved by the local enforcement agency. • The information reported on applicable sections of the Installation Certificates) (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 agency. ' ' Builder or Installer information as shown on the Installation Certificate (CF -6R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) COOL-FLO INC Responsible Person's Name: CSLB License: MICHAEL MANGAN 1438781 HERS Provider Data Registry Information Sample Group # (if aPPlicable : N/A tested/verified dwelling not-tested/verified dwelling in ' la HERS sample group HERS Rater Information CalCERTS Certificate # CC1-1798618085 HERS Rater Company Name: Air Solutions of the Desert Responsible Rater's Name: Responsible Rater's Signature: Walter W Nellis Walter W Nellis Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 12/28/2011 CC2004361 S Reg: 211-A0067286A-M2500001A-M25A Registration Date/Time: 2011/12/29 01:07:29 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: 78-790 Spyglass Hill Drive 1 of 2,`La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 11-1349r Enter the Duct System Name or Identification/Tag: System 1 of 2 Enter the Duct System Location or Area Served: Living area 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 si oke and HERS rater verify ` Note: (One of Options 1, 2 or 3 must,be attempted before utilizing, Option , Determine nominal`Fan' Flow using one of the following three n calculatiomethods x ✓ V Cooling Gsystem method: Size of condenser in Tons 3.5' x 400 1400I'CFMt Heati4gystem 21 7 a Output method: x Capacity in aThousands of Btu/hr = CFMo ✓ Measured system airflow using.ti2A3 J%irflowestro ed.,.ure Option lused`then:' fas� leakage 'x - 1 Allowed = Fan AirFlow 1400 0.15*= 210 CFM Actual Leaka e= 159 CFM , 9' Pass if Actual Leakage is less than Allowed leakage Pass Fail Option 2 used then: J,%. 2 Allowed leakage = Fan Airflow . '. x 0.10 = _ CFM Actual Leakage to outside = I, CFM Pass if Actual leakage to outside is less than Allowed leakage Pass Fail Option 3 used then: Initial leakage prior to start of work = CFM Final leakage after sealing all accessible leaks using smoke test = CFM 3 Initial leakage _ - Final leakage_ = Leakage reduction _ CFM" ((Leakage reduction _ / Initial leakage_) x 100% _ % Reduction , Pass if % Reduction > 60%1 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 , r Reg: 211-A0067284A-M2100001A-0000 Registration Date/Time: 2011/12/29 00:29:44 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE; ' CF-6R-MECH-2I-HERS Duct Leakage Test - Existing Duct System (Page 2 of 2) Site Address: 78-790 Spyglass Hill Drive 1 of 2, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of. La Quinta 11-1349 Name of TPQCP (if applicable): Control Program (TPQCP)? Yes No i ► INSTALLATION CERTIFICATE; ' CF-6R-MECH-2I-HERS Duct Leakage Test - Existing Duct System (Page 2 of 2) Site Address: 78-790 Spyglass Hill Drive 1 of 2, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of. La Quinta 11-1349 l 1� t ' iiu• , 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 ;i 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 re ijrn register boots must be sealedlto�the drywall ifjSrndke test is utilized fors compliance - applies- leakage_complance option 3 (leakage reduction by 60%):and option 4 (fiz all.ac.cessible leaks) described above New ductmstallations cannotlutilize building cavities as plenums or platformreturns in lieu of ducts paar .. . V Mastic and draw'•bands,must be usedRin com, bination: with clothbacked:rubber•edhesiveductvtape to seal , leaks at all new duct connections'��`' - DECLARATION STATEMENT �;• c I . I certify under penalty of perjury, under'the laws of the State of California, the information provided on this form is true and correct. . I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). . I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. . I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I 'am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. • I reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the installation have been met. 4., • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) COOL-FLO INC Responsible Person's Name: Responsible Person's Signature: MICHAEL MANGAN ! r MICHAEL MANGAN CSLB License: 438781 Date Signed: 12/28/2011 Position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? Yes No Reg: 211-A0067284A-M2100001A-0000 'y Registration Date/Timei 2011/12/29 00:29:44 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 li CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-21 Duct Leakage Test — Existing Duct System (Pagel of 2) Site Address: +" 78-790 Spyglass Hill Drive 1 of 2,;La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quints 11-1349 Enter the Duct System Name or Identification/Tag: System 1 of 2 Enter the Duct System Location or Area Served: Living area 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 existingdwelling, use the Installation Certificate titled "Duct Leakage Test = Completely New or Replacement Duct System." Duct Leakage Diagnostic Test - existino 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'accessilile leaks using smoke and HERS rater verify t Note: (One of Options�l, 2, or 3 must be attempted befo.re,utilizing-Option 4,.)