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CITY OF DIAMOND BAR FINMM0
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 3 SW O 1. e—y-S+
APN LOT TRACT
OWNER 3CLk4e V v[,)to. r+ 5a 1 k/Pr
ADDRESS Z 3500 _4_ A_.J Gre�
CITYVV1C"Mostd Yclr ZIP 1 T65TEL. 9 Del
APPLICANT Kn tZ TEL. CRoa� lv�'-Olp7S
CONTRACTOR R
ADDRESS
CITY 08"(156 ZlP!J STEL. OD
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 reasons)
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 I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or U portions
of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Cade: 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 Cade 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 Professit9s Code, and my license is in full force and effect.
LICENSE CLASS: C I Ok(- t0� LIC' p: 7 6 5 b%
li
DATE: I.4 CONTRACTOR:
WORKER'S COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
I have and will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by
Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for
the performance of the work for which this permit is issued. My Worker's Compensation Insurance Carrier and
Policy Number are: /p
CARRIER L 1 D ri� L[
POLICY NUMBER 76 3
(MIS 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
Compensation provisions of Section 3700 of Wr Code, I shall forfhwi om y with those provisions.
DATE: - H-
WARNING: Failure to secure Worker's Compensal on covers Ia u1, and shall s bje t an employer to criminal
penalties and civil fines up to one hundred thousand dollars 00), 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 inspe ' n purposes.
r
PERMI EM (PRI T)
IGNATUR FPER TTEE DATE
APPLICATION DATE: 4I a
ISSUE DATE: 9-I �,5 I I to
TYPE CONST.
s I l �. P/C# �'—
PERMIT# : Vii )(0—
(0—TYPE
OCC GROUP:
Scope of Work S C D N d e fn sc r o YAK
ec �Vurmae& .9vr- a -i, eaf�
# DWEL. UNITS # STORIES # BEDROOMS
DESCRIPTION SQ. FT.
FACTOR PSF ADJ. AREA/VALUATION
SFR/ADD/REM
Garage/Carport
W
Patio/Deck
LU
ILL
Pool/Spa
ZRe
-Roof
o
Commercial
Z)
m
Valuation:
Adj. Area:
QUANTITY
DESCRIPTION FEE
U
U
w
J
w
co
z
Co
J
CL
;;�
i oM
L G
L)_
L)
ri
CONSTRUCTION:
PLAN REVIEW:
ELECTRIC:
PLUMBING:
MECHANICAL:b�-
INSPECTION FEE:
ISSUANCE:
�S
SMTP:
ENERGY P/C:
ENERGY PERMIT:
RETENTION FEE:
PRE -ALT FEE:
�. cxJ
BASF:
PLOT PLAN:
ZONING CLEARANCE:
TOTAL FEES
COMMENTS:
P/C: PAID BY: VALIDATION:
RECEIPT#C9A-I g'% PAID BY: VALIDATION:
WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy
(AaAmil CITY OF DItwMOND BAR
wasAINSPECTION 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
LATH INTERIOR A a
GAS TEST r s
SCRATCH COAT
ELECTRIC METER RELEASE
GAS METER RELEASE
SPECIAL INSPECTION
FINAL BUILDING
FINAL MECHANICAL cr
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( ) 2ND( ) LIFT
WALL BOND BEAM/
WALL DRAIN/ SEAL
WALL FINAL
R0. FRAMING PLANNING APPROVAL
ROUGH FIRE APPROVAL
FINAL FIRE DEPARTMENT
FINAL PLANNING
FINAL ENGINEERING/ PW
FINAL COMMUNITY SERVICES
FINAL HEALTH DEPT.
FINAL INDUSTRIAL WASTE
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC)
Project Name:
SALYER I Date Prepared:
CF1R-ALT-02-E
(Page i of 3 )
2016-04-22
A. General Information
CF111-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented,
use one MR -ALT --02 document for each dwelling unit.
01
Project Name
SALYER
02
Date Prepared
2016-04-22
03
Project Location
23504 SHADOW CREST PL
04
Building Type
Single family
05
CA City
Diamond Bar
06
Dwelling Unit Name
HOME
07
Zip Code
91765
08
Dwelling Unit Conditioned
2252
efrigerant
Installing new SC
Installing
Installing
Floor Area (ft2)
Identification or
Location or Area
bthis-SC-11."
Number of space conditioning
containing—
09
Climate Zone
9
10
(SC) systems in this dwelling
1
I Served I
ystem•(ft2)�
system?
unit.
components?
B. Space Conditioning (SC) System Information
01
02
03
04
05
06
07
08
09
10
r
/r
► Is
the SC_
Installing a _
SC System
SC System
CFA esFA rvedJ
systema
efrigerant
Installing new SC
Installing
Installing
Installing
Identification or
Location or Area
bthis-SC-11."
ducted
containing—
—J system /
more than 40
entirely new
entirely new
Name
I Served I
ystem•(ft2)�
system?
component?--
components?
-feet of�ducts?
duct system?
SC system?
Alteration Type
System 1
225.2)
2252
I
Yes
\___ Yes_
�No
No
No
Altered space
._Yes _
. _ _y
_ _�
conditioning system
V.Q. CIICIUy llIQLCIb H,-)7UU1C1L1UI1
C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)iDiib)
This section does not apply to this project.
- Registration Number: 316-A1024000A-000000000-0000
Registration Date/Time: 2016-04-22 08:03:17
HERS Provider: USERA
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-04-22 08:03:34
crho— vorc ,,,,• n «conn
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 2 of 3 )
D. Altered Space Conditioning System (Sections 150.2(b)1E and F)
01
02
03
04
05
06
07
08
09
10
11
12
Heating
Cooling
System
Heating
Altered
Heating
Minimum
Altered
Cooling
Minimum
Required
New or
Identification
System
Heating
Efficiency
Efficiency
Cooling
Cooling
Efficiency
Efficiency
Thermostat
Replaced
New Duct
or Name
Type
Components
Type
Value
System Type
Components
Type
Value
Type
Duct Length
R -Value
Central gas
No heating
Central split
All new
Less than or
System 1
furnace
component
AFUE
80
AC
cooling
SEER
14
Setback
equal to 40
R-6
altered
components
feet
Required Documentation:
CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums: R6.
