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Home My WebLink AboutPR16-1197o= CL CITY OF DIAMOND BAR % I 1 i DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES / I - 21810 Copley Drive, Diamond Bar, CA 91765 PRESS (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarca.gov JOB SITE ADDRESS _063 (W-��3EQ QMC APN LOT TRACT OWNER SCAT QaEl- ADDRESS CITY Q. ZIPQA �dTEL. 5 APPLICANT I F CL TEL. CONTRACTOR G NC ADDRESS AV_QAC3 ��yy''.�-� Cela CITY L� �l:YLt.1r ZIP TEL. 6(OCI 20 ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reason(s) indicated below by the checkmark(s), I have placed next to the applicable item(s) [Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, after, improve, demolish, or repair, any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9) Commencing with Section 70DO of Division 3 of the Business and Professions Code] or that he or she is exempt from licensure 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). U I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or U 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 -Builder will have the burden of proving that it was not built or improved for 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 for the projects with a licensed Contractor pursuant to the Contractors' State License Law.). U I am exempt from licensure under the Contractor's State License law for the following reason(s): By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit,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/www.leginfo.ca.gov/calaw.html. 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 my license is in full force and effect. LICENSE CLASS:(2-70 GID LIC. NO.: -7,51�� 1 DATE: I CONTRACTOR: ('VICV-Q�!:1 4e(Lv\L-!3 I WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by Section 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 Numberare: CL�'.K-� n_ _� CARRIER POLICY NUMBER 71 k I,'S (THIS SECTION NEED NOT BE COMPLETED IF THE 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 0 I should become subject to the Worker's Compensa' n pr visions of Section 3700 of the Lapg Cade, I�hall fo th cQhrply wth those provisions. DATE. APPLICANT: WAR ON . Fail re to secure Worker's Compensation coverage is unlawful, nd shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000), in addition to the cost 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 read this application and state that the above information is correct.,l agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. PERMITTEE NAME (P T) c SIGNATURE OF PERMITTEE41::::71DATE If APPLICATION DATE: / P/C# ISSUE DATE: f/ /7%d I6 PERMIT# : ,P / 0 - 07 TYPE CONST. OCC GROUP: nn Scope of Work �L HCe c-<Isr`r. iia kI-a-- PCI-nr^1i"ry -m, ASIC_ • ►-Lv DICT f, -4G . # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport w Patio/Deck .Now n LU L ZRe m Pool/Spa -Roof Commercial Valuation: Adj. Area: QUANTITY DESCRIPTION FEE IS v f^T U w J w c� QE U Arre z Fri J J 4 b. CD Cr`JfMPA90 I R - CONSTRUCTION: PLAN REVIEW: fG. Obi ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMTP: r ENERGY P/C: ENERGY PERMIT: RETENTION FEE: y Od PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES J COMMENTS: P/C: PAID BY: �y VALIDATION: RECEIPT # �Dak. PAID BY: %I g Q JI VALIDATION: WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy CITY OF DIAMOND BAR INSPECTION RECORD INSPECTIONDATE INSPECTOR SETBACK/LETTER FOOTINGS FORMS SLAB UG. PLUMBING UG. ELECTRICAL UFER GROUND SEWER LATERAL MAIN WATER LINE SEWER CLEANOUT ROOF SHEATHING FLOOR SHEATHING SHEAR WALLS EXTER 9R, SHEAR WALLS INTE R .`v .; "' �'V FRAMINGNENTING ROUGH MECHANICAL' ROUGH ELECTRICAL W( ) (T('t ROUGH PLUMBING ` INSULATION WALL INSULATION CEILING DRYWALL LATH (PRE) LATH EXTERIOR LATH INTERIOR GAS TEST SCRATCH COAT ELECTRIC METER RELEASE GAS METER RELEASE SPECIAL INSPECTION FINAL BUILDING FINAL MECHANICAL FINAL ELECTRICAL FINAL PLUMBING T.C. of OCCUPANCY CERT. of OCCUPANCY JI INSPECTIONDATE INSPECTOR TRACT AND LEDGER SWITCH GEAR COMMERCIAL HOOD T -BAR INTERCEPTER HOT MOP/SHOWERPAN SEPTIC/CESSPOOL HERS REPORT RECEIVED DEMOLITION ROOF DRAINS ROUGH CONDUIT POOL/SPA ROUGH PLUMBING ROUGH ELECTRICAL ROUGH MECHANICAL GAS TEST PRE GUNITE POOL PRE DECK BONDING P -TRAP FENCE / GATE/ ALARM FINAL POOL