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Home My WebLink AboutPR16-0927r' 1 r CITY OF DIAMOND BAR i DEPARTMENT OF COMMUNITY- & DEVELOPMENT SERVICES Il ar — 21810 Copley Drive, Diamond Bar, CA 91765 PRESS Y` (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027FIRMLY BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diam arca.gov JOB SITE ADDRESS 4 h APN LOT TRACT OWNER (.. ADDRESS L G L CITY ZIP !JJ 7h), TEL. APPLICANT TEL. d CONTRACTOR N c ADDRESS CITY Z ZIP Nltl TEL. 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 items) [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 Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale. If however, the building or improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built or improved for the purpose of sale.). U I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law.). U I am exempt from licensure under the Contractor's State License law for the following reason(s): By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit,] cannot legally sell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code is available upon request when this application is submitted or at the following Web site: http/www.leginfo.ca.gov/calaw.htmi. 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 CSS: LIC. NO.: H DATE: CONTRACTOR: WORKER'S PEN TION 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 aree. j1 CARRIER Vo ratak lmA POLICY NUMBER (THIS SEC11ON 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 Comp do prows: ns of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. DATE:/APPLICANT:r WARNING: Failure to secure Worker's Compens covenlige 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 cost of the compensation, damages as provided for in section 3706 of the labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a Construction Lending Agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. PERM'� E (PRINTTT- t i SIGNATUPERMITTE DATE APPLICATION DATE: P//C# ISSUE DATE: /J.�I� PERMIT# : ln-& "DJV 2 TYPE CONST. 14061 , ir. J OCC GROUP: $ Scope of Work # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUAT(ON SFR/ADD/REM Garage/Carport CO LL ZRe 00 Patio/Deck waswift0% &%ALU Pool/Spa -Roof Commercial qprn Valuation: Adj. Area: QUANTITY DESCRIPTION FEE U U W J W cn z m J a ZU_ Q rt CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: � INSPECTION FEE: ISSUANCE: �" u SMIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: P/C: PAID BY: RECEIPT # 13&&fT_ PAID BY: VALIDATION: VALIDATION WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy 1 , CITY OF DIAMOND BAR INSPECTLON RECORD INSPECTION DATE INSPECTOR •• SETBACK/ LETTER SWITCH GEAR FOOTINGS FORMS T -BAR SLAB HOT MOP/SHOWERPAN UG. PLUMBING HERS REPORT RECEIVED UG. ELECTRICAL ROOF DRAINS LIFER GROUND POOL/SPA SEWER LATERAL ROUGH ELECTRICAL MAIN WATER LINE GAS TEST SEWER CLEANOUT POOL PRE DECK BONDING ROOF SHEATHING FENCE / GATE/ ALARM FLOOR SHEATHING WALLS: SHEAR WALLS EXTEFW R. t� WALL STEEL 1-( ) 2ND( ) LIFT SHEAR WALLS INT �l0 .k V �; r FRAMINGNENTING a ._ : 9 tj 0 AIM R:. ROUGH MECHANICAL ROUGH ELECTRICAL W( ) C ( ) q '; rf, 5� ROUGH PLUMBING ROUGH FIRE APPROVAL INSULATION WALL FINAL PLANNING INSULATION CEILING FINAL COMMUNITY SERVICES DRYWALL FINAL INDUSTRIAL WASTE LATH (PRE) LATH EXTERIOR LATH INTERIOR GAS TEST SCRATCH COAT ELECTRIC METER RELEASE GAS METER RELEASE SPECIAL INSPECTION FINAL BUILDING FINAL MECHANICAL ,s FINAL ELECTRICAL FINAL PLUMBING T.C. of OCCUPANCY CERT. of OCCUPANCY COMMENTS: • , INSPECTION INSPECTOR TRACT AND LEDGER SWITCH GEAR COMMERCIAL HOOD T -BAR INTERCEPTER HOT MOP/SHOWERPAN SEPTIC/CESSPOOL HERS REPORT RECEIVED DEMOLITION ROOF DRAINS ROUGH CONDUIT POOL/SPA ROUGH PLUMBING ROUGH ELECTRICAL ROUGH MECHANICAL GAS TEST PRE GUNITE POOL PRE DECK BONDING P -TRAP FENCE / GATE/ ALARM FINAL POOL WALLS: WALL FOOTING/STEEL WALL STEEL 1-( ) 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 ALTERATIONS - HVAC, CEC-CF I R -ALT -04-E (Revised 06114:' !'CERTIFICATE OF COMPLIANCE CFIR-ALT-04-E