HomeMy WebLinkAboutPR16-1148D IOND
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) 839-7 27 FIRMLY
BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarca.gov
JOB SITE ADDRESS —4
APN LOT TRACT
OWNER L:O Sd
4SS 1 V'iZ� Q 1,
CITW.—JL Ofd \ TEL.
APPLICANT
CONTRACTOR NC���.0 D 4.1E -
ADDRESS ' �1
CITY(f'�Lf rJO�f_h ZIP GEL. b
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
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 1, 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: hftp/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: IC. NO.:
ATE: S^ C ZG CONTA(
WORKER'S COMPENS TION DECLARATI
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.
1 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 Carder and
Policy Numbe
CARRIER£^ V 151-4 L
POLICY NUMBER Kai' DO i OZ
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100) OR LESS).
I cergfy 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 became subject to the Worker's
Compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
DATE: APPLICANT:
WARNING: Failure to secure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal
penalties and.civil fines up to one hundred thousand dollars ($100,000), in addition to the cast of the compensation,
damages as provided for in section 3708 of the labor code, interest, and attorney's fees.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a Construction Lending Agency for the performance of the work for
which this permit is issued (Sec. 3097, Civ. C.).
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I have read this application and state that the above information is correct. I agree to comply with all city and
county ordinances and state laws relating building construction, and hereby authorize representatives of this county to
enter upon the above-mentioned property f inspection purposes.
'iTE.yE- UC.E�
INT) ^ I
SIGNATURE OF PERMITTEE DATE
'APPLICATION DATE: S! \o I \L.
ISSUE DATE: S I �� 1(o PERMIT# :
TYPE CONST.
P/C#
T=R lta — \ A'4-$
OCC GROUP:
Scope of Work
# DWEL. UNITS # STORIES
# BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF
ADJ. AREA/VALUATION
SFR/ADD/REM
Garage/Carport
w
Patio/Deck
W
W
Pool/Spa
ZRe
-Roof
Commercial
m
Valuation:
Adj. Area:
QUANTITY DESCRIPTION FEE
U
w
J
W
CD
C 10
z
in
J
n.
E to
Vu r
vo G
U
U
CONSTRUCTION:
PLAN REVIEW:
ELECTRIC:
PLUMBING:
MECHANICAL:
LG \ • cnr
INSPECTION FEE:
ISSUANCE:
CJs • %�-
SMIP:
ENERGY P/C:
ENERGY PERMIT:
RETENTION FEE:
PRE -ALT FEE:
oO
BASF:
PLOT PLAN:
ZONING CLEARANCE:
TOTAL FEES
COMMENTS:
P/C: PAID BY:
RECEIPT # a I PAID BY:
VALIDATION:
VALIDATION:
WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy
� CITY OF DIY�MO(vD BAR
. INSPECTION RECORD
INSPECTION DATE
O.
SETBACK/ LETTER
FOOTINGS FORMS
SLAB
UG. PLUMBING
UG. ELECTRICAL
UFER GROUND
SEWER LATERAL
MAIN WATER LINE
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 `' ` `' �'' i;:•; ;.
LATH INTERIOR.
GAS TEST v, .:.m ircP .t a
SCRATCH COAT
ELECTRIC METER RELEASE
GAS METER RELEASE
SPECIAL INSPECTION
FINAL BUILDING
FINAL MECHANICAL /L
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
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 N0( ) 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
J I A I C Vt- UALrUNNIA
ALTERATIONS - HVAC
CEG�CF1 R-ALi 03-E Revised 01/16 CALIFORNIA ENERGY COMMISSION As
CERTIFICATE OF COMPLIANCE CF111-ALT-03-E
Alterations - HVAC CZ 1, 3 to 7 and 16 (Page 1 of 1)
Site Address: ^�
)tpU-v-rF-7-Q
Enforcement Agency:
Date Prepared:
Permit#:
A
Is --ccs_
Equipment Type
Equipment Efficiency
New: Ducting or Lineset
Required R -value
Conditioned
Floor Area (ft)
Thermostat
❑ Packaged System
M Evaporator Coil
AFUE
COP
❑ R-6 (CZ 1-10,12&13) Ducts
Served by system
W Setback
❑ Split System
M Condensing Unit
WSEER
❑ R-8' (CZ 11,14-16) Ducts
ft2
T not already
11 Furnace
❑Lineset
EER
HSPF
❑ > R-2.8 Lineset3
present must
be installed)
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.