CF2R-MCH-20-H & CF3R-MCH-20-H — Duct Leakage testing required when heating or cooling components are installed in ducted systems, or when more than 40 ft of duct length is replaced.
-Leakage rate compliance: <_ 15%, or <_ 109 leakage to outside, or seal all accessible leaks.
CF2R-MCH-25-H & CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15).
CF2RCF3R-MCH-23 & CF311-MCH-23 Air Flow >_ 300 CFM/ton required when MCH -25 is required.
Exceptions:
-Duct systems registered with HERS provider as previously sealed are exempt from MCH -20 Duct Leakage Testing requirements.
-Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flow MCH -23, or Refrigerant Charge MECH-25.
-Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Duct Leakage Testing requirements.
-Registration Number: 316-A1024000A-000000000-0000
Registration Date/Time: 2016-04-22 08:03:17
HERS Provider: USERA
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-04-22 08:03:34
crkamm Xmrcinn• n gcccnn
CERTIFICATE OF COMPLIANCE CF111-ALT-024
Alterations to Space Conditioning Systems (formerly CF-lR-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:
Documentation Author Signature:
Jim McEligot
Signature Date:
Company:
RighTime Home Services
2016-04-22
Address:
CEA/ HERS Certification Identification (if applicable):
3030 Myers St
765074
City/State/Zip:
Phone:
Riverside CA 92503
951-276-9744
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 or 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-maA 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 registereclxopy-of this Certificate.of-Compliance is required -to -be included with the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name: YY
Responsible Designer,5ignnature:
Jam/
Jim McEligot ( \
Y�
/ //—
Company ` J
`'-)
`- -- -f
Date�si ned:
RighTime Home S i es`�""
2016=04-22
Address:
3030 Myers St U.S. Energy Ra
License:
e5s74A1ssociation
City/State/Zip:
Phone:
Riverside CA 92503
951-276-9744
- Registration Number: 316-A1024000A-000000000-0000
TM
U.S. Energy Raters Association
"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 Date/Time: 2016-04-22 08:03:17
HERS Provider: USERA
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-04-22 08:03:34
c, -k.—, w—i,,,,• n ssscnn
CERTIFICATE OF INSTALLATION
CF2R-MCH-01-E
Space Conditioning Systems, Ducts, and Fans
(Page 1 of 7 )
Project Name: SALYER
Enforcement Agency: Diamond Bar Building
Department
Permit Number:
PR16-1042
Dwelling Address: 23504 SHADOW CREST PL
City: Diamond Bar
Zip Code:
91765
A. General Information
01
Dwelling Unit Name
SALYER
02
Climate Zone
9
07
Dwelling Unit Total Conditioned Floor
2252
04
Number of Space Conditioning
1
03
Area (ft2)
nftign
�rtAjtgQ�O
Systems in this Dwelling Unit.
Installing
05
Certificate of Compliance Type
Prescriptive alterations (CF1R-ALT)
06
Method used to Calculate HVAC Loads
ASHRAE_Handbook
containing
Calculated Dwelling Unit Sensible
60000
08
Calculated Dwelling Unit Heating Load
11000
07
Cooling Load (Btuh)
System (ft2)
system.
(Btuh)
components?
09
Dwelling Unit Number of Bedrooms
5
MCH -01b Prescriptive Alterations - Space -Condition i ng Systems -Ducts -and -Fans–
1
B. Space Conditioning (SC) System Information` v� 1
`
01 '�
__._102i t
�- 03 J
04 _-_ _
.. _ 05
ti ' , 06 —
07
08
09
10
SC System
SC System
CFA served
5',a
nftign
�rtAjtgQ�O
(aa�(jlnore
Installing
Installing
Identification or
Location or Area
by this SC
ducted
containing
system
than 40 feet of
entirely new
entirely new SC
Alteration Type
Name
Served
System (ft2)
system.
component.
components?
ducts?
duct system?
system?
Altered space
System 1
2252
2252
Yes
Yes
No
No
No
No
conditioning
system
Registration Number: 316-A1024000A-M0118266A-0000
Registration Date/Time: 2016-05-22 17:59:15
HERS Provider: USERA
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-05-22 17:59:20
Schema Version: 2013.1.007
00%4:
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
Condenser or Package Unit
System Identification
or Name
Cooling Efficiency
Type
U.S. E
Cooling Efficiency
Value
e
PacIdge Unit
Manufacturer
�ivsRa r�id&90
Package Unit
Model Number
f r er or
Package Unit
Serial Number
System Rated Cooling
Capacity at Design
Conditions (BTUH)
Condenser Rated
Nominal Capacity
(ton)
System 1
Central Fan
14.000
Rheem
RA1660AJlNA
W141629156
60000
5.0
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
This field
No heating
or
This field
All new
System 1
Central gas
componen
section is
or section
Central
cooling
SEER
14.000
Setback
LTE40Ft
R6
Not a CFI
furnace
t altered
not
is not
split AC
components
system
applicabl
applicable
e
D. Installed Heating Equipment Information
This section does not apply to this project.
