11070075 ENERGY INSTALLATION CERTIFICATE (Page 1 of 12) CF-6R
Site Address Permit Number
t 07E/ 110 7067,9
Installation certificates(CF-6R)are required for each and every dwelling unit. When the installation of measures that require
field verification and diagnostic testing is complete,the builder or the builder's subcontractor shall complete diagnostic
testing and the procedures specified in this section. When the installation is complete,the builder or the builder's
subcontractor shall complete the CF-611(Installation Certificate),and keep it at the building site for review by the building
department.The builder also shall provide a copy of the Installation Certificate to the HERS rater for any measures requiring
field verification and diagnostic testing,per Section 10-103(a).
t
WATER HEATING SYSTEMS:
Distribution
CEC Certified Type if N of Rated Input External
Heater Mfr Name& (Std,Point- Recirculation, Identical (kw or Tank Volume Efficiency Standby Insulation
Type Model Number of-Use,cte) Control Type Systems Btufhr)t (gallons) (EF,RE)2 Loss(%)z R-valuc2
i
6. 0 So' oZ a
2
1 For small gas storage(rated input of less thanor equal to 75,000 Btu/hr),electric resistance and heat pump water
heaters, list Energy Factor(EF). For large gas storage water heaters(rated input of greater than 75,000 Btu/hr), list
Recovery(RE),Thermal Efficiency,Standby Loss and Rated Input. For instantaneous gas water heaters, list Thermal
Efficiency and Rated Input.
2. R-12 external insulation is mandatoryfor Storage water heaters with an energy factor of less than 0.58.
Kitchen Piping:
If indicated on the CF-IR,all hot water piping>3/4 inches in diameter that runs from the hot water source to the kitchen
fixtures is insulated
Faucets&Shower Heads:
All faucets and showerheads installed are certified to the Energy Commission,pursuant to Title 24, Part 6, Section 111.
Central Water Heating in Buildings with Multiple Dwelling Units(required for prescriptive)
,1:.1A11 hot water piping in main circulating loop is insulated to requirements of§1500)
IJCentral hot water systems serving six or fewer dwelling units which have(1) less than 25' of distribution piping
outdoors;(2)zero distribution piping underground;(3)no recirculation pump; and(4) insulation on distribution piping
that eets the requirements of Section 1500)
that
hot water systems serving more than 6 dwelling units-presence of either a time control or a time/temperature
control)
✓ LTJ 1, the undersigned, verify that equipment listed above my signature is: 1) the actual equipment installed; 2)
equivalent to or more efficient than that specified in the certificate of compliance(Form CF-1 R)submitted for compliance
with the Energy Efciencv Standards for residential buildings; and 3) equipment that meets or exceeds the appropriate
requirements for manufactured devices(from the Appliance Efficiency Regulations or Part 6),where applicable.
Installing Subc tractor(Co. Name)OR General `
Contractor(C . a e)OR .wner ". 0l 1, tont"J
Signature: Dale:
Copies to: BUILDING DEPARTMENT,HERS RATER(IF APPLICABLE)BUILDING OWNER AT OCCUPANCY
INBOUND NOTIFICATION : FAX RECEIVED SUCCESSFULLY
TIME RECEIVED REMOTE CSID DURATION PAGES STATUS
February 16, 2012 2:13:18 PM PST 71 1 Received
Feb 16 2012 15: 14 HP LASERJET FAX P. 1
INSTALLATION CERTIFICATE (Page 2 of 12 CF-6R
Site Addresv / Permit Number
/0 b l2 . G U
An installation certificate is re m be posted at the building site or made available for all appropriate inspections. (The
information provided on this form is required)After completion of final inspection,a copy must be provided to the building
department(upon request)and the building owner at occupancy,per Section 10-103(a).
FENESTRATION/GLAZING:
ManitfacturerBrand
Name Total
t m Qum ty of Arco Fxseriu
(GROUP LIKE Product U-feces Plodaol SHGC k M Lute Product
$quue shading Device CoauaenM4'oeetioN
Item RODUCTS SCF-Ia vduc t SCP-lAvalue' p"" lion Fxt or Overhwa Spwisl Frames
1. - .3`f ' id in o
2.3.
qq i
4. Stn J
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
p Use values from a fenestration product's NFRC label.For fenestration products without an NFRC labe4 use the default.
values from Section 116 of the Energy Efficiency Standards.
a Installed U-factor must be less than or equal to values from CF-I R. Installed SHGC must be less than or equal to values
from CF-1 R,or a shading device(exterior or overhang) is installed as specified on the CF-I R. Alternatively,installed
weighted average U-fac tors for the total fenestration arra are less than or equal to values from CF-1R. If using default table
SHGC values from§116 identify whether tinted or not.
le IJ( I, the undersigned, verify that the fenestration/glazing listed above my signature: 1) is the actual fenestration
product installed; 2) is equivalent to or has a lower U-factor and lower SHGC than that specified in the certificaie of
compliance(Form CF-1R)submitted for compliance with the Energy Efficient),Standards for residwtial buildings; and
3)the pmdua meetsor ceeds the appropri ne req ' ants for manufactured devices(from Part 6),where applicable.