WALLS: WALL FOOTING/STEEL WALL STEEL 1 sr( ) 2ND( ) LIFT WALL BOND BEAM/ WALL DRAIN/ SEAL WALL FINAL R0. FRAMING PLANNING APPROVAL ROUGH FIRE APPROVAL FINAL FIRE DEPARTMENT FINAL PLANNING FINAL ENGINEERING/ PW FINAL COMMUNITY SERVICES FINAL HEALTH DEPT. FINAL INDUSTRIAL WASTE JI Co t L- 45 s. e-cn A CITY OF DIAMOND BAR -,'K- -E PLANS AtvQL--TAILS rl BY 7 2016 THE APPROVAL OF THESc7 "l -04S SHALL NOT BE CONSTRUED TO BE A PER'4411T FOR ANY VIOLATION OF ANY CODE OR ORDINANCE OF THIS CITY. THESE PLANS SHALL EE `N THE JOB FOR ALL R TELL N ACTIONS LJ STO 23625 EXP. 12/31/2017 CIV 11. OF ai r- &ka, CA - qX165 ACE gyOFESS/ T"r S. ST 23625 EXP. 1213112017 41- Ca -4.i Tis TtV C10. OF c T04�561 y'D %' 1.tGi4T- Y2 -T; It OWE AQCtAlE MC�-h-j Project: j , �.5 26if San.cabrlei.11l Dt W blurt CA 91789 � -` ` Voice 9995omo FaxW9- etsubju 59&9204-T"}i� j he[bst4c aol.com , . . f �_... rinvia Bv: HST Sheet# i-+-r'`ti (, �'tI j5 i�� '�` ��G � �' � ��•�—i fyc iii tiltl S,'?" . el • �VM �J Cdr �Y f � �,_ I o = 23625, p x EXP 12/31/2017 �' G P1'',--... �a n cr clvk q OF ��FCQd Gfl <� �L i t' so CITY.OF DIAMOND BAR THESE PL.AN"S Ai' -'G i; C7. TA LS bY IAi 2n �� 10 THE APPROV41 Cc 7HrSF. r tJ NS SHALL NOT BE CONSTRUEn Tf*) ar R = " �r viuLAIIG.( OF ANY CODE OR GRDIiiA SCE OF THIS CfTY. THESE PLA -NIS SHALL BE ON THE JOB FOR ALL REQUEESTED iNSPECTIONS STATE OF CALIFORNIA ALTERATIONS - HVAC I O CEC-CFI R -ALT -04-E (Revised 06114) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE CF1R-ALT-04-E - Alterations - HVAC CZ 2, and 8-15 (formerly CF -IR -ALT -HVAC) (Page 1 of 1) Site Address:-riforcement'Ageitejr: Date Prepared: Permit#: n ' Equipment Type ipment Efficiency New Ducting, Plenums, Lineset: Conditioned Thermostat R -value Floor Area (sq ft) ❑ Packaged System 11 Evaporator Coil �AFUE COP 7D6 (CZ2, 8-13) Ducting RI -R-6 Served by system ❑ Setback ';5 Split System ❑ Condensing Unit ❑ R-8' (CZ 11, 14, 15) Ducting Sgft (if not already ❑ Mini Split ❑ Compressor SEER HSPF❑ R-6 (all CZ's) Plenums present, must ❑ Furnace El Lineset EER El R-5 or R7.5) Lineset a 6e installed ) 11 TXV HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this form, is allowed to be filled out by hand. For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site. A-1. HVAC Changeout/Repair Required Compliance Documents to be left on site for Final: All Equipment, CF1R-ALT-02-E Condenser Unit, Evaporator Coil, CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24)2 -HERS, MECH-25-HERS' Compressor, TXV, Lineset, CF3R: MECH-20-HERS, MECH-(23 or 24)-HERS2, MECH-25-HERS1 Air Handler/Furnace' (Can include new ducting) Installer Requirement: Duct leakage (:S_15%, or < 10% to outside, or seal all accessible leaks), Air Flow >: 300 CFM/ton, Refrigerant Charge. Exempted.from duct leakage testing if: ❑ 1. Duct system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of duct in unconditioned space, or ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building1 ❑ 2. New HVAC System Required Compliance Documents to_be left on site for Final: All new equipment and All New Ducts' CF1R-ALT-02-E including Mini Split CF2R: MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24)-HERSZ, MECH-25-HERSZ CF3R: MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24)-HERSZ, MECH-25-HERSZ Mini Splits require CF1R-ALT-02-E, CF2R-MECH-01, and (CF2R-CF3R) MECH-25-HERS Installer Requirement: Duct leakage < 6%, Fan Efficacy (.58W/CFM), Air Flow >_ 350'CFM/ton (or alternative), Refrigerant Charge �93. All New Ducts with Replacement Required Compliance Documents to be left on site for Final: All New. Ducts' and one of more of the following CF1R-ALT-02-E replaced: Condenser Unit, Evaporator Coil, CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS Compressor, TXV, Lineset, Furnace' CF3R: MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS Installer Requirement: Duct leakage < 6%, Air Flow >_ 350 CFM/ton (or alternative), Refrigerant Charge Exempted from duct leakage testing if: ❑ 1. Existing duct systems are constructed, insulated or sealed with asbestos ❑ 4. New Ducting over 40 feet IRequired Compliance Documents to be left on site for Final: New ducting but less than All New Ducts' I CF1R-ALT-02=E, CF2R: MECH-20-HERS, CF3R: MECH-20-HERS Installer