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r _„_„�r'-°'�'�` � CITY OF DIAMOND BAR
_. . _ _
;_ DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES '
"�- �<� 21810 Copley Drive,Diamond Bar,CA 91765 PRESS
\R,��,�, (909)839-7020 Fa�c:(909)861-3117 Building Inspection Hotline(909)839-7027 FIRMLY
BUII,DING PERMIT APPLICATION
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i JOB SITE ADDRES�`��� ����M� � � � \ APPLICATION DAT . P/C#
ISSUE DATE: I d'�/ PERMIT# L / 1 / ��6 �
= APN �OT TRACT
� OWNER \� TYPE CONST. OCC GROUP:
L SS 23 � 'fl � ZONING SETBACKS
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J CITY � I I" FRONT RW ❑
� APPLICAN T L � REAR �
� SIDE/SIDE STREEf RW O
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a CONTRACTO SIDE
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� ADDAES ' PROPOSED USE
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� ARCH/ENG/DESIGNER �'
� 'ADDRESS �' #DWEL.UNITS #STORIES #BEDROOMS
� CITY J— ZIP r� TEL.
� oWNER-Bu��DEa oEcIaHATIaN DESCRIPTION SQ.FT. FACTOF PSF ADJ.AREA/VALUATION �
¢ SFR/ADD/REM I
z I hereby affrtn under penatty of perjury that I am exempt from the Coritractor's State License Law for the reason(s)
� Indicatad bebw by the checkmark(s),I have placed neM to Ne applicabie dem(s)(Sectlon 70315,Busfness and
� Garage/Carport
L Rotassio�Code:Any cfry or caumy that requlres a permrc to coretruct,aimr,Improve,demolish,or repalr,arry
z structure,prlm to its issuance,also requlres the appllwrtt for the permit to Ble a siBned stetement Uwt he or she w Patlo/Deck
i Is Ilce�ed pursuaiH ta the provlsbns af ttie Caitraclor's Sfate License Law(Chapter 9)Commencing with Sectlon pooUS a I
tt w
. n7000 of Dlvislon 3 oT ttie Buslness antl ProTessions Code]or that he or she Is exempt from licensu2 and the basis fir � P I
the alleged exemption.My violatlon of Section 7031.5 by any applicartt for a permit sub�ects the appliprrt to a cNil penatty Z Re-Roof
� of not more than five hundred dollars($500).
's � Commercial I "
� (,I,as owner of the property,or my employees wRh wages as tt�eir sale compensation,wlll do()all of or(,portlons �
� oT the work,and the shucture Is not intended or offered for sale(Sectlon 7044,Business and Professions Code:The m I
'.�� Contractors'Shate Llcense law dces not apply to an awner of property who,through employees'or personal eftort,builds
y or improves the property,provided that the imprmements are not Irrtended or offered for sale.tt however,the bullding or I
� imprwement Is sold within one year of completion,the Owner-Builder wlll have lfie 6urden of proving that it was not bullt
� or Improvetl for the Durpose of sale.). I
'� 1,as nwnar of the ro e y corttractin with licensed Cordmc0ors to constn�ct the ro ec[Sectlon I
U P D nY�amezclusivel g P 1 � Valuation: Adj.Area:
Z7044,Business and Professions Code:The Contractors'State License Law does not apply fi an owner of properry who
n bulldsorimprovesthereon,andwhacontracisfirtheproJacCswittialicensadContractarpursuanttotlteContractors'State pUANTITY DESCRIPTION FEE �
Y LJCBfISC LdW.�. � I
� (,I am exempt from Ilcensure under the CoM2ctnr's State License law tor the fallowing reason(s): �
�
L By my signaNre below I acknowiedge that,except Por my personal residence in which I must have resitled for at�east one � I
z year prior to compleUon of the improvements covered by this permtt,l cannot legaly sell a structure that I have buitt as an w I
�
owner-builder if it has not been construded in Rs entirery by licensed contractors.I understand that a copy of the applicable � I
� law,Section 7044 of the Businass and Protesslons Code is avalla6le upon reQuest when this application is submltted or at �
i ihe following Web slte_ht�A»vw.Ieginfo.ca.gov/calaw.html. � � z I
� DATE: SIGN: � I
LICB�15E0 CONTHACTOfl'S DECLAHATION �
=� I hereby affirm under penatly ot perjury that I am Ilcensed under provisians of Chapter 9(commencing with Section 7000) I
y
. �? of Dhrision 3 of the mess and Professions Code,and my license Is in lull force and eftect. � �r�,�� S
.�7n �r Zb `� I
n LICENS CLASS: .LIC.N
� DA � O CT : � � �
7d" WORI�A'S{C'',,'�,' N EC �
� I HEREBY AFARM UNDEH PENALTY OF PERJURY O�Cy�n OLLOWING DECLARATIONS: '
L
¢ I have and will malntain a Certlflcata of Consent to Self-Insure for Worker's Compensa5on,a9 provided by CONSTRUCTION: ,
� Section 3700 of the La6or Code,for the performance of the work for which this permtt Is issued. p�p,N REVIEW:
i
� I have and will maintaln Worker's Compensation Insu2nce,as requlred by Section 3700 of the LaOor Code,for ELECTRIG:
� the perfortnance af the work for which thls pertnit is issued.My Worker's Compensatlon Insurance Car�ier and
¢ PolicyNumberare: PLUMBING:
� CARRIER MECHANICAL: ��
L
Z PouCVNUMeER INSPECTION FEE:
�
� (THIS SCCTION NEED NOT BE COMPLEfED IFTHE PERMIT IS FOR ONE M1NDR�DOLLARS($100)���1. ISSUANCE: ��'-��
� I certify tliat In the peAart�ance at the wock for which this partnit's issued,I shall rrot employ any person in any manner so as N $M I P:
= becane subject tn the Worker's Canpe on Laws of d gree tfi��f I�shauld becane subject tn the Wortcer's
JCan tion p io ction 37 N labor e, h th compN�D+ ttwsa provisions. ENERGY P/G:
' J Da���Pu ENERGY PERMIT:
i /►/1
� WARNING:Failure to sewre Worker's Compensation coverage Is unlawful,and all subJect an employer to cnminal RETENTION FEE: 'V 6l
= penaltles and chril fines up to one hundred thousand dollars(5700,000),In addition to the cost ot the compe�ation,
� damages as pmvided for in sectlon 3708 af the labor code,Interest,and attomeys fees. PRE-ALT FEE:
y CONSTRUCTION LENDIHG AC�NCY BSAF:
y I hereby affirm under penalty of perJury that tl�ere Is a CanstrucGon Lending Agenty for the performance of the work for
� which this permtt is Issued(Sec.3097,Civ.C.�.
