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HomeMy WebLinkAboutPR17-7168....,,III = y 9j CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES =�®� 21810 Copley Drive, Diamond Bar, CA 91765 (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 BUILDING PERMIT APPLICATION www.ci"fdiamondbar.com ,building@diamondbarca.gov JOB SITE ADDRESS 1 h Lam^ " APN LOT TRACT OWNER 1-1-4 ADDR k!- . e CITY t v C o- I 'EL. �lr? �- — b G. li—:� APPLICANT i l— TEL. { 4 ellC- 7 CONTRACTOR e——v" ( ADDRESf CITY ZIP V�EL. ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I hereby affirm under penalfy of perjury that I am exempt from the Contractor's State License Law for the reason{sl indicated below by the checkmark(sl, I have placed next to the app€icahle €terl [Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, after, improve, demolish, or repalr, any structure, prior to its issuance, also requires the applicant for the permit to fife a signed statement that he or she Is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9) Commencing with Section 7000 of Division 3 at the Business and Professions Code] orthaf he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Sectlon 7031.5 by anyapplicantfor a permitsubjects the applicantto a clvll penalty of not more than five hundred dollars ($500). U 1, as owner of the property, or my employees with wages as their sole compensation, will do U all of or O portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, 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-Bullder will have the burden of proving that it was not built or improved tar the purpose of sale.). U i, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 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 forth@ projects with a licensed Contractor pursuanttothe Contractors' State License Law.), U I am exempt from licensure under the Contractor's State License law for the following reason(s): Date: _Sign: By my signature helow I acknowledge that, except for my personal restored rc which I must have resided for at least one year prior to completion of the improvements covered by thls pormit,l cannot legally sell a structure that i have built as an owner -builder if it has not been constructed In Its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code Is available upon request when this application is submitted or at the following Web site http/vmw.leginfo.:a.gov/calavv.htrnl, LICENSED CONTRACTOR'S DECLARATION i hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000} of Division 3 of the Business and Professions Code, and -mmyyLlicense Is In full force and effect, LICENSE CLASS: �� i NO.: / 1 , EXP. DATE: -!T NTRACTOR: WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I and will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by ectlon 3700 of the Labor Code, for the performance of the work for which this permit Is Issued. I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit Is Issued. My Worker's Compensation Insurance Carrier and Policy Number ar CARRIER POLICY NUMBER L2 �_3 gHIS SECTION NEED NOT BE COMPLETED IFTHE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS). I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation Laws of California And agree that if I should become subject to the Worker's Compensation provisions of Section 3700 of the labor Code, I shall forthwith comply with those provisions, DATE: APPLICANT'S WARNING: Failure to secure Worker's Compensation coverage Is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (5100,000), In addition to the cast of the compensation, damages as provided for in section 3708 of the labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a Construction Lending Agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). LENDER'S NAME LENDER'S ADDRESS. I certify that I have ad this application and state that the above information Is correct. I agree to comply with all city and county ordinanc rid slate laws felating to building construction, and hereby authorize representatives of this county to enter upon thmentioned property for Inspec purposes. PERMfTTEE NAME (PRIM - L" SIGNATURE OF P E DAT APPLICATION DATE: ! P//C# 2 R I TPP M Ti (08 ISSUE DATE: �� PERMIT# : P K i - - I (J TYPE CONST. OCC GROUP: Scope of Work U, f C3 r� J e Cts # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport LO Paho/Dock Lu LL PooVSpa ZRe -Roof Commercial O] valuation: Adj. Area: QUANTITY DESCRIPTION FEE V w mm IN a z o x._.,..