1. HVAC Changeout/Repair
Required Compliance Documents to be left on site for Final:
(Can include new ducting)
All Equipment,
CF1R-ALT-02-E
Condenser Unit, Evaporator Coil,
CF2R: MCH -01, MCH -20-H
Air Handler/Furnace
CF3R: MCH -20-H
Installer Requirement: Duct leakage (5 15% or, 510% to outside, or seal all accessible leaks)
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 ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building ...... I
❑ 2. New HVAC System
Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts2
CF1R-ALT-02-E
CF2R-MCH-01-E, MCH -20-H, MCH -22-H, MCH -(23 or 24)-H
CF3R-MCH-20-H, MCH -22-H, MCH -(23 or 24) -HZ
Installer Requirement: Duct leakage < 5%, Fan Efficacy (0.58W/CFM), Air Flow >_ 350 CFM/ton (or Standards Table 150.0-13 / C alternative)
❑ 3. All New Ducts with Replacement Required Compliance Documents to be left on site for Final:
Includes replacing or installing All New CF111-ALT-02-E
Ducts' and one or more of the following: CF2R-MCH-01-E, MCH -20-H, MCH -(23 or 24)-H
Condenser Unit, Evaporator Coil, Furnace CF3R-MCH-20-H, MCH -(23 or 24)-H
Installer Requirement: Duct leakage < 5%, Air Flow >_ 350 CFM/ton (or Standards Table 150.0-B / C alternative)
❑ Exempted from duct leakage testing if 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:
Adding or replacing ducts in unconditioned
CF1R-ALT-02-E
space but less than All New Ducts2
CF2R-MCH-20-H
CF3R-MCH-20-H
Installer Required to: Duct leakage (: 15% or, < 10% to outside, or seal all accessible leaks)
❑ Exempted from duct leakage testing if existing duct systems are constructed, insulated or sealed with asbestos.
' All new ducting requires R-8 insulationwhen more than 40 ft installed in CZs 11 & 14-16 and R-6 in CZs 1-10, 12 & 13, and R-6 insulation when less
than 40 ft installed. This includes in walls, between floors etc.
2 A New Duct system is when the duct system is constructed of at least 75 %new duct material,_and up to 25%may consist of reused parts from the
dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, plenums, duct material.
3 R-2.8 (1" thick insulation) for linesets 1" and less.
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 build' ion.
Responsible Designer Name: n, Date Signeci: _ License:
Steve
oct 55
Company: A\dress:� /Zip: ���-1 Phone:
fart c. ,',�\i110
1) (b2 logs -5005
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300
CERTIFICATE OF COMPLIANCE CF111-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC) (Page 3 of 3 )
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
�Q J Q
Documentation Author Signature: / �&,�a i�aU2G(�U.ti
Madrigal, Michael
�{�� �U O
Company:
Signature Date:
MMC Duct Testing
2016-05-19 08:57:58
Address:
CEA/ HERS Certification Identification (if applicable):
36200 PARADISE RANCH ROAD
City/State/Zip:
Phone:
Castaic CA 91384
818-741-5856
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 Compliance is true and correct.
2. 1 am eligible under'Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer).
3. That the'energy features and performance specifications, materials; components, and manufactured devices for the building design of system design. identified on this Certificate of Compliance conform to the
requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations.
4. 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.
5. 1 will ensure that a registered copy of this Certificate of Compliance shall be 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 Compliance is required to be included with the documentation the builders to the building owner at occupancy.
