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12-0808 (SFD)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA,'CALIFORNIA 92253 Application Number: Property Address:' APN: Application description: Property Zoning: Application valuation: 1 — t •�`�i(/ VOICE (760) 777-7012 y 4 -4 FAX (760) 777-7011 BUILDING & SAFETY DEPARTMENT ��% INSPECTIONS (760) 777-7153 BUILDING PERMIT ". Date: 7/26/12 X12 "oOn60808z�_ 52229 WHISPERING WY 767-200-999-47 -312023- DWELLING SINGLE FAMILY DETACHED LOW DENSITY RESIDENTIAL . 171399 Owner: DESERT CHEYENNE, INC. 78401 HIGHWAY 111, SUITE X LA QUINTA, CA 92253 FP (760)777-'9920F:2 AUG 2 0 2012 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: t3 7A LQPERMIT certify. that I have read this application and state that the a information is correct. I agree to comply with all city and county ordinances and state laws relating to buildin nstruction, and hereby authorize representatives /o/f Ihis co ty to nter upon the above-mentioned property f nspect ion purposes. Dater LJ ignature (Applicant or Agent): ' Contractor: Applicant: _ Architect or Engineer. GJH DEVELOPMENT INC CITY OF LA QUINTA • 27636 YNEZ ROAD C7 #151. FfAfANCEDEPT. I(760)578-3545 TEMECULA, CA 92591 Lic. No.: 916227 ----------------------------------------------------- EN ED CONTRACTOR'S DECLARATION - - - WORKER'S COMPENSATION DECLARATION hereby affirm under penalty of perjury that icensed under provisions of Chapter 9 (commencing with •_ I hereby affirm under penalty of perjury one of the following declarations: ' Section 7000) of Division 3 of the Business a ofessionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Class: B License No.: 916227 - - - XDte/ 1`0 ontractor: / 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 M Code, for the performance of the work for which this permit is issued. My workers' compensation ' _ NER-BUILDER DECLARATION I hereby affirm under penalty of perjury that I am empt from the Contractor's State License Law for the insurance carrier and licy number are: Carrier EXEMPT Policy Number. EXEMPT following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to I certify that, in the perfor nca of the work for which this permit is issued, I shall not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the ecome subject to the workers' compensation laws of California, person in any m=NALTIES 'permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, ie subject to the workers' compensation provisions of Section - License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or ,3700 of the Labforthwith comply with those provisions. 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).: atev/ is �Z '/ �rpplicant: (_ 1 1, isownerof 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 WARNING: FAILURE TO SECUROMPENSATION COVERAGE IS UNLAWFUL, AND SHALL - Contractors' State License Law does not apply,to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CLTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the DOLLARS 1$100,0001. . IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN - _ improvements are not intended or offered for sale. If, however, the building or improvement is sold within - _ SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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.). , - APPLICANT ACKNOWLEDGEMENT ' 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the ' l . 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. property who builds or improves thereon, and who contracts for the projects with acontractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for pursuant to the Contractors' State License Law.). - - whose benefit work is performed under or pursuant to any permit issued as a result of this application, ; (_) 'I am exempt under Sec. ' , B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City • - - of La Quinta, its officers, agents and empldy es for any act or omission related to the work being .' _ performed under or following issuance of thi ermit. � - Date: Owner: 2. Any permit issued as a result of this applicati becomes null and void if work is not commenced - ' within 180 days from date of issuance of su rmit, or cessation of work for 180days will subject - CONSTRUCTION LENDING AGENCY permit to cancellation. 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: t3 7A LQPERMIT certify. that I have read this application and state that the a information is correct. I agree to comply with all city and county ordinances and state laws relating to buildin nstruction, and hereby authorize representatives /o/f Ihis co ty to nter upon the above-mentioned property f nspect ion purposes. Dater LJ ignature (Applicant or Agent): ' Application Number 12-00000808 Structure Information Construction Type , TYPE V - NON RATED Occupancy Type . . . .`. DWELLG/LODGING/CONE <=10 1 Flood Zone . . NON -AO FLOOD ZONE Other struct info CODE EDITION 2010 CBC # BEDROOMS 4.00 FIRE SPRINKLERS yes GARAGE, SQ FTG 658.00 PATIO SQ FTG 319.00 NUMBER OF UNITS 1.00 1ST FLOOR SQUARE FOOTAGE 2600.00 Permit BUILDING PERMIT . Additional desc. . Permit Fee 891.50 Plan Check Fee 579.48 Issue Date Valuation 171399 Expiration Date .. _ 1/22/13 . Qty Unit Charge Per Extension BASE FEE 639.50 72.00 3.5000 THOU BLDG 100,001-500,000 .252.00 Permit" . . MECHANICAL Additional desc . Permit Fee 90.00 Plan Check.Fee'. 22.50• Issue Date Valuation . . . . 0 Expiration Date 1/22/13 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 9.0000 EA'. MECH FURNACE <=100K _ 18.00 2.00. 9.0000 EA MECH-B/C <=3HP/100K BTU 18.:00 5.0.0. 6.5000 EA MECH VENT FAN 32.50 1.00• 6:5000 ------------------------------------------------------------------------- EA MECH EXHAUST. HOOD 6.50 Permit ELEC-NEW RESIDENTIAL Additional desc"._• Permit Fee . . 119.16 Plan Check Fee 29.79 Issue Date . . . . Valuation 0 " Expiration Date 1/22/13 Qty Unit Charge Per Extension BASE FEE 15.00 2600.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 91.00 LQPERMIT - - - Application Number 12-00060808 Permit . . . . . . ELEC-NEW RESIDENTIAL Qty 'Unit Charge. Per Extension 658.00 .0200 ---------------------------------------------------------------------------- ELEC GARAGE OR NON-RESIDENTIAL 13:16 Permit PLUMBING Additional desc . Permit Fee. 166.50 Plan Check,Fee 41.63 Issue Date . . . . Valuation 0 Expiration Date 1/22/13 Qty Unit uharye Pei Extension BASE FEE 15.00 16.00 6.0000 EA PLB FIXTURE 96.00 1.00 15..0000 EA PLB BUILDING SEWER 15.00 1.00 7.5000 EA PLB-WATER HEATER/VENT' 7.50 1.00 3.0000 EA PLB WATER INST/ALT/REP• 3.00 1.00 9.0000 EA PLB LAWN SPRINKLER SYSTEM 9.00 8.00 .7500 EA PLB GAS'PIPE >=5 6.00- 1.00 .15.0000 EA PLB GAS METER 15.00 Permit".GRADING PERMIT Additional desc . Permit Fee . . . 15.00 Plan Check Fee .. .00 Issue Date . . Valuation . . . . 0 Expiration Date 1/22/13 - Qty Unit Charge Per Extension. BASE FEE, 15.00 - ----------------------------------------------- Special Notes and Comments SFD - LOT 47, PLAN 2RB, 2600 SF. PERMIT DOES NOT INCLUDE POOL, SPA, BLOCK WALLS, OR DRIVEWAY APPROACH. 2010 CODES. •Other Fees BLDG STDS ADMIN (SB1473) 7.00 DIF COMMUNITY CENTERS-RES 104.00 DIF CIVIC CENTER - RES 1089.00 ENERGY REVIEW FEE 57.95. DIF FIRE PROTECTION-RES 612.00 DIF LIBRARIES - RES 334:.00 MULTI-SPECIES (MSHCP) FEE 1254.00 DIF PARK MAINT FAC - RES 51.00 DIF PARKS/REC - RES 1773.00 STRONG MOTION (SMI) - RES 17.14 DIF STREET MAINT FAC-RES 158.00 . LQPERMIT_ Application Number . . . 