� c� k V gA A. L't -4-0 Tc�s W CONSTRUCTION: PLAN RFVIFW: ELECTRIC: PLUMBING: MECHANICAL: 19_0_ INSPECTION FEE: ISSUANCE: -2 SMIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES 1.5 COMMENTS: P/C: PAID BY: �t VALIDATION: RECEIPT # 2 5 '.3 PAID BY: 0 _ VALIDATION: LC WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy CITY OF DIAMOND BAR INSPECTION RECORD SETBACK/LETTER FOOTINGS FORMS SLAB UG. PLUMBING UG. ELECTRICAL UFFR GROUND SEWER LATERAL MAIN WATER LINE SEWER CLEANOUT ROOF SHFATI IING FLOOR SHFATI IING SHEAR WALLS EXERIOR SHEAR WALLS INFERIOR .................... FRAMING/VENTING __..... .... . ROUGH MECHANICAL ROUGH ELLCIRICAL W( ) C O ROUGH PLUMBING ............. INSULATION WAI1_ INSULATION CE7I_ING DRYWALL LAI H (PRL) LATII I XTRIOR I ATII INTLRIOR (AAS I LS I SCRATCH COAT ELECTRIC METER RELEASE. GAS METER RELEASE SPECIAL INSPECTION ol FINAL BUILDING FINAL MECHANICAL FINAL ELECTRICAL tz FINAL PLUMBING T.C. of OCCUPANCY CER€a of OCCUPANCY COMMENTS, 1 TRACT AND LEDGER SWITCH GEAR COMMERCIAL HOOD T -BAR INTERCEPTER ............... . ..... .. .. ......... HOT MOPISHOWERPAN -------------- .__ SEPTIGICESSPOOL HERS REPORT RECEIVED DEMOLITION ROOF DRAINS ROUGH CONDUIT PODUSPA ROUGH PLUMBING ROUGH ELECTRICAL ROUGH MECHANICAL _... _ GAS TEST PRE GUNITE POOL PRE DECK BONDING P -TRAP - .......... ...._,_ FENCE 1 GATE/ ALARM FINAL POOL WALL& WALL FOOTINGISTEEL WALL STEEL 1ST( ) 2ND( LIFT" WALL FIOND B[AM WALL DRAIN/ SEAL WAI.I. FINAL RO, FRAMING PLANNING APPROVAL ROUGH FIRE APPROVAL FINIAL FIRE DEPARTMENT FINAL PLANNING FINAL ENGINEERING/ PIN FINAL. 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LA to 4 Q I � ~ wCL to Lit er M V7 G7 Q CERTIFICATE OF VERIFICATION CF3R-MCH-23-H Space Conditioning System Airflow Rate (Page 1 of 4) Project Name: LAURA CURTIS i Enforcement Agency: Diamond Bar (City of) Permit Number: PR17-7168 Dwelling Address: 1414 INDIAN WELL DRIVE City: Diamond Bar Zip Code: 91765 A. Ducted Cooling System Information 01 System Identification or Name SYSTEM #1 02 System Location or Area Served WHOLE HOUSE 03 System Installation Type Alteration 04 Nominal Cooling Capacity (tons) of Condenser 3 05 Condenser Speed Type This field or section is not applicable 06 Cooling System Zonal Control Type This field or section is not applicable 07 Central Fan Integrated (CFI) Ventilation System Status Not a CFI system 08 System Bypass Duct Status No Bypass Duct 09 Date of System Airflow Rate Measurement 2017 -OS -11 10 Airflow Rate Protocol Utilized RA3.3.3.1.5 Alternative to Compliance with Minimum System Airflow Requirements B. Hole for the placement of a Static Pressure Prabe''(HSPP)`and Permanently Installed Static Pressure Probe (PSPP) in the Supply Plenum. Procedures for installing HSPP or PSPP are specified in IiA3.3.1.1. 01 Method Used to Demonstrate Compliance with the HSPP installed and labeled consistent with Figure RA3.3-1 HSPP/PSPP Requirement C. Airflow Rate Measurement Apparatus and Procedure Information Instrument Specifications are given in RA3.3.1.1, and system airflow rate measurement apparatus information is given in RA3.3.2. Airflow Rate Measurement Type used for this airflow rate Traditional Flow Capture Hood according to procedure in 01 verification. RA3.3.3.1.4 02 Manufacturer of Airflow Measurement Apparatus ALNOR 03 Model number of Airflow Measurement Apparatus EBT731 Certification Status of the Airflow Measurement Apparatus Certified by Manufacturer and listed on CEC Website at 04 Accuracy http://www.energy.ca.gov/title24/equipment_cert/ama_fas /index.html Registration Number: Registration Date/Time: 2017-08-15 08:55:41 HERS Provider: CHEERS 417-A020101398A-003-000- M 2 300OA-M 23 A CA 3uilding Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-08-15 08:55:41 2016 Residentia€ Compliance Schema Version: rev 10/16 CERTIFICATE OF VERIFICATION CF3R-MCH-23-H Space Conditioning System Airflow Rate (Page 2 of 4) MCH23c Forced Air System Airflow Rate Measurement - Alternative to Compliance with Minimum System Airflow Requirements for Altered Systems D. Alternative to Compliance with Minimum System Airflow Requirements for Altered Systems The HERS Rater shall review the information submitted on the installation certificate and perform follow-up communications with the HVAC installer or the homeowner. The system complies if the HERS Rater determines the remedial actions have been performed, and the information reported on the installation certificate is valid as specified in RA3.3.3.1.5 02 Determine that the air filter media is clean. If the air Completed 01 filter media is dirty, then replace it with clean filter 520 media The measured Airflow Rate reported on this document is 02 Open ail registers and dampers and remove any Completed obstructions. procedures given in RA3.3.3.1.5. This system shall not be Replace/Repair all accessible crushed, blocked, Completed 03 restricted, remove excess length, and sharp bends in ducts. Supported every 4 ft max. with a max. 2 in. sag 04 Clean the evaporator coil according to the manufacturer ; Completed and ensure the coil is not obstructed. 