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Home My WebLink AboutPR16-1118D WAV BAR CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY &DEVELOPMENT SERVICES 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 1I '� 20 jb.;Uo APN LOT�� TRACT OWNER Ra /Liwil r f eL ft D %iA ADDRESS t 3 b lI AA CITY 13 ZIP 41VJ TEL. Z APPLICANT era %i2A,,, t.t.J TEL. l e -7 3 S` -7 CONTRACTOR ADDRESS N l b 5fr &.' Id ex , d a!rc CITY 1" r>. -pr Y� ZIP '15 .� TEL. AJ7/ tAO 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, alter, improve, demolish, or repair, any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9) Commencing with Section 7000 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 1, 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,) 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: 9- SID LIC. NO.: '774 Z Dq DATE: r4t4 CONTRACTOR: WORKER'S COMPEfRSATIONJ4ECLARATION 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 Number are CARRIER POLICY NUMBER 4Y YIj 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 if I should become subject to the Worker's Compensate n pmvisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. DATE: �APPLICANT: 7+,/// WARNING: Failure to secure Worker's Comp�Yhrage is unlawful, and shall�s lect 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. I 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. 1? V tZi�I✓��.t PERMITTEE NAME (PRIN 01 SIGNATURE OF PER �E DATE APPLICATION DATE: ` ISSUE DATE:Jn TYPE CONST. /kC& P/C# //hr OCC GROUP: ';f Scope of Work U C n a # DWEL. UNITS If ST n "1'C A r JJ DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport LU Patio/Deck LU u- Pool/Spa ZRe -Roof Commercial DO DO Valuation: Adj. Area: QUANTITY DESCRIPTION FEE U Q U J W co z m J rl r- 93 U CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: hili L'% INSPECTION FEE: ISSUANCE: SMIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: y�G BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: AM, P/C: q PAID BY: yy VALIDATION: RECEIPT # PAID BY: VALIDATION WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy CITY OF DIAMOND BAR IJ INSPECTION RECORD INSPECTION DATE INSPECTOR SETBACK/ LETTER FOOTINGS FORMS SLAB UG. PLUMBING UG. ELECTRI ' x ` `•,r! p' UFER GROU r..'" "' yr SEWER LATERALU4 LLT: s 4� �r , 9 , :' !s MAIN WATER LIN C0 SEWER CLEANOUT ROOF SHEATHING FLOOR SHEATHING SHEAR WALLS EXTERIOR SHEAR WALLS INTERIOR FRAMINGNENTING ROUGH MECHANICAL ROUGH ELECTRICAL W( ) C ( ) 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 AAW r, FINAL ELECTRICAL FINAL PLUMBING T.C. of OCCUPANCY CERT. of OCCUPANCY COMMENTS: INSPECTION DATE O. TRACT AND LEDGER SWITCH GEAR COMMERCIAL HOOD T -BAR INTERCEPTER HOT MOP/SHOWERPAN SEPTIC/CESSPOOL HERS REPORT RECEIVED q / DEMOLITION ROOF DRAINS ROUGH CONDUIT POOUSPA 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 1sT( )2 ND( ) 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 ALTERATIONS - HVAC C=C CF1R-ALT-04=E �,Reysed 06114:: CALI-CRl71A ENERGY CG:LIF:AISS'ON CERT!F1CATE QP CO!V1PLIP.NCE CHR-ALTAM-E lterat ans -HVAC CZ 2, and 8-15 ;formerly CF -IR -ALT -HVAC) (Page 1 of 1) ! _ .-,.•:y- --_. 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. �. HVAC Changeout/Repair Required Compliance Documents to be left on site for Final: All Equipment, CFIR-ALT-02-E Condenser Unit, Evaporator Coil, 13 jr— 110 CF3R: MECH-20-HERS, MECH-(23 or 24) -HERS', MECH-25-HEP,S' Air Handler/Furnace' (Can include new ducting) or Installer Requirement: Duct leakage L15%, or < 10% to outside, or seal all accessible leaks), Air Flow >: 300 CFM/ten, Refrigerant Charge. Equipment Type 111. Duct system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of duct in unconditioned space, or Equipment Efficien cy Refired R -value ! Floor Area (sq ft) � T r:�r.� ostat i ❑ ?ackaoed Sy—m0 yaporator Coil condensing I ! AFUE CO. i ❑ R-6 (CZ 2, 8-13) rutting I Served by System Setback j (: natatready ! El split- System I Unit Cl � ( 11R-8' (211, 14', 15J Ducting, qft � present, must ❑ Mini Split E Compressor I SEEP i HS -F ! ❑ R 6 (a;l 2's) Plenums Exempted from duct leakage testing if: ❑ 1. Existing duct systems are constructed, insulated or sealed with asbestos �� QFurnace ❑ Lineset r Tv;; i EER ! f ❑ R-5 or R7.