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Home My WebLink About15-1286 =-''"� CITY OF DIAMOND BAR • � �� Q�/� .. -- F �/ > .! DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES G.. ... ' �' 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 = JOB SITE ADDRESS 2�� `'GDf�,s APPLICATION DATE� � a'� P/C# i ISSUE DATE: J �� If PERMIT# I./ �— �'�� = APN LOT TR T —� y OWNER �� TYPE CONST. OCC GROUP: J ADDRESS_��1�� COf�g��.CJ.J r- ZONING SEfBACKS � � CITY ZIP�n�/s TEL FRONT Ry�/ p ¢ APPLICANT TEL. REAR ❑ x � � SIDE/SIDE STREEf RW ❑ � CONTRACTOR SIDE p � ADDRESS I � A "8. PROPOSED USE x CITY ZIP TEL. —1 � � ARCH/ENG/DESIGNER L = ADDRESS #DWEL.UNITS #STORIES #BEDROOMS z CITY ZIP TEL. a OWNEH-BUILOEH DECLAHATION DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � = I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reason(s) SFR/ADD/REM I L indicated below by the checkmark(s),I have placed next to the applicable item(s)[Sec[ion 7031.5,Business and Garage/Carport I � Professions Cade:Any city or county that requires a permit to canstruct,alter,improve,demolish,or repair,any z structure,prior ta its issuance,also requires the applicant for fhe permit to file a signed sTatement that he or she � Patio/Deck I nis licensed pursuant ta the provisions of the Contractor's Sfate License Law(Chapter 9)Commencing with Section w � 7000 aT Division 3 of the Business and Professians Code]or that he or she is exempt from licensu2 and the basis for � Pool/Spa I � the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty C7 I ,= of not more than five hundred dollars($500). ZQ Re-Roof � (,I,as owner of the property,ar my employees with wages as their sole compensation,will do�1 all of or(�portions � Commercial I y of the work,and the structure is not intended or offered for sale(Section 7044,Business and Professions Code:The � m � Contractors'STa�License Law does not apply to an owner of property who,through employees'or personal eNort,builds I � or improves the property,provided that the improvemenls are not intended or offered for sale.If however,the building or I � 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.). - I '� I,as owner of the ro e am exclusivel contractin with licensed Contractors to construct the ro ect Section � P P�� Y 9 p � ( Valuation: Ad Area: Z 7044,Business and Professions Code:The Contractors'State License Law does not apply to an owner of property who L I � buildsorimprovesthereon,andwhocontractsfortheprojectswithalicensedContractorpursuanttotheContractors'State pUANTITY DESCRIPTION FEE � License Law.�. � I � (_,)I am exempt from licensure under the Contractor's State License law for the following reason(s): ¢ � U I2 1 By my signature below I acknowledge that,except for my personal residence in which I must have resided for at least one � I � year prior to completion of the impmvements covered by this permit,l cannot legally sell a strudure that 1 have built as an w I owner-builder if it has not been construded 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 I X the following Web site:http/www.leginfo.ca.gov/calaw.html. Z ? DATE: SIGN: � I i — LICENSED CONTHACTON'S DECLAHATION � , I a Iy 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 ett/e�c[. � J I � LICENSE C S: C•� LIC.NO.: I�� a rn �J I � Z DATE: CONTRACTOR; _� = I � (� U ¢ WOHIffA'S COMPENSATION DECLAHATION � � � y I HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OFTHE FOLLOWING DECLARATIONS: � ( � � I e and will maintain a Certificate of Consent to Self-Insure for Worker's Compensation,as provided by CONSTRUCTION: � ection 3700 of the Labor Code,for the performance of the work for which this permit is issued. p�p,N REVIEW: � I have and will maintain Worker's Campensation 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 ELECTRIC: I z ¢ Po�i�yNumber e: PLUMBING ,�, CARRIER _ MECHANICAL: �� Q!] � POLICY NUMBER O � INSPECTION FEE: '� � (THIS SECTION NEED NOT BE COMPLEfED IFhIE PFAMfT IS FOR ONE HUNDRFD DOLLPAS(5100)OR LESS). ISSUANCE: � P.