1
1
E. Installed Cooling Equipment; information ..
\
01 1 j 02 , ` — 1
03
`04 - 05 —
— %V 06
07
08
f
Condenser or Package Unit
System Identification
or Name
Cooling Efficiency
Type
U.S. E
Cooling Efficiency
Value
e
PacIdge Unit
Manufacturer
�ivsRa r�id&90
Package Unit
Model Number
f r er or
Package Unit
Serial Number
System Rated Cooling
Capacity at Design
Conditions (BTUH)
Condenser Rated
Nominal Capacity
(ton)
System 1
SEER
14.000
Rheem
RA1660AJlNA
W141629156
60000
5.0
Notes:
Registration Number: 316-A1024000A-M0118266A-0000 Registration Date/Time: 2016-05-22 17:59:15 HERS Provider: USERA
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-05-22 17:59:20
Schema Version: 2013.1.007
awr
CERTIFICATE OF INSTALLATION CF2R-MCH-01-E
Space Conditioning Systems, Ducts, and Fans (Page 3 of 7 )
F. Extension of Existing Duct System, Greater Than 40 Feet
This section does not apply to this project.
G. Installed Duct System information
This section does not apply to this project.
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: 316-A1024000A-M0118266A-0000
U.S. Energy Raters Association
Registration Date/Time: 2016-05-22 17:59:15
HERS Provider: USERA
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-05-22 17:59:20
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
MCH20
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
2252
No
Yes
No
No
No
Yes
Yes
No
exemptions
Exemption
Notes:
I
Registration Number: 316-A3024000A-M0118266A-0000
U.S. Energy Raters Association
Registration Date/Time: 2016-05-22 17:59:15
HERS Provider: USERA
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-05-22 17:59:20
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(1), 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 furnaces may not have a continuously burning pilot light. Section 110.5 and Section 110.2(d).
Cooling Equipment
Equipment Efficiency: All cooling equipment must meet the minimum efficiency requirements of Section 110.1 and Section 110.2(a) and the. Appliance Efficiency
06
Regulatio {s. .?
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. -
50.0(m)9:08
08
Condensing Unit Location: Condensing units shall nPJAP., mr eR $c1AaZ00�j0(jection 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
10
required by the prescriptive or performance requirements. See Section 150.0(m)1.
Registration Number: 316-A1024000A-M0118266A-0000 Registration Date/Time: 2016-05-22 17:59:15 HERS Provider: USERA
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-05-22 17:59:20
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,
11
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
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 been met.
Registration Number: 316-A1024000A-M0118266A-0000
U.S. Energy Raters Association
Registration Date/Time: 2016-05-22 17:59:15
HERS Provider: USERA
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-05-22 17:59:20
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:
Jim McEligot
Signature Date:
Company:
RighTime Home Services
2016-05-22 ��A—Vmg
Address:
CEA/ HERS Certification Identification (if applicable):
3030 Myers St
765074
City/State/Zip:
Phone:
Riverside CA 92503
951-276-9744
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. I reviewed -a copy of the Certificate of Compliance approved -by -the enforcement agency that identifies the specific requirements for the scope of construction or installation identified on this Certificate of
Installation, and I have ensured thafthe r quicementsthat apply to the construytion,or installation have'been met. j
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/1 6staller Name:-
Responsible Builder/Installer Signature:
/•
Jim McEligof
Company Name: (Instal ling.Subcontracto(or General.Coontractctorxf Builder/Owner) ,
Position With Company (Title):
RighTime Home Services
-J, McEligot(May 2,2016)
Address:Energ
c
030Myers St
765074
ty/State/Zip:
rC
Phone:
Date Signed:
12016-05-22
iverside CA 92503
951-276-9744
TM
This digital signature is provided in order to secure
the content of this registered document. and in no
way implies Registration Provider responsibility for
U.S. Energy Raters Association
the accuracy of the information.-
Registration Number: 316-A1024000A-M0118266A-0000 Registration Date/Time: 2016-05-22 17:59:15 HERS Provider: USERA
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-05-22 17:59:20
Schema Version: 2013.1.007
CERTIFICATE OF COMPLIANCE
CF1R-ALT 02-E
Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 3 )
Project Name:
SALYER I Date Prepared:
2016-04-22
A. General Information
CF1R-ALT-02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented,
use one MR -ALT -02 document for each dwelling unit.
01
Project Name
SALYER
02
Date Prepared
2016-04-22
03
Project Location
23504 SHADOW CREST PL
04
Building Type
Single family
05
CA City
Diamond Bar
06
Dwelling Unit Name
HOME
07
Zip Code
91765
08
Dwelling Unit Conditioned
2252
identification or
Location or Area `
`by this SCS
Floor Area (ft2)
containing system ,�
,^components?
more than 40
entirely new
entirely new
Number of space conditioning
Served
09
Climate Zone
9
10
(SC) systems in this dwelling
1
Alteration Type
System 1
2252
unit.
Yes, Yes
B. Space Conditioning (SC) System Information
01
02
03
04
05 06
07
08
09
10
Is the SC
Irista'lling a `` 1
SC System
SC System: r
CFA served./
system a
refrigerant Installing new SC
,,, Installing
Installing
Installing
identification or
Location or Area `
`by this SCS
•ducted
containing system ,�
,^components?
more than 40
entirely new
entirely new
Name I
Served
System -M)
system?
component?
-feet of -,ducts?
dud system?
SC system?
Alteration Type
System 1
2252
: Yes
Yes, Yes
N o ,,
No
No
Adhered spaceg
X2252,„
, .
conditioning ionin system
V.V. VII�rII�M I lQl�il�7 1"t�7a7Va+rGiUV��
C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)1Diib)
This section does not apply to this project.
Registration Number: 316-A1024000A-000000000-0000
Registration Date/Time: 2016-04-22 08:03:17
HERS Provider: USERA
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-04-22 08:03:34
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT HVAC) (Page 2 of 3 )
D. Altered Space Conditioning System (Sections 150.2(b)lE and F)
01
02
03
04
05
06
07
08
09
10
11
12
Heating
Cooling
System
Heating
Altered
Heating
Minimum
Altered
Cooling
Minimum
Required
New or
Identification
System
Heating
Efficiency
Efficiency
Cooling
Cooling
Efficiency
Efficiency
Thermostat
Replaced
New Duct
or Name
Type
Components
Type
Value
System Type
Components
Type
Value
Type
Duct Length
R -Value
Central gas
No heating
Central split
All new
Less than or
System 1
furnace
component
AFUE
80
AC
cooling
SEER
14
Setback
equal to 40
R-6
altered
components
feet
Required Documentation:
CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums: R6.
