HomeMy WebLinkAbout15-0206CITY OF DIAMOND BAR '
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21810 Copley Drive, Diamond Bar, CA 91755 PRESS
(909) M7020 Fax: (909)851.3117 Building Inspection Hotline(909)839.7027 FIRMLY
'tee BUILDING PERMIT APPLICATION
JOB SITE ADDRESS �2l_iW C 1yi t n e f -op .- _r— 7
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DWNER-OOaDEi DECLARATION
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PEMIEENAE(PRIzNT)
_-
M ai REOFPERMMr E --� DATE
APPLICATION DATE PICA
ISSUE DATE "�-/V� JCS' PERMIT# LL— V
TYPE CONST OCG GROUP
ZONING SETBACKS
FRONT RW ❑
REAR ❑
SIDE/SIDE STREET RW ❑
SIDE ❑
PROPOSED USE
A DWEL UNITS A STORIES D BEDROOMS
DESCRIPTION SO FT FACTOR PSF ACJ ARENVAIUATION
SFWADDREM
GWBOWC PW
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PaNPNe4k --...
W
PooVGpa I
2
ma.Ram
no
CommP w '
no
I
Valisatlal Al Ares
QUANTITY DESCRIPTION FEE j
Aa
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
..
MECHANICAL . Y7
INSPECTION FEE
ISSUANCES xP7
SMTP
ENERGY PIC
ENERGY PERMIT
RETENTION FEE
PRE -ALT FEE
BSAF
TOTAL FEES
I
COMMENTS
RECEIPT k 01 PAID BY 31il VALIDATION
WHnE— C%pa,4nmt Copy, YELLOW —Rnence Conry PINK—Avaesaor Omsy GOLDENROD —Fife Copt GREEN—Applicants Copy
CITY OF DIAMOND BAR
INSPECTION RECORD
SETBACK/ LETTER
TRACT AND LEDGER
FOOTINGS FORMS
SWITCH GEAR
SLAB
COMMERCIAL HOOD
UG PLUMBING
T -BAR
UG ELECTRICAL
INTERCEPTER
UFER GROUND
HOT MOP/SHOWERPAN
SEWER LATERAL
SEPTIC/CESSPOOL
MAIN WATER LINE
HERS REPORT RECEIVED
SEWER CLEANOUT
DEMOLITION
ROOF SHEATHING
ROOF DRAINS
FLOOR SHEATHING
ROUGH CONDUIT
SHEAR WALLS EXTERIOR
POOL/SPA
SHEAR WALLS INTERIOR
ROUGH PLUMBING
FRAMINGNENTING
ROUGH ELECTRICAL
ROUGH MECHANICAL
ROUGH MECHANICAL
ROUGH ELECTRICAL W( ) C O
GAS TEST
ROUGH PLUMBING
PRE GUNITE
INSULATION WALL
POOL PRE DECK BONDING
INSULATION CEILING
P -TRAP
DRYWALL
FENCE / GATE/ ALARM
LATH (PRE)
FINAL POOL
LATH EXTERIOR
WALLS
LATH INTERIOR
WALL FOOTING/STEEL
GAS TEST
WALL STEEL 1sT( )2 NO( I UFT
SCRATCH COAT
WALL BOND BEAM
ELECTRIC METER RELEASE
WALL DRAIN/ SEAL
GAS METER RELEASE
WALL FINAL
SPECIAL INSPECTION
RO FRAMPIGPLANNINGAPPROVAL
FINAL BUILDING i
ROUGH FIRE APPROVAL
FINAL MECHANICAL
FINAL FIRE DEPARTMENT
FINAL ELECTRICAL
FINAL PLANNING
FINAL PLUMBING
FINAL ENGINEERING/ PW
T C of OCCUPANCY
FINAL COMMUNITY SERVICES
CEITE of OCCUPANCY
FINAL HEALTH DEPT.
FINAL INDUSTRIAL WASTE
COMMENTS
CERTIFICATE OF VERIFICATION
CF3R-MCN-20-H
Duct Leakage Diagnostic Test
(Page 1 of 3 )
Project Name 23611 Golden Springs Dr th-7
Enforcement Agency City of
Diamond Bar
Permit Number
15.0276
Dwelling Address: 23611 Golden Springs Dr
M-7
City Diamond Bar
Zip Code-
91765
A System Information
01
Space Conditioning System Identification or Name
WHOLE HOUSE
02
Space Conditioning System Location or Area Served
WHOLE HOUSE
03
Budding Type from CF -1R
Single family
04
Verified Low Leakage Ducts in Conditioned Space
(VLLDCS) Credit from CF1R?
No, credit is not taken
OS
Venfied Low Leakage Air Handling Unit Credit from
CF1R2
No, credit is not taken
06
Duct System Compliance Category
Alteration
MCH -24d - Complete Replacement or Altered Duct System
S. Duct Leakage Diagnostic Test
01
Condenser Nominal Cooling Capacity (ton)
2
02
Heating Capacity {kBtu/h)
24
03
Conditioned Floor Area served by this HVAC system (ft2)
400
04
Duct Leakage Test Condition
Test final
05
Duct Leakage Test Method
Total leakage
06
Leakage Factor
015
07
Air Handling Unit Airflow, (AHUAirflow) Determination
Method
Cooling system method
08
Measured AHUAirflow
This field or section is not applicable
09
Calculated Target Allowable Duct Leakage Rate (cfm)
120
SO
Actual duct leakage rate from leakage test measurement
(cfm)
33
11
Compliance Statement System passes leakage test
Registration Number 215 A0031949A-M2000002A-M20A Registration Date/Time 2015.02-05 09 04 28 HERS Provider CaiCERTS
CA Building Energy Efficiency Standards Report Version 2014 05-08 Report Generated 2015-02-05 09 02 51
2013 Residential Compliance Schema Version 0 SiSDD
CERTIFICATE OF VERIFICATION Cf3R-MCH-20-H
Dud Leakage Diagnostic Test (Page 2 of 3 l
System was tested in its normal operation condition No temporary taping allowed
B. Duct Leakage Diagnostic Test
12
Notes
C. Additional Requirements for Compliance
01
System was tested in its normal operation condition No temporary taping allowed
02
Outside air (OA) ducts for Central fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage
testing CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet
ASHRAE Standard 62 2, and close when OA ventilation is not required, may be configured to the closed position during duct
leakage testing
03
All supply and return register boots were sealed to the drywall
04
Budding cavities were not used as plenums or platform returns in lieu of ducts
05
If cloth backed tape was used it was covered with Mastic and draw bands
06
All connection points between the air handler and the supply and return plenums are completely sealed
07
If the system complies using the Smoke Test method, the smoke test was conducted in accordance with the requirements
of Reference Residential Appendix RA3 14 3 6 Systems that comply using smoke test shall not be included in sample