05 Air handler fan speed set to high and blower wheel and Completed motor are operating properly. 06 If determined to be too small, replace the return duct Completed with a larger one and/or add a secon&return duct 07 If determined to be too small, replace the return grille Completed with a larger area grille. 08 Verification Status: System complies 09 Correction Notes: 10 Optional Notes: E. Forced Air System Airflow Rate Measurement - Best Airflow Rate Attainable 01 Required Minimum System Airflow Rate (cfm/ton) 300 02 Required Minimum System Airflow Target (cfm) 900 03 Actual System Airflow Rate Measurement (cfm) 520 The measured Airflow Rate reported on this document is 04 Compliance Statement: the best airflow rate attainable for compliance utilizing the procedures given in RA3.3.3.1.5. This system shall not be included in a sample group for HERS verification compliance Registration Number: 417 -AO 2 0101398A-003-000- M 23000A- M 2 3 A CA Building Energy Efficiency Standards 2016 Residential Compliance Registration Date/Time: 2017-08--15 08:55:41 HERS Provider: CHEERS Report Version: 2016.1.006 Report Generated: 2017-08-15 08:55:41 Schema Version: rev 10/16 CERTIFICATE OF VERIFICATION CF3R-MCH-23-H Space Conditioning System Airflow Rate (Page 3 of 4) E. Forced Air System Airflow Rate Measurement - Best Airflow Rate Attainable 05 HERS Sample Group Eligibility Not Eligible for HERS Sample Group for Airflow F. Additional Requirements Air filters that meet the applicable requirements of Standards Section 150.0(m)12 or 150.0(m)13 were properly installed in 01 the system during system air flow rate measurement identified on this Certificate of Verification. The airflow rate measurement apparatus used to perform the airflow rate measurement identified on this Certificate of 02 Verification was calibrated in accordance with the apparatus manufacturer's specifications and conforms to the instrumentation specifications given in RA3.3.1. A visual inspection shall confirm that bypass ducts that deliver conditioned supply air directly to the space conditioning 03 system return duct airflow are not used on newly constructed zonally controlled systems unless the Performance Certificate of Compliance indicates an allowance for use of a bypass duct. When a bypass duct is accounted for on the Performance Certificate of Compliance, the airflow rate shall conform to the specifications listed on the Certificate of Compliance. 04 All registers were fully open during the diagnoAc.test 05 System fan was set at maximum speed during the. dtavdstictest'. 06 If fresh air duct is part of the HVAC system it was 'not closed during the diagnostic test. 07 Airflow rate and fan watt draw shall be simultaneous measurements when used to calculate the Fan Efficacy tested value. Multi -speed compressor space cooling systems or variable speed compressor systems shall verify air flow (cfm/tan) and fan 08 efficacy (Watt/cfm) with system operating in cooling, node a):the maximum"compressor speed and the maximum air handler fan speed. For altered systems that do not comply -with th:e:mihiri um 300cfm peraon airflow rate requirement but opt to comply using the remedial actions on this MCH -23 compliance document according to Section RA3.3.3.1.5 the system's thermostat 09 shall conform to the specifications in Reference Joint Appendix JA5 and shall be capable of receiving and responding to Demand Response Signals prior to final approval of the building permit by the enforcing agency (Section 150.2(b)1Fia). 10 Verification Status: Pass - all applicable requirements are met 11 Correction Notes: The responsible person's signature on this compliance document affirms that all applicable requirements in this table have been met unless otherwise noted in the Verification Status and the Corrections Notes in this table. G. Determination of HERS Verification Compliance All applicable sections of this document shall indicate compliance with the specified verification protocol requirements in order for this Certificate of Verification as a whole to be determined to be in compliance. 