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STATE OF CALIFORNIA <br />POOL AND SPA HEATING 5Y5. <br />CECCF2R-PLB-04a Revised 03/15 CALIFORNIA ENERGY COMMISSION <br />CERTIFICATE OF INSTALLATION CF2R-PLB-03-E <br />Pool And Spa Heating Systems (Page 3 of 3) <br />Pmje""gme: Ricoom GAP.1564 IIPA Rol', Otirc, Enforcement Ate721 p 0 d Bo a, h 40-r Penne Number: <br />°"filr"dre" 1(4)3 Ai i 12-1 Po"( '2/3 <br />ay A <br />K-4 PON zinc* 9536 7 <br />DOCUMENTATION AUTHOR'S DECLARATION STATEMENT <br />1. I certify that this Certificate of Installation documentation is accurate and complete. <br />Documentation Author Name rx <br />UOCic re IC <br />Documentation Author Signature: <br />'Li OC <br />Documentation Author Company Name:, <br />SWInti P0fai- 5 <br />Date Signed: 3-33-18 <br />Address: P. 0 . Box 229.5- <br />CEAMERS Certification Identification (if applicable): <br />0W/State/Zip: <br />CCII-05/ CA 95-301 <br />Phone: <br />20C - Szi 3 - SO 9 <br />RESPONSIBLE PERSON'S PERSON'S DECLARATION STATEMENT <br />I certify the following under penalty of perjury, under the laws of the State of California: tt 1.7\4,4:- Iv , <br />e information provided on this Certificate of Installation is true and correct. , C 'N-N'a <br />t <br />The <br /> <br />f. ...- TN " <br />i am eligible under Division 3 of the Business and Professions Code in the applicable classification toraccept responsibility for the system <br />design, construction, or installation of features, materials, components, or manufactured devices for the scope of Cvork'identified on this <br />Certificate of Installation, and attest to the declarations in this statement (responsible builder/installer), otherwise 'l aiii an authorized <br />0/ - cc:, r: 44-'. representative of the responsible builder/installer. \'‘_....1 <br />( <br />\ •—•• <br />The constructed or Installed features, materials, components or manufacturedieVices (the installation) identified on this Certificate of <br />Installation conforms to all applicable codes and regulations, and the instailsation conforms to the r'ecfuirernents given on the plans and <br />specifications approved by the enforcement agency. _ <br />I reviewed a copy of the Certificate of Compliance approved by the enforcement agencithaydentifies the specific requirements for the <br />scope of construction or installation identified on this Certificate of in-it-ciliation, and l[lia,le'dnsured that the requirements that apply to the <br />construction or installation have been met. ./:\\ 4 ' \ . AC: \\ •;' <br />I will ensure that a registered copy of this Certificate of Installation shall bepoited, or made available with the building permit(s) issued for <br />the building, and made available to the enforcement agency for al applitable inspearions. i understand that a registered copy of this <br />Certificate of Installation is required to be included With the doculnentation the buildefOrd:videsta the building owner at occupancy. <br />Responsible Builder/Installer Name:yew fl y N, <br />601.; 6 <br />s'.-, Responsible Buildeifinstaller Signature: <br />Company Name: (Installing Subcont tor or General Contractor or guIlder/Ovetter)\.. — <br />... \ '‘..\\ <br />Position With Company mile): , <br />_ ri . Th,‘ 'L.' ClICR)", Address:, C\ \45' t',O. ewe- 22 P57( \ "I , rc• . .... <br />CSIE license:-±, <br />,±-N\ -LC3 91 / 465— <br />atymutegip:• :\ • • (7 - <br />Pho ne <br />'.. .2 0,) 57/3 -80 ?sr- Date Signed: <br />Registration Number: Registration Date/Time: HERS Provider: <br />CA Building Energy Efficiency Standards - 2013 Residential Compliance March 2015