groups for HERS verification compliance
OR
Verification Status
Pass - all applicable requirements are met
09
Correction Notes for this table
The responsible persons 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
D. 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.
01 ( Complies All specified verification protocol requirements on this document are met
Registration Number 215 A0031949A-M2000002A-M20A Registration DatelLme 2015 02-05 09 04 26 HERS Provider CaICERTS
CA Building Energy Efficiency Standards Report Version 2014 05-08 Report Generated 2015 02-05 09 02 51
2013 Residential Compliance Schema Version 0 SiSDD
CERTIFICATE OF VERIFICATION CF3R•MCH-20-H
Duct Leakage Diagnostic Test (Page 3 of 3 )
Documentation Author's Declaration Statement
1. I certify that this Certificate of Verification documentation Is accurate and complete.
Documentation Author Name
Documentation Author Signature
John Kwan
Company
Date Signed
1 K Air Balancing & Duct Testing
2015-02-05 09 04 28
Address
CW HERS Certification identification (if applicable)
9040 Teistar Ave #137
3012
cayj$ate(Zip
phone
EI Monte CA 91731
626-274-0522
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 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, or system performance diagnostic results that require HERS verification
identified on this Certificate of Verification comply with the applicable requirements in Reference Appendices RA2, RA3, and the requirements
specified on the Certificate of Compliance for the budding approved by the enforcement agency
4 The information reported on applicable sections of the Certificates) of Installation (CF2R) signed and submitted by the persons) responsible for the
construction or mstallahon conforms to the requirements specified on the Certdicate(s) of Compliance (CyIA) approved by the enforcement agency
5 1 will ensure that a registered copy of this Certificate of Verification shall be posted, or made available with the building permitis) issued for the
building, and made available to the enforcement agency for all applicable Inspectors 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 Contractor, or Builder/Owner)
ZABATTA HEATING AND AIR CONDITIONING
!. Responsible Bmideiwr Installer Name
CSLR License
John Zabatta
561159
HERS Provider Data Registry, information
Sample Group Number (if applicable)
welling Test Status in Sample Group (d applicable)
Tested
[Te
HERS Rater Information
HERS Rater Company Name
J K Air Balancing & Duct Testing
Responsible Rater Name
Kwan
Responsible Rater Signature
John
Responsible Rater Certification Number wJ this HERS Provider
Date Signed
CC20OS646
2015-02-05 09 04 28
DrgRaflysgncd by CalCERTS This drg+fol srgnafure is provided +n order to secure the content of fh+s regrsicveddocument and in noway implies Registration Provider
responsib+Hty lot the accuracy of the information
Registration Number 215-AO031949A-M2000002A-M20A Registration Date/Time 2015-02.05090428 HERS provider CaICERTS
CA Building Energy Efficiency Standards Report Version 201405-08 Report Generated 2015-02 05 09 02 51
2013 Residential Compliance Schema Version 0 SISDD
CERTIFICATE OF VERIFICATION
CF3R-MCH-23-H
Space Conditioning System Airflow Rate
(Page 1 of 4 )
Project Name 23611 Golden Springs Dr JN -7
Enforcement Agency. City of
Diamond Bar
Permit Number*
15-0276
Dwelling Address. 23611 Golden Springs Dr
ala
City, Diamond Bar
Zip Code.
91765
A. Ducted Cooling System Information
01
System Identification or Name
WHOLE HOUSE
02
System Location or Area Served
WHOLE HOUSE
03
System Installation Type
Alteration
04
Nominal Cooling Capacity (tons) of Condenser
2
05
Condenser Speed Type
Single Speed
06
Cooling System Zonal Control Type
Not Zonal
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
2015-02-05
10
Airflow Rate Protocol utilized
RA3 3 procedures for airflow rate measurement
S. Hale for the placement of a Static Pressure Probe (HSPP), and Permanently installed Static Pressure Probe (PSPP)
in the supply plenum.
Procedures for installing HSPP or PSPP are specified in RA3 3 11
01 I Method used to demonstrate compliance with the I 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 11, and system airflow rate measurement apparatus information is given
inRA3 32
01
Airflow Rate Measurement Type used for this airflow rate
Fan Flowmeter according to procedure in RA3 3 3 11
verification
02
Manufacturer of Airflow Measurement Apparatus
TSI
03
Model number of Airflow Measurement Apparatus
ACCU BALANCE 802083
04
Certification Status of the Airflow Measurement Apparatus
Certified by Manufacturer and listed on CEC Website at
Accuracy
http //www energy ca gov/(tbd)
Registration Number 215-A0031949A-M2300002A-M23A Registration Date/Time 201502.05 0904 28 HERS Provider CaICERTS
CA Building Energy Efficiency Standards Report Version 2014-05-08 Report Generated 2015-02-05 09 03 20
2013 Residential Compliance Schema Version 0 S1SDD
'.. CERTIFICATE OF VERIFICATION CF3R-MCH-23-H '..