CF2R-MCH-20-H & CF3R-MCH-20-H — Duct Leakage testing required when heating or cooling components are installed in ducted systems, or when more than 40 ft of duct length is replaced.
-Leakage rate compliance: <_ 15%, or15 10% leakage to outside, or seal all accessible leaks.
CF2R-MCH-25-H & CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-1S).
CF2RCF3R-MCH-23 & CF3R-MCH-23 Air Flow z 300 CFM/ton required when MCH -25 is required.
Exceotions:
-Duct systems registered with HERS provider as previously sealed are exempt from MCH -20 Duct Leakage Testing requirements.
-Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flow MCH -23, or Refrigerant Charge MECH-25.
-Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Duct Leakage Testing requirements.
E. Entirely New or Complete Replacement-Ducct System, with or without Equipment'Changeout (Sections 150.2(b)lDiia and 150.2(b)lE, F)
�.. _ This section does not apply to this project:
F. Entirely New or Complete Replacement -Space Conditioning System (Section 150.2(b)'1C)'
This sectitrhdoes not apply to this project.
Registration Number: 316-A1024000A-000000000-0000 Registration Date/Time: 2016-04-22 08:03:17 HERS Provider: USERA
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-04-22 08:03:34
Schema Version: 0.555SDD
CERTIFICATE OF COMPLIANCE CF1R-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:
Documentation Author Signature:
Jim McEligot
Signature Date:
Company:
RighTime Home Services
2016-04-22
Address:
CEA/ HERS Certification Identification (if applicable):
3030 Myers St
765074
City/State/Zip:
Phone:
Riverside CA 92503
951-276-9744
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 or 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 Complianceshall be-mad`e 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 builder provides to the building owner at occupancy.
Responsible Designer
Responsible Designer Signature:�607
iame:
Jim McEligot
Com an yi
P ._ _� ..,. ^
,Date:Signed i —
RighTime Home Services _� �/
2016 0442
Address:t+ _
U.S. Energy Rai
License:
Bits Association
3030 Myers St
City/State/Zip:
Phone:
Riverside CA 92503
951-276-9744
Registration Number: 316-A1024000A-000000000-0000
EnJ� � TM
U.S. Energy Raters Assocfatlon
'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 Date/Time: 2016-04-22 08:03:17
HERS Provider: USERA
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-04-22 08:03:34
Schema Version: 0.555SDD
CERTIFICATE OF INSTALLATION
CF2R-MCH-20-H
Duct Leakage Diagnostic Test
(Page 1 of 3 )
Project Name: SALYER
Enforcement Agency: Diamond
Bar Building Department
Permit Number:
PR16-1042
Dwelling Address: 23504 SHADOW CREST PL
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
2252
03
Building Type from CF -1R
Single family
04
Verified Low Leakage Ducts in Conditioned Space
No, credit is not taken
05
(VU -DCS) Credit from CF1R?
Total leakage
05
Verified Low Leakage Air Handling Unit (VLLAHU) Credit
No, credit is not taken
07
from CF1R?
Cooling system method
06
1 Duct System Compliance Category
Alteration
09
Calculated Target Allowable Duct Leakage (cfm)
300
MCH -20d - Complete Replacement or -Altered Duct System- _
I \. A
1...i 1 1 L- ;..--
B. Duct Leakage Diagnostic Test
01
Condenser Nominal Cooling Capacity (ton) U.S. Energy
Raters Association
02
Heating Capacity (kBtu/h)
11000.00
03
Conditioned Floor Area served by this HVAC system (ft2)
2252
04
Duct Leakage Test Condition
Test final
05
Duct Leakage Test Method
Total leakage
06
Leakage Factor
.15
07
Air Handling Unit Airflow (AHUAirflow) Determination
Method
Cooling system method
08
Measured AHUAirflow
0
09
Calculated Target Allowable Duct Leakage (cfm)
300
10
Actual duct leakage rate from leakage test measurement
(cfm)
210
11
Compliance Statement
System passes leakage test
Registration Number: 316-A1024000A-M20128S2A-0000 Registration Date/Time: 2016-05-22 18:01:28 HERS Provider: USERA
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-22 18:01:33
2013 Residential Compliance Schema Version: 2013.1.007
CERTIFICATE OF INSTALLATION CF2R-MCH-20-H
Duct Leakage Diagnostic Test (Page 2 of 3 )
C. Additional Requirements for Compliance
01
System was tested in its normal operation condition. No temporary taping allowed.
Outside air (OA) 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, the smoke test was conducted in accordance with the requirements
07
of Reference Residential Appendix RA3.1.4.3.6. Systems that comply using smoke test shall not be included in sample
groups for HERS verification compliance.