�7 � I certify that in the performance oithe work for which this pertnit is issued,I shall not employ any person in any manner so as to SMIP: � become subject tn the Wo�Cer's Compensation Laws of Califomia.Md agree that if I should become subject m the Worker's � Compensation pmvisions of Section 3700 of the La6o q�}t� ' compy with those provisions. ENERGY P/C: � J i DATE:r',��AJI� �� ENERGY PERMIT: � WARNING:Failure to secure Worker's Compensation coverage is unlavrful,and shall subject an employer to criminal RETENTION FEE: y.i J� y penalties and civil fines up to one hundred thousand dollars($100,000),in addition tn the cost of the compensation, vt� = damages as pmvided for in section 3708 of the labor code,interest,and attorney's fees. PRE-ALT FEE: i CONSTNUCTION LENDING AGENCY BSAF: y I hereby affirm under penalty of perjury that there is a Construction Lending Agency for the pertormance of the work for � which this permit is issued(Sec.3097,Civ.C.). LENDER'S NAME: = LEN�ER'SAODRESS: TOTAL FEES i I certiry that I have read this application and state that the above intormation is wrrect.I agree to comply with all city and �' �.� z counry ordinances and state s relating to building construction,and hereby authorize representatives of this county to COMMENTS: � enter upon the above-menti ne roperry for inspection purposes. J � b a PER E NAME(PRI6fT) n � Q� � v = E DATE RECEIPT#� PAID BY:iC�4f'� VALIDATION: I � WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy CITY OF DlAMO,�VD BAR INSPECTION RECQRD � � " • � � s � e o � � , � - SETBACK/LETTER ;TRACT AND LEDGER FOOTINGS FORMS �` � `� �°� �° �'� SWITCH GEAR g�qg �ri' COMMERCIAL HOOD ; UG.PLUMBING T-BAR iUG.ELECTRICAL �� "� � INTEHCEPTER UFER GROUND HOT MOP/SHOWERPAN SEWER LATERAL SEPTIC/CESSPOOL MAIN WATER LINE HERS REPORT RECEIVED � SEWER CLEANQUT DEMOLITION � ROOF SHEATHING ROOF DRAINS FLOOR SHEATHING ROUGH CONDUIT � �'�SHEAR WALLS�E7(TERIOR '�POOVSPA � ��` , �,� ��"',� �-. _�_ .�� , ��,�: �� SHEAR WALLS INTERIOR � ROUGH PLUMBING e� ,.�; � FRAMINGN�NTING . ROUGH,ELECTRICAL �^�� ,�� ° . , �� -�, � � �� -.- ,�� ; �.: ROUGH MECHANICAL // ';' V � flOUGH MECHANICAL ; s ROUGH ELECTRICAL W( }C( # 6AS TEST � �t�: �;, ,� ��,• � IROUGH PIUMBING �� ` '�PRE GUNITE ' �� ,�� so. � WSULATION WALL POOL PRE DECK BONDING ' -' �` INSl1LATI0N CEILING �P-T�P� � ��- �.;3� �� . � _ _d�, °-. �,�„�� DRYWALL FENCE!GATE/ALARM ` E -, ,;� . , LATH(PRE) FINAL POOL �_ �� LATH EXTERIOR WALLS: , LATH INTERIOR WALL FOOTING/STEEL GAS TEST WALL STEEL 1 s'( )2"0( )LIFT SCRATCH COAT � WALL BOND BEAM . EIECTRIC METER RELEASE WALL DRAINI SEAL GAS METER RELEASE WALL FINAL _ _. SPECIALINSPECTION RO.FRAMINGPt�4NNINGAPPROVAL � ��' �FINi1L BUILDING �� :. �'� � � �� '��ROUGH FIRE APP�iOVAL ."� � ;``; � �''"'` - '�� FINAL MECHANICAL � �� -� FINAL FIRE DEPARTMENT � �� >�� v ffig ;EINAL ELECTRICAL , �, FINAL PLANNING � ',, , ' � �� ; �. ee. � ', ��, y�,,,�=_ _ - �-�. ,- 'FINAL PLUMI�ING F1NAL ENGINEERING/PW ��` " '` -,." � _, T.C.of OCCUPANCY FINAL COMMUNITY SERVICES �- �� CEF#T.of OCCUPANGY � ��_" �� FINAL HEALTH DEPT. � ��.�� . � � �. fINAI INOUSTRIAL WASTE � �`' �. COMMENTS: �1�T �� l�t�i!�L ��':`N��n/� l,�l� S %�S`,,��=!��'rf, �:�;�-----y" I �`\ � �� , r . n Slm l,i�cd Prescri tive Certificete af Com lia�tce:Zq0$Residentfitl HV.4CAlterations �F-1R•AL'I'-HVAC C7lmste Zones lo to]S Sit�,A y.