Space Conditioning System Airflow Rate (Page 2 of 4 )
MCH -23a Forced Air System Airflow Rate Measurement - Newly Installed Non -Zoned Systems or Zoned Multi -Speed
Compressor
D. Forced Air System Airflow Rate Measurement
The procedures for System Airflow Rate Verification are specified in Reference Residential Appendix RA3 3
01
Required Minimum System Airflow Rate (cfm/ton)
300
02
Required Minimum System Airflow Target (cfm)
600
03
Actual System Airflow Rate Measurement (cfm)
638
04
Compliance Statement
System airflow rate complies
E. Additional Requirements
01
Air filters that meet the applicable requirements of Standards Section 150 0(m)12 or 150 0(m)13 were properly installed in
the system during system air flow rate measurement identified on this Certificate of Installation
The airflow, rate measurement apparatus used to perform the airflow rate measurement Identified on this Certificate of
02
Installation 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
system return duct airflow are not used on new or replacement zonally controlled systems unless the Performance
03
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 diagnostic test
O5
System fan was set at maximum speed during the diagnostic test
O6
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 (dm/ton) and fan
08
efficacy (Watt/cfm) with system operating in cooling mode at the maximum compressor speed and the maximum air
handler fan speed
09
Verification Status
Pass - all applicable requirements are met
10
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.
Registration Number 215-A0031949A-M2300002A-M23A Registration Date/rime 2015.02-}5090428 HERS Provider CaICERTS
CA Building Energy Efficiency Standards Report Version 2014-05-08 Report Generated 2015-02-05 0903 20
2013 Residential Compliance Schema Version 0 S1SDo
CERTIFICATE OF VERIFICATION CF3R-MCN-23-H
;pace Conditioning System Airflow Rate (Page 3 of 4 )
F. Determination of HERB 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 whale to be determined to be in compliance
01 ' Complies All specified verification protocol requirements on this document are met
Registration Number 215-AO031949A-M2300002A-M23A Registration Date/Time 2015-02-05 09 04 28 HERS Provider CalCERTS
CA Budding Energy Efficiency Standards Report version 2014-05.08 Report Generated 2015 -02 -OS 09 03 20
2013 Residential Compliance schema Version 0 SSSDO
CERTIFICATE OF VERIFICATION CF3R-MCH•23-H
Space Conditioning System Afrfiow 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
Kwan
Documentation Author Signature
John
Company
Date Signed
J K Air Balancing & Duct Testing
2015-02-05 09 04 28
Address
CEA/ HERS Certification Identification (if applicable)
9040 Telstar Ave #137
City/State/Zip
Phone
El Monte CA 91731
626.274.0522
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 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, or system performance diagnostic results that require HERS vermcation
identified on this Certificate of Verification comply with the applicable requirements in Reference Appendices RA2, RA3, and the requirements
specified on the Certificate of Compliance for the building approved by the enforcement agency
4 The information reported on applicable sections of the Certificate(s) of Installation (CUR) signed and submitted by the persons) responsible for the
construction or installation conforms to the requirements specified on the Certificates) of Compliance (CF1R) approved by the enforcement agency
S I will ensure that a registered copy of this Certificate of Verification shall be posted, or made available with the building permit(s) issued for the
budding, 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 budding owner at occupancy
Budder Or Installer Information As Shown On The Certificate Of installation
. Company Name(Insiallmg Subcontractor, General Contractor, or Budder/Owner)
ZABATTA HEATING AND AIR CONDITIONING
Responsible Budder or Installer Name
CSLR License
John Zabatta
561159
HERS Provider Data Registry Information
Sample Group Number fd applicable)77fDwelling
Test Status in Sample Group (if applicable)
Tested
HERS Rater Information
HERS Rater Company Name
J K Air Balancing & Duct Testing
Responsible Rater Name
Responsible Rater Signature
John Kwan
Responsible Rater Certification Numberw/this HERS Provider
Date Signed
CC2005646
2015-02-05 09 04 28
DrgrtaAy signed by CoICERTS This digital aRv oture is provided m oder to secure the content of this registered document and in" way rmpbes Registration Provider
responsaPhiy for the accuracy of the informal=
Registration Number 21S-A0031949A-M2300002A-M23A Registration Date/Time 2015-02-05 09 04 28 HERS Provider CaICERTS
CA Budding Energy Efficiency Standards Report Version 2014-05.08 Report Generated 2015 02-05 09 03 20
2013 Residential Compliance Schema Version 0 515DD
CERTIFICATE OF VERIFICATION CF3R-MCH-ZS-H
Refrigerant Charge Verification (Page 1 of 4 )
Project Name- 23611 Golden Springs Dr #i-7
Enforcement Agency City of
Diamond Bar
Permit Number 15.0276
Dwelling Address 23611 Golden Springs Dr
M-7
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
WHOLE HOUSE
02
System Location or Area Served
WHOLE HOUSE
03
Condenser (or package unit) make or brand
DAY AND NIGHT
04
Condenser (or package unit) model number
N4H324AKF
05
Nominal Cooling Capacity (tons) of Condenser
2
06
Condenser (or package unit) serial number
E142820842
. 07
Refrigerant Type
R -410A
08
Other Refrigerant Type (if applicable)
09
System Installation Type
Alteration
Charge Indicator Display (CID) Status (Note Even systems
This system does not have a CID device installed
10
with a CID must have refrigerant charge verified by installer)
Is the system of a type that the minimum airflow can be
Yes, this is a ducted system and one of the system airflow
11
verified using an approved measurement procedure (RA3 3
rate measurement procedures in FAB 3 or RA3 2 2 7 can be
or RA3 2 2 7)2
used to verify system airflow rate
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 compliance
from RA3 2 2 or RA1 is applicable to this system and can be
12
with the refrigerant charge verification requirements when