Required to: Duct leakage (15% or, < 10% to outside or, or seal all accessible leaks) ❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos. ' All new ducting R-8 required when more than 40 ft installed and R-6 when less than 40 ft installed. This includes in walls, between floors etc. 2 Heating only systems and Air Handler/Furnace changes do not require Air Flow MECH-(23 or 24), or Refrigerant Charge verification MECH-25 3 All New Ducts is when at least 75 percent of the duct system is new duct material, and up to 25 percent may consist of reused parts from the dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, coil, plenums, duct material) , " R-5 (1" thick insulation) for linesets 1" and less. R-7.5 (1.5" thick insulation) for linesets over 1 inch. Most mfg will require Suction line Diameter with insulation as the following 1.5-2T-2%", 2.5-3T-2'/", 3.5 to 4T-2%", 5T-4%" Contractor (Documentation Author's /Responsible Designer'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 Compliance is true and correct. - 2. 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the information on this document. 3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations (CCR). 4. That the energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the CCR. 5. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. Responsible Designer Name: �c� Responsible De igner S" nature: Date Si ned: License: 75/ �c-h�,p ►7 r� �a Company: Address: citj4ate/Zip: _ Phone: Fbr assistance or questions regarding the Energy Standk0s, contact the Energy Hotline at:'1-800-772-3300.. CERTIFICATE OF VERIFICATION CF3R-MCH-20-H Duct Leakage Diagnostic Test (Page 1 of 3 ) Project Name: 1063 Banner Ridge Rd Enforcement Agency: City of Diamond Bar Permit Number: PR161197 Dwelling Address: 1063 Banner Ridge Rd City: Diamond Bar Zip Code: 91765 A. System Information 01 Space Conditioning System Identification or Name 1063 Banner Ridge Rd 02 Space Conditioning System Location or Area Served Whole House 03 Building Type from CF -111 Single family 04 Verified Low Leakage Duds in Conditioned Space (VLLDCS) Credit from CF1R? No, credit is not taken 05 Verified Low Leakage Air Handling Unit Credit from CFiR? No, credit is not taken 06 Duct System Compliance Category Alteration MCH -20d - Complete Replacement or Altered Duct System, B. Duct Leakage Diagnostic Test 01 Condenser Nominal Cooling Capacity (ton) 4 02 Heating Capacity (kBtu/h) 47 03 Conditioned Floor Area served by this HVAC system (ft2) 1730 04 Duct Leakage Test Condition Test final 05 Duct Leakage Test Method Total leakage 06 Leakage Factor 0.15 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) 240 10 Actual duct leakage rate from leakage test measurement (cfm) 139 11 Compliance Statement: System passes leakage test Registration Number: 216-A0259003A-M2000002A-M20A Registration Date/Time: 2016-07-13 10:36:02 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-07-13 10:34:15 2013 Residential Compliance Schema Version: 2013.1.007 CERTIFICATE OF VERIFICATION CF3R-MCH-20-H Duct Leakage Diagnostic Test (Page 2 of 3 ) 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) duct connections to the central forced air duct system shall not be sealed/taped off during duct leakage testing. OA ducts used for Central Fan Integrated (CFI) Indoor Air Quality ventilation systems, or Central Fan Ventilation Cooling Systems, that utilize dampers that open only when OA is required and automatically close when OA is not required, may configure the OA damper to the closed position during duct leakage testing. 03 If a complete replacement, 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. 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 c,onducted in accordance with the requirements of Reference Residential Appendix RA3 1.4.3.6. Systems that comply using'smoke test shall not be included in sample groups for HERS verificatio.n'compliance:-••-:' - •.. ' - =' 08 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 1 Complies: All specified verification protocol requirements on this document are met. Registration Number: 216-A0259003A-M2000002A-M20A Registration Date/Time: 2016-07-13 10:36:02 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-07-13 10:34:15 2013 Residential Compliance Schema Version: 2013.1.007 CERTIFICATE OF VERIFICATION CF3R-MCH-20-H Duct Leakage Diagnostic Test (Page 3 of 3 ) Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Verification documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: I ---- Serjlankozian Company: Date Signed: Rapid Duct Testing & Air Balancing 2016-07-13 10:36:02 Address: CEA/ HERS Certification Identification (if applicable): 401 N Verdugo Rd Suite C City/State/Zip: Phone: Glendale CA 91206 818-468-5744 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 building approved by the enforcement agency. 