1 01 1 Complies: All specified verification protocol requirements on this document are met. Registration Number: Registration Date/Time: 2017-08-15 08:55:41 HERS Provider: CHEERS 417-A0201013 98A-003-000- M 2 3000A- M 23A CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-08-15 08:55:41 2016 Residential Compliance Schema Version: rev 10/16 CERTIFICATE OF VERIFICATION CF3R-MCH-23-H Space Conditioning System Airflow Rate (Page 4 of 4) Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Verification documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Garrett Williams (�"```vttWaILC"M Company: Date Signed: I Permit E Raters 2017-08-15 Address: CEA/ HERS Certification Identification (if applicable): 31225 La Baya Drive RCN13056 City/State/zip: Phone: Westlake Village CA 91362 818-735-7876 Responsible Person's Declaration statement I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Verification is true and correct. 2. 1 amthe certified HERS Rater who performed the verification identified and reported on this Certificate of Verification (responsible rater). 3. The installed features, materials, components, manufactured devices,. onsystem performance diagnostic results that require HERS verification identified on this Certificate of Verification comply with the applicalls requirements in Reference Appendices RA2, RA3, and the requirements specified on the Certificate of Compliance for the building approved' by theenforcement agency. 4. The information reported on applicabie sections of the Centificate(sj of Installation (CF2R) signed and submitted by the person(s) responsible for the construction or installation conforms to the requirements specified on th6tertificate(s) of Compliance (CF1R1 approved by the enforcement agency. 5. 1 will ensure that a registered copy of this Certificate of VerEficatiort.s — jl.b5 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 registered copy of this Certificate of Verification is required to be included with the documentation the;builder provides to the building owner at occupancy. Builder Or Installer Information As Shown On The Certificate Of Installation Company Name (Installing Subcontractor, General Cphfractor, or Builder/Owner);. ` Service Champions Responsible Builder or Installer Name: CSL13 License: Austin Smith 799170 .• . HERS Provider Data Registry Information Sample Group Number (if applicable): Dwelling Test Status in Sample Group Of applicable) N/A HERS Rater Information HERS Rater Company Name: I Permit E Raters Responsible Rater Name: Responsible Rater Signature: Garrett Williams GaIr-retrwalL "'k Responsible Rater Certification Number w/this HERS Provider: Date Signed: RCN 13056 2017-08-15 Registration Number: Registration Date/Time: 2017-08-15 08:55:41 HERS Provider: CHEERS 417-AO2010139SA-003-000-M 23000A -M 23A CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-08-15 08:55:41 2016 Residential Compliance Schema Version: rev 10/16 CERTIFICATE OF VERIFICATION CF3R-INCH-25-H Refrigerant Charge Verification (Page 1 of 4) Project Name: LAURA CURTIS Enforcement Agency: Diamond Bar (City of) Permit Number: PR17-7168 Dwelling Address: 1414 INDIAN WELL DRIVE City: Diamond Bar Zip Code: 91765 A. System Information HERS Rater to field -verify all system information, discrepancies to be noted by overwriting entry. 01 System Identification or Name SYSTEM #1 02 System Location or Area Served WHOLE HOUSE 03 Condenser (or package unit) make or brand LENNOX 04 Condenser (or package unit) model number XC16-036-230-05 05 Nominal Cooling Capacity (tons) of Condenser 3 06 Condenser (or package unit) serial number 5317F15812 07 Refrigerant Type . R=410A 08 Other Refrigerant Type (if applicable) This field or section is not applicable Liquid Line Fiter Drier Installed According to Manufactu'rers'..: Yes 09 Specifications (if applicable) 10 System Installation Type Alteration Fault Indicator Display (FID) Status (Nbte: Even'systerns with " This system does not have a FID device installed 11 a FID must have refrigerant charge verified by instailer), . Is the system of a type that the minimum airflow can be Yes, this is a ducted system and one of the system airflow 12 verified using an approved measurement procedure (RA3.3 rate measurement procedures in RA3.3 or RA333 can be or RA3.3.3)? used to verify system airflow rate requirements. Is the system of a type that approved refrigerant charge Yes, one of the Refrigerant charge verification procedures verification procedures can be used to verify compilance from RA3.2.2 or RA1 is applicable to this system and can be 13 with the refrigerant charge verification requirements when used to verify compliance temperatures are >= 55°F (RA3.2.2, or RA1)? 