12-00000808 Other Fees . . . . . . DIF TRANSPORTATION - RES 3592.00 Fee summary Charged Paid Credited: Due Permit Fee Total 1282.16 -.00 .00 1282.16 Plan Check Total 673.40 .00 00 673.40 Other Fee Total 9049.09 .00 .00 9049.09 Grand Total 1100.4.65 .00 ..00 11004.65 t Plan Submittal Job Slte'Adr Owners Ni Number, Street, or. PO City, State, Poeta) C Owners Phone Nun Owners E -Mail Addi Project Managers N Project Managers Phone Nur Project Managers E -mall Add Builder / Contra Number, Street or PO city, State, Postal C Project Square Foote 8,326 - C.hy Approval By / i Date of City Approvalzzzzz Matedals.ToBe Discarded: • i Product Tons' t Trash ,15.82 Not recyclable Product 'Ton's Asphalt 0.00 Recyclable Masonry (broken) 0.00 Recyclable. Brick/Block 0.00 Recyclable Plaster 1.67 Recyclable Cardboard -2.75 Recyclable 'Scrap Metal 0.00 Recyclable Commingled 000 Recyclable Tile (floor) 1 1.42 Recyclable Concrete Recyclable Tile (roof) 0.00 Recyclable i DrywallEARacyclable Recyclable Wood 20.82 Recyclable . Donated / Reuse' • Landscape Debris 0.00 Recyclable; •Describe Items ' Totals' Recycle Trash- _ Projected Diversion: 27.8 I understand It Is the property ownses. responsibility to autimit capias of walght tip or rseelpis to the District ` Emrironmantel coordinator as those hauls occur. I hereby certify that completion, impiementalon and adherence of the Debris Management Plan (DMP) for the above named project shall guarantee that at least 50% of the jobclte waste Is diverted from landfilling. The remaining material will be recycled or roused. I will divan, for recycling or reuse, remaining materials 1 generated from the first day of the project through the completion of the project in accordance with this pian. Thle DMP Is Issued in the name of the properly owner(s) and shall remain their property throughout the construction and/or demolition project A contractor serving es ant of the owner may obtain a DMP for the owner. However, the DMP is still issued In the name of the property owner(s) an owner retains legal responsibility for enuring that the provisions of the DMP are adhered S ` to. The property owners) and go contractor shall be kept Informed of the diversion progress through bMtonthly reports. K self -hauling, all refuse material f this project site must be taken to an approved roryder or treader s"on. , Owner / Developer / Project Manog / Superintendent Date -Building Permit Number. ` Project Description:. SFR a t Exempt: 0. (Materials may contain hazardous wastes and - are not subject to recyclingtprovisfons) , Construction Debris Management Plan ' ati 8/8/2012 81807 Ave. 52 via John Pedalino - 3a 1 78401 Hwy 111, Unit X 30 La Quanta, CA 922.53 > be 760-578.6915 e fohn®thelendetewards.eom . .. In o Silver Castro b 619-495-4624. ea i John thelandstewwds.com to Desert Cheyenne, Inc. }� i .78401 Hwy 111, Unit )dl La Quints, CA 92253 Certificate of Occupancy T-af 4 4 a" Community Development Department 11 This Certificate is issued pursuant to the requirements of Chapter 1, Section R110 of the California Residential Code, certifying that, at the time of issuance, this, structure was in compliance with the provisions of the Building Code and the various ordinbnces of the City regulating building construction and/or use. BUILDING ADDRESS: 52-229 WHISPERING WAY Use classification: SINGLE FAMILY DWELLING Occupancy Group: R3 Type of Construction: VB Code Edition: 2010 If F 1W Building Official Sprinkler Installed: YES POST IN A CONS Building Permit No.: 12-0808 Land Use Zone: RL Sprinkler Required: YES Owner of Building: DESERT CHEYENNE, INC. Address: 78-401 HIGHWAY 111. STE. G City, ST, ZIP: LA QUINTA, CA 92253 By: AJ ORTEGA Date: FEBRUARY 26: 2013 E CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF -411 -ENV -20 Building Envelope Sealing (Page 1 of 1) Site Address: Enforcement Agency: Permit Number: 52-229 Whispering Way, La Quinta CA 92253 (1) City of La Quinta 12-808 Buildinq Envelope Sealinq Diagnostic Testing Results CFM50H = the measured airflow in cubic feet per minute (cfm) at 50 pascals for the dwelling with air distribution registers unsealed. SLA = 3.819 x (CFM50 H / Conditioned Floor Area in ft2) per Residential ACM Manual Equation R3-16 Responsible Person's Name: Building Envelope Leakage CFM50H as measured using a blower door diagnostic device Greg Herington 1. Enter the blower door leakage target CFM50H value for compliance from the CF -111 2042 ® tested/verified dwelling (cfm). 2. Enter the blower door leakage minimum CFM50H value corresponding to 1.5 SLA 1021 HERS Rater Company Name: from the CF -1R (cfm). Responsible Rater's Name: 3. Enter the measured CFM50H value from the blower door test (cfm) 1865 4. The leakage test passes if the measured envelope leakage CFM50H value from row is 3 CC2004075 less than or equal to the value required for compliance from row 1, otherwise the test Pass Fail fails. check/enter Pass or Fail 5. If measured CFM50H from row 3 is less than the minimum CFM50H value corresponding to AS SLA from row 2: <a S check/enter < 1.5 SLA, otherwise check/enter >_1.5 SLA SLA* SLA *Advisory note to builder and enforcement agency: If row 5 indicates "< 1.5 SLA", it is critical to ensure that combustion and solid -fuel burning appliances in the dwelling are provided with adequate combustion and ventilation air and vented in accordance with manufacturers' installation instructions and all applicable codes as specified by ASHRAE Standard 62.2 Section 6.4. Additional information about compliance with this requirement is given in Section 4.6.5 of the Residential Compliance Manual under the topic of Combustion and Solid -Fuel Burning Appliances. '� rJ `'� :it {• 'k� 1'ti Y rt {r5:.4 i'F't�: > DECLARATIO�N!STAT MENT>lii-.' ��^ � ?» . • I certify udder penalty ofrperjury,'.under,the Imus of.the.StateW"California, the:information prowled 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 -611), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -SR) approved by the enforcement agency. Builder or Installer information as shown on the Installation Certificate (CF -611) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) G]H Development Inc Responsible Person's Name: CSLB License: Greg Herington N/A 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 # CCl-1798706088 HERS Rater Company Name: BCI Testing Responsible Rater's Name: Responsible Rater's Signature: William Irvine William Irvine Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 2/22/2013 CC2004075 Reg: 210-N0000631B-E2000053A-E20A Registration Date/Time: 2013/02/22 15:11:35 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF -4R -ENV -20 Building Envelope Sealing (Page 1 of 1) Site Address: Enforcement Agency: Permit Number: 52-229 Whispering Way, La Quinta CA 92253 (2) City of La Quinta 12-808 Building Envelope Sealing Diagnostic Testing Results CFM50H = the measured airflow in cubic feet per minute (cfm) at 50 pascals for the dwelling with air distribution registers unsealed. SLA = 3.819 x (CFM50 H / Conditioned Floor Area in ft2) per Residential ACM Manual Equation R3-16 Responsible Person's Name: Building Envelope Leakage CFM50H as measured using a blower door diagnostic device Greg Herington 1. Enter the blower door leakage target CFM50H value for compliance from the CF-iR 2042 ® tested/verified dwelling (cfm). 2. Enter the blower door leakage minimum CFM50H value corresponding to 1.5 SLA 1021 HERS Rater Company Name: from the CF -1R (cfm). Responsible Rater's Name: 3. Enter the measured CFM50H value from the blower door test (cfm) 1865 4. The leakage test passes if the measured envelope leakage CFM50H value from row is 3 IN Pass Fail less than or equal to the value required for compliance from row 1,, otherwise the test fails. check/enter Pass or Fail 5. If measured CFM50H from row 3 is less than the minimum CFM50H value corresponding to A.5 1.5 SLA from row 2: <75 check/enter < 1.5 SLA, otherwise check/enter 2!1.5 SLAI SLA* SLA *Advisory note to builder and enforcement agency: If row 5 indicates "< 1.5 SLA", it is critical to ensure that combustion and solid -fuel burning appliances in the dwelling are provided with adequate combustion and ventilation air and vented in accordance with manufacturers' installation instructions and all applicable codes as specified by ASHRAE Standard 62.2 Section 6.4. Additional information about compliance with this requirement is given in Section 4.6.5 of the Residential Compliance Manual under the topic of Combustion and Solid -Fuel Burning Appliances. •DECLARAT-I-O,NrST"ATEM;EN' ECLARATIO,NrSTATEMENT 1Y` .;i a' { I certify under penalty of perjury, unde'r'the•la s of.'the State of Calliifomia�Ehd�lnfo ma on provided on this formas true and corrects • I am the certified HERS rater who performed the verification services identified and reported on this certificate (respcnsible 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 -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) G]H Development Inc Responsible Person's Name: CSLB License: Greg Herington N/A 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 # CC1-1798706088 HERS Rater