LENDER'S NAME:
Y LENDEA'SADDRESS: �'
� I ceNfy I have reatl this appll e ihat the above Intormation is wttect.I agree to comply with all dry and TOTAL FEES
� cou rdl ances and state la rela�ng u i cons'Re�ian,and here6y authonze representatives ot this county to COMMENTS:
z
� ente on the abwe-mentloned rly f I p n purpose �
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PERMI.. � ' I
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AN M �ATE RECEIPT# ���� K PAIDBY: VALIDATION:
WHITE—Department Copy,YELLOW—Flnance Copy,PINK—Assessor Copy,GOLDENROD—Fle Copy,GREEN—AppllcanYs Copy
CITY OF DIAMOND BAR
INSPECTION RECORD � �
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SETBACIVLETTER ��������,� -�� �`_ ° � ��° ,„ � ,���� '.< �� TFtAGTANDLEDGER
�FOOTItJGSpFORit?IS � �� ���# ���°.��,� »�''' ���� � � ,:��, ' SWITCH GEAR
'SL�qg�.; �h£ ���,��s� `� � "���' ;��.'� CONIMERCIALHOOD
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�UG.P�UMBING , s ;3.� �.��� � $�.��L�- M� .,,,�,� 3..x=. T-BAR
iUG.ELECTRICAL,a�. � . ,� � � �M�%'� �' � �;r��.�'=. � INTERCEPTER
� �;�_�a� �" ���,��<- -`�����., �� <<�; r��,;�,,.���,�n HOTMOP/SHOWERPAN
'UFER GFIOUND � � °m, ��
SEWER LATERAL SEPTIC/CESSPOOL
MAIN WATER LINE HERS REPORT RECEIVED
SEWER CLEANOUT DEMOLITION
ROOF SHEATHING ROOF DRAINS
FLOOR SHEATHING ROUGH CONDUI7
`SFIEAR�WAL�LS�E?lTERIOR ��R,��: � �-�,',�u ����, ��, '` Pt?01.lSPA ��� � � �`�'��� - ��, ����^�� �.�,° �a�
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FRAMING/VENTING .._..�..� �. „ � ,,m
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LATH EXTER�OR WA��'�
IATH INTERIOR WALL FOOTING/STEEL
GAS TEST WALL STEEL 1 Sr� �2No� ����
SCRATCH COAT WALL BOND BEAM
ELECTRlC METER RELEASE WALL DRAIN!SEAL
GAS METER RELEASE WALL FINAL
SPECIAL INSPECTION ;FiO'FPJUN9JG�4PL�ANPl1NGAPPROVAL��� � �� ��v��� � `�' �''
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�T.C.of OCCUPANCY � � ��_� ���� ����� ���°� � `�" � F�INAL GOMM!lNtTY�SERVIGES � � � �
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COMMENTS:
CERTIFICATE OF VERIFICATION CF3R-MCH-20-H
Dud Leakage Diagnostic Test , (Page 1 of 3).
Project Name: 23640 Monument Canyon Dr Enforcement Agency: City of Permit Number: 14-4787
UNIT F Diamond Bar '
Dwelling Address: 23640 Monument Canyon City: Diamond Bar Zip Code: 91765
Dr UNIT F
A. System information - �
t
01 Space Conditioning System Identification or Name WHOLE HOUSE
02 Space Conditioning System Location or Area Served WHOLE HOUSE �
03 Building Type from CF-1R Single family
04 Verified Low Leakage Ducts in Conditioned,5pace No,credit is not taken
(VLLDCS).Credit from CF1R?
05 Verified Low Leakage Air Handling Unit Credit from No,credit is not taken
CF1R?
_ . __ , . .� - , . „
-
� � _ ,.,
06 Duct System Cornpliance�JCategory ;: � ' , Alteration
F."� :s,y � .�� �
�
q t
MCH-20d-Complete,Replacement o'r_Alte�ed Duct System r , � �.,.;:
B. Duct Leakage Diagnostic Test �
01 Conclenser Nominal Cooling Capacity(ton) 2.5
,� .
02 Heating Capacity(kBtu/h) . 40
03 Conditioned Floor Area served by this HVAC system (ft2) 920 �
04 Duct Leakage Test Condition � Test final
05 Duct Leakage Test Method Total leakage
06 �Leakage Factor 0.15 � .