Responsible Designer Name:
�provides
Responsible Designer Signature:
Lucey, Steve
Company:
Date Signed:
COMFORT ZONE INC
2016-05-19 13:13:08
Address:
License:
P 0 BOX 594
760955
City/State/Zip:
Phone:
GLENDORA CA 91740
626-963-8383
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-A0186573A-000000000-0000 Registration Date/Time: 2016-05-19 13:13:08 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-05-19 08:58:25
Schema Version: 0.555SDD
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:
Madrigal, Michael
Company:
Signature Date:
MMC Duct Testing
2016-05-20 09:59:00
Address:
CEA/ HERS Certification Identification (if applicable):
36200 PARADISE RANCH ROAD
City/State/Zip:
Phone:
Castaic CA 91384
1818-741-5856
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;:andthe -
iristaliation 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 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.
5. 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:
Lucey, Steve
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
Position With Company (Title):
COMFORT ZONE INC
Owner
Address:
CSLB License:
P 0 BOX 594
760955
City/State/Zip:
Phone:
Date Signed:
12016-05-20
GLENDORA CA 91740
1626-963-8383
10:37:35
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-AO186573A-M0100002A-0000 Registration Date/Time: 2016-05-20 10:37:35 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-05-20 09:51:12
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:
Michael Madrigal
QVC
Company:
Signature Date: 2016-05-20 09:59:01
MMC Duct Testing
Address:
CEA/ HERS Certification Identification (if applicable):
36200 PARADISE RANCH ROAD SPACE 6
City/State/Zip:
Phone:
Castaic CA 91384
818-741-5856
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; I am required to take
corrective action at my expense. I understand that Energy Commission and HERS Provider representatives will also perform quality assurance checking
of installations, including those approved as part of a sample group but not checked 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.
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:
Steve Lucey
p/
Company Name: (Installing Subcontractor or General Contractor or
PositionWith Company (Title):
Builder/Owner)
Owner
COMFORT ZONE INC
Address:
CSLB License:
P O BOX 594
760955
City/State/Zip:
Phone:
Date Signed:
GLENDORA CA 91740
626-963-8383
2016-05-20 10:38:32
Third Party 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 no way implies Registration Provider
responsibility for the accuracy of the information.
Registration Number: 216-A0186573A-M2000002A-0000 Registration Date/Time: 2016-05-20 10:38:32 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-20 09:53:31
2013 Residential Compliance Schema Version: 2013.1.007
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:
�GC�((W
Michael Madrigal
CAW
l
Company:
Signature Date: 2016-05-20 09:59:01
MMC Duct Testing
Address:
CEA/ HERS Certification Identification (if applicable):
36200 PARADISE RANCH ROAD SPACE 6
City/State/Zip:
Phone:
Castaic CA 91384
818-7,41-5856
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; I am required to take
corrective action at my expense. I understand that Energy Commission and HERS Provider representatives will also perform quality assurance checking
of installations, including those approved as part of a sample group but'not checked 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.
S. I reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the specific requirements for the scope of
construction or installation identified on this Certificate of Installation, and I.h,ave 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:
Steve Lucey
p/
Company Name: (Installing Subcontractor or General Contractor or
Positioh With Company (Title):
Builder/Owner)
Owner .
COMFORT ZONE INC
Address:
CSLB.License:
P O BOX 594
760955
City/State/Zip:
Phone: !
Date Signed:
GLENDORA CA 91740
626-963-8383
2016-05-20 10:38:54
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 no way implies Registration Provider
responsibility for the accuracy of the information.
Registration Number: 216-A0186573A-M2300002A-0000 Registration Date/Time: 2016-05-20 10:38:54 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-20 09:54:38
2013 Residential Compliance Schema Version: 0.555SDD
CERTIFICATE 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:
Michael Madrigal
�V/l
Company:
Signature Date: 2016-05-20 09:59:01
MMC Duct Testing
Address:
CEA/ HERS Certification Identification (if applicable):
36200 PARADISE RANCH ROAD SPACE 6
City/State/Zip:
Phone:,
Castaic CA 91384
818-741-5856
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; I am required to take
corrective action at my expense. I understand that Energy Commission and HERS Provider representatives will also perform quality assurance checking
of installations, including those approved as part of a sample group but not checked 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.