�� Erijorcenienl cy: Dat�� „/ Pern�il iR :�r�� c. '�� Conditianed F2aor b ui ment ' List Minimum Ef�'ician Z Duct insulation re uirement Area Thermastflt ❑ ckeged Unit � Over 4Q ft of dncts$dded ar f Grnacc i�AFE3fi ❑COP . �,SeE6ack �f aor Coi! (�SEBR O HSPF teplaced in unconditioned space Serv�stem (If na�atready �ndensing Unit ❑�ER 17 Resistance �R 6 (CZ I D-I3) present,mux�be �7 Uther 0 R 8 (CZ 14•I3) insratled} I.F.qaipnr+a�,r Type:Chorsse the equipmenr beirrg installed;rf more than one rystem,use anaiher CF-IR-ALT-HY�lC for each system. l.Min�'rlrum Bquipmrnt Effrauuies:13 SEER, 78°r6 r3FU1"� 7.1HSPFfor typicat residentiul systeans: HERS YERIFICATIQN St7M1ViA'RY Listed be3ow are fa�HVAC a3teration Optians. 'i]ae installer decidrs what work is bemg done and picks ane of tha appropriare Options. Each Option lists the HERS measures that must be conducted.A eopy of the farms shal]be left on si2e for final inspection and a copy givcn to the hameowner. At final,the inspector verifies t}iat the work listed on this form was in fect the work completed by the instulle e inspector also vcrifies that each appmpriate CF-6R and registered CF-4R forms(no hand filled CF-ARs atlawed}are fiited out and si . s � nfa Octaber 1 2010,a r 'at+ered co oi the CF-iR and C�-6It sriall alsa be oa site for fi�ast' ection. ],HVAC Chengeout Required Fotms: • All HVAC Equipment replaced CF•6R forms: MECH•Q4,MECH-2I-HERS and(far split systems)MECH-25-HEItS � CF-4R forms: MECH-2I and for lit stems MEGH-25 ; • Condenser Cai}szsd!ar �.6R forms: MECH-2l-HERS and(for split systems)MECH-25-HERS" '� z�aoor co�i�,a rer CF-4R fornys: MECH-2I and(for split systems) MECH-25 . �,fl�� ' _ :For Split Systems:Duct]eakage<]5 percent;..RC�CCA>_300.CFM/tQn(N�inilz;umAir.Flow.Requiretnent),-TMA,I�3-- - --_._.._.,---_.--.---_ ._ .._ - -. ..__ lFor Psckaged Units: Duct leakage<�5 peroent Exemptcd from duct leaicage testing if-. L]l.Duc#system�as doeumented to have been previous2y seeled and confirmed throngh HERS verificaiion,or O 2.D'uct syskems with less than 40]inear feet in unconditioned space,or � ❑3.Existin duct stems are constructed,insuteud or sealed with asbestas D�.New HVAC System Required Forms: - � Cut in ot�angeout with new CF-6R forms: MECH-04,MECH-20-HERS,end(for split systems)MECH-22-HERS,and MECH 2S-HERS duets:(all new dueting a�al] �.aR forms: MECH 2d-,end(for spl'st systems)MECH-22,and MECH 25 new G ui 7[�Bnt) For Split Systems:Duct leakage<6 percent;RC,CCA_>350 CFM/ton,FWD,TMA�i,STMS,and either HSPP or PSPP. �8T P8CIt8 ed Unita:Duct leaka e{6 ercent 3:New Uucts with Re iscement Re uired Forme: �� Q Inctudes replscing or installing all new dueting CF-6R forms: MECH-04,MECH-20-2iERS,end(for split systems)MECH-25-HERS I and/or autdaor condensing unit andior indoor CF-4R forms:MECH-20 and{for split systema)MBC�3-25 cai]and/ar furnace. Not all equipment changed. �'or Splet Systemss Duct Ieakage<6 percent,RC,CCA>_300 CFM/ton,TMAH � For Packa ed Units:Duct leaka e<6 ercent � O 4.New Duct'xn over d0 feet Re ulred Forms: e Inciudes adding or replacing more than 40 �.6R forms: MECH•Q4,MECH-2I-HERS CF-4R forn�s: MECH-21 Sinear feet of duot in uncanditittned s ace. For split system or gackaged ua�ts: Duct leakage<15 percent - D EXCEP"110N:Existin duct skems constrvcte insulated or sealed witfi asbestos. Contractor(Dncumentation Aut6or's/Responsible Designer's Decleration Stabemeat) c I certify thet this Cenificate of Compliance dooiunr.ntation is acciaate and complete. _ e 1 atst elfgible under Divisian 3 of the Cslifosnia Bussness and Pmfessions Caie to accept respons�blity for tha design identified an this Certifiaate of Compliance. 4 I certify that the energy fsahuns and perfortnanco speaificationsfor the design idtntified on Shis C':eeriificate af Compiiance canform ta tht tequiremcnts pf 7'itle 24, Parts 1 and 6 pf the Califomia Cade of Regulations. � ?he design features identified on this Ceriificatc of Compliance are consistent with the information docuisiented on other applicable aompliancc forms,worksheets, ca]cutations, lans ificaii s submitted to the enforctment a en for a toval with the rmii a ' tian. Neme: ComP�►Y� Date:�`�,`"p ! .