14 Date of Refrigerant Charge Verification for this system 2017-08-11 Refrigerant charge verification method used. Subcooiing (outdoor temperature must be equal to or 15 greater than 55 degF) 16 person who performed the Refrigerant Charge Verification HERS rater reported on this Certificate of Installation 17 HERS Verification Compliance Requirement Status System does not qualify for group sampling 18 Refrigerant charge verification method used by HERS Rater. Subcooling Registration Number: 417-A020101398A-003-000-M 25000A-M25A CA Building Energy Efficiency Standards 2016 Residential Compliance Registration Date/-Fime: 2017-08-15 08:55:59 HERS Provider: CHEERS Report Version: 2016.1.006 Report Generated: 2017-08-15 08:55:59 Schema Version: rev 10/16 CERTIFICATE OF VERIFICATION CF3R-MCH-25-H Refrigerant Charge Verification (Page 2 of 4) MCH -25b - Refrigerant Charge Verification - Subcooling Method S. Metering Device Verification HERS Rater is required to visually field verify all information from CF2R. Subcooling Method can only be used on systems that have a variable metering device. j 01 1 Refrigerant metering device I Thermostatic Expansion Valve (TXV) 02 1 Subcooling Method applicability status 4 Subcooling Method is applicable to this system. C. Instrument Calibration HERS Raters are required to calibrate their diagnostic tools. Procedures for instrument calibration are given in Reference Residential Appendix RA3.2.2 and RA3.2.2.2 01 Date of Digital Refrigerant Gauge Calibration 2017-08-01 02 Date of Digital Thermocouple Calibration 2017-08-01 03 Digital Refrigerant Gauge Calibration Status ;calibration is current 04 Digital Thermocouple Calibration Status Calibration is current D. Measurement Access Hole (MAH) Verification HERS Raters are required to visually field, verify MAH.. Procedures for.installing MAH are specified in Reference Residential Appendix RA3.2.2.3 - 01 Method Used to Demonstrate Compliance with the MAH installed and labeled consistent with Figure 3.2-1 Measurement Access Hole (MAH) Requirement E. Minimum System Airflow Rate Verification Procedures for verifying minimum system airflow are specified in Reference Residential Appendix RA3.3.3. 01 Minimum Required System Airflow Rate (cfm) 900 System complies using the alternative remedial actions 02 System Airflow Rate Verification Status specified in RA3.3.3.1.5. This System does not qualify for group sampling F. Data Collection and Calculations HERS Rater must independently collect all data in this section. Procedures for determining Refrigerant Charge using the Standard Charge Verification Procedure are given in Reference Residential Appendix RA3.2.2 and RA3.2.2.2 01 Lowest Return Air Dry Bulb Temperature that Occurred 74 During the Refrigerant Charge Verification Procedure ('F) Registration Number: Registration Date/Time: 2017-08-15 08:55:59 HERS Provider: CHEERS 417-A020101398A-003-000-M25000A-M 25A CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-09-15 08:55:59 2016 Residential Compliance Schema Version: rev 10/16 CERTIFICATE OF VERIFICATION CF3R-MCH-25-H Refrigerant Charge Verification (Page 3 of 4) F. Data Collection and Calculations HERS Rater must independently collect all data in this section. Procedures for determining Refrigerant Charge using the Standard Charge Verification Procedure are given in Reference Residential Appendix RA3.2.2 and RA3.2.2.2 01 Measured Condenser Air Entering Dry -Bulb Temperature 77 02 (Tcdnderser,db) 122 03 Evaporator Saturation Temperature (Tevaporator, sat) from Outdoor temperature is within range for using Subcooling 03 Outdoor Temperature Qualification Status refrigerant charge verification method 04 Measured Liquid Line Temperature (T4quid) (°F) 82 05 Measured Liquid Line Pressure (Plgwd) (prig) 268 05 Condenser Saturation Temperature (Tcondenser, Sat) from 88 06 Digital Gauge or P-TTable using Line F05 (°F) Yes, documentation to be provided upon request 07 Measured Subcooling (Line F06 - Lilne F04 (°F) 6 08 Target Subcoohng from Manufacturer (°F) 5> System complies with Subcooling Method -Must aiso pass 09 Compliance Statement: metering device verification, next section G. Metering Device Verification HERS Rater must independently collect all data in this section. Procedures