-) L:neset' ' Heating only systems and Air Handler/Furnace changes do not require Air Flow MECH-(23 or 24), or Refrigerant Charge verification MECH-25 ice irste,le�rJ i HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options belo-.u. At permit application this I 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. �. HVAC Changeout/Repair Required Compliance Documents to be left on site for Final: All Equipment, CFIR-ALT-02-E Condenser Unit, Evaporator Coil, CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24)' -HERS, MECH-25-HERS' Compressor, TXV, Lineset, CF3R: MECH-20-HERS, MECH-(23 or 24) -HERS', MECH-25-HEP,S' Air Handler/Furnace' (Can include new ducting) Installer Requirement: Duct leakage L15%, or < 10% to outside, or seal all accessible leaks), Air Flow >: 300 CFM/ten, Refrigerant Charge. Exempted from duct leakage testing if: 111. Duct system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of duct in unconditioned space, or 113. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building 112. New HVAC System Required Compliance Documents to be left on site for Final All new equipment and All New Ducts' CF111-ALT-02-E including Mini Split CF2R: MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS', MECH-25-HERS2 CF3R: MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS', MECH-25-HERSZ Mini Splits require CFIR-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 _ ❑ 3. All New Ducts with Replacement Y Required Compliance Documents to be left on site for Final. All New Ducts' and one or more of the following CFIR-ALT-02-E replaced: Condenser Unit, Evaporator Coil, CF2R: MECH-01, PAECH-20-HERS, PAECH-(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 Required Compliance Documents to be left on site for Final New ducting but less than All New Ducts' CFIR-ALT-02-E CF2R: MIECH-20 HERS, CF3R: MECH 20 -HERS Installer Required to: Duct leakage (S_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. ' 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 W' 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 t-Docasrentation Author's /Responsible Designer'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 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 i provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement i agency for approval with this building permit application. Responsible Designer Name: Responsible Designer Signature: Date Signed: License: Company: Ad ss: G y%State/L'p: Phone: co i •� y / For assistance or questions regarding the Energy 5tandaros, contact the tnergy novme ar: i-avu-1 is—V- CERTIFICATE OF VERIFICATION CF3R-MCH-20-H Duct Leakage Diagnostic Test (Page 1 of 3 ) Project Name: BONNIE PALLOTTA Enforcement Agency: City of Diamond Bar Permit Number: pr161118 Dwelling Address: 1435 ROLLING KNOLL ROAD City: Diamond Bar Zip Code: 91765 A. System Information 01 Space Conditioning System Identification or Name System 1 02 Space Conditioning System Location or Area Served Location 1 03 Building Type from CF -1R Single family 04 Verified Low Leakage Ducts in Conditioned Space No, credit is not taken 05 (VLLDCS) Credit from CF1R? Total leakage 05 Verified Low Leakage Air Handling Unit Credit from No, credit is not taken 07 CF1R? Cooling system method 06 X34 , Duct System Compliance CategoryQF Alteration 09 Calculated Target Allowable Duct Leakage Rate (cfm) 300 . y .... MCH -20d - Complete Replacement or AlteredDuct`System - - B. Duct Leakage Diagnostic Test 01 Condenser Nominal Cooling Capacity (ton) 5 02 Heating Capacity (kBtu/h) 0 03 Conditioned Floor Area served by this HVAC system (ft2) 2300 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) 300 10 Actual duct leakage rate from leakage test measurement (cfm) 299 F-11 Compliance Statement: System passes leakage test Registration Number: 216-A0165835A-M2000002A-M20A Registration Date/Time: 2016-05-31 11:20:46 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-31 10:22:03 2013 Residential Compliance I 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. 