BMCH2016-003078-495 CALLE TAMPICO C& 0 D e4ziii Q"
LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT (�
BUILDING PERMIT fJ
Application Number: BMCH2O16-0030 Owner:
Property Address: 79262 CALLE PALMETO ANTHO YF
APN: 604381021 79262 OLS
Application Description: ROSS RESIDENCE / HVAC CHANGE OUT LA QUINTA,
Property Zoning:
Application Valuation: $1,000.00
Applicant:
IE INC
31225 LA BAYA
WESTLAKE VILLAGE, CA 91362
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: C20, C36 License No.: 686310
r
Date: ZZ )(. Contractor: Sw�VL
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair
any structure, prior to its issuance, also requires the applicant for the permit to file a
signed statement that he or she is licensed pursuant to the provisions of the
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division
3 of the Business and Professions Code) or that he or she is exempt therefrom and the
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a
permit subjects the applicant to a civil penalty of not more than five hundred dollars
($500).:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for sale.
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
apply to an owner of property•who builds or improves thereon, and who does the work
himself or herself through his or her own employees, provided that the improvements
are not intended or offered for sale. If, however, the building or improvement is sold
within one year of completion, the owner -builder will have the burden of proving that
he or she did not build or improve for the purpose of sale.).
(� I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
I I I am exempt under Sec. B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.),
Lender's Name:
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
a NSPE70NS (I6'1777-7153
�1 (J
rr-B 22 20
QUINTA
Contractor:
HARRISON ENTERPRISES INC DBA GENERAL AIR
31170 RESERVE DRIVE
THOUSAND PALMS, CA 92276
(760)343-7488
LIC. No.: 686310
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the performance
of the work for which this permit is issued.
I have and .will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this permit
is issued. My workers' compensation insurance carrier and policy number are:
Carrier:- Policy Number: _
I certify that in the performance of the work for which this permit is issued, I
shall not employ any -person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Date:Z Z]d l Applicant: y
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose
request and for whose benefit work is performed under or pursuant to any permit
issued as a result of this application , the owner, and the applicant, each agrees to, and
shall defend, indemnify and hold harmless the City of la Quinta, its officers, agents, and
employees for any act or omission related to the work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is
not commenced within 180 days from date of issuance of such permit, or cessation of
work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
Date: 411 L_ Signature (Applicant or Agent)
29
VOICE (760) 777-7125
FAX (760) 777-7011
a NSPE70NS (I6'1777-7153
�1 (J
rr-B 22 20
QUINTA
Contractor:
HARRISON ENTERPRISES INC DBA GENERAL AIR
31170 RESERVE DRIVE
THOUSAND PALMS, CA 92276
(760)343-7488
LIC. No.: 686310
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the performance
of the work for which this permit is issued.
I have and .will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this permit
is issued. My workers' compensation insurance carrier and policy number are:
Carrier:- Policy Number: _
I certify that in the performance of the work for which this permit is issued, I
shall not employ any -person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Date:Z Z]d l Applicant: y
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose
request and for whose benefit work is performed under or pursuant to any permit
issued as a result of this application , the owner, and the applicant, each agrees to, and
shall defend, indemnify and hold harmless the City of la Quinta, its officers, agents, and
employees for any act or omission related to the work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is
not commenced within 180 days from date of issuance of such permit, or cessation of
work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
Date: 411 L_ Signature (Applicant or Agent)
xnd DESCRI TPAIDt$ $PAIUDATE
1�� PTION, e r ACCQCINT� F� Q
�,NTYAMOUNT
�.-� 1 ARM 14�"�,�y
BSAS SB1473 FEE 101-0000-20306
0 $1.00 $0.00
Y<.e
AD
1
y.
`•¢CHEaCsK #Kza��wi �CLTu: D�BY
:a'd
,
3A�.-i£..e "§'.", % x 1 �a..vta..Yi=✓ "*.n'"i:t .. i:d.:, .Y.ts . ?.
Total Paid for BUILDING -STANDARDS ADMINISTRATION BSA: '$1.00 4 $0.00
:-; d ..��i....fr',-+e.akYS"y k
�'"`t,v#d.v�:s�"'✓+'.-Ir�vi+'
¢yi»9•n
.'�ti'<iFNs"%�. ..i�'
,` may+ ''v '.%Kk EC.
Yw'<at✓"xl•:r 'S v?S?i�
NDESCRIP`TION� a
A,+tl.i�: _X<. ..
t& :ACCOUNT?LQTY$
<...Y'A.:5r..
e.'w Fv4
�AMOUNT,PAID
9�ee�mi6=XFL"F. ls.�.
PAIDDATE
AIR HANDLER.