I i Alterations - HVAC CZ 2, and 8-15 (formerly CF -IR -ALT -HVAC) (Page 1 of 1) I -I^ ite Add l -_-.c• c j � ' ... Equipment e E ui Equipment Efficient I T 1 Type q p Y 1\1e,11 Di cti oJ, Plenums Lineset: Corw.di:-,ionell Required R -value Floor Area (sq ft) TnPrmostat ❑ Packaged System ET Evaporator Coil❑ ❑ Split System I�ondensing Unit AFU CO R-6 (CZ 2, 5-13) Ducting Served bysystem m e sgft I ElSetback (%1 not already I ❑ Mini Split ; ❑ Compressor I i 'EER /S HSPF I ❑ R-8' (CZ 11, 14, 15) Ducting ❑ R 6 (al! CZ's} Plenums present, must P(Furnace ❑ Linesetf 1 ❑ TXV EER I 1 1 ❑ R-5 or R7.5) Lineset4 i be insta;iedJ i 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. ❑ 2. HVAC Changeout/Repair _ Required Compliance Documents to be left on site for Final: All Equipment, CFI11-ALT-02-E Condenser Unit, Evaporator Coil, CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24)' -HERS, MECH-25-HERSZ Compressor, TXV, Uneset, CF3R: MECH-20-HERS, MECH-(23 or 24)-HERSZ, MECH-25-HERSZ Air Handler/Furnace' (Can include new ducting) Installer Requirement: Duct leakage (< 15%, or < 10% to outside, or seal all accessible leaks), Air Flow >_ 300 CFM/ton, Refrigerant Charge. Exempted from duct leakage testing if: ❑ 1. Duct system registered with HERS provider as previously sealed, or 112. There is less than 40 linear feet of duct in unconditioned space, or 113. Existin_g_duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building -Required ❑ 2. New HVAC System Compliance Documents to be left on site for Final All new equipment and All New Ducts3 CF111-ALT-02-E including Mini Split CF2R: MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS', MECH-25-HERS- CF3R: MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24)-HERS2, MECH-25-HERS7 Mini Splits require CFIR-ALT-02-E, CF2R-MECH-01, and (CF2R-CF3R) MECH-25-HERS Installer Requirement Duct leakage < 6%, Fan Efficacy (.58W/CFM), Air Flow >_ 350 CFM/ton (or alternative), Refrigerant Charge-IrlT� 3. All New Ducts with Replacement"Required Compliance Documents to be left on site for Final: All New Ducts' and one or more of the following CF113-ALT-02-E replaced: Condenser Unit, Evaporator Coil, CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS Compressor, TXV, Lineset, Furnace' CF3R: MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-2S-HERS Installer Requirement: Duct leakage < 6%, Air Flow >_ 350 CFM/ton (or alternative), Refrigerant Charge Exempted from duct leakage testing if: ❑ 1. Existing duct systems are constructed, insulated or sealed with asbestos ❑ 4. New Ducting over 40 feet Required Compliance Documents to be left_ o_ n site for Final _ New ducting but less than All New Ducts CFIR-ALT-02-E, CF2R: MECH-20-HERS, CF3R: MECH-20-HERS Installer Required to: Dud leakage (< 15% or, < 10% to outside or, or seal all accessible leaks) ❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos. 'All new ducting R-8 required when more than 40 ft installed and R-6 when less than 40 ft installed. This includes in walls, between floors etc. - Heating only systems and Air Handler/Furnace changes do not require Air Flow MECH-(23 or 24), or Refrigerant Charge verification MECH-25 3 All New Ducts is when at least 75 percent of the duct system is new duct material, and up to 25 percent may consist of reused parts from the dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, coil, plenums, duct material) ` R-5 (1" thick insulation) for linesets 1" and less. R-7.5 (1.5" thick insulation) for linesets over 1 inch. Most mfg will require Suction line Diameter with insulation as the following 1.5-2T-2%", 2.5 -3T -2'/a", 3.5 to 4T-2%", 5T-4%8" 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. 1 3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations (CCR). 4. That the energy features and performance specifications, materials, components, and manufactured devices for the building design or • system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the CCR. 5. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. Responsible Designer Name: Responsible Designer Signature: Date Signed: 'f/h License: o3 u' -� Company : ; City/State/Zip: Phone: I For assistance or questions regarding the Energy Standards, contact the Energy tiotiine at: a-auu-iic--3Liu 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: L Robert Bachus��ti%�RC,�d ,� Company: Date Signed: Advancing Home Performance, Inc. 2016-05-06 10:17:49 Address: CEA/ HERS Certification Identification (if applicable): 74998 Country Club Drive. STE# 220-420 City/State/Zip: Phone: Palm Desert CA 92260 760-851-8648 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)) of7nstallation (CF2R)-sighed and,submitted by the person(s) responsible for the construction or installation conforms to the equirements'specified ori the Certificate(s) of Compliance (CF,SR) approved by the enforcement`agency. 5. 1 will ensure that a registered copy of this Certificate of Verificationahall be posted,, or made,available with the building permit(s) issued for the building, and made available to the enforce ment.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 p�roJides to the building owner at-mcupancy. Builder Or Installer Information As'Shown'On`4The Certificate'Of Installation Company Name (Installing Subcontractor, General Contractor, or Builder/Owner): ALL PRO AIR Responsible Builder or Installer Name: CSLB License: Sheldon Lane 934601 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: Advancing Home Performance, Inc. Responsible Rater Name: Responsible Rater Signature: Robert Bachus %k�G�l�o�L6dC>LO� Responsible Rater Certification Number w/ this HERS Provider: Date Signed: CC2005695 2016-05-06 10:17:49 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-A0170014A-M2300002A-M23A Registration Date/Time: 2016-05-06 10:17:49 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-06 10:17:18 2013 Residential Compliance Schema Version: 0.555SDD 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: Robert Bachus Company: Date Signed: Advancing Home Performance, Inc. 2016-05-06 10:17:49 Address: CEA/ HERS Certification Identification (if applicable): 74998 Country Club Drive. STE# 220-420 City/State/Zip: Phone: Palm Desert CA 92260 760-851-8648 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 6 the Certificate(s) of Installation (CF213) signed.and submitted -by the person(s) responsible for the construction or installation conforms to the req uirem ents"specified ori the Certificate(s) of Compliance (CF1R) approved by the enforcement:agency. 5. 1 will ensure that a registered copytof this Certificate of,Verification shall be posted, -or made�available with the,6uilding permit(s) issued for 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 docume tation the builder provides to the building 'owner at-occup'ancy. Builder Or Installer Information As Shown On'`The Certificate Of Installation Company Name (Installing Subcontractor, General Contractor, or Builder/Owner): ALL PRO AIR Responsible Builder or Installer Name: CSLB License: Sheldon Lane 934601 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: Advancing Home Performance, Inc. Responsible Rater Name: Responsible Rater Signature: Robert Bachus Responsible Rater Certification Number w/ this HERS Provider: Date Signed: CC2005695 2016-05-06 10:17:49 Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider responsibility for the accuracy of the information. Registration Number: 216-A0170014A-M2500002A-M25A Registration Date/Time: 2016-05-06 10:17:49 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-06 10:17:35 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/��^E'f p Sheldon Lane �X/ (�/� er Company: Signature Date: 2016-05-06 10:18:26 ALL PRO AIR Address: CEA/ HERS Certification Identification (if applicable): 415 GLENHILL DR City/State/Zip: Phone: RIVERSIDE CA 92507 1951-684-0880 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 venfy.compliance, and that if'such checking identifies defects; I am required