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 02 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. ,,..... If the system complies using the Smoke;Test method tWsmoke test was conducted in accordance with the requirements 07 of Reference Residential Appendix RA3'1.4 3 6 Systems that comply using smoke test shallnot be included in'sample groups for HERS verification compliance: � . V-� _ 08 Verification Status - lare mete --- ss - all applicable requirements PP 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 I Complies: All specified verification protocol requirements on this document are met. Registration Number: 216-A0165835A-M2000002A-M20A Registration Date/Time: 2016-05-31 11:20:46 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-31 10:22:03 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: � Ian Jacoby can dacobJt Company: Date Signed: i PERMIT E RATERS 2016-05-31 10:23:42 Address: CEA/ HERS Certification Identification (if applicable): 31225 La Baya Drive #213 City/State/Zip: Phone: West Lake Village CA 91362 818-735-7876 Responsible Person's Declaration statement I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Verification is true and correct. 2. 1 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`'the Certifica2e(s) of Installationi(CF212) signed and sutimitte'd3'by the person(s) responsible for the construction or installation conforms to the requirements specified on the Cert ficate(s) of Compliance (CF,1R) approved by,,the enforcement agency. &de.available � 5. 1 will ensure thata registered copy of this Certificate of Verification shall be posted or s with he�building permit(s ssued for the applieab�le I'unde and`that a registered, copy of this;Certificate of building, and made available to the,enforcement atatgency,for all inspections Verification is required to be'jncluded with the documenion the bwlderprovides to the building owner at occupancy. Of Builder Or Installer Information As Shown On'The"'Certificate Installation Company Name (Installing Subcontractor, General Contractor, or Builder/Owner): W C HEATING & AIR CONDITIONING INC Responsible Builder or Installer Name: CSLB License: Rusty Cochran 779604 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: i PERMIT E RATERS Responsible Rater Name: Responsible Rater Signature: Richard Douthit Responsible Rater Certification Number w/ this HERS Provider: Date Signed: CC2006570 2016-05-31 11:20:46 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-A0165835A-M2000002A-M20A Registration Date/Time: 2016-05-31 11:20:46 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-31 10:22:03 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: BONNIE PALLOTTA Enforcement Agency: City of Diamond Bar Permit Number: pr161118 Dwelling Address: 1435 ROLLING KNOLL ROAD City: Diamond Bar Zip Code: 91765 A. Ducted Cooling System Information 01 System Identification or Name System 1 02 System Location or Area Served Location 1 03 System Installation Type Alteration 04 Nominal Cooling Capacity (tons) of Condenser 5 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 syste4W SIFF20,m 08 System Bypass Duct Status` NoBypassDuct 09 Date of System Airflow Rate"Weasurement x 2016.05-25 - t; . 10 Airflow Rate Protocol utilized w � fir... � �. ��._..� 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. 01 Method used to demonstrate compliance with the HSPP installed and labeled consistent with Figure RA3.3-1 HSPP/PSPP requirement C. Airflow Rate Measurement Apparatus and Procedure Information Instrument Specifications are given in RA3.3.1.1, and system airflow rate measurement apparatus information is given in RA3.3.2. Airflow Rate Measurement Type used for this airflow rate Traditional Flow Capture Hood according to procedure in 01 verification. RA3.3.3.1.4 02 Manufacturer of Airflow Measurement Apparatus ALNOR 03 Model number of Airflow Measurement Apparatus EBT731 Certification Status of the Airflow Measurement Apparatus Certified by Manufacturer and listed on CEC Website at 04 Accuracy http://www.energy.ca.gov/title24/equipment—cert/ama—fas /index.html Registration Number: 216-A0165835A-M2300002A-M23A Registration Date/Time: 2016-05-31 11:20:46 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-31 10:22:42 2013 Residential Compliance Schema Version: 0.555SDD 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) 1500 03 Actual System Airflow Rate Measurement (cfm) 1769 04 Compliance Statement: System airflow rate complies E. Additional Requirements Air filters that meet the applicable requirements of.Standards Section 150.0(m)12 or 150.0(m)13 were properly installed in 01 the system during system air flow rate measurement identified on this