1/01=0000-42402
0
$36.26
$0.00
'xP'Y'!:1 �UFYSX..'-Px"d ''?-fqj
PAID BYP
R.fi �i:Y Gi;:i yt..::b..Y�,, F� rE"iy'.
�� METHOD
d''f... -'✓p L."'-F(y
RECEIPTS#��
�,
CHECK #g:...<
i'�•:<"i.-'w�AWEisuat:
CLTDBY;
x .. ,
,,
',�<:
#<
�; DESCRIPTION:
ACCOUNTQTY
AMO�UNT'�PAID
µ4-
IN
bFb,PAID
DATE'
..,E
,
<�, 'ra�c8=, 'i` M S sx�F D �Z2t:
,ff..F•YMY &r..
�� -7`^+u ..-^ni?.. ✓+.ataS.:C�. sx+."-;
.._ -, .a;� <zt�<+ PZYZ
AIR HANDLER PC
101-0000-42600
0
$12.09
$0.00
PAI:.D,;BY¢�;_it ;
METIODY �5RECEIPT#
':i$ 4''
#
CLTD BYE„
.4=`
.:._:<... gP, ,E.n_ s-.'.-: .»s
�._ .-.
`� E;+at-c+..r-..�^¢;.,-_rcY- a
'.;CHECK
sbn,.#'-...a''zi°:x%':Faa`.<:,nxa?a�,u «bx'?';-.; a✓e�✓✓Ea.
a <r, �...Ki:.-,:....a.sc:.%;
,rzr�>&-W.fr,Ta,ae'-:w:,..k
y``>
3tli•`Y'�^i4`&�TA..t::t "'''•CY..i
e `a: �ACCQUNT Y3QTY,AMOUNT�
P;
t.fE 'Y9c Y,'x5,', "'S. D*
+,ff3 -.,T z: I.,v...
`E,�yPgID
{'b.
PAID DATE
�.DE$CRIPTION .",
.. .. ... a.-.. i<+.a-�..x
y'h
`..ss.�t
.fi4eu1.?3^
A.m, X'ffi�RaiT,iri':YefF f -z : 4t,:��,,v�^=:m%✓e�a.
EVAPORATIVE COOLER
101-0000-42402
0
$12.09
$0.00
x +f} b ,.;5 '<..+°f`E.;.a,'''vSrF#a<,�'{
PAID>BY a7r
�
4'y "'"-kl;: '.trv.�,si d•�h<y,q'Tao
METHOD
`<X}fr
'fAr}�#o{lE� V'L..y`a.4•ri,�
RECEIPT
S'ie`i✓y}•�a�i"j5-...<Q... Y �},.... F,
.^.i'.'? h
,EC T #
CHECK #�
CLT.D BYE.
. 1'';' PYty.E .'. 4(.�":'i,x'F. '<4.-M•
za
qm
-Yd<$ rF"';,...4{+r✓ix, .�<{. _. *S`°Y{
+
aPrt"T�Y ,'�F .,$il:k `w'Ci. E".d3yN.^iF`,a
i'rY�iv< <: -$* ia,. 4a'v
c}t Fm'viflzH' 5,'!4
.DESCRIPTION e ��
.�.
w'.A000l1�"sQTMO
PAIDa<
PAs DyDATEi
EVAPORATIVE COOLER PC
101-0000=42600
0
$12.09
$0.00.
sz
nziff
?%ra'Y3E�k�.:� v^'r« ,�..
RECEIPT #�,`
�'�"i�t�-.� ' t- r, . q
G K #aCllD
'k•Lf ' =4.c_3<m-;-r+�S�
k
z,g frz�METHODit-
CHE
BYE
Total Paid for MECHANICAL: $72.53 $0.00
-', -.a<-
DESCRIPTIONy ` yS G
Z'' YY'�?: £`L'...r S
n 6�,ACCOUNT `; '.s
4�xPAID '
PAID DATE
4
C.k'kY:k.2SS'rvrt.�...5�£,Ck
; \\+ l�o
....J".
'QTI'.�AMOUNT#
:.S �c
.'.�.`- ..t✓fid.: _tier 2:l'. -K}
'Y.k.'%" ....<..,2., x ;a':
<i 7I. ` f-.v�
PERMIT ISSUANCE
101-0000-42404'
0
$91.85.
$0.00
,.ss..{�,••bE.�Q-,AMY••.'..
PAID BYE b
My"'u_-� �K`f:o�`c.'»+ra''„�a .�.::, :a-
3 "METHOD.;
0!11%;11
4
"':'<ia. s._.:.i'�:?. Y< _'k4<y,
� Rb-b"'T�# +
;D 4ti
' ` #
,CLTD BYn
��d -{
.... -9r: ! ," x'u�'k: .„<:a�;
„
'AYi.�v.3fi¢.:..G.'$4:'SS..'-,d{r,.v.xx+...E.#t;�c^'<•%fr.<.`=�t,.:.