The responsible persons signature onthiscompliance document affirms, all applicable iFequirements in -this table have
been met. 4
U.S. Energy Raters Association
Registration Number: 316-A1024000A-M2012852A-0000 Registration Date/Time: 2016-05-22 18:01:28 HERS Provider: USERA
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-22 18:01:33
2013 Residential Compliance Schema Version: 2013.1.007
CERTIFICATE OF INSTALLATION CF2R-MCH-20-H
Duct Leakage Diagnostic Test (Page 3 of 3 )
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Installation documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Jim McEligot
Signature Date:
Company:
RighTime Home Services
2016-05-22
Address:
CEA/ HERS Certification Identification (if applicable):
3030 Myers St
765074
City/State/Zip:
Phone:
Riverside CA 92503
1951-276-9744
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
conforn-Is_to.all applicabk�odes and regulations,.and the installation,conforms•to the,requirements.given on the plans.and specifications approved by
�;
the enforcement agency. t _
4. 1 understand that a HERS rater will check the installatio to verify compliance, and that if such checking identifies defects; I ani required to take
corrective action at my expense. I understand -that -Energy Commission and'HERS Provider.representafives,will also perform quality assurance checking
of installations, including those app oved 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. I reviewed a copy of the Certificate"of Complianceapproved by the enforcement agency that identifies the spenficrequirements 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. U■S. Energy Raters Association
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:
Jim McEligot
Company Name: (Installing Subcontractor or General Contractor or
Position With Company (Title): 7H. La oT
Builder/owner)
Install Manager', -Jim McEligot (May 2, 2076)
RighTime Home Services
Address:
CSLB License:
3030 Myers St
765074
City/State/Zip:
Phone:
Date Signed:
Riverside CA 92503
951-276-9744
12016-05-22
Third Party Quality Control Program (TPQCP) Status:
Name of TPQCP (if applicable):
TI:1
�\ This digital signature is provided in order to secure
[ the content of this registered document. and in no
way implies Registration Provider responsibility for
U.S. Energy Raters Assoctattotn the accuracy of the information.'
Registration Number: 316-A1024000A-M2012852A-0000 Registration Date/Time: 2016-05-22 18:01:28 HERS Provider: USERA
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-22 18:01:33
2013 Residential Compliance Schema Version: 2013.1.007
CERTIFICATE OF INSTALLATION
CF2R-MCH-23-H
Space Conditioning System Airflow Rate
(Page 1 of 3 )
Project Name: SALYER
Enforcement Agency: Diamond
Bar Building Department
Permit Number:
PR16-1042
Dwelling Address: 23504 SHADOW CREST PL
City: Diamond Bar
Zip Code:
91765
A. Ducted Cooling System Information
01
System Identification or Name
System 1
02
System Location or Area Served
2252
03
System Installation Type
Replacement
04
Nominal Cooling Capacity (tons) of Condenser
5.0
05
Condenser Speed Type
Single Speed
06
Cooling System Zonal Control Type
Not Zonal
07
Central Fan Integrated (CFI) Ventilation System Status
Not a CFI system
08
System Bypass Duct Status �. �____
No Bypass Duct
09
Date of System Airflow Rate. Measuremeft
t d
X2016-05-17
10
Airflow Rate Protocol utili �d
RA3.3 procedures for airflow rate measurement
B. Hole for the placement of a Static Pressure ProbJVHBP)jFanor&ynRtVe�tmle AFt&Ggiatlg obe (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
Flow Grid according to procedure in RA3.3.3.1.2
01
verification.
02
Manufacturer of Airflow Measurement Apparatus
DG700
03
Model number of Airflow Measurement Apparatus
DG700
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: 316-A1024000A-M23009761A-0000 Registration Date/Time: 2016-05-22 T18:00:3 HERS Provider: USERA
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-22 18:00:44
2013 Residential Compliance Schema Version: 0.555SDD
CERTIFICATE OF INSTALLATION CF2R-MCH-23-H
Space Conditioning System Airflow Rate (Page 2 of 3 )
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)
350
02
Required Minimum System Airflow Target (cfm)
1750
03
Actual System Airflow Rate Measurement (cfm)
1982
04
Compliance Statement:
System airflow rate complies
E. Additional Requirements
01
Air filters that meet the applicable requirements of Standards Section 150.0(m)12 or 150.0(m)13 were properly installed in
the system during system air flow rate measurement identified on this Certificate of Installation.
The airflow rate measurement apparatus used,to perform the airflow rate measurement identified on this Certificate of
02
Installation was calibrated in accordance with the apparatus manufacturer's_specifications and conforms to the
instrumentation specifications given in-RA3.3.1� _—
i
A visual inspecc`tion shalllcconfirm-that bypass ducts that deliver conditioned supply air directly to the space conditioning
system return ducYairflow are not used"on newly constructed zonally controlled systems_ uAn�less the Performance Certificate
03
of Compliance indicates an allowance for use of a bU4Qu(Energa)PR@ �r SeCoirEttkMormance
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.
The responsible person's signature on this compliance document affirms that all applicable requirements in this table have
been met.
Registration Number: 316-A1024000A-M23009761A-0000 Registration Date/Time: 2016-05-22 T18:00:3 HERS Provider: USERA
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-22 18:00:44
2013 Residential Compliance Schema Version: 0.555SDD
CERTIFICATE OF INSTALLATION CF2R-MCH-23-H
Space Conditioning System Airflow Rate (Page 3 of 3 )
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Installation documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Jim McEligot
Signature Date:
Company:
RighTime Home Services
2016-05-22
Address:
CEA/ HERS Certification Identification (if applicable):
3030 Myers St
765074
City/State/Zip:
Phone:
Riverside CA 92503
951-276-9744
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
conforN.to.all applicable codes and regulations,.and the installationsonforms.to th_e.requirements given on the plans and. specifications approved by
the enforcement agency. y
-the
4. 1 understand that a HERS rater'will check 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 requiied corrective action and additional checking/testing of other installations in that HERS
sample group will be performed at my expense..—,/ n
5. I reviewed a copy of the Certificate of Compliance approved by the en forcemenfagency that identifies the specificrequirements 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. U.S. Energy Raters Association
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:
Jim McEligot
Company Name: (Installing Subcontractor or General Contractor or
Position With Company (Title):
Builder/Owner)
Install Manager Jim McEligot (May 2, 2016)
RighTime Home Services
Address:
CSLB License:
3030 Myers St
765074
City/State/Zip:
Phone:
Date Signed:
Riverside CA 92503
951-276-9744
12016-05-22
Third Party Quality Control Program (TPQCP) Status:
Name of TPQCP (if applicable):
Till
_. A\/ "This digital signature is provided in order to secure
k the content of this registered document, and in no
L� 4 way implies Registration Provider responsibility for
U.S. Energy Raters As, aciatlon the accuracy of the information."