Q� Air Handling Unit Airflow(AHUAirflow) Determination Cooling system method •
Method
08 Measured AHUAirflow This field or section is not applicable
09 Calculated Target Allowable Duct Leakage Rate(cfm) 150
10 Actual duct leakage rate from leakage test measurement 143 �
� (cfm) • -
11 Compliance Statement:System passes leakage test '
Registration Number:214-A0121346A-M2000002A-M20A Registration Date/Time: 2014-10-20 16:52:59 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards Report Version:2014-05-08 Report Generated:2014-10-20 16:51:30
2013 Residential Compliance Schema Version:0.515DD
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 �
O1 System was tested in its normal operation condition. No temporary taping allowed.
Outside air(OA)ducts for Central Fan Integrated (CFI)ventilation systems,shall not be sealed/taped off during duct leakage
�Z testing.CFI OA ducts that utilize controlled motorized dampers,that open only when OA ventilation is required to meet
ASHRAE Standard 62.2,and close when OA ventilation is not required, may be configured to the closed position during duct
leakage testing. '
03 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 poirits�between the air,handlera�nd>the supply and'return,plenums,are completely sealed.
r� F:
If the system.'c�omplies using�the Smoke Test method the smoke,test w'as conducted in accordance with the requirements
07 of Reference,Residential�Qppendix RA3.1.4.3.6.Systems that coro`ply using smoke test shall nof be included in sample
groups for HE�RS�"�.verification compliance. >>� � , -- �� - . ��- �� �� � •��� ��� � !'�' �r �
08 Verification Status: Pass-all applicable requirements are met '
09 Correction Notes for this table:
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:
. • , �
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.
O1 Complies:All specified verification profocol requirements on this document are met.
Registration Number:214-A0121346A-M2000002A-M20A Registration Date/Time: 2014-10-20 16:52:59 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards Report Version:2014-05-08 Report Generated:2014-10-20 16:51:30
2013 Residential Compliance Schema Version:0.515DD
CERTIFICATE OF VERIFICATION CF3R-MCH-20-H
Duct Leakage Diagnostic Test (Page 3 of 3) �
' i
Documentation Author s Declaration Statement
1. I certify that this Certificate of Verification documentation is accurate and complete.
Documentation Author Name: Documentation Author Signature: �
JohnKwan
Company: Date Signed:
1.K.Air Balancing&Duct Testing 2014-10-20 16:52:59
Address: CEA/HERS Certification Identification(if applicable�:
9040 Telstar Ave#137 3012 �
City/State/Zip: Phone: �
EI Monte CA 91731 626-274-0522
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
�n �� g� pproved b the enforcement a enc r � �` '
specified on,thepCertificate';of Compliance;for the bwldin�a� y _ g y i �
4. The information reported'on applicable s"ections of the Certificate(s)of Installation(CF2R)signed and submitted by'the person(s)responsible for the �
construction'�or installation conforms to tfie requirements speafied:on the Ce�tificate(s)of Compliance(CF1R)approved by the enforcement agency.
S. I will ensure;that a registered`copy of this Ce�tificate of Verification sFiall be posted,or made a'vailable with the building perm,it(s)issued for the
,a � ,
� building,and�made availatile to the enforcement agency'for�all applicable inspections..l underst@nd that a registered copy of tfii.s Certificate of
Verification is requi�ed to be included'witfi the documentation the builder provides to the building owner at occupancy. ' '
Builder Or Installer Information As Shown On The Certificate Of Installation
Company Name(Installing Subcontractor,General Contractor,or Builder/Owner):
JAMES POLAND
Responsible Builder or Installer Name: , CSLB License:
JAMES POLAND 644094 .
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.K.Air Balancing&Duct Testing
Responsible Rater Name: " Responsible Rater Signature: � �
John Kwan �
Responsible Rater Certification Number w/this HERS Provider: Date Signed:
CC2005646 2014-10-20 16:52:59
Digitally signed by CaICERTS. This digital signature is provided in order ro secure the content of this registered document,and in no way implies Registration Provider
responsibility for the accuracy of the information.
Registration Number.214-A0121346A-M2000002A-M20A Registration Date/Time: 2014-10-20 16:52:59 HERS Provider.CaICERTS
CA Building Energy Efficiency Standards Report Version:2014-05-08 Report Generated:2014-10-20 16:51:30
2013 Residential Compliance Schema Version:0.51SDD
'� ' i
CERTIFICATE OF VERIFICATION . CF3R-MCH-23-H
Space Conditioning System AirFlow Rate , (Page 1 of 4)
Project Name: 23640 Monument Canyon Dr Enforcement Agency: City of Permit Number: 14-4787
UNIT � � F Diamond Bar
Dwelling Address: 23640 Monument Canyon City: Diamond Bar Zip Code: 91765
Dr UNIT F
A. Ducted Cooling System Information
, O1 System Identification orName WHOLE HOUSE �
02 System Location or Area Served WHOLE HOUSE
03 System Installation Type Alteration
� 04 Nominal Cooling Capacity(tons)of Condenser 2.5
05 Condenser 5peed Type ' Single Speed
06 Cooling System Zonal Control Type Not Zonal
_ ., , , ., . . _ ,. ;.. , .h,- _..
07 Central Fan Integrated (GFI)Ventilation System Status� ; Not a CFI system
r,. .