4. The information reported on applicable sections of'the Certificate(s),of Installation (MR) signed 'and:submitted'by the person(s) responsible for the construction or installation conforms to the requirements specified on the Certificate(s) of Compliance (CF1R) approved by the enforcement agency. 5. 1 will ensure that a registered copy,of this Certificate of Verificationshall be posted,'or made available with the building permit(s) issued fog the building, and made available to the enforcement agency for all applicable inspections. I understand that a.registered copy of this Certificate of q builder provides to the building owner at occupancy. ed with the documentation the l y Verification is required to be indud n -" Builder Or Installer Information As Shown On The Certificate C1f Installation Company Name (Installing Subcontractor, General Contractor, or Builder/Owner): MCLAY SERVICES INC Responsible Builder or Installer Name: CSLB License: Archie McLay 751629 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: Rapid Duct Testing & Air Balancing Responsible Rater Name: Responsible Rater Signature: Serj Jankozianr,_=2 Responsible Rater Certification Number w/ this HERS Provider: Date Signed: CC2006125 2016-07-13 10:36:02 Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider responsibility for the accuracy of the information. Registration Number: 216-A0259003A-M2000002A-M20A Registration Date/Time: 2016-07-13 10:36:02 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-07-13 10:34:15 2013 Residential Compliance Schema Version: 2013.1.007 CERTIFICATE OF VERIFICATION CF3R-MCH-23-H Space Conditioning System Airflow Rate (Page 1 of 4 ) Project Name: 1063 Banner Ridge Rd Enforcement Agency: City of Diamond Bar Permit Number: PR161197 Dwelling Address: 1063 Banner Ridge Rd City: Diamond Bar Zip Code: 91765 A. Ducted Cooling System Information O1 System Identification or Name 1063 Banner Ridge Rd 02 System Location or Area Served Whole House 03 System Installation Type Alteration 04 Nominal Cooling Capacity (tons) of Condenser 4 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 20i6 -07-i3" 10 Airflow Rate Protocol utilized [TA3.3 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. Ol IMethod used to demonstrate compliance with theI 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. 01 Airflow Rate Measurement Type used for this airflow rate Traditional Flow Capture Hood according to procedure in verification. RA3.3.3.1.4 02 Manufacturer of Airflow Measurement Apparatus TSI 03 Model number of Airflow Measurement Apparatus 8371 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: 216-A0259003A-M2300002A-M23A Registration Date/Time: 2016-07-13 10:36:02 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-07-13 10:35:07 2013 Residential Compliance Schema Version: 0.555SDD 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: SerjJankozian Documentation Author Signature: Company: Date Signed: Rapid Duct Testing & Air Balancing 2016-07-13 10:36:02 Address: CEA/ HERS Certification Identification (if applicable): 401 N Verdugo Rd Suite C City/State/Zip: Phone: Glendale CA 91206 .818-468-5744 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 building approved by the enforcement agency. 