Registration Number: 316-A1024000A-M23009761A-0000 Registration Date/Time: 2016-05-22 T18:00:3 HERS Provider: USERA
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-22 18:00:44
2013 Residential Compliance Schema Version: 0.555SDD
CERTIFICATE OF INSTALLATION
CF2R-MCH-25-H
Refrigerant Charge Verification
(Page 1 of 4 )
Project Name: SALYER
Enforcement Agency: Diamond
Bar Building Department
Permit Number:
PR16-1042
Dwelling Address: 23504 SHADOW CREST PL
City: Diamond Bar
Zip Code:
91765
A. System Information
Each system requiring refrigerant charge verification will be documented on a separate certificate.
01
System Identification or Name
System 1
02
System Location or Area Served
2252
03
Condenser (or package unit) Make or Brand
Rheem
04
Condenser (or package unit) Model Number
RA1660AJINA
05
Nominal Cooling Capacity (tons) of Condenser
5.0
06
Condenser (or package unit) Serial Number
W141629156
07
Refrigerant. -Type--,-- - �� q----- -
-11-410A ---,
08
Other Refrigerant Type (if applica ble)
09
System Installation Typel i ~� — £
`Replacement -
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' t r)
nergy Raters Association
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
2016-05-17
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
HVAC system installer
15
reported on this Certificate of Installation
16
HERS Verification Compliance Requirement Status
System qualifies for group sampling
MCH -25b - Refrigerant Charge Verification - Subcooling Method
Registration Number: 316-A1024000A-M25008452A-0000 Registration DateMme: 2016-05-22 18:02:48 HERS Provider: USERA
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-22 18:02:54
2013 Residential Compliance Schema Version: 2013.1.007
CERTIFICATE OF INSTALLATION CF2R-MCH-25-H
Refrigerant Charge Verification (Page 2 of 4 )
B. Metering Device Verification
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
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
2016-05-17
02
Date of Digital Thermocouple Calibration
2016-05-17
03
Digital Refrigerant Gauge Calibration Status
Calibration is current
�04
Digital Thermocouple Calibration Status
Calibration is current
D. Measurement Access Hole (MAH) Verification
Procedures forinstalling MAH are specified in Reference__ Residential Appendix RA3.2:2.3 _ ?
01
Minimum Required System Airflow Rate (cfm)
Method used to demonstrate ccimpliance`with the
♦Return side of system is ocated'entirely within conditioned
01
Measuremlent•`Access Hole (MAH) requirement,
space such that an accurate return -air dry-bulb temperature
w� �1
can,be taken at the return grille
83.0
condenser, db)
E. Minimum System Airflow Rate Verification U.S. Energy Raters Association
Procedures for verifying minimum system airflow are specified in Reference Residential Appendix RA3.2.2.7.
01
Minimum Required System Airflow Rate (cfm)
1750.0
02
System Airflow Rate Verification Status
System complies with minimum airflow rate requirements
F. Data Collection and Calculations
Procedures for determining Refrigerant Charge using the Standard Charge Verification Procedure are given in
Reference Residential Appendix RA3.2.2.
01
Lowest return air dry bulb temperature that occurred during
81.0
the refrigerant charge verification procedure (degreeF)
02
Measured Condenser air entering dry-bulb temperature (T
83.0
condenser, db)
03
Outdoor Temperature Qualification Status
Outdoor temperature is within range for using Subcooling
refrigerant charge verification method
04
Measured Liquid Line Temperature (Thquid) (degreeF)
99.0
Registration Number: 316-A1024000A-M25008452A-0000 Registration Date/Time: 2016-05-22 18:02:48 HERS Provider: USERA
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-22 18:02:54
2013 Residential Compliance Schema Version: 2013.1.007
CERTIFICATE OF INSTALLATION CF2R-MCH-25-H
Refrigerant Charge Verification (Page 3 of 4 )
F. Data Collection and Calculations
Procedures for determining Refrigerant Charge using the Standard Charge Verification Procedure are given in
Reference Residential Appendix RA3.2.2.
05
Measured Liquid Line Pressure (Pliquld) (ping)
91.0
06
Condenser saturation temperature (Tcondensor, sat) from digital
102.0
Measured�Suction line p essurei(Ps.Ction) (prig)/
gauge or P -T Table using Line F05 (degree F)
07
Measured Subcooling
3.0
08
Target Subcooling
3.0
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
MeasuredSuctionline temperature (Tsuction) (degreeF)_„______
98.0
02
Measured�Suction line p essurei(Ps.Ction) (prig)/
X86.0
Evaporator saturation temperature'(Tevaporator, sat) from
*91.0 --
03
digital gauge or�P-T Table using liheG02 (degr f F)
04
Measured Superheat
7.0`
05
Measured Superheat is between 4 and 25 deg F (inclusive)
Passes CEC requirement
Measured Superheat is within manufacturer's specifications,
Yes, documentation to be provided upon request
06
if known
07
Compliance Statement: Metering device verification passes
Verification of Charge Indicator Display - CF2R-MCH-25d - CID
H. Charge Indicator Display
Procedures for the Charge Indicator Display Verification are detailed in RA3.4.2
This section does not apply to this project.
I. Charge Indicator Display - Additional Requirements
This section does not apply to this project.