,� ., ��• �
OS System Bypass DUct Status:� ' • No�Bypass Duct� �
,, r, . . . ,
_.,,,-,
09" Date of System Airflow Rate Measurement' {` � � � 2014-10-20 � � � ` " ' '
. 10 Airflow Rate Protoco(utilized RA3.2.2.7.3 Rlternative to Compliance with Minimum
• System Airflow Requirements
B. Hole for the placement of a Static Pressure Probe (HSPP),and Permanently installed Static Pressure Probe (PSPP)
in the supply plenum.
Procedures for installing HSPP or PSPP are specified in RA3.3.1.1.
O1 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 airffow rate measurement apparatus information is given
in RA3.3.2.
01 Airflow Rate Measurement Type used for this airflow rate Fan Flowmeter according to procedure in RA3.3.3.1.1
verification.
02 Manufacturer of Airflow Measurement Apparatus SHORTRIDGE
03 Model number of Airflow Measurement Apparatus FLOWHOOD 8400
04 Certification Status of the Airflow Measurement Apparatus Certified by Manufacturer and listed on CEC Website at
Accuracy htt
p://www.ene rgy.ca.gov/(tbd)
Registration Number:214-A0121346A-M2300002A-M23A Registration Date/Time: 2014-10-20 16:52:59 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards Report Version:2014-OS-08 Report Generated:2014-10-20 16:52:30
2013 Residential Compliance Schema Version:0.515DD
CERTIFICATE OF VERIFICATION CF3R-MCH-23-H
Space Conditioning System Airflow Rate � (Page 2 of 4)
MCH23c Alternative to Compliance with Minimum System Airflow Requirements for Altered Systems
D.Alternative to Compliance with Minimum System Airflow Requirements for Altered Systems
The installer shall attempt to correct non-compliant system airflow,rates by performing the following remedial actions
as specified in RA3.2.2.7.3 �
01 Determine that the air filter media is clean. If the air filter Completed
media is dirty,then replace it with clean filter media
02 Open all registers and dampers and remove any Completed
obstructions.
Replace/Repair all accessible crushed, blocked, restricted, Completed ,
03 remove excess length, and sharp bends in ducts.Supported �
every 4 ft max.with a max. 2 in sag
04 Clean the evaporato�coil according to the manufacturer and Completed
ensure the coil is not obstructed.
_�.���,,,�,
05 Air handler fan�speed set to high and blower.wheel and n Completed -
��.�, b "' 1 �..,,�" F�,'� ti,,�i x'
motor are operating properly: ,
�, , . 3 . .
� �-, r z
06 If determined�t�o be'foo smalf;`�epl'ace tfie �eturn du'ct with a �'Completed°� � �
larger one,and/or add a second return duct.
�� If determined to be too"small, replace the return grille with Completed
a larger area grille. .
O8 Verification Status: • System complies
09 Correction Notes: N/A
Optional Notes:additional information not relevant to N/A
10 correction for responses given in Rows 01 through 07 in this ' ' '
section: '
E. Forced Air System Airflow Rate Measurement- Best Airflow Rate Attainable
The procedures for System Airflow Rate Verification are specified in Reference Residential Appendix RA3.3.
01 Required Minimum System Airflow Rate(cfm/ton) 300
02 Required Minimum System Airflow Target(cfm) 750 �
03 Actual System Airflow Rate Measurement(cfm) 722
04 Compliance Statement: 5ystem does not comply with minimum airflow rate
requirement
05 HERS Sample Group Eligibility Not Eligible for HERS Sample Group for Airflow
Registration Number:214-A0121346A-M2300002A-M23A Registration Date/Time: 2014-10-20 16:52:59 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards Report Version:2014-05-08 Report Generated:2014-10-20 16:52:30
2013 Residential Compliance Schema Version:0.51SDD i
CERTIFICATE OF VERIFICATION ` CF3R-MCH-23-H
Space Conditioning System Airflow Rate ' (Page 3 of 4)
F.Additional Requirements
O1 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.
A visual inspection shall confirm that bypass ducts that deliver conditioned supply air directly to the space conditioning
system return duct airflow are not used on new or replacement zonally controlled systems unless the Performence
03 Certificate of Compliance indicates an allowance for use,of a bypass duct.When a bypass duct is accounted for on the
Performance Certificate of Compliance,the airflow rate shall conform to the specifications listed on the Certificate of
Compliance. '
04 All registers were fully open during the diagnostic test.
05 System fan was set at maximum speed during the diagnostic test.
06 If fresh air duct is•part'of.the HVAC system.,it was not'closed during the diagnostic test.:-`
,,.„�-� �'� � � ��' .. .� �._;
07 Airflow rate and�fan watt draw shall`be simultaneous measurements wlien used t'o calculate�the Fan Efficacy tested�value.
, � ;
� °. , �.,' , . ' . � . • .
Multi-speed compressor space coolirig systems�or variable speed::compressor systemsshall v.erif,y air flow(cfm/ton)and fan
08 efficacy(Watt/cfm)with system operating in cooling mode at the maximum eompressor 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.
G. Determination of HERS Verification Compliance
All applicable sections of this document shall indicate compliance with the specified verification protocol
requirements in order for this Certificate of Verification as a whole to be determined to be in compliance. , �
O1 Complies:All specified verification protocol requirements on this document are met.