4. The information reported on applicable sections of the Certificate(s) of Installation (CF2R) signed and submitte&by the person(s) responsible for the construction or installation conforms to the requirements specified on the Certificate(s) of Compliance (CF1R) 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 permit(s) issued for the building, and made available to the enforcement agency forall 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 atoccupancy. Builder Or Installer Information As Shown On The -Certificate Of Installation Company Name (Installing Subcontractor, General Contractor, or Builder/Owner): MCLAY SERVICES INC Responsible Builder or Installer Name: CSLB License: Archie McLay 751629 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: Rapid Duct Testing & Air Balancing Responsible Rater Name: Responsible Rater Signature: --� Serj Jankozian_ Responsible Rater Certification Number w/ this HERS Provider: Date Signed: CC2006125 2016-07-13 10:36:02 Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider responsibility for the accuracy of the information. Registration Number: 216-A0259003A-M2300002A-M23A Registration Date/Time: 2016-07-13 10:36:02 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-07-13 10:35:07 2013 Residential Compliance Schema Version: 0.555SDD CERTIFICATE OF VERIFICATION CF3R-MCH-25-H Refrigerant Charge Verification (Page 1 of 4 ) Project Name: 1063 Banner Ridge Rd Enforcement Agency: City of Diamond Bar Permit Number: PR161197 Dwelling Address: 1063 Banner Ridge Rd 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 1063 Banner Ridge Rd 02 System Location or Area Served Whole House 03 Condenser (or package unit) make or brand Carrier 04 Condenser (or package unit) model number 24VNA949A300 05 Nominal Cooling Capacity (tons) of Condenser 4 06 Condenser (or package unit) serial number 1016E11047 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 can be or RA3.2.2.7)? 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 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 55F (RA3.2.2, or RA1)? 13 Date of Refrigerant Charge Verification for this system 2016-07-13 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 r17 Refrigerant charge verification method used by HERS Rater. Subcool Registration Number: 216-A0259003A-M2500002A-M25A Registration Date/Time: 2016-07-13 10:36:02 HERS Provider: CalCERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-07-13 10:35:31 2013 Residential Compliance Schema Version: 2013.1.007 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: Documentation Author Signature: -- Serj Jankozian Company: Date Signed: Rapid Duct Testing & Air Balancing 2016-07-13 10:36:02 Address: CEA/ HERS Certification Identification (if applicable): 401 N Verdugo Rd Suite C City/State/Zip: Phone: Glendale CA 91206 818-468-5744 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 building approved by the enforcement agency. 4. The information reported on applicable sections of the Certificate(s) of instMation+(CF2R) signed and submitted by the persons) responsible for the i construction or installation conforms to the requirements specified on the Certificates) of Compliance (CF1R) approved by the enforcementagency. 5. 1 will ensure that a registered copy.of this Certificate of Verification shall be posted, -or made available with the building 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 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): MCLAY SERVICES INC Responsible Builder or Installer Name: CSLB License: Archie McLay 751629 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: Rapid Duct Testing & Air Balancing Responsible Rater Name: Responsible Rater Signature: —( Serj Jankozian Responsible Rater Certification Number w/ this HERS Provider: Date Signed: CC200612S 2016-07-13 10:36:02 Digitally signed by Ca(CERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider responsibility for the accuracy of the information. Registration Number: 216-A0259003A-M2500002A-M25A Registration Date/Time: 2016-07-13 10:36:02 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-07-13 10:35:31 2013 Residential Compliance Schema Version: 2013.1.007 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 1 of -7 ) Project Name: 1063 Banner Ridge Rd Enforcement Agency: City of Diamond Bar Permit Number: PR161197 Dwelling Address: 1063 Banner Ridge Rd City: Diamond Bar Zip Code: 91765 A. General Information 01 Dwelling Unit Name 1063 Banner Ridge Rd 02 Climate Zone 9 03 Dwelling Unit Total Conditioned Floor 1730 04 Number of Space Conditioning 1 CFA served Area (ft2) Installing a Installing new SC Systems in this Dwelling Unit. Installing 05 Certificate of Compliance Type Prescriptive alterations (CF113-ALT) 06 Method used to Calculate HVAC Loads NotApplicableEquipmentChangeout 07 Calculated Dwelling Unit Sensible This field or section is not applicable 08 Calculated Dwelling Unit Heating Load This field or section is not applicable Name Cooling Load (Btuh) System (ft) ducted (Btuh) components? 