10-0429 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: `�. 10-00000429
Property Address: 78550 AVENIDA LA FONDA
APN: 770-142-012-196 -000000-
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 6500
Tj-'�v 4 4v Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:^ -
------------------
LICENSED CONTRACTOR'S DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: C20 LicenseNo.: 374937
Date: 7 / / d'//l`' Contract1-1 or.
/�/
L '`
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Code) or
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(_) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
( ) I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
t Lender's Name: _
Lender's Address:
LQPERMIT
Owner:
BOOND, NAOMI
78550 AVENIDA LA FONDA
LA QUINTA, CA 92253
(
Contractor:
PALM DESERT AIR GOND CO
42081 BEACON HILL
PALM DESERT, CA 92211
(760)346-0677
LiC. No.: 374937
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/18/10
D °
•MAY .18 2010-
C1 -V OF 1 A IQUINTA
-----------------------------------------------
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 SOUTHERN INS Policy Number WSIO03802-01
_ I certify that, in the performance of the work for which this permit is issued, 1 shall not employ any
person in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
• 3700 of the Labor Code, I shall forthwith co/l/ply ith those provisions.
Date: 19hO Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, -AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1 . Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and h reby authorize representatives
of this county ttor enter upon the above-mentioned property for inspection pur es.
+Date '� p 4Signature-(Applicant or AgeAt1:'� sy
�_ '
Application Number . . . . . 10-00000429
Permit . . . MECHANICAL
,
Additional desc .
Permit Fee 33.00 Plan Check Fee
8.25
Issue Date Valuation
0
Expiration Date 11/14/10
Qty Unit. Charge Per
Extension
BASE FEE
15.00
1.00 9.0000 EA MECH FURNACE <=100K
9.00
1.00 9.0000 EA MECH B/C <=3HP/100K BTU
9.00
----------------------------------------------------------------------------
Special Notes and Comments.
REPLACE - (1) 4. 0 TON HEAT PUMP PACKAGE—
SYSTEM 14 SEER.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged_ Paid Credited
----------------------------------------
Due
-----------------
Permit Fee Total 33.00 .00 ..00
33.00
Plan Check Total 8.25 .00 .00
8.25
Other Fee Total 1.00 .00 .00
1.00
Grand Total 42.25 .00 .00
42.25
1
LQPMI IT
Prescriptive Certificate of Compliance: Residential CFAR-ALT
Residential Alterations Page 1 of 1
Project Name: Climate Zone # of Stories
BOOND, NAOMI 15 1
General Information: '
Site Address: 78-550 ADV. LA FONDA
Date
5/18/10
Enforcement Agency:
Building Type: M Single Family. ❑ Multi Family
Front Orientation: ❑ N ❑ E ❑ W ❑ S
Project Type: ❑ Alteration M HVAC Replacement ❑ Duct Replacement ❑
Conditioned Floor Space (CFS):
NOTE: This form is not to be used for new construction or additions.
HVAC Systems — Heatin
:
Duct Insulation
Thermostat
Configuration (Split
Equipment Type
Capacity
AFUE
HSPF
R -Value
Type
or Package)
HP PACKAGE
47,500
N/A
8.0
N/A
SET BACK
PACKAGE
HVAC Systems — Coolin
:
Pipe Insulation
Thermostat
Configuration (Split
Equipment Type
Capacity
SEER
EER
R -Value
Type
or Package)
HP PACKAGE
47,500
14.00
12.00
N/A
SET BACK
PACKAGE
HERS Verification Summary:
Duct Sealing & Testing — HERS verification is required for this measure.
❑ Yes 0 No In Climate Zones 2 and 9-16, if more than 40 linear feet of new or replacement ducts are installed in unconditioned
space, the ducts are to be sealed per §152(b)1 Dii and the newly installed ducts are to be insulated per §151(f)10.
O Exception: Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos.
❑ Yes 0 No In Climate Zones 2 and 9-16, if the existing space -conditioning system (HVAC equipment and ducting) is replaced,
the ducts are to be sealed per §152(b)1 Di.
0 Yes ❑ No In Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced (including the replacement of the air
handler, outdoor condensing unit of a split system, cooling or heating coil, or the furnace heat exchanger) the ducts
are to be sealed per §152(b)1 E.
❑ Exception: Duct systems that are documented to have been previously sealed confirmed through HERS
verification in accordance with procedures in the Reference Residential Appendix RA3.
❑ Exception: Duct systems with less than 40 linear feet in unconditioned space.
❑ Exception: Existing duct systems are constructed, insulated or sealed with asbestos.
Refrigerant Charge — Split System — HERS verification is required for this measure.