Registration Number:214-A0121346A-M2300002A-M23A Registration Date/Time: 2014-10-20 16:52:59 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards Report Version:2014-05-08 Report Generated:2014-10-20 16:52:30
2013 Residential Compliance Schema Version:0.51SDD
CERTIFICATE OF VERIFICATION � CF3R-MCH-23-H
�Space Conditioning System Airflow Rate (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: �
JohnKwan
Company: Date Signed: ,
J.K.Air Balancing& Duct Testing 2014-10-20 16:52:59
Address: CEA/HERS Certification Identification(if applicable�:
9040 Telstar Ave#137
Ciry/State/Zip: Phone:
EI Monte CA 91731 626-274-0522
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 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 Certificefe'iof Compliance;for the tiuilding;approve,d"6y the enf`o�cement agency �` � ,';�� 'V��
4.. The information.reported'on applicable sections"of the Certificate(s)o�lnstallation(CF2R)sgned and submitted by`the person(s)responsible for the
construction`:o�'installation conforms to the requirements specified on the Certificate(s)of Corripliance(CF1R)approved by the enforcement agency.
5. I will ensure`tFiat a registered copy of this Certificate of Verification'shall be postedi,or made available with the building;,permit(s)issued for the
building,and`made availatile.to'the enf'orcement,agency'for�all applicable inspections:lundersta�nd that a registered copy of this Certificate of
Verification is required�to be included with the�documenfation the 6uilde�provides to the building owner at occupancy. °
Builder Or Installer Information As Shown On The Certificate Of Installation
Company Name(Installing Subcontractor,General Cbntractor,or Builder/Owner�:
JAMES POLAND.
Responsible Builder or Installer Name: , � CSLB License:
JAMES POLAND 644094 , �
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.K.Air Balancing& Duct Testing
Responsible Rater Name: Responsible Rater Signature: �
John Kwan
Responsible Rater Certification Number w/this HERS Provider: Date Signed:
CC2005646 2014-10-20 16:52:59
Digitally signed by Ca10ERTS. This digital signature is provided in order to secure ihe content of this registered document,and in no way implies Registration Provider
responsibility for the accuracy of the information.
Registration Number:214-A0121346A-M2300002A-M23A Registration Date/Time: 2014-10-20 16:52:59 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards Report Version:2014-05-08 Report Generated:2014-10-20 16:52:30
2013 Residential Compliance � Schema Version:0.515DD
�
CERTIFICATE OF INSTALLATION CF2R-MCH-20-H
Duct Leakage Diagnostic Test (Page 1 of 3)
i
Projett Name: 23640 Monument Canyon Dr Enforcement Agency: City of Permit Number: 14-4787
UNIT F Diamond Bar
Dwelling Address: 23640 Monument Canyon City: Diamond Bar Zip Code: 91765
Dr UNIT F
A.System Information ,
01 Space Conditioning System Identification or Name WHOLE HOUSE
02 Space Conditioning System Location or Area Served WHOLE HOUSE '
03 Building Type from CF-1R Single family
04 Verified Low Leakage Ducts in Conditioned Space No,credit is not taken
(VLLDCS)Credit from CF1R?
05 Verified Low Leakage Air Handling Unit(VLLAHU)Credit No,credit is not taken
from CF1R? '
_
_ _. ,
.. . , ,, , ,
06 Duct System Compliance Category , .' Alteration �. '
_ , .
�;r , �.. � :
, , . .
�� '
MCH-20d-Complete,Repla ement o�Altered Duct System= �
B. Duct Leakage Diagnostic Test
O1 Condenser Nominal Cooling Capacity(ton) 2.5
02 Heating Capacity(kBtu/h) 40
03 Conditioned Floor Area served by this HVAC system (ft2) 920
04 Duct Leakage Test Condition Test final
05 Duct Leakage Test Method Total leakage
06 Leakage Factor 0.15 �
�� Air Handling Unit Airflow(AHUAirFlow) Determination Cooling system method ,
Method
08 Measured AHUAirflow This field or section is not applicable
09 Calculated Target Allowable Duct Leakage(cfm) 150 �
10 Actual duct leakage rate from leakage test measurement 143 • .
(cfm)
11 Compliance Statement:System passes leakage test
Registration Number:214-A0121346A-M2000002A-0000 Registr.ation Date/Time: 2014-10-20 16:54:28 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards Report Version:2014-05-08 Report Generated:2014-i0-20 16:39:51
2013 Residential Compliance Schema Version:0.51SDD
, CF2R-MCH-20-H
CERTIFICATE OF INSTALLATION
Duct Leakage Diagnostic Test (Page 2 of 3)
� . 4
i, C.Additional Requirements for Compliance �
01 System was tested in its normal operation condition. No temporary taping allowed.
Outside air(OA)ducts for Central Fan Integrated (CFI)ventilation systems,shall not be sealed/taped off during duct leakage
�Z testing.CFI OA ducts that utilize controlled motorized dampers,that open only when OA ventilation is required to meet.
ASHRAE Standard 62.2,and close when OA ventilation is not required,may be configured to the closed position during duct
leakage testing.
03 All supply and return register boots were sealed to the drywall.
' 04 Building cavities were not used as pienums or piatform returns in lieu of ducts.
', OS 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 res onsible erson's si nature on th_is com liance documenti affirms tHaf all applicable requirements in this table have
been met. p R' g ,;�� � p ,. .
. .
i r:
. . .. . .. ,�... _... .-.: . .. ::� . ��-.. �� , .��,.•�- ' � .. . .
_r.i-.... , , ... . . , .. . . . .. . ,. .