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 l 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.
I
Responsible Builder/Installer Name:
Responsible Builder/Installer Signature:
Steve Lucey
p�
Position With Company (Title):
Company Name: (Installing Subcontractor or General Contractor or
Builder/Owner)
Owner
COMFORT ZONE INC
Address:
CSLB License:
P 0 BOX 594
760955;
City/State/Zip:
Phone: -
Date Signed:
GLENDORA CA 91740
626-9.63-8383
2016-05-20 10:38:54
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 no way implies Registration Provider
responsibility for the accuracy of the.information.
Registration Number: 216-A0186573A-M2500002A-0000 Registration Date/Time: 2016-05-20 10:38:54 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-20 09:58:16
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:
Michael MadrigalU��P�
Documentation Author Signature: p
Company:
Date Signed:
MMC Duct Testing
2016-05-20 10:01:43
Address:
CEA/ HERS Certification Identification (if applicable):
36200 PARADISE RANCH ROAD SPACE 6
City/State/Zip:
Phone:
Castaic CA 91384
818-741-5856
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 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 Verification 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
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
I
Company Name (Installing Subcontractor, General Contractor, or Builder/Owner):
COMFORT ZONE INC
Responsible Builder or Installer Name:
CSLB License:
Steve Lucey.
760955
HERS Provider Data Registry Information
Sample Group Number (if applicable):
-T
Dwelling Test Status in Sample Group (if applicable)
Tested
i
HERS Rater Information
I '
HERS Rater Company Name:
MMC Duct Testing
Responsible Rater Name:
Responsible Rater Signature: L7 �
Michael Madrigal
Li��!CZPG
Responsible Rater Certification Number w/ this HERS Provider:
Date Signed:
CC2005738
2016-05-20 10:01:43
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-A0186573A-M2000002A-M20A Registration bate/Time: 2016-05-20 10:01:43 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-20 10:00:14
2013 Residential Compliance Schema Version: 2013.1.007
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:
Michael Madrigal
Documentation Author Signature: r� pp
W
clftt G
Company:
Date Signed:
MMC Duct Testing
2016-05-20 10:01:43
Address:
CEA/, HERS Certification Identification (if applicable):
36200 PARADISE RANCH ROAD SPACE 6
City/State/Zip:
Phone: .
Castaic CA 91384
81&741-5856
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 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 Verification 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
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):
COMFORT ZONE INC
Responsible Builder or Installer Name:
CSLB License:
Steve Lucey
760955
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:
MMC Duct Testing
Responsible Rater Name:
Responsible Rater Signature:
Michael Madrigal
:� 2ac
Responsible Rater Certification Number w/ this HERS Provider:
Date Signed:
CC2005738
2016-05-20 10:01:43
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-A0186573A-M2300002A-M23A Registration Date/Time: 2016-05-20 10:01:43 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-20 10:01:10
2013 Residential Compliance Schema Version: 0.555SDD
I
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: ' DD
Michael Madrigal
CA6Cf�ad
Company:
Date Signed:
MMC Duct Testing
2016-05-20 10:01:43
Address:
CEA/HERS Certification Identification (if applicable):
36200 PARADISE RANCH ROAD SPACE 6
City/State/Zip:
Phone:
Castaic CA 91384
818-741-5856
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 submitted by the person(s) responsible for the
construction or installation conforms to the requirementsspecified, on the Certificate(s) of Compliance (MR) 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 for all applicable inspections. 1 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):
COMFORT ZONE INC
Responsible Builder or Installer Name:
CSLB License:
Steve Lucey
760955
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:
MMC Duct Testing
Responsible Rater Name:
Responsible Rater Signature:
Michael Madrigal
Responsible Rater Certification Number w/ this HERS Provider:
Date Signed:
CC2005738
2016-05-20 10:01:43
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-A0186573A-M2500002A-M25A Registration Date/Time: 2016-05-20 10:01:43 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-20 10:01:36
2013 Residential Compliance Schema Version: 2013.1.007