CHECK ,
s<iM-Y'Ci.:f'-Lv.!,
ii
` iS'n'sh
Total Paid for PERMIT ISSUANCE: $91.85 $0.00,
TOTALS:• •�
Description: ROSS RESIDENCE / HVAC CHANGE OUT
Type: MECHANICAL Subtype:. Status: UNDER REVIEW
Applied: 2/22/2016 RSE
Approved: 2/22/2016 MFA
Parcel No: 604381021 Site Address: 79262 CALLE PALMETO LA QUINTA,CA 92253
Subdivision: TR 25953 Block: Lot: 29
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $1,000.00 Occupancy.Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
CONTACTS
Details: REPLACE 3 TON EVAPORATOR COIL [2013 ENERGY] CARBON MONOXIDE ALARM(5) TO BE INSTALLED PRIOR TO FINAL INSPECTION.
2013 CALIFORNIA BUILDING CODES.
„,_j Applied to Approved
CHRONOLOGY
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESSI
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
IE INC
31225 LA BAYA
WESTLAKE
VILLAGE
CA
91362
(460)485-0453
CONTRACTOR
HARRISON ENTERPRISES INC DBA
GENERAL AIR
31170 RESERVE DRIVE
THOUSAND
PALMS
CA
92276
(460)485-0453
OWNER
ANTHONY ROSS
79262 CALLE PALMETO
LA QUINTA
CA92253
(460)485-0453
Printed: Monday, February 22, 2016 12:41:49 PM 1 of 2
SYSTEMS
PARENT PROJECTS
Printed: Monday, February 22,'2016 12:41:49 PM 2 of 2.
,
SYSTEMS
CL
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
BY
Y
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
Total Paid for BUILDING STANDARDS ADMINISTRATION
$1.00 $0.00
BSA:
AIR HANDLER
101-0000-42402
0
$36.26
$0.00
AIR HANDLER PC
101-0000-42600
0
$12.09
$0.00
EVAPORATIVE COOLER
101-0000-42402
0
$12.09
$0.00
EVAPORATIVE COOLER
101-0000-42600
0
$12.09
$0.00
PC
Total Paid for MECHANICAL: $72.53 $0.00
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
TOTALS: $165.38 00
PARENT PROJECTS
Printed: Monday, February 22,'2016 12:41:49 PM 2 of 2.
,
SYSTEMS
ri
Bin. #11D3
bl ��
Cj Of %d Quinta ,
UO BltNding 8r Safety Msion
P.O. Box 1504,78-495 Calle Tampico
la.QWnta, CA 92253 -:(760) 777-7012
Building Permit 'Application and Tracking Sheet
Permit #
Project Address: 79262 Calle Palmeto
Owner's Name:. Anthony Ross "
A. P. Number.
Address: 79262 Calle Palmeto
Legal Description:
Contractor. General Air Conditioning
City, ST, Zip: La Quinta, CA 92247
..F"�.',",-^fig
Telephone: 760-485.0453 r s
Address: 31170 Reserv.e ,Drive
Project Description: Replace .3tQ Evapoartive Coil
City, ST, Zip: Thousand Palms, CA 92276
Telephone: 760-343-7488
State Lic. # : 686310
City Lie. 9:
Arch., Engr., Designer
Address:
City, ST, Zip:
Telephone:
Vii- Y
State Lic. #: "
•�"�%�%��:✓s<�� ..�
Name of Contact Person: Steven Schnierer
Construction Type: . Occupancy:
P%lect tYPe (circle one): New Add'n Alger Repair Demo
Sq. FL: #Stories: #Units:
Telephone # of Contact Person: 818-735-7876
Estimated Value of Project: $1,000.00
APPLICANT: DO NOT WRITE BELOW THIS UNE
M
Submittal
Req'd
Reeld
TRACENG
PERMIT FEES
Plan Sets
Plan Check submitted.Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cates.
Called Contact Person
Plan Check Balance.
Title 24 Calci.