Registration Number:214-A0121346A-M2000002A-0000 Registration Date/Time: 2014-10-20 16:54:28 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards Report Version:2014-05-08 Report Generated:2014-10-20 16:39:51
' 2013 Residential Compliance Schema Version:0.51SDD ,
CERTIFICATE OF INSTALLATION � CF2R-MCH-20-H
Duct Leakage Diagnostic Test (Page 3 of 3)
Documentation Author's Declaration Statement .
i. I certify that this Certificate of Installation documentation is accurate and complete.
Documentation Author Name: ' Docume�tation Author Signature: /J�y�� ���
James Poland �
company: signature oate: 2014-10-20 16:54:28
JAMES POLAND .
Address: CEA/HERS Certification Identification(if applicable}:
1437 RANCHO HILLS DR
City/State/Zip: Phone:
CHINO HILLS CA 91709 ' (909)606-9417
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 Gertifi�ate of Installation is true and correct.
2. I am eligible under Division 3 oYthe eusiness 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 ma.nufactured 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 enforceme�t agency.. - � • • � ,
4. I understand that a HERS rater will check the installation to ve�ify compliance;and that if such checking idenfifies defects;J,am required to take
corrective action at my expense.:l understand that Energy Commission and HERS Provider representatives will also,perform.quality assurance checking
of installations,including those approved as part of.a�sampfe group but noYchecked'by a HERS tater,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 Comptiance approved by the enforcement agency that identifies the specific requirements for the scope of
construction or installation identified ori 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 tie 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:
James Poland
Company Name:�Installing Subcontractor or General Contractor or Position With Company(Title): '
Builder/Owner) OWNER
JAMES POLAND
Addresr.' CSLB License:
1437 RANCHO HILLS DR 644094
City/State(Zip: Phone: Date Signed:
CHINO HILLS CA 91709 (909)606-9417 2014-10-20 16:54:28
Third Par[y Quality Control Program(TPQCP)Status: Name of 7PQCP(if applicable):
r
Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document,and in no way implies Registration Provider .
responsibility for the accuracy of the information.
. Registration Number:214-A0121346A-M2000002A-0000 Registration Date/Time: 2014-10-20 16:54:28 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards Report Version:2014-05-08 Report Generated:2014-10-20 16:39:51
2013 Residential Compliance Schema Version:0.51SDD
CERTIFICATE OF INSTALLATION CF2R-MCH-23-H
Space Conditioning System Airflow Rate . (Page 1 of 4)
Project Name: 23640 Monument Canyon Dr Enforcement Agency: City of Permit Number: 14-4787
UNIT F Diamond Bar
Dwelling Address: 23640 Monument Canyon City: Diamond Bar Zip Code: 91765
Dr UNIT F
A. Ducted Cooling 5ystem Information
01 System Identification or Name WHOLE HOUSE
02 System Location or Area Served WHOLE HOUSE ,
03 System Installation Type Alteration
04 Nominal Cooling Capacity(tons)of�Condenser 2.5 , _
05 Condenser Speed Type Single Speed
06 Cooling System Zonal Control,Type Zonally Controlled
�t.:,
07 Central Fan Integrated (CFI)Ventilation System Status ; ' - Not e CFI system„;�^
/., . � . - .. � .,.
OS System Bypass;Duct Statusr�` , . No Bypass Duct`` , �
,i. � � � � �
09 Date of System Airflow Rate Nleasurement 2014-10-20 � ' " �
10 Airflow Rate Protocol utilized RA3.2.2.7.3 Alternative to Compliance with Minimum
System Airflow Requirements
B.Hole for the placement of a Static Pressure Probe (HSPP), and Permanently installed Static Pressure Probe(PSPP)
in the supply plenum. •
Procedures for installing HSPP or PSPP are specified in RA3.3.1.1. '
O1 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.
01 Airflow Rate Measurement Type used for this airflow rate Fan Flowmeter according to procedure in RA3.3.3.1.1
verification.
02 Manufacturer of Airflow Measurement Apparatus SHORTRIDGE
03 Model number of Airflow Measurement Apparatus FLOWHOOD 8400
04 Certification Status of the Airflow Measurement Apparatus � Certified by Manufacturer and listed on CEC Website at
Accuracy http://www.energy.ca.gov/(tbd) .
Registration Number:214-A0121346A-M2300002A-0000 Registration Date/Time: 2014-10-20 16:54:28 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards. Report Version:2014-05-08 Report Generated:2014-10-20 16:41:39
2013 Residential Compliance Schema Version:0.515DD
CERTIFICATE OF INSTALLATION , CF2R-MCH-23-H
Space Conditioning System Airflow Rate (Page 2 of 4) '
MCH23c Alternative to.Compliance with Minimum System Airflow Requirements for Altered Systems
� D.Alternative to Compliance with Minimum System Airflow Requirements for Altered Systems
The installer shall attempt to correct non-compliant system airflow rates by performing the following remedial actions
as specified in RA3.2.2.7.3
O1 Determine that the air filter media is clean. If the air filter Completed
media is dirty,then replace it with clean filter media
�Z Open all registers and dampers and remove any Completed •
obstructions.
IReplace/Repair all accessible crushed, blocked, restricted, Completed
03 remove excess length,and sharp bends in ducts.Supported
every 4 ft max.with a max. 2 in sag
04 Clean the evaporator coil according to the manufacturer and Completed
ensure the coil is not obstructed.
���. .
