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CERTIFICATE OF INSTATLATION cF2R-MCH-20-H <br />Duct Leakage Diagnostic Test (Page 3 ol3) <br />Documentation Author's Declaration Statement <br />1. lcertify that this Certificate of lnstallation documentation is accurate and complete. <br />Oocumentation Author Name <br />Serzhik Akopyan <br />Rapid Duct Testing & Air Balancing <br />Sitnature Oate <br />2017-12-08 <br />PO Box 10021 <br />CEIy' HERS Certifi.ation ldentiffcation (if applicable) <br />RCN13038 <br />clty/statezip: <br />Burbank CA 91510 818-468-5744 <br />Responsible Person's Declaration statement <br />lcertify the followins under penalty of p€.lury, under lhe lawt ofthe State ofCalifornia: <br />1. The information provided on this Cenificate of lnstallation is true a6d correct. <br />2. lam either: a)a responsible perion eli8ible under Division 3 ofthe Susiness.nd Professions Code in the applicable claslification to.ccepr <br />r€sponsibility fo.lhe rystem deri8n, conn.ucnon, or inrtallation of features, materials, componenls, or manufactured devices fo. the scope of work <br />identified on thir Certiflcate of lnstallation and attest to the declar.tionr in this statement, or b) I am .n autho.i.ed rep.esentative oI !he rerponrible <br />perron and atte( to the declarationi in this statement on the resporEible pe6on'r beheli <br />3. The construded or installed feature r, malerialr, com po.rcfiE o. manufactured devices (the install.tion) idenlified on rhir Certificate of lnstallation <br />conforms to all.pplic.ble cod€t aod re8ulations and lhe lnstallatjon confo.hs to the requiremenB given o^ the Certific.te ofComplian.e, plan5, and <br />rpecallcations approved by the enlorcement atency. <br />4. I und erstand that a H E RS rate. will che.k the installatron to yedfy cornpli.nce and if such chec kinB detern! ioes th€ intta llation hilr to compv I am <br />required to offer any ne.essa ry .o rrective action at no ch.rg. to th. bulldlnS owner <br />5. I will ensure th.t e re8in.r€d copy of this Cen ificate of lortalhtio.r ihall hG ported, or made avaalable with th e burldinS perm it{s) rssued for the <br />building, and mad€ available to the enforcement aSency for allapril@ble inspections. I understand thar. re8irtered copy oI this Cenificate ol <br />lnnall.tion rs required to b€ rncluded with the do.umentation lhe hrilder provides to the buildint owner at o.cupancy. <br />Besponsible guild€r/ln5taller Name <br />Anna lsabella <br />sesponsible Builder/lnstaller Sig..ture <br />S?rli*' Akoryo,v ( a.'$bri42n ) <br />Comp.ny Name: (lnstallint Subcontrrctor or General Contractor or <br />AG Heating & Air Conditioning <br />Position With Comp.ny (Title) <br />Contractor/lnstaller <br />14520 Keswick Street <br />CSl.8 Ucense <br />5s8220 <br />City lstrteaip <br />Van Nuys CA 91405 818-988-5388 <br />DatP Signed: <br />2017 -72-OA <br />Third PartyQualityCont.ol Protram (IPQCP) Sratus N.me of TPQCP (ifapplic.ble) <br />Digita y signed by CHEERST'. <br />docuhent, and in no way impl, <br />This digital signature is provided in order to secure the content of this reqistered <br />ies Registration Provider responsibility For the accuracy of the information. <br />Regi5tration Number: <br />417-A0201331004,000-001-M20002A-0000 <br />Registration Dateff ime: 2017-12-08 14:35:41 HERS PTov deT: CHEERS <br />CA Building Energy Efficiency Standards <br />2016 Residential Compliance <br />Report Ve6ion: 2016.1.006 <br />Schema Versioni rev 03/15 <br />Report Generated: 2017'12-08 14:15:43 <br />I Do(umentatlon Author Sr8nature: <br />I s".liL Atapya,\,