- Address: � ' License: �. � /"1 `J� �• Ciiy/StatelZap: � Phane: �� — J- CERTIFICATE OF COMPLIANCE CFiR-ALT-02-E _ Alteretions to Space Conditioning Systems(formerly CF-IR-ALT HVAC) (Page 3 of 3) Documer�tation Author's Declaration Statement 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: J �L��_ _/� pikschus,dan �i ��Y� Company: Signature Date: KLAUS&SONS CONSTRUCTION INC 2015-06-14 10:14:07 Address: CEA/HERS Certification Identification(if applicable): P O BOX 1085 City/State/Zip: Phone: UPLAND CA 91785 (909)982-5698 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 corred. 2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or rystem design identified on this Certificate of Compliance(responsible designer). - 3. That the energy features and performance specifications,materials,componenu,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-•-'�, �- :� 4. The building design features or system design features identrf�ed on th�s Certificate of Cortipliance are consistent wrth the mformation;provided on ottier applscable'compliance documents,worksheets, calculations,plans and specifications su6mitted to the enforcement agency for approval with,this building permit application. i ; . : ; : � -; -:> . f : ..� 5. I will ensure that a registered copy of this Certificate of:Compliance shali be made a�ailable with;the buiiding permit(s).issued for;the building,and made availabie to.Yhe;enforcement agency for all applicable ,. inspedions.I understand that a registered copy of thisCectificate of ComplianceEis required to be;included with the documentation.thebuilder provides to:ihe building owner at occupancy. Responsible Designer Name: ``-?, � t� ,.�..-. �' '_� +.-��' Responsible Designer Signature. -- t � � " pikschus;dan ��G�JC�Ld' Company: Date Signed: KLAUS&SONS CONSTRUCTION INC 2015-06-14 10:14:07 Address: License: P 0 BOX 1085 320990 City/State/Zip: Phone: UPLAND CA 91785 (909)982-5698 Digitally signed 6y CaICERTS. This digital signature is provided in order to secure the content o/this registered documen�and in no way implies Registration Provider responsibiliry for the accuracy of the inlormation. Registration Number:215-A0158579A-000000000-0000 Registration Date/Time: 2015-06-14 10:14:07 HERS Provider:CaICERTS CA Building Energy Efficiency Standards-2013 Residentiai Compliance Report Version:2014-03-31 Report Genereted:2015-06-14 10:13:43 Schema Version:0.5555DD � I CERTIFICATE OF INSTALLATION CF2R-MCH-20-H Duct Leakage Diagnostic Test (Page 3 of 3) Documentation Author's Declaration Statement 1.I certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: /,� Jua�Quintero a��. Compa�y: sig�ature oate: 2015-06-14 11:16:37 J&J Hers Services Address: CEA/HERS Certification Identification(if applicable): 2324 Genevieve Street CC2006395 City/State/Zip: Phone: San Bernardino CA 92405 909-633-3985 Responsible Person's Declaration statement I certify the following under penalty of perjury,under the taws of the State of California: 1. The information provided on this Certificate of Installation is true and correct. 2. I 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 manufadured 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 understand that a HERS rater will check the�nstallaUon to'venfy compliance,,and that if such-checking identifies defects t atm re,gwred to,take` corrective adion at my expense.I understand that Energy Commission and HER$Provider representatrves will also perform quality assurance checking , . , �.. _. � of installations,including those approved as part of'a sample group but not checked by`a:HER$rater,and if�those installations faif to meet ffie ;,i re uirements of such uali ' � q q ty assurance checking,the required wrrective.action and additional checking/testing of other installations in that.HERS sample group will be performed at my expense.,1�-�— —' �` k� ;, �� ;� i , r�_.:3' 5. 