Company Name: BCI Testing Responsible Rater's Name: Responsible Rater's Signature: William Irvine William Irvine Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 2/22/2013 CC2004075 Reg: 210-N0000631B-E2000054A-E20A Registration Date/Time: 2013/02/22 15:11:35 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF -4R -ENV -2] Quality Insulation Installation (QII) - Framing Stage Checklist (Page 1 of 2) Site Address: Enforcement Agency: Permit Num.ber: 52-229 Whispering Way, La Quinta CA 92253 City of La Quinta 12-808 Quality Insulation Installation (QII) - Framing Stage Checklist Air barrier installation and preparation for insulation must be done at framing stage before insulation is ins.alled. If there are any "No" answers, rows not filled out, or a signature missing then this is not a valid form and cannot be accepted by the building department or HERS rater. SPF insulation can be considered an air barrier when the bottom and top plates of vertical framing and bot -i ends of horizontal framing, including band and rim joists, are sprayed to completely fill the cavity adjacent to and "n contact with the framing to a distance of 5.5 inches away from the framing for open cell SPF (ocSPF) or 2.0 inches away from the framing for closed cell SPF (ccSPF). SPF can be considered as an air barrier with less than the above thickeess when a product data or specification sheet is provided that shows the product meets an air permeance no greater than 0.02 L/s-m2 at 75 Pa pressure differential when tested in accordance to ASTM E2178 or ASTM E283. All structural framing areas shall be insulated in a manner that resists thermal bridging of the assembly separating conditioned from unconditioned space. Structural bracing, tie -downs, and framing of steel, or specific framing used to meet structural requirements of the CBC are allowed and must be insulated. These areas shall be called out on the building plans with diagrams and/or specific design drawings indicating the R -value of insulation and faste-iing method to be used. ✓ FLOOR AIR BARRIER n 1 n❑ No ® NA All gaps in the raised floor to unconditioned space or to outside larger than 1/8" filled with foam or caulk. (NA if SPF meets conditions above) Y[e]s P rR All openings in the raised floor including second floors, such as under a tub where the drain penetrates the floor are sealed. (NA if slab on grade) WALLS AIR BARRIER e All gaps to outsidellarger than, �8�' filled with foam �orf�caulk. (NA if SPF cogditicns above) es L^( os` f}t i' " ANopenings in top'and;bottom plate to the outside ihUihf&ior,;and,exterior walls;`mcludi'ng: holes drilled for.,electneal end -plumbing larger than 1/8" fi41etl with.ftiam on,ca�ulk. (NAif, SPF meets condgpitions;abovtte)..LL�¢ ® Yes ? 1 ' b. w IMS st M+M .' T4f #ii 451 f h .. ` , i RaaiZ xga* or �ka�.:de"ot p�el*the home��;j �9Y. Yes0 j `- ,-�.: All"gaps"around. window's`a'nd doors cai lked.or foainetl: Low�'rekpanding:,foam reco'mmen'ded if allowed" by window manufacturer. (Stuffing with fiberglass not acceptable) ATTIC INSPECTION ® Vis' j'a Attic rulers appropriate to the material installed are evenly distributed throughout attic to verify depth. (NA if SPF or batt) ®❑ Y � NA Number of rulers installed 12 Attic area (sgft) 2600 _, 250 = l minimum number of rulers 1 installed. Must round up. (NA if SPF or batt) es o ALL rulers visible from attic access.(NA if SPF or batt) Yes IP 19 Eave vents baffles installed at all eave vents to prevent air movement under or into insulation. (NA if SPF) CEILING AIR BARRIER es o All draft stops in place t, form a continuous ceiling air barrier no gaps larger than 1/E". (NA if SPF meets conditions above Pe, FoYes No a fVA All dropped ceilings/soffits covered with hard covers. Gaps around or in the hard cover larger than 1/8" filled with foam or caulk. (NA if no drops) es To Openings around flue shafts fully sealed with flashing and caulked. (NA if no Flue shafts) Reg: 210-N0000631B-E2100055A-E21A Registration Date/Time: 2013/02/22 15:13:33 HERS P-ovider: CalCERTS, Inc. 2008 Residential Compliance Forms May 2012. CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF -4R -ENV -21 Quality Insulation Installation (QII) - Framing Stage Checklist (Page 2 of 2) Site Address: Enforcement Agency: Permit Number: 52-229 Whispering Way, La Quinta CA 92253 1 City of La Quinta 12-808 Fes—Po IR Piping shaft openings fully sealed and caulked. (NA if no pipe shafts) ® e o ❑ NA Penetrations through the ceiling air barrier from electrical boxes in the ceiling, fire alar --n boxes, etc. sealed with caulk or foam. (NA if no penetrations) ® e P ❑ NA All duct chases, fireplace chases, and double walls sealed air tight at the ceiling level. All gaps into shafts larger than 1/8" filled with foam or caulk (NA if none of the above or SPF meets conditions above) V'GARAGE ROOF/CEILING AIR BARRIER FOR TWO STORIES (no conditioned space aver garage) es I o 19 Air barrier installed at joists in garage to house transition (between floors). No gaps larger than 1/8" [allowed. (NA if SPF meets conditions above) GARAGE ROOF/CEILING AIR BARRIER FOR TWO STORIES (conditioned space over garage) FP HERS Provider Data Registry Information Sample Group # (if applicable): N/A If insulation is to be installed at subfloor then subfloor has no gaps over 1/8". Air barrer installed at joists in garage to house transition (between floors). Use of SPF meeting conditions above as the air barrier satisfies the requirement to seal the gaps. es Po o ® NA If insulation is to be installed at ceiling of garage then ceiling and joists to the outside have no gaps over 1/8". (NA if SPF meets conditions above or no conditioned space over garage.) 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 agencv. Builder or Installer information as shown on the Installation Certificate (CF -6111) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Empire Insulation Responsible Person's Name: CSLB License: Jennifer Carr 1860072 HERS Provider Data Registry Information Sample Group # (if applicable): N/A ® tested/verified dwelling ❑ not-testedfverified dwelling in la HERS sampla group HERS Rater Information CaICERTS Certificate # CC1-1798706088 HERS Rater Company Name: BCI Testing Responsible Rater's Name: Responsible Rater's Signature: William Irvine William Irvine Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 10/27/2012. CC2004075 In Reg: 210-N0000631B-E2100055A-E21A Registration Date/Time: 2013/02/22 15:13:33 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms May 2012 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF -411 -ENV -22 Quality Insulation Installation (QII) - Insulation Stage Checklist .(Page 1 of 3) Site Address: Enforcement Agency: Permit Number: 52-229 Whispering Way, La Quinta CA 92253 City of La Quinta 12-808 All structural framing areas shall be insulated in a manner that resists thermal bridging of the assembly separating conditioned from unconditioned space. Structural bracing, tie -downs, and framing of steel, or specialized framing used to meet structural requirements of the CBC are allowed and must be insulated. These areas shall be called out on the building plans with diagrams and/or specific design drawings indicating the R -value of insulation and fastening method to be used. SPF insulation can be considered an air barrier when the bottom and top plates of vertical framing and both ends of horizontal framing, including band and rim joists, are sprayed to completely fill the cavity,adjacent to and in contact with the framing to a distance of 5.5 inches away from the framing for open cell SPF (ocSPF) or 2.0 inches away from the framing for closed cell SPF (ccSPF. SPF can be considered as an air barrier with less than the above thickness when a product data or specification sheet is provided that shows the product meets an air permeance no greater than 0.02 LJs-m2 at 75 Pa pressure differential when tested in accordance to ASTM E2178 or ASTM E283. Closed cell and open cell manufacturers claim various R -values per inch. In California the maximum R -value that can bu claimed for ccSPF is an R -value of 5.8 per inch and for ocSPF is an R -value of 3.6 per inch. Higher R -values per inch cannot be claimed even with . manufacturer data. Insulation Stage Checklist FLOOR INSULATION P i ® f1A All floor joist cavity insulation installed to uniformly fill the cavity side-to-side and end-to-end, NO gaps. (NA if slab on grade) PP NA Insulation in full contact with the subfloor, NO gaps. (NA if slab on grade) Fe o IR Batts: cut to fit around wiring and plumbing, or split (delaminated). (NA if loose fill, SPF, or slab on grade) es o ® NA Batts: shall be properly supported to avoid gaps, voids, and compression. (NA for other forms of insulation) es ❑o N ® f7K Insulation R -value same or greater than listed on CF -1R. (NA for slab on grade) P * 4140.," ®®f, NA r' Gaps between studs largenthanil/8, the ;cavity must be filled with insulation orlfoam. (NA for slab on gPes rade) "t �'' 4,�X1'4': i , ,-listthe required floor cavltyR value from CF -1R; R- iDetermine required thickness for„ccSPF�(requied R -value k/;SSR) a aches), oCwiwequred thick4ness for ocSPF" (:R -value. /13.6kx_±+'` orches) (NA!fiir;otherjforms.pf insulafi�6.ZAI -q. ai,...yCdr,^: +tl*+�..