Registration Number: 316-A1024000A-M25008452A-0000 Registration Date/Time: 2016-05-22 18:02:48 HERS Provider: USERA
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-22 18:02:54
2013 Residential Compliance Schema Version: 2013.1.007
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:
Jim McEligot
Signature Date:
Company:
RighTime Home Services
2016-05-22
Address:
CEA/ HERS Certification Identification (if applicable):
3030 Myers St
1765074
City/State/Zip:
Phone:
Riverside CA 92503
951-276-9744
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 applicablecodes and regulations,.and the installationsonforms to the requirements give 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 u derstand that.En rgy Commission and'HERS Provider representatives,will also perfoim 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
requiremIents'of such quality assurance checking, the required corrective action and additional checking/testing of other. installations in that HERS
sample group will be,performed at my expense.,,.,)
5. I reviewed a co, py of the Certificate of Compliance.approved by the enforcementagencythst 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. U.S. Energy Raters Association
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:
Jim McEligot
Company Name: (Installing Subcontractor or General Contractor or
Position With Company (Title): t G T
Builder/Owner)
Install Manager imMcEligot (May(t2,2018)
RighTime Home Services
Address:
CSLB License:
3030 Myers St
765074
City/State/Zip:
Phone:
Date Signed:
Riverside CA 92503
951-276-9744
12016-05-22
Third Party Quality Control Program (TPQCP) Status:
I Name of TPQCP (if applicable):
Ti!1
-This digital signature is provided in order to secure
the content o/ this registered document, and in no
way implies Registration Provider responsibility for
U.S. Energy Raters Association the accuracy of the information.'
Registration Number: 316-A1024000A-M25008452A-0000 Registration Date/Time: 2016-05-22 18:02:48 HERS Provider: USERA
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-22 18:02:54
2013 Residential Compliance Schema Version: 2013.1.007
CERTIFICATE OF VERIFICATION
CF3R-MCH-20-H
Duct Leakage Diagnostic Test
(Page 1 of 3 )
Project Name: SALYER
Enforcement Agency: Diamond
Bar Building Department
Permit Number:
PR16-1042
Dwelling Address: 23504 SHADOW CREST PL
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
2252
03
Building Type from CF -111
Single family
04
Verified Low Leakage Ducts in Conditioned Space
No, credit is not taken
04
(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
Duct System Compliance Category
Alteration
09
Calculated Target Allowable Duct Leakage Rate (cfm)
300
i t
MCH -20d - Complete Replacement or�Altered Duct System
I I ♦ \ i -
J
B. Duct Leakage,Diagn'ostic Test ;
01
Condenser Nominal Cooling Capacity (ton) U.S.
&E-a-lergy Raters Association
02
Heating Capacity (kBtu/h)
11000
03
Conditioned Floor Area served by this HVAC system (ft2)
2252
04
Duct Leakage Test Condition
Test final
05
Duct Leakage Test Method
Total leakage
06
Leakage Factor
.15
07
Air Handling Unit Airflow (AHUAirflow) Determination
Method
Cooling system method
08
Measured AHUAirflow
0
09
Calculated Target Allowable Duct Leakage Rate (cfm)
300
10
Actual duct leakage rate from leakage test measurement
(cfm)
117
11
Compliance Statement: System passes leakage test
Registration Number: 316-A1024000A-M2010631A-M20A Registration Date/Time: 2016-05-22 18:42:47 HERS Provider: USERA
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-22 18:42:52
2013 Residential Compliance Schema Version: 2013.1.007
CERTIFICATE OF VERIFICATION CF3R-MCH-20-H
Duct leakage Diagnostic Test (Page 2 of 3 )
B. Duct Leakage Diagnostic Test
12 Notes:
C. Additional Requirements for Compliance
01
System was tested in its normal operation condition. No temporary taping allowed.
Outside air (OA) duct connections to the central forced air duct system shall not be sealed/taped off during duct leakage
02
testing. OA ducts used for Central Fan Integrated (CFI) Indoor Air Quality ventilation systems, or Central Fan Ventilation
Cooling Systems, that utilize dampers that open only when OA is required and automatically close when OA is not required,
may configure the OA damper to the closed position during duct leakage testing.
03
If a complete replacement, all supply and return register boots were sealed to the drywall.
04
Building cavities were not used as plenums or platform returns in lieu of ducts.
05
If cloth backed tape was used it was covered with Mastic and draw bands.
06
All connection points between the air handler and the supply and return plenums are completely sealed.
If the systemcomplies using the Smoke Test,method, the smoke test was conducted,in accordance with`the requirements
07
of Reference Residential Appendix RA3,1.4.3.6. Systems that comply using smoke test shall not be included in sample
for�HERS verification compliance.
O8
groups
I Y
Verification,Stat s "� .`y Pass -all applicable requirements are met
09
Correction Notes for this table U.S.
Energy Raters Association
The responsible persons signature on this compliance document affirms that all applicable requirements in this table have
been met unless otherwise noted in the Verification Status and the Corrections Notes in this table.
D. Determination of HERS Verification Compliance
All applicable sections of this document shall indicate compliance with the specified verification protocol requirements in order
for this Certificate of Verification as a whole to be determined to be in compliance.
01 1 Complies: All specified verification protocol requirements on this document are met.
Registration Number: 316-A1024000A-M2010631A-M20A Registration Date/Time: 2016-05-22 18:42:47 HERS Provider: USERA
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-22 18:42:52
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:
Jose Cervantez
Company:
Date Signed: ' I ^_
JC HERS RATING
2016-05-22
Address:
CEA/ HERS Certification Identification (if applicable):
136 Half Dome Way
1095730
City/State/zip:
Phone:
Perris CA 92570
951-217-0805
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 thetCertiflcate(s) of Iiii6ilation (CF2R) signed and "submitted by the; pe�son(s) responsible for the
construction or installation conforms to the'requirements specified on the Certificates) of Compliance (MR) approved by ttie enforcement agency.