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 that the requirements that apply to the construction or installation have been met. 6. I 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: dan pikschus Company Name:(Ins[alling Subcontractor or General Contrector or Position With Company(Title): Builder/Owner) Owner KLAUS&SONS CONSTRUCTION INC Address: CSLB License: P O BOX 1085 320990 City/State/Zip: Phone: Oate Signed: UPLAND CA 91785 (909)982-5698 2015-06-14 11:20:39 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 documen�and in no way implies Registration Provider responsibility for the accuracy of the information. Registration Number:215-A0158579A-M2000002A-0000 Registration Date/Time: 2015-06-14 11:20:39 HERS Provider:CaICERTS CA Building Energy Efficiency Standards Report Version:2014-05-08 Report Generated:2015-06-14 10:45:03 2013 Residential Compliance Schema Version:0.51SDD i CERTIFiCATE OF INSTALLATION CF2R-MCH-23-H Space Conditioning System Airflow Rate (Page 3 of 3) I 1 Documentation Author s Declaration Statement 1.I certify that this Certificate of Installation documentation is accurate and complete. Oocumentation Author Name: Documentation Author Signature: Juan Quintero �� Company: Signature Date: 2015-06-14 11:16:37 J&J Hers Services Address: CEA/HERS Certification Identification(if applicable): 2324 Genevieve Street CC2006395 City/State/Zip: Phone: San Bernardino CA 92405 909-633-3985 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. I 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 Installatlon conforms to all applicable codes and regulations,and the installation conforms.to the requi[ements given on,the plans and specifications approved by theenforcementagency. � -'.". �., � ��,�- , y ' `"� '�- ` -,r 4. I understand that a HERS rater will check the installation to•,venfy compliance,and that If,'such checking identifies defects I am requtred to taRe 1 corrective action at my expense;l understand�that Energy Commis3ion and HERS Provide�representatives will also perform quaiity assurance checking of installations,including those approved as part:of a�sample group but not checked by a:HERS,rater and if those ins[allations faii to meef the .,;;`i : _ .„ requvements of such quality assurance checking,the required corrective,action and additional,checking/testing ofiother installations;in thatNERS sample group will be performed at my expense`'--1 ;- � " : '=' , i. �? ',J _Y � '� 5. 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 that the requirements that apply to the construction or installation have been met. 6. I will ensure that a�egis[ered copy of this Certificate of Installation shall be posted,or made available with the building permit(s)issued for the building,and made a�railable to the enforcement agenty 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 occupanty. Responsible Builder/Installer Name: Responsible Builder/Installer Signature: dan pikschus Company Name:(Installing Subcontrador or General Contractor or Position With Company(Title): ' Builder/Owner) OWn@f I KLAUS&SONS CONSTRUCTION INC Address: CSLB License: P O BOX 1085 320990 Ciry/State/2ip: Phone: Date Signed: UPLANO CA 91785 (909)982-5698 2015-06-14 11:20:39 Third Party Quality Control Program�TPQCP)Status: Name of TPQCP(if applicable): DigitaNy signed by CaICERTS. This digita/signature is provided in order to secure the content of this registered document and in no way implies Registration Provider responsi6iliry for the accuracy of the information. Registration Number:215-A0158579A-M2300002A-0000 Registration Date�me: 2015-06-14 11:20:39 HERS Provider:CaICERTS CA Building Energy Efficiency Standards Report Version:2014-05-08 Report Generated:2015-06-14 10:50:42 2013 Residential Compliance Schema