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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