Certificate of Verification. The airflow rate measurement apparatus used to performAhe airflow rate measurement�identified on th&Cert3ificatAf 02 Verification was calibrated in accordance with the apparat6s manufacturer's specif cations and conformso the instrumentation specifications given in RAS 3 1.3' Arm A visual inspection shall confirm that bypass ducts that d liver conditioned supply air directly to the space conditioning system return duct airflow are not used on newly constructed zonally controlled systems unless the Performance Certificate 03 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 (cfm/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: 216-A0165835A-M2300002A-M23A Registration Date/Time: 2016-05-31 11:20:46 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-31 10:22:42 2013 Residential Compliance Schema Version: 0.555SDD CERTIFICATE OF VERIFICATION CF3R-MCH-23-H Space Conditioning System Airflow Rate (Page 3 of 4 ) F. 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: 216-A0165835A-M2300002A-M23A Registration Date/Time: 2016-05-31 11:20:46 HERS Provider: CalCERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-31 10:22:42 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: Documentation Author Signature: �/ � Ian Jacoby cyan daeobI Company: Date Signed: i PERMIT E RATERS 2016-05-31 10:23:42 Address: CEA/ HERS Certification Identification (if applicable): 31225 La Baya Drive #213 City/State/Zip: Phone: West Lake Village CA 91362 818-735-7876 Responsible Person's Declaration statement I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Verification is true and correct. 2. 1 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 Ion this Certificate of Verification comply with the.applicable requirements in Reference Appendices RA2, RA3, and the requirements specifiedon, the Certificate of Compliance for the building approved by the enforcement agency. 4. The information reported on applica11 b 11 le sectionsf"the Certificates) of Installati11 on ( CUR I)rsigned and sUbmitted''by the per responsible for the �iw .1 1 � !W, , construction or installation conforms to the r'equirements�specified= the Certificates) of Compliance (CF1R) approved by the enforcementmgency. 5. 1 will ensure that -a registered copy of this Certificate of Verificatiowshall be posted or mad ailable with the building permits) issued for the building, and made available to the enforcement agency for all applicable inspections. I unde rstand.that a registeredicopy of,thKCertificate.of r o " w ri - 'R. _ .k $ 4�da'�` .l P Verification is required to be included with the documentation the builder provides to the building owner at occupancy. _... Builder Or Installer Information As Shown bn'The Certificate""Of Installation Company Name (Installing Subcontractor, General Contractor, or Builder/Owner): W C HEATING & AIR CONDITIONING INC Responsible Builder or Installer Name: CSLB License: Rusty Cochran 779604 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: i PERMIT E RATERS Responsible Rater Name: Responsible Rater Signature: / Richard Douthit `�Ci�^�,,�,,/ ` Responsible Rater Certification Number w/ this HERS Provider: Date Signed: CC2006570 2016-05-31 11:20:46 Digitally signed by CaICERTS. 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-A0165835A-M2300002A-M23A Registration Date/Time: 2016-05-31 11:20:46 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-31 10:22:42 2013 Residential Compliance Schema Version: 0.555SDD a ! 0." CERTIFICATE OF VERIFICATION CF3R-MCH-25-H Refrigerant Charge Verification (Page 1 of 4 ) Project Name: BONNIE PALLOTTA Enforcement Agency: City of Diamond Bar Permit Number: pr161118 Dwelling Address: 1435 ROLLING KNOLL ROAD City: Diamond Bar Zip Code: 91765 A. System Information HERS Rater to field -verify all system information, discrepancies to be noted by overwriting entry. 01 System Identification or Name System 1 02 System Location or Area Served Location 1 03 Condenser (or package unit) make or brand LENNOX 04 Condenser (or package unit) model number XC16-060-230-05 05 Nominal Cooling Capacity (tons) of Condenser 5 06 Condenser (or package unit) serial number , 5815LO1987 07 Refrigerant Type R-410A*t 08 Other Refrigerant Type (if6applicable) _ :"V"-, 1�k 44.5% 09 System Installation Type,Alteratiori , 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 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 RAI 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 RAI)? 