Version:0.555SDD CERTIFICATE OF INSTALLATION CF2R-MCH-25-H Refrigerant Charge Verification (Page 5 of 5) Documentation Author's Declaration Statement 1. I certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name: Documentation Author Signature��/�`�A�•�`— Juan Quintero -« ��G�' company: signature oate: 2015-06-14 11:16:37 J&J Hers Services Address: CEA/HERS Certification Identification(if applicable): 2324 Genevieve Street CC2006395 City/State/Zip: Phone: San Bernardino CA 92405 909-633-3985 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. I am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, tonstruction,or installation of features,materials,components,or manufactured devices for the scope of work identified on this Certifiwte of Installation and attest to the declaretions 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 Certifiwte of Installation conforms to all applicable codes and regulatlons,_and the inrtallation conforms to the requirements given on the plans and specifications approved by the enforcement agency. � f�"`� b �- , - t 4. I understand that a HERS rater will check the installation to;venfy compliance,and that if such checking ideniifies defects I am�requ�r,ed to take' corrective action at my expense;�� + ' � � I•understand�that Energy Commisslon and HERS Provide�representatives will also perform quality assurarice checking of installations,including those app�oved as part of;a sample gro.up but:not checked:by a,HERS rater,and if.those�insfallations fail'to meet ttie . `.�'i ,. _ _ . . requirements of such qualiry assurence checking,the required correctiveaction and additional checking/testing of other instatlations,in that HERS sam le rou will be erformed at m,ex ense`` ,� �F � '` -- �%` ` " � � .: '" p B P P y= p ,i_! ._ � � '+�s ..�:' �� ' �•%.... ' '�',.� �: � ,�; ; ..E 5. I reviewed a co of the Certificate of Com liance a {r_.r py p dproved�by the enforcement agency that identifies the specific requirements for the scope of construction or installation identified on this Certificate of Instal�ation,and I have ensured that the requirements that apply to the construction or installation have been met. 6. I 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 6uilder provides to the building owner at occupancy. Responsible Builder/Installer Name: Responsible Builder/Installer Signature: dan pikschus Company Name:�1nstalling Subcontractor or General Contractor or Position With Company(Title): Builder/Owner) OWflef KLAUS&SONS CONSTRUCTION INC Address: CSLB License: P O BOX 1085 320990 City/State/ZiP� Phone: Date Signed: UPLAND CA 91785 (909)982-5698 2015-06-14 11:20:39 Third Party Quality Control Progrem(TPQCP)Status: Name of TPQCP(If applicable): Digitally signed by CalCEATS. This digital signature is provided in order to secure the content of this registered documen4 and in no way implies Registration Provider responsibility for the accuracy of the information. Registration Number:215-A0158579A-M2500002A-0000 Registration Date/Time: 2015-06-14 11:20:39 HERS Provider:CaICERTS CA Building Energy Efficiency Standards Report Version:2014-05-08 Report Generated:2015-06-14 11:02:30 2013 Residential Compliance Schema Version:0.551SDD i CERTIFICATE OF VERIFICATION CF3R-MCH-20-H Duct Leakage Diagnostic Test (Page 3 of 3) Documentation Author's Declaration Statement • 1.I certify that this Certificate of Verification documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Juan Quintero �lls?A'j�(�G!IG�rJtd' Company: Date Signed: 1&1 Hers Services 2015-06-14 11:15:54 Address: CEA/HERS Certification Identification(if applicable): 2324 Genevieve Street City/State/Zip: Phone: San Bernardino CA 92405 909-633-3985 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. I am the certified HERS Rater who perFormed the verification identified and reported on this Certificate of Verification(responsible reter). 