�'`W..« WALL INSULATION ® Y ❑❑ f0 NA Batts, loose fill mineral fiber, mineral wool, and cellulose: fills cavity and is in contact with air barrier. ocSPF: shall completely fill cavities of 2x4 inch framing or less. Cavities greater than 2x4 inch framing dimensions must be filled to the thickness calculated above. ccSPF: insulation is not required to fill the cavities of framed assemblies provided the installed thickness of insulation conforms to the thickness calculated above. ® Yes ❑ No 9 Double walls and bump -outs - insulation fills the cavity or additional air barrier installed in the cavity so that the insulation fills the cavity and in contact with the air barrier. (NA if SPF meets conditions above and meets the required R -value) Pe, o 0 Insulation installed in exterior walls adjacent to tub/shower, walls under stzirs, and fireplace. Insulation required to fill wall cavity. Cavity required to be air tight. (NA if none of the above) es All gaps around windows and doors filled with insulation or filled with low expanding foam. P P 9 Batts: no voids/depressions greater than 3/4” in ANY stud bay. (NA for other forms of insulation) ®❑ e P NA Batts: voids/depressions less than 3/4" allowed as long as the area is not greater than 10% of the surface area for each stud bay. (NA for other forms of insulation) es o IR Loose Fill: no gaps or voids. Insulation completely fills the cavity. (NA for dther forms of insulation) YCegs PO Gaps between studs larger than 1/8" the cavity must be filled with insulation or foam. Reg: 210-N0000631B-E2200052A-E22A Registration Date/Time: 2013/02/22 15:20:46 HERS Provider: CalCERTS, inc. 2008 Residential Compliance Forms May 2012 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF -4R -ENV -22 Quality Insulation Installation (QII) - Insulation Stage Checklist (Page 2 of 3) Site Address: 52-229 Whispering Way, La Quinta CA 92253 Enforcement Agency: 1 City of La Quinta Permit NLmber: 12-808 es o 0 All Rim -joists to the outside insulated. (NA if no Rim -joists) es 0 No Insulation installed at corner channels, wall intersections, and adjacent to tub/shower enclosures insulated to proper R -Value. es 0 o All skylight shafts and attic kneewalls insulated with minimum R-19. (NA if no skylights, kneewalls or in conditioned attic) ® Yes ❑ No [:] No Insulation in full contact with air barrier or wall finish for skylight shafts and attic kneewalls. (NA if no skylight or kneewalls) KA I Installed wall insulation R -value equal to or greater than what is listed on the CF -1R. es o R SPF: insulation installed without gaps and to provide an air seal when specified as an air barrier. (NA for other forms of insulation) .� `s Po � 0 "" SPF: list the required wall cavity R -value from CF -1R, R-_13.0 . Determine required thickness for ccSPF (required R -value 13.0 / 5.8R) = 2.2 inches), or required thickness for ocSPF (required R -value 13.0 / 3.6 = 3.6 inches). (NA for other forms of insulation) es Rno SPF: measure thickness of wall insulation in 6 random areas. Minimum thickness for ccSPF shall be more than 1/2 inch less than the required thickness listed above. Minimum thickness for ocSPF shall be no more than 1 inch less than the required thickness listed above. (NA for other forms of insulation) CEILING/ROOF INSULATION YES oGaps between studs larger than 1/8" the cavity must be filled with insulation or foam. es o Batts: no gaps/voids/depressions greater than 3/4". (NA for other forms of insulation) ,�.. 6a Yes ❑r� OF. ❑~ I IV❑A Batts: voids/depression§less than 3/4"511owed<as Dong as;the area is1not.g4,eater.tharnjrl0% of the surface area for;6ach,stuclbay. (NA for�other forms ofjirisulation) Y Yes N 7 NA VVIV, +ayr. r � ~ -EAT," ,. r4�" , � ;;!q Loose Fill NOc.gaps or:voids allowed+�(NAfor other forms of insulation),. +, ,# yt ,t,�~1 et,; 'P" _ xa' Y es ❑of' o ` N �y *` t pit Fx a �D� �t 5f+u1� ar All ceiling(roof{ m'sulation installedrto urnformly it the cavltyiside-C side and„end-o en td , 'TW .'pro 1•.. 'fil;t. <<i d ,.',+J'�ak.ua. hGH' a. �,. •`LF '?E;'?'.:°'.-ucfm++rm' Insulation in full contact with the ceiling/roof, NO gaps. to Yes ' � 1. Insulation in contact with air barrier. es o Batts: cut to fit around wiring and plumbing, or split (delaminated). (NA for ogler forms of insulation) ® e o 9 Batts taller than bottom chord must expand over the bottom chord or additional insulation installed Iso bottom chord not visible. (NA for other forms of insulation) ME o R Batts cut to fit around ALL webbing. No gaps allowed between webbing and batts. (NA for other forms of insulation) ❑ e P ® NA SPF: list the required ceiling R -value from CF -1R, R- 13.0. Determine required thickness for ccSPF (required R -value 13.0 / 5.8R) = 2.2 inches), or required thickness for ocSPF (required R -value 13.0 / 3.6 = 13.0 inches). (NA for other forms of insulation) es o XX SPF: measure thickness of ceiling insulation in 6 random areas. Minimum thickness for ccSPF shall be no more than 1/2 inch less than the required thickness listed above. Minimum -:hickness for ocSPF shall be no more than 1 inch less than the required thickness listed above. (NA for,other forms of insulation) es o R HVAC Platform and Catwalks - insulated to R -value equal to ceiling R -value listed on CF -1R. If less insulation installed then called out on CF -1R. (NA if no platform or catwalks) es o Attic access gasketed. (NA of no attic access) ® Yes Po ❑ R. Attic access insulated with rigid foam or batt insulation using adhesive or mechanical fastener. Attic access door R -value equal to ceiling R -value listed on CF -1R. If less insulation installed then called out on CF -1R. (NA if no attic access) es o R Recessed light fixtures covered full depth with insulation. If SPF used then ocher forms of insulation used to cover or enclose fixture in a box fabricated from 1/2 -inch plywood, 18 ga. sheet metal, 1/4 -inch hard board or drywall. SPF or other insulation then covers light fixture to full depth. (NA is no recessed light fixtures) 10 es o All recessed light fixtures in non conditioned space are IC rated and air tigh- (AT). (NA if no recessed light fixtures) Reg: 210-N0000631B-E2200052A-E22A Registration Date/Time: 2013/02/22 15:20:46 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms May 2012 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF -411 -ENV -22 Quality Insulation Installation (QII) - Insulation Stage Checklist (Page 3 of 3) Site Address: Enforcement Agency: Permit Number: 52-229 Whispering Way, La Quinta CA 92253 City of La Quinta 12-808 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. Builder or Installer information as shown on the Installation Certificate (CF -6R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Empire Insulation All recessed light fixtures are sealed with a gasket or caulk between the housing and the ceiling. (NA es o o if no recessed light fixtures) Sample Group # (if applicable): N/A PCeiling ❑ not-tested/verified dwelling in la insulation equal to or greater than what is listed on the CF -1R. HERS sample group HERS Rater Information CaICERTS Certificate # CC1-1798706088 Loose Fill: Minimum thickness required to meet the stated R -value listed on CF -1R. Insulation rulers es o 0 visible for verifying.the installed R -value for blown