❑ Yes Ll No In Climate Zones 2 and 8-15, when the existing HVAC equipment is replaced (including the replacement of the air
handler, outdoor condensing unit of a split system A/C or heat pump, cooling or heating coil, or the furnace heat
exchanger) a refrigerant charge measurement shall be verified per 152 b 1 F.
Central Fan Integrated (CFI) Ventilation System and Fan Watt Draw
The ventilation requirements of §150 o do not apply to existing residential homes.
Ducted Split Systems — Air Conditioners and- Heat- Pumps: Airflow — HERS verification is required for this measure.
❑ Yes 0 No In Climate Zones 10 through 15, when the existing space -conditioning system (HVAC equipment and ducting) is
replaced, the airflow and fan waft draw shall be verified per 152 b 1 Ci to meet the requirements of §151(07B.
Documentation Author's Declaration Statement
I certify that this Certificate of Compliance documentation is accurate and c te.
Name: KARL BROWN ISignatur
.
Company: PALM DESERT AIR CONDITIONING & HEATING COMPA Y
Date: 5/18/10
Address:42-081 BEACON HILL
City, State, Zip Code: PALM DESERT, CA 92211
Phone: (760) 346-0677
Registration Number:
2008 Residential Compliance Forms
Registration Date 8 Time: HERS Provider:
PDAC January 2010
Bin #
City Of ra Quinta
Building 8L Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
'
Permit #
' -•'
Project Address: 78550 AVD. LA FONDA
Owner's Name: BOOND, NAOMI
A. P. Number:
Address: 78550 AVD. LA FONDA
Legal Description:
City, ST, Zip: LA QUINTA, CA 92253
Contractor: Palm Desert Air Conditioning & Heating Company
telephone:
<>«<>:::::;><:::>::>::>:::?::>»:< ::»>;..:
Address: 42081 Beacon Hill
Project Description:
City, ST, Zip: Palm Desert, CA 92211
IREPLACE ONE 1 4.0 TON HEAT
Telephone: (760) 346-0677
:> .;>;;:.;::;:;;:<;;;;:;:<;;:;;:•;:;;:::>>:>:::;:;:.:
PUMP PACKAGE SYSTEM,
State Lic. # : 374937 City Lic. #: 100886
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
State Lic``•>%
Name of Contact Person: KARL BROWN
Construction Type: Occu anc
P
Project type circle one): New Add n Altor Dem
o<epair
Sq. Ft.: # Stories: #Units:
Telephone # of Contact Person: (760) 346-0677
Estimated Value of Project: $6,500
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed '
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
hd Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
Prescriptive Certificate of Compliance: Residential CF -1 R -ALT
Residential Alterations Page 1 of 1
Project Name: Climate Zone # of Stories
BOOND, NAOMI 15 1
General Information:
Site Addres 7s 8-550.ADV.-LA-FONDA-7
Date
Enforcement Agency:
5/18/10
Building Type: M Single Family ❑ Multi Family
Front Orientation: ❑ N ❑ E ❑ W ❑ S
Project Type: ❑ Alteration C6 HVAC Replacement ❑ Duct Replacement ❑
Conditioned Floor Space (CFS): NOTE:
This form is not to be used for new construction or additions.
HVAC Systems — Heatin
:
Duct Insulation
Thermostat
Configuration (Split
Equipment Type
Capacity
AFUE
HSPF
R -Value
Type
or Package)
HP PACKAGE
. 47,500
N/A
8.0
N/A
SET BACK
PACKAGE
HVAC Systems — Cooling:
Pipe Insulation
Thermostat
Configuration (Split
Equipment Type
Capacity
SEER
EER
R -Value
Type
or Package)
HP PACKAGE
47,500
14.00
12.00
N/A
SET BACK
PACKAGE
HERS Verification Summary:
Duct Sealing & Testing — HERS verification is required for this measure.
❑ Yes 0 No In Climate Zones 2 and 9-16, if more than 40 linear feet of new or replacement ducts are installed in unconditioned
space, the ducts are to be sealed per §152(b)1Dii and the newly installed ducts are to be insulated per §151(f)10.
❑ Exception: Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos.
❑ Yes 0 No In Climate Zones 2 and 9-16, if the existing space -conditioning system (HVAC equipment and ducting) is replaced,
the ducts are to be sealed per §152(b)1Di. ,
EI Yes ❑ No In Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced (including the replacement of the air
handler, outdoor condensing unit of a split system, cooling or heating coil, or the furnace heat exchanger) the ducts
are to be sealed per §152(b)1 E.
❑ Exception: Duct systems that are documented to have been previously sealed confirmed through HERS
verification in accordance with procedures in the Reference Residential Appendix RA3.
❑ Exception: Duct systems with less than 40 linear feet in unconditioned space.
❑ Exception: Existing duct systems are constructed, insulated or sealed with asbestos.