Air handler fan speed set to high and blower wheel and Complefed ' �. '
05 �. ,�. � ,� �
� motor are op'e'rating properl�y �` i �,°„� � ���.? � � �,; �� ;�:,, "' � �
. . � . � ,, • -�_ � •
, ,; , : ,, , ; � `. �
06 �f determined to be�foo small;'replace the:cetu'rn duct with a Completed �
larger one and/or add a second return duct.
�� If determined to be too small, replace the return grille with Completed
� a larger area grille.
If any of the above were not completed list the Action N/A
08 Required and a description of why the action could not be �
completed: �
E. Forced Air System Airflow Rate Measurement-Best Airflow Rate Attainalile
The procedures for System Airflow Rate Verification are specified in Reference Residential Appendix RA3.3.
O1 Required Minimum System Airflow Rate(cfm/ton) '300
� 02 Required Minimum System Airflow Target(cfm) 750
03 Actual System Airflow Rate Measurement(cfm) 722
04 Compliance Statement: System does not comply with minimum airflow rate
requirement
05 HERS Sample Group Eligibility Not Eligible for HERS Sample Group for Airflow
Registration Number:214-A0121346A-M2300002A-0000. Registration Date/Time: 2014-10-20 16:54:28 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards Report Version:2014-05-08 Report Generated:2014-10-20 16:41:39
2013 Residential Compliance Schema Version:0.515DD �
i _ � .
CERTIFICATE OF INSTALLATION CF2R-MCH-23-H
Space Conditioning System Airflow Rate (Page 3 of 4) i
F.Additional Requirements
O1 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 specif'ications given in RA3.3.1.
A visual inspection shall confirm that bypass ducts that deliver conditioned supply air directly to the space conditioning
system return duct airflow are not used on new or replacement zonally controlled systems unless the Performance
03 Certificate of Compliance indicates an allowance for use of a bypass duct.When a bypass duct is accounted for on the
Performance Certificate of Compliance,the airflow rate shall conform to the specifications listed on the Certificate of
Compliance. '
04 All registers were fully open during the diagnostic test. �
05 System fan was set at maximum speed during the diagnostic test.
06 If fresh air duct is;parf"of.the HVAC system it.was'�not�closed during the diagnostic test ." � I
,� ;_ f� �. . ; :; �
07 Airflow rate a'nd fan watt draw-shall�be simultaneous�measu'reme'nts when used:to calculate the Fan Efficacy tested value. �
F �
yt
Multi-speed.c'ompressor space cooling systems or,variable�speed;compressor systemsshall�.ve�ify air flowa(cfm/,xon)and fan I
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:214-A0121346A-M2300002A-0000 Registration Date/Time: 2014-10-20 16:54:28 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards Report Version:2014-05-08 Report Generated:2014-10-20 16:41:39
2013 Residential Compliance Schema Version:0.51SDD
, CERTIFICATE OF INSTALLATION � CF2R-MCH-23-H
Space Conditioning System Airflow Rate � (Page 4 of 4)
I
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Installation documentation is accurate and complete.
Documentaiion Author Name: Documentation Author Signature: /,)�`�� ���
James Poland �
�ompany: sgnature oate: 2p14-10-20 16;54:28 ,
1AMES POLAND
Address: CEAJ HERS Certification Identification(if applicable}:
1437 RANCHO HILLS DR �
City/State/Zip: ' Phone:
CHINO HILLS CA 91709 (909)606-9417
Responsible Person's Declaration statement
I certify the following under penalty of perjury,under the laws of the 5tate 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 oc,installed•features,materials,components or manufactured devices(the,installation)identified on this Certificate of Installation
conforms to al6applicable,codes and regulations,and the installation conforms to the requirements given on the plans and specifications approved by I
the enforcement agency. ;:� , ��' ,� � ;� ' � .,r�� �, � -
4. I understand that a HERS retePwill check•the installation to verify compliance;'and'thaf if such cFiecking idenUfies defeds';I am required'to take
corrective action at my expense.'I understand that Energy Commission and NERS Provider rePresentatives will also perform gualityassurance checking
of installations,including those approved as part of a semple groupbut�not checkedby 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. " I
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 oc 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 regis[ered copy of this CertiEicate 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:
James Poland '
Company Name:(Installing Subcontractor or General Contractor or Position With Company(Title):
BuilderJowner) OWNER
JAMES POLAND
Address: CSLB License:
1437 RANCHO HILLS DR 644094
City/State/Zip: , Phone: Date Signed:
CHINO HILLS CA 91709 (909)606-9417 2014-10-20 16:54:28
Third Party Quality Control Progrem(TPQCP)Status: Name of TPQCP(if applicable): �
Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document,and in no way implies Registration Provider
responsibility for the accuracy of the information. �
Registration Number:214-A0121346A-M2300002A-0000 Registration Date/Time: 2014-10-20 16:54:28 HERS Provider:CaICERTS
CA Building Energy Efficiency Standards Report Version:2014-05-08 Report Generated:2014-10-20 16:41:39
2013 Residential Compliance Schema Version:0.51SDD �
� : ,
CERTIFICATE OF INSTALLATION CF2R-MCH-25-E
Refrigerant Charge Verification (Page 1 of 3)
Project Name: 23640 Monument Canyon Dr Enforcement Agency: City of Permit Number: 14-4787
UNIT . F Diamond " Bar
Dwelling Address: 23640 Monument Canyon City: Diamond Bar Zip Code: 91765
Dr UNIT F
A.System Information •
O1 System Identification or Name WHOLE HOUSE
02 System Location or Area Served WHOLE HOUSE
03 Condenser(or package unit) make or brand ALLIED
04 Condenser(or package unit) model number RGE13A0050WP-3A
05 Nominal Cooling Capacity(tons)of Condenser 2.5
06 Condenser(or package unit)serial number 169ZL03558 .
, _�.. ....