S. I will ensure that a registered copy of this Certificate of Verification shall be. posted, or made available with the building permit(s) issued for the
1 i
building, made available to the enforcement agency for all applicable inspections. I understand that a'registered copy of this Certificate of
land
Venficati+ n is�required to be included with the documentation the builder provides to the building owner at occupanCyr- - -'
1 k
j,f
Builder Or Installer Information As -Shown On,The Certificate Of Installation :r` r
Company Name (Installing Subcontractor, General Contractor, or BuilderU.S.: Energy Raters Association
RighTime Home Services
Responsible Builder or Installer Name:
CSLB License:
Jim McEligot
765074
HERS Provider Data Registry Information
Sample Group Number (if applicable):
Dwelling Test Status in Sample Group (if applicable)
316-19153
Tested
HERS Rater Information
HERS Rater Company Name:
JC HERS RATING
Responsible Rater Name:
Responsible Rater Signature:
Jose Cervantezose
L e.f✓a�,7ea
dose Cervantez (May 22, 2016
Responsible Rater Certification Number w/ this HERS Provider:
Date Signed:
1095730
2016-05-22
,.. •, �-�-^� TM
4_> -This digital signature is provided in order to secure
r the content of this registered document, and in no
way implies Registration Provider responsibility for
U.S. Energy Raters Association the accuracy of the information."
Registration Number: 316-A1024000A-M2010631A-M20A Registration Date/Time: 2016-05-22 18:42:47 HERS Provider: USERA
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-22 18:42:52
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: SALYER
Enforcement Agency: Diamond
Bar Building Department
Permit Number:
PR16-1042
Dwelling Address: 23504 SHADOW CREST PL
City: Diamond Bar
Zip Code:
91765
A. Ducted Cooling System Information
01
System Identification or Name
System 1
02
System Location or Area Served
2252
03
System Installation Type
Replacement
04
Nominal Cooling Capacity (tons) of Condenser
5.0
05
Condenser Speed Type
Single Speed
06
Cooling System Zonal Control Type
Not Zonal
07
Central Fan Integrated (CFI) Ventilation System Status
Not a CFI system
08
System BypassjDuct Status �' `/"
No, Bypass Duct
Date of System Airflow Rate; Measurement' �
"2016-0S-22 -'
F09
10
Airflow Rate Protocol utilized /�
RA3.3 proceduresfor-airflow%ratemeasurement
B. Hole for the placement of a Static Pressure ProbeGP)JENwrff13,,nRttVig�t@lA'eAa§trtoFtriau'WiRobe (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
Flow Grid according to procedure in RA3.3.3.1.2
01
verification.
02
Manufacturer of Airflow Measurement Apparatus
DG700
03
Model number of Airflow Measurement Apparatus
DG700
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: 316-AS024000A-M23007689A-M23A Registration Date/Time: 2016-05-22 18:41:02 HERS Provider: USERA
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-22 18:41:07
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
I
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)
350.0
02
Required Minimum System Airflow Target (cfm)
1750
03
Actual System Airflow Rate Measurement (cfm)
1958
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
the system during system air flow rate measurement identified on this Certificate of Verification.
Fn2)
Theairflow rate measurement apparatus used.to perform the airflow rate measurement identified on this Certificate of
Verification was calibrated in accordance -with the apparatus manufacturer's -specifications and conforms to the
instrumentation specifications given -in_RA3.3 T�,
i A
A visual inspect o sh I confirm that bypass ducts that deliver conditioned supply air directly to the space conditioning
system return duct -airflow are not used'oh newly constructed zonally controlled systems unless the Performance Certificate
03
of Compliance indicates an allowance for use of a bU4&uEmargyp tersccAefoodetkMormance
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: 316-A1024000A-M23007689A-M23A Registration Date/Time: 2016-05-22 18:41:02 HERS Provider: USERA
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-22 18:41:07
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.
101 I Complies: All specified verification protocol requirements on this document are met.
`yf
U.S. Energy Raters Association
0
Registration Number: 316-A1024000A-M23007689A-M23A Registration Date/Time: 2016-05-22 18:41:02 HERS Provider: USERA
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-22 18:41:07
2013 Residential Compliance Schema Version: 0.555SDD
CERTIFICATE OF VERIFICATION CF3R-MCH-23-H
Space Conditioning System Airflow Rate (Page 4 of 4 )
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Verification documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Jose Cervantez
Company:
Date Signed: �_ _ _"
JC HERS RATING
2016-05-22
Address:
CEA/ HERS Certification Identification (if applicable):
136 Half Dome Way
1095730
City/State/Zip:
Phone: '
Perris CA 92570
951-217-0805
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 ofthe�Certificate(s) oflnka—Ilation (CF2R) signed and submitted by the person(s) responsible for the
construction or installation conforms to the -require ments 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, Land made available to the enforcement agency for all applicable inspections. I understand that a'registered copy of thisCertificate of
Verification is'required to be included with the documentation the builder provides to the building owner at occupancy.
{ 1 i n a
On,The Certificate Of Installation
Builder Or Installer Information As -Shown
Company Name (Installing Subcontractor, General Contractor, or Builder .S.: Energy Raters Association
RighTime Home Services
Responsible Builder or Installer Name:
CSLB License:
Jim McEligot
765074
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:
JC HERS RATING
Responsible Rater Name:
Responsible Rater Signature:
Cep(✓a,rei
Jose Cervantez
ose
ose Cervantez Ma 22, 2016
Responsible Rater Certification Number w/ this HERS Provider:
Date Signed:
1095730
2016-05-22
1ATM
"This digital signature is provided in order to secure
U\ the content of this registered document. and in no
way implies Registration Provider responsibility for
` the accuracy of the information. -
U.S. Energy Raters Ass=lcalon
Registration Number: 316-A1024000A-M23007689A-M23A Registration Date/Time: 2016-05-22 18:41:02 HERS Provider: USERA
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016 -OS -22 18:41:07
2013 Residential Compliance Schema Version: 0.555SDD