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 applica6�e sedions of.the Certificate(s),of Installaf'ion(CF2R)signed arid`su6mitfed,by the per;on(s)responsible for the construction or installation conforms to the:requirements;specified�on the Certificate(s�of Compliance(CFiR)approved by the enforcement;agency. ... t'. � � . ., L..• i � _•, .�. .• � ; .- 5. I will ensure that a registered copy of this Certificate of Ve�ification'shall be posted,or made available with the.6uitding pe►mrt(s)'issued fo�the building,and made available to fhe,enforcement agency.for all applicable.inspections.(understand that a registe`red.:copy of this'Certdicate.of�,s�� Verification is required to be'included with the documentation the builder provides to fhe bwlding owner at occupancy. " " "�+ - v r= - ,.a- �r' �., a>.w � y•��'��' '� . ...J! �,..y_l.i Builder Or Installer Information As Shown On The Cerlificate Of Installation ` ' ` ` "' -� - Company Name(Installing Subcontrac[or,General Contractor,or Builder/Owner): KLAUS&SONS CONSTRUCTION INC Responsible Builder or Installer Name: CSLB License: dan pikschus 320990 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: J&J Hers Services Responsible Rater Name: Responsible Rater Signature: Juan Quintero �!lQ�tfi��L�iG�PJt4' Responsible Rater Certification Number w/this HERS Provider: Date 5igned: CC2006395 2015-06-14 11:15:54 Digitally signed by Ca/CERTS. This digital signature is provided in order to secure the content of this registered documen4 and in no way implies Registration Provider responsibility/or the accuracy of the informatron. Registration Number:215-A0158579A-M2000002A-M20A Registration Date/Time: 2015-06-14 11:15:54 HERS Provider:CaICERTS CA Building Energy Efficiency Standards Report Version:2014-05-08 Report Generated:2015-06-14 11:05:04 2013 Residential Compliance Schema Version:0.515DD � I i � I CERTIFICATE OF VERIFICATION CF3R-MCH-23-H Space Conditioning System Airflow Rate (Page 4 of 4) Documentation Author's Declaration Statement i.I certify that this Certificate of Verification documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Juan Quintero �!lsZXi��G�i��Jtd� Company: Date Signed: 1&1 Hers Services 2015-06-14 11:15:54 Address: CEA/HERS Certification Identification(if applicable): 2324 Genevieve Street CC2006395 City/State/Zip: Phone: San Bernardino CA 92405 909-633-3985 Responsible Person's Declaration statement I certify the following under penalty of pery'ury,under the laws of the State of California: 1. The information provided on this Certificate of Verification is true and correct. 2. I am the certified HERS Rater who performed the verification identified and reported on this Certiffcate 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 Comptiance for the building approved by the enforcement agency. -n, 4. The information reported on applicable sections:ofxhe Certificate(s),of installation(CF2R}signed and submit[ed;by the person(s)responsible for the construction or installaUon conforms to thefrequirementsspecified�on the Certificate(s)of Compliance(CF1R)approved by the:enforcement agency. 5. I will ensure that a registered copy of this Certificate of,Verificatiorr'shall be posted;or made availahie with the;6uilding permit(s)jissued fo�the building,and made available to the enforcementagency.fo�all applicable inspections.f understandthat a registered;copy of this'Certificate of.:,�� Verification is required to be included with the documen4ation the 6uilder pro'vides to the building owner atoccupancy. ' ' ``' " - '� ', :, .�. ;+.