09 Dwelling Unit Number of Bedrooms 4 MCH -011b Prescriptive Alterations - Space Conditioning Systems Ducts and Fans B. Space Conditioning (SC) System Information 01 02 03 04 05 06 07 08 09 10 SC System SC System CFA served Is the SC Installing a Installing new SC Installing more Installing Installing Identification or Location or Area by this SC system a refrigerant system than 40 feet of entirely new entirely new SC Alteration Type Name Served System (ft) ducted containing? components? ducts? duct system? system? system. component. Altered space 1063 Banner Whole House 1730 Yes Yes Yes No No No conditioning Ridge Rd system Registration Number: 216-A0259003A-M0100002A-0000 Registration Date/Time: 2016-07-13 10:40:43 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-07-13 10:27:00 Schema Version: 2013.1.007 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 7 of 7 ) Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: �- Jankozian, Serj-� Company: Signature Date: Rapid Duct Testing & Air Balancing 2016-07-13 10:39:01 Address: CEA/ HERS Certification Identification (if applicable): 401 N Verdugo Rd City/State/Zip: Phone: Glendale CA 91206 1818-468-5744 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 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,confdYms 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 reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the specific requirements forthe 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. 5. 1 will ensure that a registered copy of this Certificate of Installation shall be posted or made available with the building permits) ssued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a registered copy of this Certificate of"lnstallation is required to be included 'with the` documentation the builder provides to the building owner at occupancy. Responsible Builder/Installer Name: Responsible Builder/Installer Signature: pp �wflwl McLay, Archie G9 Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Position With Company (Title): MCLAY SERVICES INC Owner Address: CSLB License: 2036 ARROW HWY 751629 City/State/Zip: Phone: Date Signed: LA VERNE CA 91750 909-392-2202 12016-07-13 10:40:43 Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document, and in no way implies Registration Provider responsibility for the accuracy of the information. Registration Number: 216-A0259003A-M0100002A-0000 Registration Date/Time: 2016-07-13 10:40:43 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-07-13 10:27:00 Schema Version: 2013.1.007 CERTIFICATE OF INSTALLATION CF2R-MCH-20-H Duct Leakage Diagnostic Test (Page 1 of 3 ) Project Name: 1063 Banner Ridge Rd Enforcement Agency: City of Diamond Bar Permit Number: PR161197 Dwelling Address: 1063 Banner Ridge Rd City: Diamond Bar Zip Code: 91765 A. System Information 01 Space Conditioning System Identification or Name 1063 Banner Ridge Rd 02 Space Conditioning System Location or Area Served Whole House 03 Building Type from CF -111 Single family 04 Verified Low Leakage Ducts in Conditioned Space (VLLDCS) Credit from CF1R? No, credit is not taken 05 Verified Low Leakage Air Handling Unit (VLLAHU) Credit from CF1R? No, credit is not taken 06 Duct System Compliance Category Alteration MCH -20d - Complete Replacement or Altered Duct System B. Duct Leakage Diagnostic Test - 01 Condenser Nominal Cooling Capacity (ton) 4 02 Heating Capacity (kBtu/h) 47 03 Conditioned Floor Area served by this HVAC system (ft2) 1730 04 Duct Leakage Test Condition Test final 05 Duct Leakage Test Method Total leakage 06 Leakage Factor 0.15 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) 240 10 Actual duct leakage rate from leakage test measurement (cfm) 139 11 Compliance Statement System passes leakage test Registration Number: 216-A0259003A-M2000002A-0000 Registration Date/Time: 2016-07-13 10:40:44 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-07-13 