13 Date of Refrigerant Charge Verification for this system 2016-05-25 Refrigerant charge verification method used. Subcooling (outdoor temperature must be equal to or 14 greater than 55 degF) Person who performed the Refrigerant Charge Verification HERS rater 15 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: 216-A0165835A-M2500002A-M25A Registration Date/Time: 2016-05-31 11:20:46 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-31 10:23:14 2013 Residential Compliance Schema Version: 2013.1.007 CERTIFICATE OF VERIFICATION CF3R-MCH-25-H Refrigerant Charge Verification (Page 2 of 4 ) MCH25b - Refrigerant Charge Verification - Subcooling Method B. Metering Device Verification - HERS Rater is required to visually field verify all information from CF2R Subcooling Method can only be used on systems that have a variable metering device. 01 Refrigerant metering device Thermostatic Expansion Valve (TXV) 02 Subcooling Method applicability status Subcooling Method is applicable to this system. C. Instrument Calibration - HERS Raters are required to calibrate their diagnostic tools. Procedures for instrument calibration are given in Reference Residential Appendix RA3.2.2 and RA3.2.2.2 01 Date of Digital Refrigerant Gauge Calibration 2016-05-01 02 Date of Digital Thermocouple Calibration 2016-05-01 03 Digital RefrigerantGauge Calibration Status Calibration is current 04 Digital Thermocouple Calibration Status � 4 ,- !-1CaliUr iici is currents ... � „- D. Measurement Access Hole (MAH) Verification -'HERS Raters"are required to visually:•fieldverify MAH Procedures for installing MAH arespecifiedli,n,y eference Residential Appendix:RA3 2:2.3 R; 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) 1500 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 73 the refrigerant charge verification procedure (degreeF) Measured Condenser air entering dry-bulb temperature (T 71 02 condenser, db) 03 Outdoor Temperature Qualification Status Outdoor temperature is within range for using Subcooling refrigerant charge verification method Registration Number: 216-A0165835A-M2500002A-M25A Registration Date/Time: 2016-05-31 11:20:46 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-31 10:23:14 2013 Residential Compliance Schema Version: 2013.1.007 CERTIFICATE OF VERIFICATION CF3R-MCH-25-H Refrigerant Charge Verification (Page 3 of 4 ) 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 04 Measured Liquid Line Temperature (Tiiquid) (degree F) 74 05 Measured Liquid Line Pressure (PGgwd) (pisg) 241 06 Condenser saturation temperature (Tcondensor, Sat) from digital 81 gauge or P -T Table using Line F05 (degree F) 07 Measured Subcooling 7 08 Target Subcooling 7 04 Compliance Statement: System complies with Subcooling Method - Must also pass metering device verification, next 09 section G. Metering Device: Verification Procedures for the verification of proper metering device operation are specified in RA3.2.2.6.2 01 Measured Suction line temperature (T(degreeF)- 57r. DOWN suction) 02 Measured Suction line prdssure'(Psuction) (ps) '"103 Evaporator saturation temperature (Tevapo ato,,sat)Nfhom� 33 03 digital gauge or P -T Table using line G02 (degreeF) 04 Measured Superheat 24 05 Measured Superheat is between 3 and 26 deg F (inclusive) Passes CEC requirement Measured Superheat is within manufacturer's specifications, Not known 06 if known 07 Compliance Statement: Metering device verification passes H. Determination of HERS Verification Compliance All applicable sections of this document shall indicate compliance with the specified verification protocol requirements in order for this Certificate of Verification as a whole to be determined to be in compliance. O1 1 Complies: All specified verification protocol requirements on this document are met. Registration Number: 216-A0165835A-M2500002A-M25A Registration Date/Time: 2016-05-31 11:20:46 HERS Provider: CalCERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-31 10:23:14 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: �/ /' Ian Jacoby cyan dacobJt. Company: Date Signed: i PERMIT E RATERS 2016-05-31 10:23:42 Address: CEA/ HERS Certification Identification (if applicable): 31225 La Baya Drive #213 City/State/Zip: Phone: West Lake Village CA 91362 818-735-7876 Responsible Person's Declaration statement I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided'on this Certificate of Verification is true and correct. 