�1 Determme..nom`inal Fari Flow using one ofothe following three calculation met1iods rr-?:ygj ;m' q�Y,•�i:. ✓ V Cooling system method: Size of,condenser in Tons 3.5 x 400 1400 CFM' Heating system method: 21.7 x + Output Capacity m:Thousands of Btu/hr=,���««««««-CFM pYaa x 40 ✓ Measured,system+airflow usingki2A3}3 airflow test,procedures; CFM,,; „�. `'' { ►� Option 1 used then 1 Allowed leakage = Fan Flow .1.400 x 0.15 = rn 210 CFM y. Actu_al,Leakage`= 159 CFM4.- 1 + Pass if Leakage Actual is less than Allowed Pass Fail Option 2 used then: %ff p 's `Flow 2 Allowed leakage = Fan "_' x 0.10 = _ CFM Actual Leakage to outside:-= I Y CFM ' ,1"` r •. Pass if Leakage Actual is less than Allowed Pass Fail Option 3 used then: ° r Initial leakage prior to start of work = _ CFM Final leakage after sealing all accessible leaks using smoke test = CFM 3 Initial leakage — - Final leakage _ = Leakage reduction CFM ((Leakage reduction _ / Initial leakage _) x 100% _ % Reduction Pass if % Reduction > 600/a Pass Fail Option 4 used then: 4 All accessible leaks repaired using smoke. HERS rater must verify (No sampling). No smoke allowed to leak from system. Including ducts, plenums, air handler and door panel. Pass if all accessible leaks have been repaired using smoke Pass Fail ' Y • t . t Reg: 211-A0067284A-M2100001A-M21A Registration_ Date/Time: 2011/12/29 00:58:17 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING - CF-4R-MECH-21 Duct Leakage Test - Existing Duct System' a (Page 2 of 2) Site Address: 78-790 Spyglass Hill Drive 1 of 2, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 11-1349 t ' 1 V 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 requi'red`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. M i. �.� v All supply/and return register boots must be sealed to the: drywall if,sm oke test Is uUllzed forecompliance - applies to'duct leakage. compliance option 3: (leakage`redu'ctionby 60 /o)"and option 4� fix' all accessible leaks) described above ( _ V New ductiinstallations cannot utilize build ing,cavitiess plenums 6nplatrorm, returnslin lieu,of ducts: - , '� ,� it V Mastic and draw'bands must 6e used in corrtinatlonwifh doth backed'rubber'adhesi`ve duct'tape to seal t. leaks at;all new ducct connections DECLARATION STATE MENTj_ ` E • 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 w'ho,pefformed the verification'services identified and reported on this certificate (responsible rater). • The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the local enforcement agency. • The information reported on applicable sections of the Installation 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 -6111) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) COOL-FLO INC Responsible Person's Name: CSLB License: MICHAEL MANGAN 1438781 HERS Provider Data Registry Information Sample Group # (if applicable): N/A tested/verified dwelling not-tested/verified dwelling in a HERS sample group HERS Rater Information CalCERTS Certificate # CC1-1798618083 HERS Rater Company Name: Air Solutions of the Desert Responsible Rater's Name: Responsible Rater's Signature: Walter W Nellis Walter W Nellis Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 12/28/2011 ' CC2004361 Reg: 211-A0067284A-M2100001A-M21A ,Registration Date/Time: 2011/12/29 00:58:17 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms r March 2010 f INSTALLATION CERTIFICATE CF-611-MECH-2I-HERS ' Duct Leakage Test — Existing Duct System (Page 1 of 2) 3. Reduce leakage by.60% and conduct smoke and fix all leaks Site Address: 78-790 Spyglass Hill Drive 2 of 2, La Quinta CA 92253 Enforcement Agency: City c La Quints Permit Number: 11rmit N Note: (One'of Options 1, 2 or 3 niust-be.:attempted,,before utilizing, Option 4.,)-;_ Determine nominal Fan Flow using one of thelfollowing thred calculation methods Cooling system method: Size of condenser m Tons 3.5 r x 400 f 1400 CFM (System 1) ✓ Heating"system method': 21 Z�x' . 4Output Capacity m Thousands of Btu/hr = ✓ Measured system airflow,using!KA3 3 airflow test procedures,- CFM f ; Enter the Duct System Name or Identification/Tag: System 2 of 2 Enter the Duct System Location or Area Served: Bedrooms. 