in insulation. (NA for other forms of insulation) ® Yes �] No [] No Loose Fill: insulation uniformly covers the entire ceiling (or roof) area from outside of all exterior walls. (NA for other forms of insulation) Weight of Mineral -Fiber Loose -fill (Fiberglass, Rock wool) - Target R -value from CF -111) �❑ YeS o Minimum weight from insulation bag label to meet target R -value (Ib./ft2) . Weight of insulation from coring tool (lb). Area of coring tool (ft2). Sample weight = (Ib./ft2). Is sample weight (Ib./ft2) the same as or greater than required weight (Ib./ft2) (NA for other forms of insulation) Thickness - ALL Loose -Fill Insulation - Target R -value (from CF -1R) 38 . Required thickness from ® insulation bag label to meet Target R -value for (Installed Thickness 10.59 (in)), and (Settled Yes No No Thickness 10.27 (in)). Average Installed thickness 10.5 (in). Is Installed Thickness the same as or greater than Required Thickness? (NA for other forms of insulation) GARAGE ROOF/CEILING INSULATION FOR TWO STORIES(no conditioned space over garage) Pe, I o I IRR Insulation installed at joists against the air barrier in the garage to house transition. All wall I insulation requirements above must be met. (NA if conditioned space over garage). GARAGE ROOF/CEILING INSULATION FOR TWO STORIES(conditioned space over garage) PP ® NA If insulation is to be installed at subfloor then the insulation must also be installed at joists against the air barrier in.the garage to house transition. All ceiling and wall insulation requirements above Must be met. (NA if no conditioned space over garage).,,,,_ es ; o, 4 �„ •.. Ionareqfrinsulation is tb"'be installed af`ceilingSof,ga�age then,the't)oists'lto the outside must be insulated and l' al the insulatiuicements listed above must be met (NA if no conditioned space over garage). 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. Builder or Installer information as shown on the Installation Certificate (CF -6R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Empire Insulation Responsible Person's Name: CSLB License: Jennifer Carr 1860072 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 # CC1-1798706088 HERS Rater Company Name: BCI Testing Responsible Rater's Name: Responsible Rater's Signature: William Irvine William Irvine Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 10/27/2012 CC2004075 0 Reg: 210-N0000631B-E2200052A-E22A Registration Date/Time: 2013/02/22 15:20:46 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms May 2012 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-20 Duct Leakage Test - Completely New or Replacement Duct System (Page 1 of 2) Site Address: Enforcement Agency: Permit Number: 52-229 Whispering Way, La Quinta CA 92253 (1) City of La Quints 12-808 Enter the Duct System Name or Identification/Tag: 1 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 certificate is required for compliance for completely new duct systems installed in new dwelling construction, and also For completely new or replacement duct systems in existing dwellings. For existing dwellings, a completey 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. nurt I PaknaP niannnctir Tact - rmmnlPtPly npw nr rPnlarpmpnt dart cvctpm Enter a value for the Allowed Leakage (CFM) for the duct system leakage verification. The value entered must be the VLLDCS criteria or one of the three calculated leakage rates described below. Verified Low Leakage Ducts in Conditioned Space (VLLDCS) Compliance Credit. If compliance credit for Allowed verified low leakage ducts in conditioned space is shown in the special features section of the CF -1R, the Leakage leakage to outside test method must be used to verify duct leakage (refer to RA3.1.4.3.4), and 25 CFM must (CFM) be entered for Allowed Leakage. Allowed leakage calculation - (select one calculation method from this section). Use 6% (leakage factor = 0.06) for calculations. When utilizing Low Leakage Air Handler (LLAH) credit, the allowed duct leakage may be specified by the CF -1R to be less than 6%, in which case the user-specified leakage rate must be used in the calculations below. For example, if the user-specified leakage (specified as a percentage of fan airflow) is reported on the CF -1R as 3%, then use aleakage factor of 0.03 in the calculations below. ® Cooling system method: Nominal capacity of condenser in Tons 3 5 x 400 x leakage factor_ 84 CFM p- j ❑ Heating system method 21.7 x 4 �+ Output Capacityrnn Th�ousand5:'of Btu/hr x leakagexfactor CFM f11PMeasuredairflowimethod1'�4Mihere 1�1.� AF5.-� �ax;leaka e. 4, ; ��Enter measured,fz nflow,m.CF g factor, = w:, r+ � i � Enter value for Actual leakage (CFM) in the right column, from measurement using applicable duct leakage pp 9 Actual Leakage pressurization test procedure from Reference Residential Appendix RA3.l(CFM @ 25 Pa). (CFM) List Actual Leakage from duct leakage te!st(CFM) r64 Pass if Actual Leakage is less than Allowed Leakage ® Pass ❑ Fail For complete replacement of duct systems only, if the 6 percent leakage rate criteria cannot be met, a smoke test should be performed to verify that the excess leakage is coming only from a pre-existing furnace cE.binet (air handler cabinet), and not from otheraccessible portions of the duct system. A HERS rater must verily the installation (No sampling allowed). List Actual Leakage from smoke test(CFM) Pass if all accessible leaks (except for existing air handler) are sealed using smoke ❑ pass ❑Fail t� Reg: 210-N0000631B-M2000048A-M20A Registration Date/Time: 2013/02/22 15:25:01 HERS Erovider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-2( Duct Leakage Test - Completely New or Replacement Duct System .(Page 2 of 2) Site Address: Enforcement Agency: Permit Number: 52-229 Whispering Way, La Quinta CA 92253 (1) 1 City of La Quinta 12-808 Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct eakage 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 dosed position during duct leakage testing.• ® All supply and return register boots must be sealed to the drywall ® New duct installations cannot utilize building cavities as plenums or platform returns in lieu of ducts.. , Mastic andjdraw bands must be use( din�ycombinatio.n'witLh'y'iClYothlbacked, rubber ubber adheBasivke'�1 ductf�g(SapS e=to�se-al leaks at uct connections (� 1... DECLAkkTION STATE;M(E14,1 ;' iy �,.� �w,l t ` F::. ;, Ice penaityjoper)y ender tfielWws ofd e. State alifornla ation'pro pro dedon!thisformtru�e+and carred: I am the•certifiedHERS rater who performed the,venricatlon):5en+ices;ldentifiedland reportedonfthis,certificate,( responsiblefrater)af"{?� • ir} .. tiaEa`r5x , �K ^i.- .. ..�I .a%+ The installed'feature, material; compohent„or manufactured device requiring'HERS verlflcatlon that'is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the equirements 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. Builder or Installer information,as shown on the Installation Certificate (CF -6R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) JBS Mechanical, Inc. Responsible Person's Name: CSLB License: Kim Sico 183798S HERS Provider Data Registry Information Sample Group # (if applicable): N/A ® tested/verified dwelling ❑ not-testedperified dwelling in la HERS samplia group HERS Rater Information Ca10ERTS Certificate # CC1-1798706088 HERS Rater Company Name: BCI Testing Responsible Rater's Name: Responsible Rater's Signature: William Irvine William Irvine Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 12/7/2012 CC2004075 Reg: 210-N0000631B-M2000048A-M20A Registration Date/Time: 2013/02/22 15:25:01 HER.. Provider: CalCERTS, Inc. 2008 Residential,Compliance Forms August 2009 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-20 Duct Leakage Test - Completely New or Replacement Duct System (Page 1 of 2) Site Address: Enforcement Agency: Permit Number: 52-229 Whispering Way, La Quinta CA 92253 (2) City of La Quinta 12-808 Enter the Duct System Name or Identification/Tag: 2 Enter the Duct System Location or Area Served: living Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the 1welling. ' . This certificate is required for compliance for completely new duct systems installed in new dwelling construction, and also For completely new or replacement duct systems in