used to verify compliance
temperatures are greater than or equal to SSF (RA3 2 2, or
RA1)3
13
Date of Refrigerant Charge Verification for this system
2015-02-05
14
Refrigerant charge verification method used
Subcooling (outdoor temperature must be equal to or
greater than 55 degF)
15
Person who performed the Refrigerant Charge Verification
HERS rater
reported on this Certificate of Installation
16
HERS Verification Compliance Requirement Status
System does not qualify for group sampling
17
Refrigerant charge verification method used by HERS Rater
Subcool
Registration Number 215-A0031949A-M2500002A-M25A Registration Date[Time 2015.02-05 09 04 28 HERS Provider CaICERTS
CA Building Energy Efficiency Standards Report Version 2014.05-08 Report Generated 2015.02-05 09 03 49
2013 Residential Compliance Schema Version 05SISDD
CERTIFICATE OF VERIFICATION CF3R-MCH-25-H
Refrigerant Charge Verification (Page 2 of 4 )
Standard Charge Verification Procedure - CF3R-MCH-25b - Subcooling Method
B Metering Device Venccation - HERS Rater is required to visually field verify all information from CF2R
Subcoolmg Method can only be used on systems that have a variable metering device
01
Refrigerant metering device
Thermostatic Expansion Valve (TXV)
02
Subcoolmg Method applicability status
Subcoolmg 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
2015-02-02
02
Date of Digital Thermocouple Calibration
2015.02.02
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 MAN
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 2 2 7
01
Minimum Required System Airflow Rate (cfm)
600
02
System Airflow Rate Verification Status
System complies with minimum airflow rate requirements
F Data Collection - 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 during
71
the refrigerant charge verification procedure (degreeF)
02
Measured Condenser air entering dry-bulb temperature (T
60
condenser db)
Registration Number 215-A0031949A-M2500002A-M25A Registration Date/Time 2015-02.05 09 04 28 HERS Provider CaICERTS
CA Budding Energy Efficiency Standards Report Version 2014-05 08 Report Generated 2015-02-05 09 03 49
2013 Residential Compliance Schema Version 0 55150D
CERTIFICATE OF VERIFICATION CF3R-MCH-25.H
Refrigerant Charge Verification (Page 3 of 4 )
Measured Suction line temperature (Tsumon) (degreeF)
F Data Collection - 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
03
Outdoor Temperature Qualification Status
Outdoor temperature is within range for using Subcoolmg
refrigerant charge verification method
04
Measured Liquid Line Temperature (Tuqu d) (degreeF)
64
05
Measured Liquid Line Pressure (Pirquid) (pisg)
236
06
Condenser saturation temperature (Tcondenwr, sat) from digital
gauge or P -T Table using line F05 (degree F)
80
07
Measured Subcoolmg
16
O8
Target Subcoolmg
13
09
Compliance Statement System complies with Subcoolmg Method - Must also pass metering device verification, next
section
G. Metering Device Verfication
Procedures for the verification of proper metering device operation are specified in RA3 2 2 6 2
01
Measured Suction line temperature (Tsumon) (degreeF)
56
02
Measured Suction line pressure (Psucnor) (psig)
102
03
Evaporator saturation temperature (TevapaatoGsat) from
digital gauge or P -T Table using line G02 (degreeF)
36
04
Measured Superheat
20
05
Measured Superheat is between 4 and 25 deg F (inclusive)
Passes CEC requirement
06
Measured Superheat is within manufacturer's specifications,
if known
Yes, documentation to be provided upon request
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.
01 I Complies All specified verification protocol requirements on this document are met
Registration Number 215-A0031949A-M2500002A-M25A Registration Date/Time 2015.02.05 09 04 28 HERS Provider CaICERTS
CA Building Energy Efficiency Standards Report Version 2014-05-08 Report Generated 2015-02.OS 09 03 49
2013 Residential Compliance Schema Version 0 551500
'......... CERTIFICATE Of VERIFICATION CF3R-MCH-25-H
Refrigerant Charge Verification (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
Kwan
Documentation Author Signature
John
Company
Date Signed
J K Air Balancing & Duct Testing
2015.02-05 09 04 28
Address
CEA/ HERS Certification Identificetion (if applicable)
9040 Telstar Ave #137
3012
Gty/state/Zip
Phone
EI Monte CA 91731
626-274-0522
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 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, or system performance diagnostic results that require HERS verification
identified on this Certificate of Verification comply with the applicable requirements in Reference Appendices RA2, RA3, and the requirements
specified on the Certificate of Compliance for the budding approved by the enforcement agency
4 The information reported on applicable sections of the Certificate(s) of Installation (CF2R) signed and submitted by the persons) responsible for the
construction or installation conforms to the requirements specified on the Certificate(s) of Compliance (CFIR) approved by the enforcement agency
5 1 will ensure that a registered copy of this Certificate of verification shall be posted, or made available with the budding permrth) issued for the
budding, 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 budder provides to the budding owner at occupancy
Builder Or installer Information As Shown On The Certificate Of installation
Company Name (installing Subcontractor, General Contractor, or Budder/Owner)
ZASATTA HEATING AND AIR CONDITIONING
Responsible Budder or Installer Name
CSi8 license
John Zabatta
561159
HERS Provider Data Registry Information
Sample Group Number (if applicable)Dwelling
Test Status in Sample Group (if applicable)
Tested
HERS Rater information
HERS Rater Company Name
1 K Air Balancing & Duct Testing
Responsible Rater Name
Responsible Rater Signature
John Kwan
Responsible Rater Cendicabon Numberw/ this HERS Provider
Date Signed
CC2005646
2015-02.05 09 04 28
DrgrtaUysrgnadby CalCERTS This dileral signature as provided in order to secure the content of this registered document andin re, wayrmp6es Registration Provider
responsibdity for the accuracyof the information