2. 1 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 1. of the Certificates) of,•,Installaiion`i(CF2R) signed`and.submittedlby the person(s) responsible for the construction or installation conforms to the requiremenmspeci ec! n the Certificates) of Compliance (CF1Rapproved by he enforcement,agency. 11 -) 5. 1 will ensure that a registered copy,of this Certificate of verificationshall be posted; or made ayailabI6 with the,.building permit(s) issued for the u,.. building, and made available to the,enforcemennt,agency for all applicable inspections. I nderstand that a registere6copy ofthi Certiflcaf of Verification is required to be included with the documentation the builder provides to tiie building owner at occupahcy. Builder Or Installer Information As Shown On The"Certificate"Of Installation Company Name (Installing Subcontractor, General Contractor, or Builder/Owner): W C HEATING & AIR CONDITIONING INC Responsible Builder or Installer Name: CSLB License: Rusty Cochran 779604 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: i PERMIT E RATERS Responsible Rater Name: Responsible Rater Signature: (__ /�j) y.� Richard Douthit C�Ci;^� k/6'f`C��L(/ Responsible Rater Certification Number w/ this HERS Provider: Date Signed: CC2006570 2016-05-31 11:20:46 Digitally signed by CaICERTS. 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-A0165835A-M2500002A-M25A Registration DateTime: 2016-05-31 11:20:46 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-31 10:23:14 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: BONNIE PALLOTTA Enforcement Agency: City of Diamond Bar Permit Number: pr161118 Dwelling Address: 1435 ROLLING KNOLL ROAD City: Diamond Bar Zip Code: 91765 A. General Information 01 Dwelling Unit Name BONNIE PALLOTTA 02 Climate Zone 9 03 Dwelling Unit Total Conditioned Floor 2300 04 Number of Space Conditioning 1 CFA served Area (ft2) Installing aInstalling new SC Systems in this Dwelling Unit. Installing 05 Certificate of Compliance Type Prescriptive alterations (CF1R-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 (ftZ) ducted (gtuh ) components? 09 Dwelling Unit Number of Bedrooms 3 MCH -01b Prescriptive Alterations - Space Conditioning Systems Ducts nd Fans �= B. Space Conditioning (SC) System Information E kr M O1 02 03 04 05 06 07 08 09 10 SC System SC System CFA served Is the SC Installing aInstalling new SC Installing more Installing Installing Identification or Location or Area by this SC a systemsystem refrigerant than 40 feet of entirely new entirely new SC Alteration Type Name Served System (ftZ) ducted containing components? ducts? duct system? system? system. component. Altered space System 1 Location 1 2300 Yes Yes Yes No No No conditioning system Registration Number: 216-A0165835A-M0100002A-0000 CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: 2016-05-31 10:21:37 Report Version: 2013 Rev 1.007 Schema Version: 2013.1.007 HERS Provider: CaICERTS Report Generated: 2016-05-31 10:18:43 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 2 of 7 ) C. Space Conditioning (SC) System Alterations Compliance Information 01 02 03 04 05 06 07 08 09 10 it 12 13 Rated Heating Capacity, Name Heating Efficiency Type; Value a Manufacturer Model Number nu nber Output (BTUH) -oil*x, - _ a ? .- W Central Fan fir, a , System 1 AFUE 0.8 LENNOX �C-03 SL280UH090XV60 5915G27y7729 70 Notes: Integrated Heating Cooling New or (CFI) System Altered Heating Minimum Altered Cooling Minimum Required Replaced New Ventilation Identification Heating Heating Efficiency Efficiency Cooling Cooling Efficiency Efficiency Thermostat Duct Duct System or Name System Type Component Type Value System Type Components Type Value Type Length R -Value Status All new All new System 1 Central gas heating AFUE 0.8 Central cooling SEER 16 Setback LTE40Ft R6 Not a CFI furnace componen split AC components system is D. Installed Heating Equipment Information 01 02 _93 04-y„ 05 _ 06 07 System Identification or 1-161 ng Efficiency t Heat ng^U ) Heating Unit Heatin&Unit serial Rated Heating Capacity, Name Heating Efficiency Type; Value a Manufacturer Model Number nu nber Output (BTUH) -oil*x, - _ a ? .