Plans picked up
Construction
Flood plain plan
Plans resubmitted '
Mecharilcal
Grading plan
V Review, ready for corrections%Sstte
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Review, ready for correetionsTissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr '
Date of permit issue
Seho61 Fees
Total Permit Fees
STATE OF CALIFORNIA -
ALTERATIONS - HVAC
CEC-CFIR-ALT-04-E Revised 03115 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CFIR-ALT-04-E
Alterations - HVAC CZ 2, and 8-15 (formerly CF -IR -ALT -HVAC) (Page 1 of 1)
Site Address:
Ag cy:
Enforcementen
C' L0. b;Jin
Da
e Pr pared:
Z2 I(o
PermitN:
Equipment Type
Equipment Efficient y
New Ducting, Plenums, Lineset:
Conditioned
Thermostat
Required R -value
Floor Area (sq ft)
❑ Packaged
Coil
AFUE
COP
0 R-6 (CZ 2, 8-13) Ducting
Served by system
Setback
System
13 Condensing Unit
❑ R-8' (CZ 11, 14, 15) Ducting
2yo gsqft
(If not olreody
El Split System
❑ Compressor
SEER
HSPF
❑ R-6 (all CZ's) Plenums
present must
❑ Mini Split
❑ Lineset
EER
0 R-5 or R7.5) Lineset°
be installed)
❑ Furnace
❑ TXV
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to orie of the options below. At permit application this
form is allowed to be filled out by hand. For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site.
1. HVAC Changeout/Repair
Required Compliance Documents to be left on site for Final:
All Equipment,
CF111-ALT-02-E
Condenser Unit, Evaporator Coil,
CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24)' -HERS,. MECH-25-HERS'
Compressor, TXV, Lineset,
CF3R: MECH-20-HERS, MECH-(23 or 24)-HERSZ, MECH-25-HERSZ
Air Handler/Furnace' (Can include new ducting)
Installer Requirement: Duct leakage (S.15%, or < 10% to outside, or seal'all accessible leaks), Air Flow *1?: 300 CFM/ton, Refrigerant Charge.
Exempted from duct leakage testing if:
❑ 1. Duct system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of duct in unconditioned space, or
❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building
❑ 2. New HVAC System
Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts'
CF1R-ALT-02-E
including Mini Split
CF2R: MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24)-HERSZ, MECH-25-HERS'
CF3R: MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS', MECH-25-HERSZ
Mini Splits require CF1R-ALT-02-E, CF2R-MECH-01, and (CF2R-CF3R) MECH-25-HERS
Installer Requirement: Duct leakage:5 6%, Fan Efficacy (.58W/CFM), Air Flow 2 350 CFM/ton (or alternative), Refrigerant Charge
❑ 3. All New Ducts with Replacement
Required Compliance Documents to be left on site for Final:
All New Ducts' and one or more of the following
C1`111 -ALT -02-E .
replaced: Condenser Unit, Evaporator Coil,
CF2R: MECH-03, MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS
Compressor, TXV, Lineset, Furnace'
CF3R: MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS
Installer Requirement: Duct leakage < 6%; Air Flow 2 350 CFM/ton (or alternative), Refrigerant Charge
Exempted from duct leakage testing if: ❑ 1. Existing duct systems are constructed, insulated or sealed with asbestos
❑ 4. New Ducting over 40 feet
Required Compliance Documents to be left on site for Final:
New ducting but less than All New Ducts'
CF1R-ALT-02-E, CF2R: MECH-20•HERS, CF3R: MECH-20-HERS
Installer Required to: Duct leakage (: 15% or, < 10% to outside or, or seal all accessible leaks)
EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos.
' All new ducting R-8 required when more than 40 ft installed and R-6 when less than 40 ft installed. This includes in walls, between floors etc.
Z Heating only systems and Air Handler/Furnace changes do not require Air Flow MECH-(23 or 24), or Refrigerant Charge verification MECH-25
' All New Ducts is when at least 75 percent of the duct system is new duct material, and up to 25 percent may consist of reused parts from the
dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, coil, plenums, duct material)
° R-5 (1" thick insulation) for linesets 1" and less. R77.5 (1.5" thick insulation) for linesets over 1 inch. Most mfg wil[require Suction fine Diameter
with insulation as the following 1.5-2T-2%", 2.5-3T-2'/.", 3.5 to 4T -2N..", ST -4%'
Contractor (Documentation Author's /Res)onsible Designer's Declaration Statement)
I certify the following under penalty of perjury, under the laws of the State of California:
1. The information provided on this Certificate of Compliance is true and correct.
2.' 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the information on this document.
3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24, Parts 1 and 6 of the California Code of Regulations (CCR).
4. That the energy features and performance specifications, materials, components, and manufactured devices for the building design or
system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the CCR.
S. The building design features or system design features identified on this Certificate of Compliance are consistent with the information
provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement
agency for approval with this building permit application.
Responsible Designer Name:
RSgkaaybl�e Designer Sign ture:
•
Da[ signal
License:
eveY� Sa�nh�er
� -
�• Ito
fo�sb310
Company:
Gerc.1
Address:
\l70 Zesexv�br
city/state/Zip:
I r. 9227
Phone: '
"7100,3°43-7'F
For assistance or questions r6garding the Energy Standards, contact the Energy Hotline at: 1-800-77Z-33UU