Registration Number 215-A0031949A-M2500002A-M25A Registration Date/Time 2015.02-05 09 04 26 HERS Provider CaiCERTS
CA Building Energy Efficiency Standards Report Version 2014-05-08 Report Generated 2015 02-05 09 03 49
2013 Residential Compliance Schema Version 0 551SDD
CERTIFICATE OF INSTALLATION
CFZR-MCH-20-H
Duct Leakage Diagnostic Test
(Page 1 of 3 )
Project Name. 23611 Golden Springs Or #0
Enforcement Agency City of
Diamond Sar
Permit Number
15-0276
Dwelling Address: 23611 Golden Springs Dr
#i•7
City. Diamond Bar
Zip Code:
91765
A System information
01
Space Conditioning System Identification or Name
WHOLE HOUSE
02
Space Conditioning System Location or Area Served
WHOLE HOUSE
03
Building Type from CF -IR
Single family
04
Verified Low Leakage Ducts in Conditioned Space
(VLLDCS) Credit from CF1R2
No, credit is not taken
OS
Verified Law Leakage Air Handling Unit (VLLAHU) Credit
from CF1R7
No, credit is not taken
06
Duct System Compliance Category
Alteration
MCH-2Od - Complete Replacement or Altered Duct System
Et Duct Leakage Diagnostic Test
D1
Condenser Nominal Cooling Capacity (ton)
2
02
Heating Capacity (kBtu/h)
24
03
Conditioned Floor Area served by this HVAC system (1`12)
900
04
Duct Leakage Test Condition
Test final
05
Duct Leakage Test Method
Total leakage
06
Leakage Factor
015
07
Air Handling Unit Airflow (AHUAirflow) Determination
Method
Cooling system method
08
Measured AHUAirflow
This field or section is not applicable
09
Calculated Target Allowable Duct Leakage (cfm)
120
10
Actual duct leakage rate from leakage test measurement
(cfm)
33
11
Compliance Statement System passes leakage test
Registration Number 215-A0031949A-M2000002A-0D00 Registration Date/Time 2015.02-05 09 05 17 HERS Provider CaICERTS
CA Building Energy Efficiency Standards Report Version 2014 05-08 Report Generated 2015.02.05 08 53 38
2013 Residential Compliance Schema Version 0515DD
CERTIFICATE OF INSTALLATION CFZR-MCH-20-H
Duct Leakage Diagnostic Test (page 2 of 3 )
C Additional Requirements for Compliance
01
System was tested in its normal operation condition No temporary taping allowed
Outside air [OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage
02
testing CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet
ASHRAE Standard 62 2, and close when OA ventilation is not required, may be configured to the closed position during duct
leakage testing
03
All supply and return register boots were sealed to the drywall
04
Building cavities were not used as plenums or platform returns in lieu of ducts
OS
If cloth backed tape was used it was covered with Mastic and draw bands
O6
All connection points between the air handler and the supply and return plenums are completely sealed
If the system complies using the Smoke Test method, the smoke test was conducted in accordance with the requirements
07
of Reference Residential Appendix RA3 14 3 6 Systems that comply using smoke test shall not be included in sample
groups for HERS verification compliance
The responsible persons signature on this compliance document affirms that all applicable requirements in this table have
been met,
Registration Number 215-A0031949A-M2000002A-0000 Registration Date/Time 2015.02.05 09 05 17 HERS Provider Ca10ERTS
CA 8uddmg Energy Efficiency Standards Report Version 2014-05-08 Report Generated 2015.02.05 08 53 36
2013 Residential Compliance Schema Version 0 S1SDD
,;
CERTIFICATE OF INSTALLATION CF2R-MCH-20-H
Duct Leakage Diagnostic Test (Page 3 of 3 )
Documentation Author's Declaration Statement
1 I certify that this Certificate of Installation documentation is accurate and complete.
Documentation Author Name
Documentation Author Signature /J_ }.. .+_�
John Zabatta
O�fArl --Z
Company
Signature Date 2015-02-05090517
ZASATTA HEATING AND AIR CONDITIONING
Address
CEA! HERS Certification Identification (d applicable)
PO BOX 9368
City/State/Zip
Phone
ALTA LOMA CA 91701
(909) 989-9200
Responsible Person's Declaration statement
I certify the following under penalty of perjury, under the laws of the State of California
I The Information provided on this Certificate of Installation is true and correct
2 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design,
construction, or installation of features, materials, components, or manufactured devices for the scope of work Identified on this Certificate of
Installation and attest to the declarations m this statement {responsible budder/installer), otherwise I am an authorized representative of the
re5ponsible builder/installer
3 The constructed or installed features, materials, components or manufactured devices (the installation) identified on this Certificate of Installation
conforms to all applicable codes and regulations, and the installation conforms to the requirements given on the plans and specifications approved by
the enforcement agency
4 1 understand that a HERS rater will check the installation to verify compliance, and that if such checking identifies defects, I am required to take
corrective action at my expense I understand that Energy Commission and HERS Provider representatives will also perform quality assurance checking
of mstaflalums, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fad to meet the
requirements of such quality assurance checking, the required correctrve action and additional checkmg7testing of other installations in that HERS
sample group will be performed at my expense
5 I reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the specific requirements for the scope of
construction or installation identified on this Certificate of installation, and I have spurred that the requirements that apply to the construction or
installation have been met
6 1 will ensure that a registered copy of this Certificate of Installation shall be posted or made available with the budding permigs) issued for the
budding, and made available to the enforcement agency for all applicable inspections I understand that a registered copy of this Certificate of
Installation is required to be included with the documentation the budder provides to the budding owner at occupancy
Responsible Budder/lostatier Name
Responsible Braider/Installer Signature '..