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 J 4. Fix all accessible leaks using smoke and HERS rater verify Note: (One'of Options 1, 2 or 3 niust-be.:attempted,,before utilizing, Option 4.,)-;_ Determine nominal Fan Flow using one of thelfollowing thred calculation methods Cooling system method: Size of condenser m Tons 3.5 r x 400 f 1400 CFM �GFM ✓ Heating"system method': 21 Z�x' . 4Output Capacity m Thousands of Btu/hr = ✓ Measured system airflow,using!KA3 3 airflow test procedures,- CFM f ; Option;i used then 'sem 1 Allowed leakage = Fan Airflow 1400.' x0.1 = ' 210 CFM Actual Leakage,=� 853 CFM-<, Pass if. Actual Leakage is less than Allowed leakage Pass Fail Option 2 used then:,, 2 Allowed leakage = Fan Airftow.,V 1400- x 0.10 = 140 CFM Actual Leakage to outside = '- CFM "yPaes if Actual leakage to outside is less than Allowed leakage Pass Fail Option 3 used then: 11 Initial leakage prior to start of work = _ CFM Final leakage after sealing all accessible leaks using smoke test = _ CFM 3 Initial leakage _ - Final leakage _ = Leakage reduction _ CFM ((Leakage reduction _ / Initial leakage__) x 100% _ % Reduction Pass if % Reduction > 600/6 Pass Fail Option 4 used then: 4 All accessible leaks repaired using smoke test. HERS rater must verify (No Sampling). Pass if all accessible leaks have been repaired using smoke Pass Fail Reg: 211-A0067286A-M2100001A-0000 Registration Date/Time: 2011/12/29 00:36:41 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 n 1 , . r V Outside. air (OA) ducts for Central Fan Integrated' (CFI) ventilation systems, shall not be sealed/taped off , during duct Ieakage.testing. CFh.OA`ducts that utilize controlled motorized dampers, that open only when OA '+ ventilation is req'uir'ed 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 suppl.yand,return register boots ust besealedtoathedrywall ifs moketest is utilized for{compliance - applies to. duct leakage_compl ance optibh 3 (leakage, red uctidimby at 0%)>and ooptlon 4 (fix all accessible leaks) described above 7E 0, New duct£Installatlons cannot .utilize building cavities asfplenum or pI tform l eturns In lieu of ducts p fir.. 3i^ <�° F�.- Mastic and-draw'�bands must be use imcomb.lnation with cloth=backed rubber. adhesive°duct"ta a to seal � 1 leaks at all new duct connections>„et DECLARATION STATEMENT. 5. • I certify under penalty of perjb_ y, under the laws of the State of California, the information provided on this form is true and correct. • I am eligible under Division 3 ofthe a Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). . I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am !! required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. • I reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -IR 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) INSTALLATION CERTIFICATE CF-6111-MECH-2I-HERS „ Duct -Leakage Test - Existing Duct System (Page 2 of 2) Site Address: 78-790 Spyglass Hill Drive 2 of 2, La Quints CA 92253 Enforcement Agency: Permit Number: . Position With Company (Title): . (System 1) City of La Quinta 11-1349 1 , . r V Outside. air (OA) ducts for Central Fan Integrated' (CFI) ventilation systems, shall not be sealed/taped off , during duct Ieakage.testing. CFh.OA`ducts that utilize controlled motorized dampers, that open only when OA '+ ventilation is req'uir'ed 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 suppl.yand,return register boots ust besealedtoathedrywall ifs moketest is utilized for{compliance - applies to. duct leakage_compl ance optibh 3 (leakage, red uctidimby at 0%)>and ooptlon 4 (fix all accessible leaks) described above 7E 0, New duct£Installatlons cannot .utilize building cavities asfplenum or pI tform l eturns In lieu of ducts p fir.. 3i^ <�° F�.- Mastic and-draw'�bands must be use imcomb.lnation with cloth=backed rubber. adhesive°duct"ta a to seal � 1 leaks at all new duct connections>„et DECLARATION STATEMENT. 5. • I certify under penalty of perjb_ y, under the laws of the State of California, the information provided on this form is true and correct. • I am eligible under Division 3 ofthe a Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). . I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am !! required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. • I reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -IR that apply to the installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder , provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) COOL-FLO INC , Responsible Person's Name: Responsible Person's Signature: MICHAEL MANGAN MICHAEL MANGAN CSLB License: 438781 Date Signed: 12/28/2011 Position With Company (Title): Is this installation monitored by a Third Party Quality Name of.TPQCP (if applicable): Control Program (TPQCP)? Yes No r 4 •+'. Reg: 211-A0067286A-M2100001A-0000 Registration Date/Time: 2011/12/29 00:36:41 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010