existing dwellings. For existing dwellings, a completely new or ,eplacement duct system can also include existing parts of the original duct system (e.g., register boot& air handler, coil, plenums, etc.) if those parts are accessible and they can be sealed. hurt 1 pakanp niannnctir Tpct - rmmnlptply naw nr rpnlarpmpnt rlurt cvctpm Enter a value for the Allowed Leakage (CFM) for the duct system leakage verification. The value enterer must be the VLLDCS criteria or one of the three calculated leakage rates described below. Verified Low Leakage Ducts in Conditioned Space (VLLDCS) Compliance Credit. If compliance credit for Allowed verified low leakage ducts in conditioned space is shown in the special features section of the CF -111, the Leakage leakage to outside test method must be used to verify duct leakage (refer to RA3.1.4.3.4), and 25 CFK must (CFM) be entered for Allowed Leakage. Allowed leakage calculation - (select one calculation method from this section). Use 6% (leakage factor = 0.06) for calculations. When utilizing Low Leakage Air Handler (LLAH) credit, the allowed duct leakage ray be specified by the CF -1R to be less than 6%, in which case the user-specified leakage rate must be used in the calculations below. For example, if the user-specified leakage (specified as a percentage of fan airflow) is reported on the CF -1R as 3%, then use aleakage factor of 0.03 in the calculations below. ® Cooling system method: Nominal capacity of condenser in Tons 3.5 x 400 x leakage factor 84 CFM f�f �v5 Mt Heating ❑ system method: 21.7 x ' Y A4butput Capaacityam Th6usan'ds Btu/hr factor of x leakage CSt 3M �$ y' �.. ` j' t `'�' y:. 7t7 s,y r , i rt �i„ut✓+e$� i `L' - h4 r, •; ❑ Measu ed,airflow1 . methods (RA3r3) Enter measured fan,flow m'CFM here x,,leakage:factorw.rt , �, �t r Enter value for Actual leakage (CFM) in the right column, from measurement using applicable duct leakage Actual Leakage pressurization test procedure from Reference Residential Appendix RA3.1(CFM @ 25 Pa). (CFM) List Actual Leakage from duct leakage t2st(CFM) 83 Pass if Actual Leakage is less.than Allowed Leakage ® Pass ❑ Fail For complete replacement of duct systems only, if the 6 percent leakage rate criteria cannot be met, a smoke test should be performed to verify that the excess leakage is coming only from a pre-existing furnace cabinet (air handler cabinet), and not from otheraccessible portions of the duct system. A HERS rater must verify the installation (No sampling allowed). List Actual Leakage from smoketest(CFM) Pass if all accessible leaks (except for existing air handler) are sealed using smoke ❑ pass ❑ Fail Reg: 210-N0000631B-M2000049A-M20A Registration Date/Time: 2013/02/22 15:25:01 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-20 Duct Leakage Test - Completely New or Replacement Duct System (Page 2 of 2) Site Address: Enforcement Agency: Permit Number: 52-229 Whispering Way, La Quinta CA 92253 (2) 1 City of La Quinta 12-808 PPIOutside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct eatesting. 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 --losed position during duct leakage testing. ® All supply and return register boots must be sealed to the drywall ® New duct installations cannot utilize building cavities as plenums or platform returns in lieu of ducts _ 'N r v, s Mastic and;draw bands must be used in combma mr with Cloth,backed;'RrUDDer aonesveeductltape o seal leaks at 1 3 Fu connections !, x - Nv DECLARATION STATEMENT;,.:.� I!y ".3r at, q. ..,,i tr`i`:/ '-sl�i"�, •t � 1't; t a �^sx i t # ., .�'' y '� ;. �-: I cert,fy u der penalty o�ftpe� ry rider th4,eelaws or tthe. S 3e of California t e info�rma�tion pr wd tl on 11 1,this form s tru 4an�d rrre¢t. I a11 m the ee`rtihedaHERSraterwho,pe"vfo*medhevenfiw aG.ionrvices ldente dandirep4orted onithis;certiflcate(v�spo iblefirater) �T • The installed:feature; material; component, ormanufactured device requiring HERS veriFlcation that is identiFled`-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 applicablesections of the Installation Certificate(s) (CF -6R), signed and submitted Ly the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -1F.) 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) 3BS Mechanical, Inc. Responsible Person's Name: CSLB License: Kim Sico 1837985 HERS Provider Data Registry Information Sample Group # (if applicable): N/A tested/verified dwelling❑ not-testecjverified, dwelling in la -HERS sample group HERS Rater Information CalCERTS Certificate # CC1-1798706088 HERS Rater Company Name: BCI Testing Responsible Rater's Name: Responsible Rater's Signature: William Irvine William Irvine Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 12/7/2012 CC2004075 .Reg: 210-N0000631B-M2000049A-M20A Registration Date/Time: 2013/02/22 15:25:01 HErS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-23 Verification of High EER Equipment (Page 1 of 1) Site Address: Enforcement Agency: Permit Number: 52-229 Whispering Way, La Quinta CA 92253 City of La Quinta 12-808 Verification of High EER Equipment Procedures for verification of High EER Equipment are described in Reference Residential Appendix RA3.-!. For dwelling units with multiple systems, the procedures must be applied to each system separately. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additio ial systems in the dwelling as applicable. 1 System Name or Identification/Tag 1 2 CSLB License: Kim Sico 2 System Location or Area Served bedrooms living ❑ not-tested/verified dwelling in 3 Certified EER Rating of the installed equipment HERS Rater Information CalCERTS Certificate # CC1-1798706088 HERS Rater Company Name: BCI Testing Responsible Rater's Name: Responsible Rater's Signature: (Btu/Watt-hr) 11.5 11.5 Date Signed: 12/5/2012. CC2004075 4 Make and Model Number of the installed Outdoor Unit CARRIER CARRIER CA13NA042 CA13NA042 5 Make and Model Number of the installed Inside Coil ALLSTYLE ALLSTYLE ASFM4220A28G ASFM4220A28G 6 Make and Model Number of the installed Furnace or Air BRYANT BRYANT Handler. 3103AV04870 3103AV04870 7 Minimum Equipment EER required for compliance as it 11 reported on the CF -1R ® When a high EER system specification includes a time delay relay, the installation of the time delay relay must be verified for compliance credit. Refer to Reference Residential Appendix RA3.4.3 for the Time Delay Relay Verification Procedure. ® When installation of specific matched equipment is necessary to achieve a high EER, installation of the specific equipment must be verified for compliance credit. Refer to Reference Residential Appendix RA3.4.3 for the Matched Equipment Verification Procedure. If the Certified EER Rating in row 3 is equal to or greater 8 than the required minimum EER in row 7, the unit complies. PASS PASS If the unit complies enter Pass 4�w{r 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 i(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 submittec 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 -611) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) 3BS Mechanical, Inc. Responsible Person's Name: CSLB License: Kim Sico 1837985 HERS Provider Data Registry Information Sample Group # (if applicable): N/A ® tested/verified dwelling la ❑ not-tested/verified dwelling in HERS sample group HERS Rater Information CalCERTS Certificate # CC1-1798706088 HERS Rater Company Name: BCI Testing Responsible Rater's Name: Responsible Rater's Signature: William Irvine William Irvine Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 12/5/2012. CC2004075 f,M�C Reg: 210-N0000631B-M2300050A-M23A Registration Date/Time: 2013/02/22 15:30:00 EERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING C =-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: 52-229 Whispering Way, La Quinta CA 92253 City of La Quinta 12-808 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 :ompliance with the refrigerant charge verification requirement. TMAH and STMS are not required for compliance, when e CID is utilized for compliance. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an acid'•tional 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 1 2 System Location or Area Served bedrooms I living 1 ® Yes ❑ No 5/16 inch (8 mm) access hole upstream of evaporative coil in the -eturn 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. Enter Pass or Fail ✓ ® Pass ✓ ❑ Fail .i STMS - Sensor_on„the. Evaporator Coil.._... System Name'.br Ideriification/Tag '.,L41„i 3 ❑Yes r ❑'Nor 4'' The sensor is facto installed, or field'insf8ii6d accoedin to manufacturer s ' yxe Ecutive specifications, or is^insfalled by methods/specificationsyapproved,� ❑ No specifications, or is installed by methods/specifications approved by the Executive ithe r E' •Director. k•i# Nr' tj t=z ' , ;,� �No, �E The sensor wi're.is4te urinated with"�a standard mipi:,p g swtable Earticonnect onkto a ;' 4 ❑ Y,es dig italtthermometer yTfie sensor mmi'plug is accessible to thekins allmg ,technician and the HERS rater without changing the airflow through the condenser coil 8 'and the HERS rater'without changing the airflow through the condenser coil 5 ❑ 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 saturation temperature of the coil. Yes to 3, 4, and S is a pass. Enter N/A if STMS are not ✓ ®N/A ✓ [3 Pass ✓ ❑Fail applicable. Otherwise enter Pass or Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag 1 1 12 The sensor is factory installed, or field installed according to mar.ufacturer's 6 ❑ Yes ❑ No specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 7 ❑ Yes ❑ No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 8 ❑ Yes ❑ No When attached to a digital thermometer, the sensor provides an indication of the saturation temperature of the coil. Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not ✓ ® N/A ✓ ❑ Pass TV ❑ Fail applicable. Otherwise enter Pass or Fail Reg: 210-N0000631B-M2500056A-M25A Registration Date/Time: 2013/02/22 15:37:53 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 :ERTIFICATE OF FIELD VERIFICATION &DIAGNOSTIC TESTING CF-4R-MECH-2E tefrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5, Site Address: Enforcement Agency: Permit Number: 52-229 Whispering Way, La Quinta CA 92253 1 City of La Quinta 12-808 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 5S°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 1 2 FZ Date ofTherm0c ple;Calibration T ,E� 2/1/2013tk ;� System Location or Area Served bedrooms living Y.,IL v {.C%_. L. Outdoor Unit Serial # 0313X76832 0313X76832 Outdoor Unit Make CARRIER CARRIER Outdoor Unit Model CA13NA042 CA13NA042 Nominal Cooling Capacity Btu/hr 42000 42000 Date of Verification ;: ,a F2/22/2013 2/22/2013 Calibration of Diagnostic Instruments Date of Refrigerant Gauge Calibration 2/1/2013 (must be re -calibrated. monthly) FZ Date ofTherm0c ple;Calibration T ,E� 2/1/2013tk ;� N G]us�t bearec�alibrated monthly) !(�i'A .fit'" .` ho, L ,NN__� �` Y.,IL v MeasuredrTemnerat ures'H151, A System Name or Identification/TagN;`?,`T1 ,+�, 1'. .: :t�*ck'T ii�rf�..:ia-, '�t. L'$t�,14 yp�1�i .,PGF"�..Klc..! .�"•'a ! t_. Y.,IL v {.C%_. L. Supply eva at& leaven d ulb PP Y o ( P. 9)'alr� ryb , , temperature (Tsupply, supply, db Return (evaporator entering) air dry, -bulb temperature (Treturn, db) Return (evaporator entering) air wet -bulb temperature (Treturn, wb) Evaporator saturation temperature 30.3 29.8 (Tevaporator, sat) Condensor saturation temperature 77.6 79.1 (Tcondensor, sat) Suction line temperature (Tsuction) 34.9 44.7 Liquid Line Temperature (Tliquid) 64.3 63.5 Condenser (entering) air dry-bulb 59.3 62 temperature (Tcondenser, db) 0 Reg: 210-N0000631B-M2500056A-M25A Registration Date/Time: 2013/02/22 15:37:53 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms - March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 52-229 Whispering Way, La Quinta CA 92253 1 City of La Quinta 12-808 Minimum Airflow Reauirement Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge Verification. The temperature split method is specified in Reference Residential Appendix RA3.2. System Name or Identification/Tag Calculate: Actual Temperature Split = Treturn, db - Tsupply, db Target Temperature Split from Table RA3.2-3 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - Target Temperature Split = Passes if difference is between -4°F and +4°F or, upon remeasurement, if between -4°F and -100°F Enter Pass or Fail Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified usirr3 one of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual cooling coy_ airflow is measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in tF'e table below. Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) System Name or Identification/TagE 1y"� �iM"i 2� &P, wry . r kI e CalculatednMihimum Airflow Requirement(CFM) kt'R_:A.' 10$0 y" �+�t;t�l'.`'. au .. £;: 1050 �y;Y, u 4 J}• f k!i'4;VN'1:1 'jy "{•' aS i aFFS.V ] d"N �Y T 4Y Measured Ai`rflowtysmg RA3 3,4procedures CFM)�1530� `� it 7 F Y W "IS 1537,��., a , yy,, Passes if measured airflow is greaterahan or-' equal to the calculated minimum airflow PASS PASS 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 Reg: 210-N0000631B-M2500056A-M25A Registration Date/Time: 2013/02/22 15:37:53 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 • • �� a •� • •. ' � r '� • • :R ,... - INSTALLATION CERTIFICATE ' • CF-4R-MECH-25 Refrigerant Charge Verification ---Standard Measurement Procedure (Page 4 of 5) Site Address: - Enforcement Agency: Permit Number:, 52-229 Whispering Way, La Quinta CA 92253 .City of La Quinta 12-808 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 1 - 2 Calculate: Actual Superheat = . y?- Calculate: Actual Subcooling = 13.3 15.6 . Tcondenser, sat - Tliquid suction evaporator; sat 4 � t ' Target Subcooling specified by manufacturer - ' 15 - 15 4 Calculate difference: -1.7 0.6 _. Actual Subcooling - Target Subcooling = specification is not available) System passes if difference is between _ System passesY actual superheat is�Withimthe allowable superheat range �' '�,V i4 F.#3�PASS".-' ` PASSfi ao'. -4°F and +4°F - • . ' I . PASS PASS - s: Enter Pass or Fail + s Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to to used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. 4 1 2 Calculate: Actual Superheat = . y?- 4.6 J . suction evaporator; sat 4 � t ' • ; manufacturer's specifications (or use range r' Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to to used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag 1 2 Calculate: Actual Superheat = . y?- 4.6 14.9 T -T yak. suction evaporator; sat Enter allowable superheat range from ; manufacturer's specifications (or use range 3 to 26 3 to 26 between 3°F and 26°F if manufacturer's specification is not available) System passesY actual superheat is�Withimthe allowable superheat range �' '�,V i4 F.#3�PASS".-' ` PASSfi ao'. •#; Enter PasFail r}� 01 5, frs�a,. s: + L J - rilj• A�� .� � C [j ry�j�v 0 �i� t A y�' t (y;�54•mi;,.+ �"�t,trf+�• rS`' 7 p : 'i+:� •. • + :i� r+�k�i•�ra r •1•. r, _w rtdx%5r > :hr4k ilr(�1' ` 3cyL- c" `r+Elva wig f Y .?v401.$ • "'vt. °' 1 y 7" tY"«'`C`SS y 'F r? a.��: l Try �'+�ti. r • a fL i , .t.. ' ';,�,ry. ,.;.^..0"S''�'��t-•„': :•sem' . •._!. 1 .. '!' l , lic Reg:.210-N0000631B-M2500056A-M25A Registration•Date/Time: 2013/02/22 15:37:53 HE2S Provider: CalCERTS, Inc.: y 2008 Residential'Compliance Forme �March`2010 ' J - rilj• A�� .� � C [j ry�j�v 0 �i� t A y�' t (y;�54•mi;,.+ �"�t,trf+�• rS`' 7 p : 'i+:� •. • + :i� r+�k�i•�ra r •1•. r, _w rtdx%5r > :hr4k ilr(�1' ` 3cyL- c" `r+Elva wig f Y .?v401.$ • "'vt. °' 1 y 7" tY"«'`C`SS y 'F r? a.��: l Try �'+�ti. r • a fL i , .t.. ' ';,�,ry. ,.;.^..0"S''�'��t-•„': :•sem' . •._!. 