Refrigerant Charge — Split System — HERS verification is required for this measure.
❑ Yes 0 No In Climate Zones 2 and 8-15, when the existing HVAC equipment is replaced (including the replacement of the air
handler, outdoor condensing unit of a split system A/C or heat pump, cooling or heating coil, or the furnace heat
exchanger) a refrigerant charge measurement shall be verified per §152 b 1 F.
Central Fan Integrated (CFI) Ventilation System and Fan Watt Draw
The ventilation requirements of §1 50 o do not apply to existing residential homes.
Ducted Split Systems — Air Conditioners and Heat Pumps: Airflow — HERS verification is required for this measure.
❑ Yes 0 No In Climate Zones 10 through 15, when the existing space -conditioning system (HVAC equipment and ducting) is
replaced, the airflow and fan waft draw shall be verified per 152 b 1 Ci to meet the requirements of §151(07B.
Documentation Author's Declaration Statement
I certify that this Certificate of Compliance documentation is accurate and com le
Name: KARL BROWN
Signature:
Company: PALM DESERT AIR CONDITIONING & HEATING COMPdW
Date: 5/18/10
Address:42-081 BEACON HILL
City, State, Zip Code: PALM DESERT, CA 9221.1
Phone: (760) 346-0677
Registration Number: Registration Date & Time: HERS Provider:
2008 Residential Compliance Forms PDAC January 2010
M
Installation Certificate
CF-6R-MECH-21-HERS
Duct Leakage Test – Existing Duct System
Page 1 of 2
Site Address:
Enforcement Agency: Permit Number:
78-550 LA FONDA, LA QUINTA 92253
10-429
Cl -Measured system airflow using RA3.3 airflow test procedures: CFM.
Option 1 used then:
Enter the Duct System Name or Identification Number:
#1
Enter the Duct System Location or Area Served:
HOUSE
NOTE: Submit one Installation Certificate for each ducts stem that must demonstrate compliance in the dwelling.
uuct t-eaKa a uta nusErc r est – —1-11 6J4V•
aoption 1: Measured leakage less than 15% of Fan Airflow.
❑ Option 2: Measured leakage to outside less than 10% of Fan Airflow,
❑ Option 3: Reduced leakage by 60% or more, and conduct smoke test to seal all accessible leaks.
O Option 4: Fix all accessible leaks using smoke test, and HERS rater must verify.
Determine nominal Fan Airflow using one of the following three calculation methods.
fid' Cooling system method: Size of condenser in Tons�� x 400 = 6 vasa CFM.
O ating Output CHeating system method: 21.7 x Heapacity (Btuh/k) = CFM.
Cl -Measured system airflow using RA3.3 airflow test procedures: CFM.
Option 1 used then:
Allowed leakage = Fan Airflow M20 x.15= Z410 CFM.
� %
1
Actual leakage CFM + Fan Airflow x 100 =
❑ Pass O Fail
Pass if Actual Leakage is less than Allowed Leakage.
Option 2 used then:
Allowed leakage = Fan Airflow X.10 = CFM.
2
Actual leakage = CFM _ Fan Airflow x 100 =
❑ Pass O Fail
Pass if Actual Leakage to outside is less than Allowed Leakage.
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 L Initial leakage x 100 =
O Pass ❑ Fail
Pass if % >_ 60%.
Option 4 used then:
4
All accessible leaks repaired using smoke test. HERS rater must verify (no sampling).
O Pass O Fail
Pass if all accessible leaks have been sealed using Smoke Fest.
Registration Number: Registration Date & Time: HERS Provider:
2008 Residential Compliance Forms PDAC January 2010
a - d eZb:OT OT bT daS
Installation Certificate
Responsible Person's Name:
Responsible Person's Signature:
WILLIAM MC COY
CF-6R-MECH-2I-HERS
Duct Leakage Test — Existing Duct System
Date Signed:
Position / Title: G
374937
Page 2 of 2
Site Address:
78-550 LA FONDA, LA QUiNTA 92253
Is this installation monitored by a Third Party Quality
Enforcement Agency:
Permit Number:
10-429
HVAC Systems —Heating:
Equipment Type
Manufacturer
Model Number
AFUE
HSPF
Load
Capacity
HP PACKAGE
AMERICAN STANDARD
4WCY404BB1000AA
NIA
8.0
47,500
47,500
HVAC Systems — Cooling:
Equipment Type
Manufacturer
Model Number
SEER
EER
Load
Capacity
HP PACKAGE
AMERICAN STANDARD
4WCY4048131000AA
14.00
12.00
47,500
47,500
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.
• 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 -1 R) form approved by the enforcement agency that identifies
the specific requirements for the installation. 1 certify that the requirements detailed on the CF -1 R 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.