John Zabatta
Company Name (Installing Subcontractor or General Contractor or
Position With Company (Title)
Builderlowner)
OWNER
ZABATTA HEATING AND AIR CONDITIONING
Address
CSLB License
PO BOX 9368
561159
City/statej2ip
Phone
Date Signed
ALTA LOMA CA 91701
(909) 989-9200
2015-02-05 09 05 17
Third Party Quality Control Program (TPQCP) Status
Name of TM9 CP (if app1,tobIs)
Digitally signed by CatCERTS This drgrtalsignature rs provided in order to secure the content of this registered document and in me way implies Registration Provider
responsibility lot theaccuracy ofthe axle matron
Registration Number 215-A0031949A-M2000002A 0000 Registration Date/Time 2015-02-05 09 05 17 HERS Provider CaICERTS
CA Building Energy Efficiency Standards Report Version 2014-05.08 Report Generated 2015-02.05 08 53 36
2013 Residential Compliance Schema Version 0 S1SDD
'i CERTIFICATE OF INSTALLATION CFZR-MCH-23-H
!. Space Conditioning System Airflow Rate (Page 1 of 3 }
Project Name 23611 Golden Springs Dr th-7 Enforcement Agency City of Permit Number 15.0276
Diamond Bar
Dwelling Address. 23611 Golden Springs Dr City, Diamond Bar Zip Code: 91765
M-7
A. ducted Cooling System Information
'.... 01
System Identification or Name
WHOLE HOUSE
02
5ystem Location or Area Served
WHOLE HOUSE
' 03
System Installation Type
Alteration
'... 04
Nominal Cooling Capacity (tons) of Condenser
2
05
Condenser Speed Type
Single Speed
06
Cooling System Zonal Control Type
Not Zonal
07
Central Fan Integrated (CFI) Ventilation System Status
Not a CFI system
O8
System Bypass Duct Status
No Bypass Duct
09
Date of System Airflow Rate Measurement
2015-02-05
10
Airflow Rate Protocol utilized
RA3 3 procedures for airflow rate measurement
B. Hole for the placement of a Static Pressure Probe (HSPP), and Permanently Installed Static Pressure Probe (PSPP)
in the supply plenum.
Procedures for installing HSPP or PSPP are specified in RA3 3 1 1
01IMethod used to demonstrate compliance with the I 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 11, and system airflow rate measurement apparatus information is given
in RA3 3 2
01
Airflow Rate Measurement Type used for this airflow rate
Fan Flowmeter according to procedure in RA3 3 3 11
verification
02
Manufacturer of Airflow Measurement Apparatus
TSI
03
Model number of Airflow Measurement Apparatus
ACCU BALANCE 802083
04
Certification Status of the Arfiow Measurement Apparatus
Certified by Manufacturer and listed on CEC Website at
Accuracy
http Hwww energy ca gov/(tbd)
Registration Number 215-A0031949A-M2300002A-0000 Registration Date/Time 2015.02-05 09 05 17 HERS Provider CaICERTS
CA Budding Energy Efficiency Standards Report version 2014 -OS -08 Report Generated 2015-02-05 08 S4 50
2013 Residential Compliance Schema Version 0 51SDD
CERTIFICATE OF INSTALLATION CFZR-MCH-23-H
Space Conditioning System Alrflow Rate (Page 2 of 3 )
MCH -23a Forced Air System Airflow Rate Measurement - Newly Installed Non -Zoned Systems or Zoned Mufti -Speed
Compressor
D. Forced Air System Airflow Rate Measurement
The procedures for System Airflow Rate Verification are specified in Reference Residential Appendix RA3 3
01
Required Minimum System Airflow Rate (cfm/ton)
300
02
Required Minimum System Airflow Target (dm)
600
03
Actual System Airflow Rate Measurement (cfm)
638
04
Compliance Statement
System airflow rate complies
E. Additional Requirements
01
Air filters that meet the applicable requirements of Standards Section 150 0(m)12 or 150 0(m)13 were properly installed in
the system during system air flow rate measurement identified on this Certificate of Installation
The airflow rate measurement apparatus used to perform the airflow rate measurement identified on this Certificate of '...
02
Installation 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
system return duct airflow are not used on new or replacement zonally controlled systems unless the Performance
03
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 diagnostic test
05
System fan was set at maximum speed during the diagnostic test
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 (cfmlton) and fan
08
efficacy (Watt/cfm) with system operating in cooling mode at the maximum compressor speed and the maximum air
handier fan speed
The responsible person's signature on this compliance document affirms that all applicable requirements in this table have
been met
Registration Number 215-A0031949A-M2300002A-0000 Registration Date rime 2015-02-05 09 05 17 HERS Provider Ca10ERTS
CA Budding Energy Efficiency Standards Report Version 2014-05-08 Report Generated 2015-02-05 OB 54 50
2013 Residential Compliance Schema Version 0 51500
CERTIFICATE OF INSTALLATION CF2R-MCH-23-H
Space Conditioning System Airflow Rate (Page 3 of 3 )
Documentation Authoes Declaration Statement
1.1 certify that this Certificate of Installation documentation is accurate and complete.