1 .. '!' l , lic Reg:.210-N0000631B-M2500056A-M25A Registration•Date/Time: 2013/02/22 15:37:53 HE2S Provider: CalCERTS, Inc.: y 2008 Residential'Compliance Forme �March`2010 ' INSTALLATION CERTIFICATE C= -4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: 52-229 Whispering Way, La Quinta CA 92253 1 City of La Quinta 12-808 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 action3 were taken, all applicable verification criteria must be re -measured and/or recalculated. System Name or Identification/Tag 1 2 HERS Provider Data Registry Information Sample Group # (if applicable): N/A System meets all refrigerant charge and airflow ❑ not-testedlIverified dwelling in HERS sample group requirements. PASS PASS Responsible Rater's Name: Responsible Rater's Signature: Enter Pass or Fail William Irvine Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 2/22/2013 CC2004075 DECLARATION STATEMENT, t;;. • 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 •3n 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 -IR) approved by the local enforcement agency. The information reported on applicable sections of the Installation Certificate(s) (CF -611), signed and submitted ty the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -1F) 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) 7BS Mechanical, Inc. Responsible Person's Name_: CSLB License: Kim Sico 1837985 HERS Provider Data Registry Information Sample Group # (if applicable): N/A ® tested/verified dwelling la ❑ not-testedlIverified dwelling in HERS sample group HERS Rater Information CalCERTS Certificate # CC1-1798706088 HERS Rater Company Name: BCI Testing Responsible Rater's Name: Responsible Rater's Signature: William Irvine William Irvine Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 2/22/2013 CC2004075 Reg: 210-N0000631B-M2500056A-M25A Registration Date/Time: 2013/02/22 15:37:53 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF -6R -ENV -01 Envelope — Insulation; Roofing; Fenestration. (Page 1 of 3) Site Address: LOT 47 RANCHO SANTANA, LA QUINTA, Enforcement Agency: Permit Number: . CA f If more than one person has responsibilityfor installation of the items on this certificate, each person shall prepare and sign a certificate applicable to the portion of construction for which they are responsible; alternatively, the person with chief responsibilityfor construction shall prepare and sign this certificate for the entire construction. All applicable Mandatory Measures with check boxes require to be`checked to ensure the mandatory measures have been met. ' Description of Insulation 1. RAISED FLOOR Material: Brand Name: Thickness (inches)-" Thermal Resistance (R -Value): • 17.1 §150(d): Minimum R-13 insulation in raised wood -frame floor or equivalent U -factor. 2. SLAB FLOOR/PERIMETER Material: Brand Name: Thickness (inches):. Thermal Resistance (R -Value): y t. Perimeter Insulation Depth (inches): 0 § 150(1): Water absorption rate for the insulation material alone without facings is no greater than 0.3%; water vapor permeance rate is no greater than 2.0 perm/inch and shall be protected from physical damage and UV light deterioration.. , 13. EXTERIOR WALL a. Insulation Type (e.x. Batt, Loose Fill; Spray Foam) a. Thermal Resistance (R -Value): R-13 - _ b.. Insulation Type (e,x. Batt, Loose Fill, Spray Foam) b'. Thermal Resistance (R -Value): Brand: CERTAINTEED - Spray/Loose fill)-. ' -Spray/Loose fill),Installed Actual Thickness Contractor's min installed weight/ftz lb " (inches): Manufacturer's installed weight per square foot to achieve Thermal Resistance (R -Value) F F. -D §150(c): Minimum R-13'insulation in wood -frame wall or equivalent U -factor. Exterior Foam Sheathing (rigid Insulation) y Material: Brand Name. Thickness (inches) Thermal Resistance (R -Value): 4. FOUNDATION WALL ' Material: Brand Name: Thickness (inches): .Thermal Resistance (R -Value): 5. CEILING Batt or Blanket Type: BATT - Brand Name: CERTAINTEED Loose Fill Type: CELLULOSE Thermal Resistance (R -Value): R-38 ' Spray Foam Type: Brand Name: CERTAINTEED a' Installed Actual Thickness (inches): -12" Contractor's min installed weight/ft" lb Manufacturer's installed weight ner souare foot to achieve Thermal Resistance (R -Value): ' 0 §150(a): Minimum R-19 insulation in wood -frame ceiling or equivalent U -factor. .. 6. ATTIC ROOF INSULATION AND/OR ATTIC RADIANT BARRIER Material' ' ' Brand Name - Material: Brand Name: . Thickness (inches): Thermal Resistance.(R-Value): O §118(a): Insulation installed meets Standards for Insulating Material. M § 150(g): Mandatory Vapor barrier installed in Climate Zones 14 or 16. 2008 Residential Compliance Forms *. August 2009 t INSTALLATION CERTIFICATE CF -6R -ENV -01 Envelope —Insulation; Roofing; Fenestration (Page 2 of 3) Site Address: Enforcement Agency: Permit Number: z Description of R ofina Products CRRC Product ID Manufacturer Manufacturer/Brand Name (GROUP LIKE RODUCT Product Roof 1 Product Init1,013olar INSTALLATION CERTIFICATE CF -6R -ENV -01 Envelope —Insulation; Roofing; Fenestration (Page 2 of 3) Site Address: Enforcement Agency: Permit Number: z Description of R ofina Products CRRC Product ID Manufacturer Manufacturer/Brand Name (GROUP LIKE RODUCT Product Roof Roof Product Init1,013olar Aged Solar Thermal Number' Information Brand/Model Type Area Sloe Weight 2 ect3nce Retlectancet Emittance 2 , 3 I, 4 5 1. The CRRC Product ID Number c be obtained from the Cool Roof Rating Council ' Rated Product Directory 4t ww. coolroofs. org/products/search. 2. The weight in lbs per square feet ofrth roofing product being installed 3. Check box if the Aged Reflectance is a c Iculated value using the equation low, footnote 4. 4. If the aged reflectance is not available in a Cool Roof Rating Council's ated Product Directory then use the initial reflectance value from the directory and use the equation (0.2+0.7(p,,,;, t — 0.2) to obtain a calc aced aged value. 9 LI CHECK APPLICABLE BOX BELOW IF EXE PT FROM THE ROO NG PRODUCT "COOL ROOF" REQUIREMLNT.- n The roof area covered by building integrated hotovoltaic pa is and building integrated solar thermal panels are exempt from the above Cool . Roof criteria. 0 Roof constructions that have thermal mass over roo embrane with a weight of at least 25 Ib/ is exempted from the above Cool Roof criteria. To apply Liquid Field Applied Coatings, the coating mus applied with a minimum dry mil thickness of 20 mils- across the entire roofsurface and meet minimum performance requirements listed in §I IJ(i)3 a Table 118-C. Select the ap Itcable coating I I Aluminum -Pigmented Asphalt Roof Coating I...I ment-Based Roof Coating 1 I_] Other 9 CI CRRC-1 Label Attached to CF -6R (Note if no CRRC-1 label is available, thiscoy5fiance method canno a used and another method is required to meet compliance). i FENESTRATION/GLAZING Item Manufacturer/Brand Name (GROUP LIKE RODUCT //Product U- factor' Product SHGC' # of Panes NFR Certified' Total Quantity of Like Product (Optional) Add. Exterior Area Shading Dev.. ft2 or Overhang Comments/ Location/ Special Features I. 2 , 3 4 5 6 _ 8. • t. Use valuesfrom o fenestration product's NFRC Certified Label. For fenestration products without an NFRC label, use the an -fault values from Section 116, Table 116-A and 1 /6-B of the 2008 Energy Efficiency Standards. NFRC Label Certificates shall not be removed until the building inspector has verified the efficiency. Enter Yes or No. ❑ §116(a)1: Doors and windows between conditioned and unconditioned spaces designed to limit air leakage. LI § 116(a)2 and 3: Actual fenestration products installed are equivalent to or have a lower U -factor and/or a lover SHGC than that specified on the Certificate of Compliance (Form CF -1 R). C3 § l 16(a)4: Fenestration products (except field -fabricated windows) have a label listing the certified U -Factor, certified Solar Heat Gain Coefficient (SHGC), and infiltration that meets the requirements of §10-111(a) 1-1 § 117: Exterior doors and windows weather-stripped; all .joints and penetrations caulked and sealed. 2008 Residential Compliance Forms August 2009 .INSTALLATION CERTIFICATE " CF -6R -ENV -01 Envelope - Insulation; Roofing; Fenestration „ (Page 3 of 3) Site Address: LOT 47 RANCHO SANTANA, LA QUINTA, Enforcement Agency: Permit Number: CA s . r DECLARATION STATEMENT • r w 1 '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 certifcate (the installation) conforms 1 to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency.. t ` • I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by the enforcement agency that identifies the specific -. ' *c requirements for the installation. I certify that the requirements detailed on the CF -1R that apply. to the installation have been met. t 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. e. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) EMPIRE INSULATION, INC. Responsible Person's Name: JOHN MIRANDA, Responsible Person's Signature: CSLB License: 860072Date Signed: 12/10/12 Position With Company (Title): DUCTION ANAGER t 2008 Residential Compliance Forms August 2009 -rw - X14 -f A' :,,i �, • f•�,.,i'