- W L fir, a , System 1 AFUE 0.8 LENNOX �C-03 SL280UH090XV60 5915G27y7729 70 Notes: Registration Number: 216-A0165835A-M0100002A-0000 Registration Date/Time: 2016-05-31 10:21:37 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016 -OS -31 10:18:43 Schema Version: 2013.1.007 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 3 of 7 ) E. Installed Cooling Equipment information 01 02 03 04 05 06 07 08 Condenser or Package Unit System Identification or Name Cooling Efficiency Type Cooling Efficiency Value Condenser or Package Unit Manufacturer Condenser or Package Unit Model Number Condenser or Package Unit Serial Number System Rated Cooling Capacity at Design Conditions (BTUH) Condenser Rated Nominal Capacity (ton) System 1 SEER 16 LENNOX XC16-0050-230- 58151-01987 60000 5 Notes: H. Installed Air Filter Device Information This section does not apply to this project. I. Air Filter Device Requirements This section does not apply to this project. Registration Number: 216-A0165835A-M0100002A-0000 Registration Date/Time: 2016-05-31 10:21:37 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-05-31 10:18:43 Schema Version: 2013.1.007 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 4 of 7 ) J. HERS Verification Requirements 01 02 03 04 05 06 07 08 09 10 MCH2O MCH21 MCH22 MCH23 MCH25 MCH28 Exemption from Minimum Exemption R -Value for AHU System SC System From Duct Duct Ducts In Ducts Located AHU Fan Airflow Identification or Location or Area Leakage Leakage Conditioned In Cond Space Efficacy Rate Refrigerant Return Duct Design Name Served Requirements Test Space Verification (W/cfm) (cfm/ton) Charge Table 150.0-C or D System 1 Location 1 No Yes No No No Yes Yes No exemptions Exemption Notes: Registration Number: 216-A0165835A-M0100002A-0000 Registration Date/Time: 2016-05-31 10:21:37 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-05-31 10:18:43 Schema Version: 2013.1.007 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 5 of 7 ) K. Space Conditioning Systems, Ducts and Fans Mandatory Requirements and Additional Measures Note: Additional mandatory requirements from Section 150.0 that are not listed here may be applicable to some systems. These requirements may be applicable to only newly installed equipment or portions of the system that are altered. Existing equipment may be exempt from these requirements. Heating Equipment Equipment Efficiency: All heating equipment must meet the minimum efficiency requirements of Section 110.1 and Section 110.2(a) and the Appliance Efficiency 01 Regulations. Controls: All unitary heating systems, including heat pumps, must be controlled by a setback thermostat. These thermostats must be capable of allowing the occupant 02 to program the temperature set points for at least four different periods in 24 hours. See Sections 150.0(i), 110.2(b). Sizing: Heating load calculations must be done on portions of the building served by new heating systems to prevent inadvertent undersizing or oversizing. See sections 03 150.0(h)1 and 2). Furnace Temperature Rise: Central forced -air heating furnace installations must be configured to operate at or below the furnace manufacturer's maximum 04 inlet -to -outlet temperature rise specification. See Section 150.0(h)4. . 05 Standby Losses and Pilot Lights: Fan -type central furnacesima of havea con—tin uouslyburning pilotAlightSe tion 110.5and Section 110.2(d). 6 'Aw v Cooling Equipment � 0 All rnbst'meet the°minimum efficiency requirements of Section 110.1 and Section 110'2(a) and the Appliance Efficiency 06 Equipment Efficiency: cooling equipment Regulations. Refrigerant Line Insulation: All refrigerant line insulation in split system air conditioners and heat pumps must meet the R -value and protection requirements of Section 07 150.0(j)2 and 3, and Section 150.0(m)9. 