Documentauan Author Name
Documentation Author Signature_/_. q_jyr-
John Zabatta
FiYX/6a7LfaG�"
Company
Signature Date 2015-02-05 09 05 17
ZABATTA HEATING AND AIR CONDITIONING
Address
CEA/ HEELS Certification Identification (if applicable)
PO BOX 9368
Gty/State/zip
Phone
ALTA LOMA CA 91701
(909) 989-9200
Responsible Person's Declaration statement
I certify the following under penalty of perjury, under the laws of the State of California
J The information provided on this Certificate of installation is true and correct
2 I am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design,
construction, or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of
Installation and attest to the declarations in this statement (responsible builder/installer), otherwise I am an authorized representative of the
responsible builder/installer
3 The constructed or installed features, materials, components or manufactured devices (the installation) identified on this Certificate of Installation
conforms to all applicable codes and regulations, and the installation conforms to the requirements given on the plans and specifications approved by
the enforcement agency
4 I understand that a HERS rater will check the installation to verify compliance, and that it such checking identifies defects, 1 am required to take
corrective action at my expense I understand that Energy Commission and HERS Provider representatives will also perform quality assurance checking
of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fad to meet the
requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS
sample group will be performed at my expense
5 I reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the specific requirements for the scope of
construction or installation identified on this Certificate of installation, and I have ensured that the requirements that apply to the construction or
installation have been met
6 I will ensure that a registered copy of this Certificate of Installation shall be posted, or made available with the budding perme(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
Installation is required to be included with the documentation the builder provides to the building owner at occupancy
'.. Responsible Budder/Installer Name
Responsible Budder/Installer SignaSure
John Zabatta
j Company Name (Installing Subcontractor or General Contractor or
Position With Company (Title)
'.. audder/Owner)
OWNER
ZABATTA HEATING AND AIR CONDITIONING
Address
CSLB License
PO BOX 9368
562159
Cny/State/Zip
Phone
Date Signed
ALTA LOMA CA 91701
1(909) 984-4200
2015-02-05 09 05 17
Third Party Quality Control Program (TPQCP) Status
Name of TPQCP Bf applicable)
DigitairsignedbyUCERTS This digital signature is provided in order to secure the content of this registereddocument and in noway implies Registration Provider
responsibility for the accuracy of the information
Registration Number 215-A0031949A•102300002A-0000 Registration Date/Time 2015-02-05 09 05 17 HERS Provider CaiCERTS
CA Budding Energy Effic ency Standards Report Version 2014-05-08 Report Generated 201502-05 08 54 50
2013 Residential Compliance Schema Version 0 SSSDD
CERTIFICATE OF INSTALLATION
CF2R-MCH-25-H
Refrigerant Charge Verification
(Page 1 of 5 )
Project Name. 23611 Golden Springs Dr M-7
Enforcement Agency City of
Diamond Bar
Permft Number
15-0276
Dwelling Address 23611 Golden Springs Dr
M-7
City Diamond Bar
Zip Code*
91765
A. System Information
Each system requiring refrigerant charge verification will be documented on a separate certificate
O1
System Identification or Name
WHOLE HOUSE
!. 02
System Location or Area Served
WHOLE HOUSE
03
Condenser (or package unit) make or brand
DAY AND NIGHT
04
Condenser (or package unit) model number
N4H324AKF
0S
Nominal Cooling Capacity (tons) of Condenser
2
06
Condenser (or package unit) serial number
E142820842
07
Refrigerant Type
R -410A
08
Other Refrigerant Type (if applicable)
09
System Installation Type
Alteration
10
Charge Indicator Display (CID) Status (Note Even systems
This system does not have a CID device installed
with a CID must have refrigerant charge verified by installer)
Is the system of a type that the minimum airflow can be
Yes, this is a ducted system and one of the system airflow
11
verified using an approved measurement procedure (RA3 3
rate measurement procedures in RA3 3 or RA3 2 2 7 tan be
or RA3 2 2 7)?
used to verify system airflow rate
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 compliance
from RA3 2 2 or RAl is applicable to this system and can be
12
with the refrigerant charge verification requirements when
used to verify compliance
temperatures are greater than or equal to 55F (RA3 2 2, or
RAl)7
13
Date of Refrigerant Charge Verification for this system
2015-0205
14
Refrigerant charge verification method used
Subcoohng (outdoor temperature must be equal to or
greater than 55 degF)
15
Person who performed the Refrigerant Charge Verification
HERS rater
reported on this Certificate of Installation
16
HERS Verification Compliance Requirement Status
System does not qualify for group sampling
Registration Number 215-A0031949A-M2500002A-0000 Registration Date/Time 201542.05 0905 17 HERS Provider CaICERTS
CA Building Energy Efficiency Standards ReportVersion 2014-05.08 ReportGenerated 2015-02.05 085909
2013 Residential Compliance Schema Version OSSSSDD
CERTIFICATE OF INSTALLATION CF2R-MCH-25-H
Refrigerant Charge Verification (Page 2 of 5 )
Standard Charge Verification Procedure - CFZR-MCH-25b - Subcooling Method
B. Metering Device Verfication
Subcoohng Method can only be used on systems that have a variable metering device
01
Refrigerant metering device
Thermostatic Expansion Valve (TXV)
02
Subcoohng Method applicability status
Subcoohng Method is applicable to this system
C Instrument Calibration
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
2015-02.02
02
Date of Digital Thermocouple Calibration
2015-02-02
03
Digital Refrigerant Gauge Calibration Status
Calibration is current
04
Digital Thermocouple Calibration Status
Calibration is current
D Measurement Access Hole (MAH) Verification
Procedures for installing MAH are specified in Reference Residential Appendix RA3 2 2 3
Ol ( Method used to demonstrate compliance with theI MAH installed and labeled consistent with Figure 3 2-1
nt
Measurement Access Hole (MAH) requireme
E Minimum System Airflow Rate Verification
Procedures for verifying minimum system airflow are specified in Reference Residential Appendix RA3 2 2 7
01
Minimum Required System Airflow Rate (cfm)