07 Refrigerant Type R-410A ' -
08 Other Refrigerant Type(if`applicable) ~ � ; �
..., -. , :,. , ,. :,, -_ ..
09 System Installation Type � Alteration .
10 Charge Indicator Display(CID)Status(Note: Even systems This system does not have a CID device installed
' with a CID must have refrigerant charge verified by installer)
. Is the system of a type that the minimum airflow can be Yes,this is a ducted system and one of the system airflow
11 verified using an approved measurement procedure(RA3.3 rate measurement procedures in RA3.3 or RA3.2.2J can be
or RA3.2.2.7)? used to verify system airflow rate , �
, 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 RA1 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
RAl)? ,
13 Date of Refrigerant Charge Verification for this system 2014-10-20
14 Refrigerant charge verification method used. New package unit factory charge
15 Person who performed the Refrigerant Charge Verification HERS rater
, reported on this Certificate of Installation
16 HERS Verification Compliance Requirement Status HERS verification of refrigerant charge is not required
CF2R-MCH-25f New Package Unit With Factory Charge
Registration Number:214-A0121346A-M2500002A-0000 Registration Date/Time: 2014-10-20 16:54:28 HERS Provider:CaICERTS
CA.Building Energy Efficiency Standards . Report Version:2014-05-08 Report Generated:2014-10-20 16:45:24
2013 Residential Compliance Schema Version:0.551SDD
CERTIFICATE OF INSTALLATION CF2R-MCH-25-E
Refrigerant Charge Verification . (Page 2 of 3)
B. Measurement Access Hole(MAH)Verification
Procedures for installing MAH are specified in Reference Residential Appendix RA3.2.2.3
01 Method used to demonstrate compliance with the MAH installed and labeled consistent with Figure 3.2-1
Measurement Access Hole(MAH) requirement
C. Minimum System Airflow Rate Verification '. �
Procedures for verifying minimum system airflow are specified in Reference Residential Appendix RA3.2.2.7.
O1 Minimum Required System Airflow Rate(cfm) 750 . �
System Airflow Rate Verification Status System complies using the alternative remedial actions
02 specified in RA3.2.2.7.3.This System does not qualify for
group sampling
D.Verification of New Package Unit Factory Charge I
Note:There is no HERS verification requirement for the MCH-25f.The Enforcement Agency�has responsibility for
verification of the�MCH-25f.� ,� '� �, '� r' - ,.'
�r � ��:
, . _ � ,
01 Provide the AHRI certificate number fo'r the installed new ' D932308P01 '. ��,
package unit with fectory charge. �
The responsible persons signature on this document affirms that this new package unit has correct refrigerant charge as
02 provided by the manufacturer prior to shipment frorti the factory,and no modifications have been made to this packaged
unit that would result in a change to the amount of refrigerant in the unit. .
Registration Number:214-A0121346A-M2500002A-0000 Registration Date/Time: 2014-10-20 16:54:28 NERS Provider:CaICERTS
CA Building Energy Efficiency Standards Report Version:2014-05-08 Report Generated:2014-10-ZO 16:45:24
2013 Residential Compliance � Schema Version:0.5515DD
CERTIFICATE OF INSTALLATION GF2R-MCH-25-E
Refrigerant Charge Verification (Page 3 of 3)
Documentation Author's Declaration Statement � '
i. I certify that this Certificate of Installation documentation is accurate and complete.
Documentation Author Name: , Documentation Author Signature:
James Poland � �L� ����
Company: Signature Date:
JAMES POLAND
Address: C / R e ic d I rfication(if applicable):
1437 RANCHO HILLS DR
City/State/Zlp: Phone:
CHINO HILLS CA 91709 (909)606-9417
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 eligi6le 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 aftest to the declarations inthis statement(responsible builder/installer),otherwise I am an authorized representative of ihe
responsible builder/installer.
3. The constructed or-install,ed�features,mater,ials,components ormanufactured devices(the:installation)identified on this Certificate of Installation
conforms to all•applicabletcodes and regulation's,and the installation conforms to the:requirements giv.en on the plans and specifications approved by
the enforcement;agency. r ''� ,' " ` ;.'` � '� �
4. I reviewed a;copy of the Certificate of Complian�ce approved b.y the enforcerrierit agency that identifies the specific requirements for the scope of
construction"or installation identified on this Certificate of Installation,and I have ensured that'the requirements that apply to the construction or
installation have been`met.: � - '
5. 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:
James Poland .
Company Name:(Installing Subcontractor or Gene�al Contractor or Position With Company(Title): %J���� ���
Builder/Owner) - OWNER D�
JAMES POLAND '
Address: CSLB License:
1437 RANCHO HILLS DR 644094 ,
City/State/Zip: Phone: - Date Signed:
CHINO HILLS CA 91709 . • (909)606-9417
2014-10-20 16:54:28
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:214-A0121346A-M2500002A-0000 Registration Date/Time: 2014-10-20 16:54:28 HERS Provider:Ca10ERTS
CA Building Energy Efficiency Standards Report Version:2014-05-08 Report Generated:2014-10-20 16:45:24
2013 Residential Compliance Schema Version:0.5515DD
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