�._ �._� ;_ -,. . �. ..._.. _: ,-�,�•. ��, Builder Or Installer Information As Shown On The Certi�cate�Of Installation` ' �-� " ��t � � 3;�Y:;` Company Name(Installing Subcontrac[or,General Contractor,or Builder/Owner): KLAUS&SONS CONSTRUCTION INC Responsible Builder or Installer Name: CSLB License: dan pikschus 320990 HERS Provider Data Registry Information Sample Group Number(if applicable): Dwelli�g Test Status in Sample Group(if applicable) i Tested ' HERS Rater Information HERS Rater Company Name: J&J Hers Services ResponsibleRaterName: ResponsibleRaterSignature: ��/�`��k�`_ Juan Quintero ;��, Responsible Rater Certification Number w/this HERS Provider: Date Signed: CC2006395 2015-06-14 11:15:54 Digita/ly signed by CalCERTS. 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:215-A0158579A-M2300002A-M23A Registration Oate/Time: 2015-06-14 11:15:54 HERS Provider:CaICERTS CA Building Energy Efficiency Standards Report Version:2014-05-08 Report Generated:2015-06-14 11:06:57 2013 Residential Compliance Schema Version:0.555SDD , f ' I CERTIFICATE OF VERIFICATION CF3R-MCH-25-H Refrigerant Charge Verification (Page 4 of 4) Documentation Author's Declaration Statement 1.I certify that this Certificate of Verification documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Juan Quintero ��Ri{�j�(d�iqG��,PJt�' Company: Date Signed: 1&1 Hers Services 2015-06-14 11:15:54 Address: CEA/HERS Certification Identification(if applicable): 2324 Genevieve Street � City/State/Zip: Phone: San Bernardino CA 92405 909-633-3985 Responsible Person's Declaration statement I certify the following under penalty of pery'ury,under the laws of the State of California: 1. The information provided on this Certificate of Verification is true and correc[. 2. I am the certified HERS Rater who performed the verification identified and reported on this Certlficate of Verification(responsible rater). 3. The insta�led features,materfals,components,manufactured devices,or system performance diagnostic results that require HERS verification identified on this Certificate of Verifiwtion 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. s, 4. The informatian reported on applicable sections:of the Certificate�s)of Iristallation(CF2R)s�gned and submitEed;by the person(s)responsible for the construction or installation conforms to the�equirements'specified�on the Certificate(s)of Corripliance(CFiR)approved by the enforcemenY.agency. 5. I will ensure that a registered copy of this Certificate of,Verification shall be posted;or made available with the tiuilding permit(s);issued for the building,and made available to 4he enforcement agency for all applirable inspections.I�understand:that a regisEe�ed copy of:this�Certificate of;;.�.� ,; , ., . , ... ;,..; s. '_.,, .. Verification is requlred to be'included with the documentation the builder pro'vides to the building owner aYoccupancy. ' '� •�. , � , . >. .� _. .,_.. ,, ,.. -- :. ..- t'Y"„ .. _..` '' . f .- � "i /t ;-. _......, ,�.._:� ..... . .. . .. . �.__�t Builder Or Installer Information As"Shown On�The Certi�cate Of Installation'' � r ```` �` '```r" ""' �� '� Company Name(Installing Subcontractor,General Contractor,or Builder/Owner): � KLAUS&SONS CONSTRUCTION INC Responsible Builder or Installer Name: CSLB License: dan pikschus 320990 � 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: J&J Hers Services Responsible Rater Name: Responsible Rater Signature: � Juan Quintero KRsUj�(GG�iG�P�t�B' Responsible Rater Certification Number w/this HERS Provider: Date Signed: CC2006395 2015-06-14 11:15:54 Digitally signed 6y CaICERTS. This digital signature is provided in order to secure the content of this registered documen�and in no way implies Registration Provider responsibility for the accuracy of the information. Registration Number:215-A0158579A-M2500002A-M25A Registration Date/Time: 2015-06-14 11:15:54 HERS Provider:CaICERTS CA Building Energy Efficiency Standards Report Version:2014-05-08 Report Generated:2015-06-14 11:10:53 2013 Residential Compliance Schema Version:0.5515DD