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: PALM DESERT AIR. CONDITIONING & HEATING CO.
Responsible Person's Name:
Responsible Person's Signature:
WILLIAM MC COY
CSLB License:
Date Signed:
Position / Title: G
374937
08/24/10
INSTALLER /�J
Is this installation monitored by a Third Party Quality
Name of TCQCP:
Control Program (TPQCP): 0 Yes 0 No
Registration Number: Registration Date & Time: HERS Provider:
2008 Residential Compliance Forms PDAC January 2010
6-d e2b:01 01 tl daS
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21
Dud Leakage Test - Existing Duct System (Page 1 of 2)
Site Address' Enforcement Agency: Permit Number:
78-550 La Fonda, La Quinta CA 92253 (System 1) City of La Quint1 10-429
Enter the Duct System Name or Identification/Tag: System 1
Enter the Duct System Location or Area Served: Whole House
Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the
dwelling.
This installation certificate is required for compliance for alterations and additions in existing dwellings i
space conditioning systems and duct systems.
Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of
the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible
and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling,
use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. "
Duct Leakage Diagnostic Test - existing duct system
Select one compliance method from the following four choices.
0 1. Measured leakage less than 15% of fan flow
O 2. Measured leakage to outside less than 10% of Fan Flow
�l 3. Reduce leakage by 60% and conduct smoke and fix all leaks
0 4. Fix all accessible leaks using smoke and HERS rater verify
Note: (One of Options 1, 2, or 3 must be attempted before utilizing Option 4.)
Determine nominal Fan Flow using one of the following three calculation methods.
✓ 0 Cooling system method: Size of condenser in Tons 4 x400= 1600 CFM
✓ G Heating system method: 21.7 x _ Output Capacity in Thousands of Btu/hr = _ CFM
✓ O Measured system airflow using RA3.3 airflow test procedures: _ CFM
Option 1 used then:
1
Allowed leakage = Fan Flow 1600 x 0.15 = 240 CFM
Actual Leakage = _26_ CFM
Pass if Leakage Actual is less than Allowed
Pass Fail
Option 2 used then:
2
Allowed leakage = Fan Flow _ x 0.10 = CFM
Actual Leakage to outside = —CFM
Pass if Leakage Actual is less than Allowed
n Pass n 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 leakages x 100% _ % Reduction
Pass if % Reduction > 60%
Pass i 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 handier and door panel.
Pass if all accessible leaks have been repaired using smoke
D Pass Fail
Reg: 210-A0016296A-000000000-M21A Registration Date/Time: 2010/09/14 14:55:49 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms March 2010
9i'd eq�,:oj OT bi daS
G
8
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21
Duct Leakage Test - Existing Dud System (Page 2 of 2)
Site Address: Enforcement Agency: Permit Number:
78-550 La Fonda, La Quinta CA 92253 (System 1) City of La Quinta 10-429
I
0 Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off
during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA
ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may
be configured to the closed position during duct leakage testing.
0 All supply and return register boots must be sealed to the drywall if smoke test is utilized for compliance
- applies to duct leakage compliance option 3 (leakage reduction by 60%) and option 4 (fix all accessible
leaks) described above.
O New duct installations cannot utilize building cavities as plenums or platform returns in lieu of ducts.
B Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct tape to seal
leaks at all new duct connections
DECLARATION STATEMENT
. 1 certify under penalty of perjury, under the laws of the State of Califomia, the information provided on this form Is true and correct.
. 1 am the certified HERS rater who performed the verification services Identified and reported on this certificate (responsible rater).
. The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the
Installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified
on the Certificate(s) of Compliance (CF -111) approved by the local enforcement agency.
. The information reported on applicable sections of the Installation Certificate(s) (CF -611), signed and submitted by the person(s)
responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -IR) approved by the
enforcement agency.
Builder or Installer information as shown on the Installation Certificate (CF -6111)
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
PALM DESERT AIR CONDITIONING CO INC
Responsible Person's Name:
Ps License:
William McCoy
1374937
HERS Provider Data Registry Information
Sample Group # (if applicable): 169966
70 tested/verified dwelling ❑ not-tested/verified dwelling in
a HERS sample group
HERS Rater Information CalCERTS Certificate * CCi-1798510548
HERS Rater Company Name:
Air Experts Air Conditioning
Responsible Rater's Name:
Responsible Rater's Signature:
Paul Van Vtymen
Paul Van Vlymen
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed: 8/24/2010
CC2004367
Reg: 210-A0016296A-000000000-M21A
2008 Residential Compliance Forms
LI*d
Registration Date/Time: 2010/09/14 14:55:49 HERS Provider: CalCERTS, Inc.
March 2010
eet,:OT 01 bT daS