for the verification of proper metering device operation are specified in RA3 2.2.6:2..: 01 Measured Suction Line Temperature (Tsucton) (°F) 66' 02 Measured Suction Line Pressure (Psucti 0 (psig) 122 03 Evaporator Saturation Temperature (Tevaporator, sat) from 41 Digital Gauge or P -T Table using Line G02 (°F) 04 Measured Superheat (Line G01- Line G03) (°F) 25 Measured Superheat (Line 604) is between 3°F and 26°F Passes CEC requirement 05 (inciusive) Measured Superheat (Line G04) is within Manufacturer's Yes, documentation to be provided upon request 06 Specifications ( if known) 07 Compliance Statement: Metering device verification passes H. Determination of HERS Verification Compliance All applicable sections of this document shall indicate compliance with the specified verification protocol requirements in order for this Certificate of Verification as a whole to be determined to be in compliance. 1 01 1 Complies: All specified verification protocol requirements an this document are met. j Registration Number: Registration Date/Time: 2017-08-15 08:55:59 HERS Provider: CHEERS 417-A020101398A-003-000-M25000A-M25A CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-08-15 08:55:59 2016 Residential Compliance Schema Version: rev 10/16 CERTIFICATE OF VERIFICATION CF3R-MCH-25-H Refrigerant Charge Verification (Page 4 of 4) Documentation Author's Declaration Statement 1. I certify that this Certificate of Verification documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Garrett Williams CjarrettWaUa,"w Company: Date Signed: I Permit E Raters 2017-08-15 Address: CEA/ HERS Certification Identification (if applicable): 31225 La Bay@ Drive RCN13056 City/State/Zip: Phone: Westlake Village CA 91362 818-735-7876 Responsible Person's Declaration statement I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided or this Certificate of Verification is true and correct. 2. 1 am the certified HERS Rater who performed the verification identified and reported on this Certificate of Verification (responsible rater). 3. The installed features, materials, components, manufactured devices;: ar system performance diagnostic results that require HERS verification identified on this Certificate of Verification comply with ,tiie3pplipMe requirements in Reference Appendices RA2, RA3, and the requirements specified on the Certificate of Compliance for the building,approved'by theenforcemert agency. 4. The information reported on applicable sections of the Certificate(s)of, Ihstailation (MR) signed and submitted by the person{s) responsible forthe construction or installation conforms to the requirements.sgecified on.tf e Certificate(s) of Compliance (CF1R) approved by the enforcement agency. S. I will ensure that a registered copy of this Certificate of Verificat:'ort shall'b'e:posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applitable,inspections. I understand that a registered copy of this Certificate of Verification is required to be included with the documentation the:f wilder provides to the building owner at occupancy. Builder Or Installer Information As Shown On The Certificate Of Installation Company Name (Installing Subcontractor, General Contractor, or_l�uilder/Owner) Service Champions Responsibie Builder or Installer Name: CSLB License: Austin Smith 799170 HERS Provider Data Registry Information Sample Group Number (if applicable): Dwelling Test Status in Sample Group (if applicable) N/A HERS Rater Information HERS Rater Company Name: I Permit E Raters Responsible Rater Name: Responsible Rater Signature: Garrett Williams Ga T-eW W01iavrzx Responsible Rater Certification Number w/ this HERS Provider: Date Signed: RCN13056 2017-08-15 Registration Number: Registration Date/Time: 2017-08-15 08:55:59 HERS Provider: CHEERS 417-A020101398A-003-000-M25000A-M25A CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-08-15 0$:55:59 2016 Residential Compliance Schema Version: rev 10/16 Vi;;o Q rD T -0 rD O d rr ro ro v 0 Q r N 3 N � o Ln Co si w m Lnm n �% z m �n •C O y T 7 rt fD m 1 n n n 3 D a o 7 m o CL 3 O� = as r � q b�0 ray, fD S y V1 3 cm O Or _rt n O C m rD O In "p l< O CLp O m o N•d Vfo O m c a 3 in Un rn m rD m rD �, rr n 3 scot �< o a _ W lAl 3 H C r�•F n a (D Q - 3 rD y Q q -C y � rt c rD p m A "' m rL Gn d •ti m n m Q O 3 m d O M FD O 0] 00 O o a p m — Ln w 3 3 S va rt su v rD A CT) O y � O w FD O D n thID G1 m O O_ rr rt ID O M I"f rD w rt rt � S m Di rD C 3 W D rt O 7 OV OZ aq rr 3 D D n ti. 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