08 Condensing Unit Location: Condensing units shall not be placed within five (5) feet of a dryer vent outlet. See Section 150.0(h)3A. Sizing: Cooling load calculations must be done on portions of the building served by new cooling systems to prevent inadvertent undersizing or oversizing. See Section 09 150.0(h)1 and 2. Air Distribution System Ducts, Plenums and Fans Insulation: In all cases, unless ducts are enclosed entirely in directly conditioned space, the minimum duct insulation value is R-6. Note that higher values may be 30 required by the prescriptive or performance requirements. See Section 150.0(m)1. Registration Number: 216-A0165835A-M0100002A-0000 Registration Date/Time: 2016-05-31 10:21:37 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-05-31 10:18:43 Schema Version: 2013.1.007 CERTIFICATE OF INSTALLATION CF2R-MCH-01-E Space Conditioning Systems, Ducts, and Fans (Page 6 of 7 ) K. Space Conditioning Systems, Ducts and Fans Mandatory Requirements and Additional Measures Note: Additional mandatory requirements from Section 150.0 that are not listed here may be applicable to some systems. These requirements may be applicable to only newly installed equipment or portions of the system that are altered. Existing equipment may be exempt from these requirements. Connections and Closures: All installed air -distribution system ducts and plenums must be, sealed and insulated to meet the requirements of CMC Sections 601.0, 602.0, 603.0, 604.0, 605.0 and ANSI/SMACNA-006-2006: Supply -air and return -air ducts and plenums must be insulated to a minimum installed level of R-6.0 or 11 enclosed entirely in directly conditioned space as confirmed through field verification and diagnostic testing in accordance with the requirements of Reference Residential Appendix RA3.1.4.3.8. Heat Pump Thermostat 12 A thermostat shall be installed that meets the requirements of Section 110.2(b) and Section 110.2(c). 13 The thermostat shall be installed in accordance with the manufacturers published installation specifications 14 First stage of heating shall be assigned to heat pump heating. 15 Second stage back up heating shall be set to come.on only when the indoor set temperature cannot be met. The responsible person signature on this compliance document affirms�': that all applicable;requirements in`this table have bepilien met. Registration Number: 216-AO165835A-MO100002A-0000 .4T 4 Registration Date/Time: 2016-05-31 10:21:37 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016 -OS -31 10:18:43 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: //// J,n Jacoby, Ian acoc Company: Signature Date: i PERMIT E RATERS 2016-05-31 10:21:03 Address: CEA/ HERS Certification Identification (if applicable): 31225 La Baya Drive #213 City/State/Zip: Phone: West Lake Village CA 91362 818-735-7876 Responsible Person's Declaration statement I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Installation is true and carred. 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 WK authorized representative of the responsible builder/installer. _' applicable the 3. The constructed or installed features, materials, components or mariufaduredidevices,(the installation) identified on this Certificate of Installation conforms to all codes and regulations, and 4- i4 a3, p as by the agency. installation conforms to the requirements given on the plans and specificationsapproved enforcement -- 4. I reviewed a copy of the Certificate of Compliance approved by the enforcement agency that-identifi the specific equirementsJor the scope oft, owjruction or iinstallation identified on this Certificate of Installation, and I have ensured that the requiremethat apply to the construction or installation have been met. nts X7 # g py,of this Certificate of Installation shall be posted, or made available with the building permit(s) issued for the building and madeYavailable to the enforcement agency for all 5. I will ensure that a registered co applicable inspections. I understand that a registered copy of this Certificate o?1nstallation is required to be included with the documentation the Builder p"i'ovides to the building owner at occupancy. Responsible Builder/Installer Name: Responsible Builder/Installer Signature: /� eear� Cochran, Rusty Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Position With Company (Title): W C HEATING & AIR CONDITIONING INC EMPLOYEE Address: CSLB License: 25976 MADISON AVE 779604 City/State/Zip: Phone: Date Signed: MURRIETA CA 92562 951-600-0700 2016-05-31 10:21:37 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-A0165835A-M0100002A-0000 Registration Date/Time: 2016-05-31 10:21:37 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-05-31 10:18:43 Schema Version: 2013.1.007