to,take' corrective action at my expenseA understand that Energy Commission and HERS Provider representatives will also perform quality assurance checking of installations, including those approved as pact_of a sampie group but not checked,by.a1HERS`rater, and if tho'seirisiallation's fail to meet the , requirements of such quality assurarice 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: Sheldon Lane Company Name: (Installing Subcontractor or General Contractor or Position With Company (Title): Builder/Owner) Owner ALL PRO AIR Address: CSLB License: 415 GLENHILL DR 934601 City/State/Zip: Phone: Date Signed: RIVERSIDE CA 92507 951-684-0880 2016-05-06 10:18:26 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 noway implies Registration Provider responsibility for the accuracy of the information. Registration Number: 216-A0170014A-M2300002A-0000 Registration Date/Time: 2016-05-06 10:18:26 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-06 10:15:15 2013 Residential Compliance 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: ��`E^C _ Lane, Sheldon er Company: Signature Date: ALL PRO AIR 2016-05-06 10:18:26 Address: CEA/ HERS Certification Identification (if applicable): 415 GLENHILL DR City/State/Zip: Phone: RIVERSIDE CA 92507 1951-684-0880 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'conforrns toYall applicable codes and regulations, and the installation conforms to the requirements given on the plans and specifications approved by the enforcement agency. �y - 4. 1 reviewed a copy of the Certificate of Compliance approved by the'enforcement agency that identifies the_specific r ` uirements 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�y building permit(s) issued for the building and matle,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 withttetlocumentation hebuildei rovides to the building owner at occupancy. Responsible Builder/Installer Name: Responsible Builder/Installer Signature: Lane, Sheldon Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Position With Company (Title): ALL PRO AIR OWNER Address: CSLB License: 415 GLENHILL DR 934601 City/State/Zip: Phone: Date Signed: RIVERSIDE CA 92507 951-684-0880 12016-05-06 10:18:26 Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider responsibility for the accuracy of the information. Registration Number: 216-A0170014A-M0100002A-0000 Registration Date/Time: 2016-05-06 10:18:26 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-05-06 10:14:22 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��E�,�J Sheldon Lane er Company: signature Date: 2016-05-06 10:18:26 ALL PRO AIR Address: CEA/ HERS Certification Identification (if applicable): 415 GLENHILL DR City/State/Zip: Phone: RIVERSIDE CA 92507 1951-684-0880 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-tovenfycompliance, and that if such -checking identifies defects I am required to take* corrective action at my expense'.' l understand that EnergyComm'ission and HERS Provider representatives will also perform quality assurance checking of installations, including ihoseappr�oved as pact of"a sample group but;not:checked by.a HERS rater, and if those installations fail to meettfie requirements of such quality assurance checking, the required correctiveaction 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 they 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: Sheldon Lane Company Name: (Installing Subcontractor or General Contractor or Position With Company (Title): Builder/Owner). Owner ALL PRO AIR Address: CSLB License: 415 GLENHILL DR 934601 City/State/Zip: Phone: Date Signed: RIVERSIDE CA 92507 951-684-0880 2016-05-06 10:18:26 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 noway implies Registration Provider responsibility for the accuracy of the information. Registration Number: 216-A0170014A-M2500002A-0000 Registration Date/Time: 2016-05-06 10:18:26 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-05-06 10:16:14 2013 Residential Compliance Schema Version: 2013.1.007