10:27:33 2013 Residential Compliance Schema Version: 2013.1.007 CERTIFICATE OF INSTALLATION CF2R-MCH-20-H Duct Leakage Diagnostic Test (Page 3 of 3 Documentation Author's Declaration Statement 1.1 certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: �— I Seri Jankozian� Company: Signature Date: 2016-07-13 10:39:01 Rapid Duct Testing & Air Balancing Address: CEA/ HERS Certification Identification (if applicable): 401 N Verdugo Rd Suite C City/State/Zip: Phone: Glendale CA 91206 1818-468-5744 Responsible Person's Declaration statement 1 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 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. 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'understandi hat 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 thecked by a HERS'rater, and if,those installations fail to meet the. - requirements of such quality assurance checking, the required corrective action and additional checking/testing of -other installations in that.HERS sample group will be performed at my expense:•t 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 I have ensured 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 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 Installation is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Builder/Installer Name: Responsible Builder/Installer Signature: Archie McLay �� 2(Ael G Company Name: (Installing Subcontractor or General Contractor or Position With Company (Title): Builder/Owner) Owner MCLAY SERVICES INC Address: CSLB License: 2036 ARROW HWY 751629 City/State/Zip: Phone: Date Signed: LA VERNE CA 91750 909-392-2202 2016-07-13 10:40:44 Third Party Quality Control Program (TPQCP) Status: Name of TPQCP (if applicable): Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider responsibility for the accuracy of the information. Registration Number: 216-A0259003A-M2000002A-0000 Registration Date/Time: 2016-07-13 10:40:44 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-07-13 10:27:33 2013 Residential Compliance Schema Version: 2013.1.007 CERTIFICATE OF INSTALLATION CF2R-MCH-23-H Space Conditioning System Airflow Rate (Page 1 of 3 ) Project Name: 1063 Banner Ridge Rd Enforcement Agency: City of Diamond Bar Permit Number: PR161197 Dwelling Address: 1063 Banner Ridge Rd City: Diamond Bar Zip Code: 91765 A. Ducted Cooling System Information 01 System Identification or Name 1063 Banner Ridge Rd 02 System Location or Area Served Whole House 03 System Installation Type Alteration 04 Nominal Cooling Capacity (tons) of Condenser 4 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 2016-07-13 10 Airflow Rate Protocol utilized .: ' TRA3.3 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. Ol IMethod used to demonstrate compliance with theI 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. O1 Airflow Rate Measurement Type used for this airflow rate Traditional Flow Capture Hood according to procedure in verification. RA3.3.3.1.4 02 Manufacturer of Airflow Measurement Apparatus TSI 03 Model number of Airflow Measurement Apparatus 8371 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: 216-A0259003A-M2300002A-0000 Registration Date/Time: 2016-07-13 10:40:44 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-07-13 10:29:09 2013 Residential Compliance Schema Version: 0.555SDD CERTIFICATE OF INSTALLATION CF2R-MCH-23-H Space Conditioning System Airflow Rate (Page 3 of 3 Documentation Author's Declaration Statement 1.1 certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Seri Jankozian Company: Signature Date: 2016-07-13 10:39:01 Rapid Duct Testing & Air Balancing Address: CEA/ HERS Certification Identification (if applicable): 401 N Verdugo Rd Suite C City/State/Zip: Phone: Glendale CA 91206 1818-468-5744 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 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. 1 understand that a HERS rater will check the installation to verify compliance, and that if such checking identifies defects; lam required to take corrective action at my expense.II 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'bya HERS rater,:and if,those installations fail to meet the - requirements of such quality assurance checking, the required corrective action and additional checking/testing of -other installations in that -HERS sample group will be performed at my expense. 