600
02
System Airflow Rate Verification Status
System complies with minimum airflow rate requirements
F. Data Collection and Calculations
Procedures for determining Refrigerant Charge using the Standard Charge Verification Procedure are given in
Reference Residential Appendix RA3 2 2
01
Lowest return air dry bulb temperature that occurred during
71
the refrigerant charge verification procedure (degreeF)
02
Measured Condenser air entering dry-bulb temperature (T
60
mndenw, db)
Registration Number 215-A0031949A.M2500002A-0000 Reg±stration Date/Time 2015-02-05 09 05 17 HERS Provider CaICERTS
CA Building Energy Efficiency Standards Report Version 2014-05-08 Report Generated 2015-02-05 08 59 09
2013 Residential Compliance Schema Version 0 SSSSDD
CERTIFICATE OF INSTALLATION CFZR-MCH-25-H
Refrigerant Charge Verification (Page 3 of 5 }
Measured Suction line temperature (Ts.c ) (degreeF)
F. Data Collection and Calculations
Procedures for determining Refrigerant Charge using the Standard Charge verification Procedure are given in
Reference Residential Appendix RA3 2 2
03
Outdoor Temperature Qualification Status
Outdoor temperature is within range for using Subcooling
refrigerant charge verification method
04
Measured Liquid Line Temperature (Tirqu,d) (degreeF)
64
05
Measured Liquid Line Pressure (Plpa,d) (pisg)
236
06
Condenser saturation temperature (Tmndensor,sat) from digital
gauge or P -T Table using Line FOS (degree F)
80
07
Measured Subcooling
16
08
Target Subcooling
13
09
Compliance Statement System complies with Subcooling Method - Must also pass metering device verification, next
section
G Metering Device Verfication
Procedures for the verification of proper metering device operation are specified in RA3 2 2 6 2
01
Measured Suction line temperature (Ts.c ) (degreeF)
S6
02
Measured Suction line pressure (Psuchon) (prig)
102
03
Evaporator saturation temperature (Te+<aaoraw,,sat) from
digital gauge or P -T Table using line G02 (degreeF)
36
04
Measured Superheat
20
05
Measured Superheat is between 4 and 25 deg F (inclusive)
Passes CEC requirement
06
Measured Superheat is within manufacturer's specifications,
if known
Yes, documentation to be provided upon request
07
Compliance Statement Metering device verification passes
Verification of Charge Indicator Display - CF2R-MCH-25d - CID
H. Charge Indicator Display
Procedures for the Charge Indicator Display Verification are detailed in RA3 4 2
This section does not apply to this project
Registration Number 215-A0031949A-MZ500002A 0000 Registration Date/Time 2015-02-05 09 05 17 HERS Provider CaICERTS
CA 9uildmg Energy Efficiency Standards Report Version 2014.05-08 Report Generated 2015-02.05 095909
2013 Residential Compliance Schema Version 0 SSiSDD
CERTIFICATE OF INSTALLATION CF2R-MCH-25•H
Refrigerant Charge Verification (Page 4 of 5 )
1. Charge Indicator Display Additional Requirements
This section does not apply to this project
Registration Number 215-A0031949A-M2500002A-0000 Registration Date[Time 2015-02.0509 05 17 HERS Provider CaICERTS
CA Building Energy Efficiency Standards Report Version 2014.05-08 Repon Generated 2015.02-05 08 5909
2013 Residential Compliance Schema Version 0 551SDD
CERTIFICATE OF INSTALLATION CF2R-MCH-25-H
Refrigerant Charge Verification (Page 5 of 5 )
Documentation Author's Declaration Statement
1.1 certify that this Certificate of Installation documentation Is accurate and complete%.,
Documentation Author Name
Documentation Author Signaturedy
John Zabatta
9 �(f> g
Company
Signature Date 2015-0205 09 05 17
ZABATTA HEATING AND AIR CONDITIONING
Address
CEA/ HERS Certification Identification (if applicable)
PO BOX 9368
City/State/Zip
Phone
ALTA LOMA CA 91701
(909) 989-9200
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 Installation is true and correct
2 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design,
construction, or Installation of features, materials, components, or manufactured devices for the scope of work Identified on this Certificate of
Installation and attest to the declarations in this statement (responsible builder/installer), otherwise 1 am an authonred representative of the
responsible budder/installer
3 The constructed or mstalled features, materials, components or manufactured devices (the installation) Identified on this Certificate of installation
conforms to all applicable codes and regulations, and the Installation conforms to the requirements given on the plans and specifications approved by
the enforcement agency
',. 4 1 understand that a HERS rater will check the Installation to verify compliance, and that if such checking identifies defects, I am required to take
corrective action at my expense Iunderstand that Energy Commission and HERS provider mieresentatives will also perform quality assurance checking
of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fad to meet the
requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS
sample group will be performed at my expense
5 1 reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the specific requirements for the scope of
construction or installation identified on this Certificate of installation, and f have ensured that the requirements that apply to the continuation or
installation have been met
6 I will ensure that a registered copy of this Certificate of Installation shall be posted or made available with the budding permits) 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
Installation is required to be Included with the documentation the builder provides to the budding owner at occupancy I
Responsible Builder/Installer Name
Responsible Budder/Installer Signature
John Zabotta
Company Name (Installing Subcontractor or General Contractor or
Position With Company (Title)
Builder/Owner)
OWNER
MATTA HEATING AND AIR CONDITIONING
Address
CSLB License
PO BOX 9368
561159
City/State/Zip
Phone
Date Signed
ALTA LOMA CA 91701
{909) 489-9200
2015.02.05 09 05 17
Thud Party Quality Control Program (TPQCP) Status
Name of TPQCP pf applies life)
Digitally signed by CaXiarin This signal signature rs provided in order to secure the content of this registered documentand in noway implies Registration Provider
responsibility for the accuracy of she information
Registration Number 215-A0031949A-M2S00002A-0000 Registration Date/Time 2015-02-05 09 05 17 HERS Provider CaICERTS
CA Building Energy Efficiency Standards Report Version 2014-05.08 Report Generated 2015-02-05 09 59 09
2013 Residential Compliance Schema Version 0 S515DD
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