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 I have ensured 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 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 Installation is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Builder/Installer Name: Responsible Builder/Installer Signature: Archie McLay G Company Name: (Installing Subcontractor or General Contractor or Position With Company (Title): 61 Builder/Owner) Owner MCLAY SERVICES INC Address: CSLB License: 2036 ARROW HWY 751629 City/State/Zip: Phone: Date Signed: LA VERNE CA 91750 909-392-2202 2016-07-13 10:40:44 Third Party Quality Control Program (TPQCP) Status: Name of TPQCP (if applicable): Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider responsibility for the accuracy of the information. Registration Number: 216-A0259003A-M2300002A-0000 Registration Date/Time: 2016-07-13 10:40:44 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-07-13 10:29:09 2013 Residential Compliance Schema Version: 0.555SDD CERTIFICATE OF INSTALLATION CF2R-MCH-25-H Refrigerant Charge Verification (Page 1 of 4 ) Project Name: 1063 Banner Ridge Rd Enforcement Agency: City of Diamond Bar Permit Number: PR161197 Dwelling Address: 1063 Banner Ridge Rd City: Diamond Bar Zip Code: 91765 A. System Information Each system requiring refrigerant charge verification will be documented on a separate certificate. 01 System Identification or Name 1063 Banner Ridge Rd 02 System Location or Area Served Whole House 03 Condenser (or package unit) Make or Brand Carrier 04 Condenser (or package unit) Model Number 24VNA949A300 05 Nominal Cooling Capacity (tons) of Condenser 4 06 Condenser (or package unit) Serial Number 1016E11047 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 can be or RA3.2.2.7)? 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 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 55F (RA3.2.2, or RA1)? 13 Date of Refrigerant Charge Verification for this system 2016-07-13 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 MCH -25b - Refrigerant Charge Verification - Subcooling Method Registration Number: 216-A0259003A-M2500002A-0000 Registration Date/Time: 2016-07-13 10:40:44 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-07-13 10:30:09 2013 Residential Compliance Schema Version: 2013.1.007 CERTLjICATE OF INSTALLATION CF2R-MCH-25-H Refrigerant Charge Verification (Page 4 of 4 ) Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: I I Serj Jankozian Company: Signature Date: 2016-07-13 10:39:01 Rapid Duct Testing & Air Balancing Address: CEA/ HERS Certification Identification (if applicable): 401 N Verdugo Rd Suite C City/State/Zip: Phone: Glendale CA 91206 1818-468-5744 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 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. q r' 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.] understand that EnergVCommission 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 faii.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.- xpense. 5. 1 reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the specific requirements for the scope of 5. 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. 1 will ensure that a registered copy of this Certificate of Installation 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 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 Builder/Installer Name: Responsible Builder/Installer Signature: Archie McLay p, f�fZGP� C Company Name: (Installing Subcontractor or General Contractor or Position With Company (Title): 61 Builder/Owner) Owner MCLAY SERVICES INC Address: CSLB License: 2036 ARROW HWY 751629 City/State/Zip: Phone: Date Signed: LA VERNE CA 91750 909-392-2202 2016-07-13 10:40:44 Third Parry Quality Control Program (TPQCP) Status: Name of TPQCP (if applicable): Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider responsibility for the accuracy of the information. Registration Number: 216-A0259003A-M2500002A-0000 Registration Date/Time: 2016-07-13 10:40:44 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-07-13 10:30:09 2013 Residential Compliance Schema Version: 2013.1.007