Item its Si a ate Installing Subcontractor(Co.Name)OR
(if applicable) Central Contractor(Co.Name)OR Owner
OR Wiudo-w Distributor
C d I Ar � Wina(Du� � L�oarr�c•
Item Ns Signature Date Installing Subcontractor(Co.Name)OR
(if applicable) General Contractor(Co.Name)OR Owner
OR Window Distributor
Item tis Signature Date Installing Subcontractor(Co.Name)OR
(if applicable) Ca.•neral Contractor(Co.Name)OR Owuer
OR Window Distributor
Copies to:Building Department,HERS Rater(if applicable)Building Owner at Occupancy ,
INSTALLATION CERTIFICATE (Page 3 of 12) CF-6R
Site Address Permit Number
/o i CCr G>7
An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (The
information provided on this form is required)After completion of final inspection,a copy must be provided to the building
department(upon request)and the building owner at occupancy,per Section 10-103(a).
HVAC SYSTEMS:
Heating Equipment
CEC nd M Mfr. N of Efficiency I Duct Duct or Heating Heating
Equip Type Name ae and Model Identical (APUD,ete.) Location Piping Load Capacity
k>. heat um umber S stems 2CF-I R value) attic,etc. R-value Btu/hr (Btu/hr)
6n01ce Pf01 NP(50360 a � Aad;c 260 601000 �C;00
tirna 6914A602ga6o `leo A#< R.6- 0 60to6o 5-6t00b
Cooling Equipment
ctcncy
?ffi
CIiC Certified Mfr. q of 1Duct Cooling Cooling
Equip Type Name and Model Identical (SEER or HER) Location Duct Load Capacity
(pkg.heal um Number Systems >_CF-I R value) attic,etc. R-value Bm/hr) (Btufhr
vFffp i3-
Pa(3Nao2K �� A {t� �G.o 2 { A': KE7
G 03(. ° A tc— (Z6.0 2le-PTJ
1. >symbol reads greater than or equal to what it indicated on the Cr-IR value.
Include both SEER and EER if compliance credit for high EER air conditioner is claimed.
✓ 1:11 I, the undersigned, verify that equipment listed above is: 1) is the actual equipment installed,2)equivalent to or
more efficient than that specified in the certificate of compliance (Form CF-IR) submitted for compliance with the
Energv Cfciencv Standards for residential buildings, and 3) equipment that meets or exceeds the appropriate
requirements for manufactured devices(from the Appliance Efciencv Regulations or Part 6),where applicable.
Installing Subco tractor(Co. Name)OR General
Contractor(Co a e)OR Owner Gees 1 Y y) I ca/
Signature: Date:
VV
Copies to: BUILDING DEPARTDI ENT, IIERS RATER(IF APPLICABLE)BUILDING OWNER AT OCCUPANCY
INSTALLATION CERTIFICATE (Page 4 of 12) CF-GR .
Site Address Permit Number
&; rot nSC / 10-100-TS-
INSTALLER
0-100"iSINSTALLER C6MPLIANCE STATEMENT FOR DUCT LEAKAGE
INSTALLER COMPLIANCE STATEMENT
The building was: ✓ ❑Tested at Final ✓ ❑ Tested at Rough-in
INJSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE FOR NEW DUCTS:
1 Remove at least one supply and one return register,and verify that the spaces between the register boot and the interior Finishing
y 111 are properly sealed.
3 If the house rough-in duct leakage test was conducted without an air handler installed, inspect the connection points between the
�r handler and the supply and return plenums to verify that the connection points are properly sealed.
@'Inspect all jointsto ensure that no cloth backed rubber adhesive duct tape is used on new ducts.
✓ ❑ DUCT LEAKAGE REDUCTION
Procedures or veld vera[cation and dia nostic testing o air distributions stems are available in RACM,AppendiXRC4.3
NEW CONSTRUCTION:
Duct Pressurization Test Results(CFM @25 Pa) Measured
Values
I Enter Tested Leakage Flow in CFM:
Fan Flow: Calculated(Nominal: ✓ ❑ Cooling✓❑ Heating)or V" ❑ Measured
2If Fan Flow is Calculated as 400 cf nllon x number of tons or as 21.7 cfm/(kl3lu/hr)x Beating ✓ ✓
Capacity in Thousands of Blu/hr,enter total calculated or measured fan flow in CFM here:
3 Pass if Leakage Percentage< 6% for Final or<4%at Rough-in without air handle: 01ass ❑ Fail
100 x Line# I / Line#2)11
ALTERATIONS: Duet System and/or IIVAC Equipment Change-Out
4 Enter Tested Leakage Flow in CFM from Pre-Test of Existing Duct System Prior to Duct
System Alteration and/or Equipment Change-Out.
Enter Tested Leakage Flow in CFM from Final"rest of New Duct System or Altered Duct -
5 System for Duct System Alteration and/or Equipment Chan e-Out.
Enter Reduction in Leakage for Altered Duct System
6 Line#4 Minus Line#5 — (Only if Applicable)
7 Enter Tested Leakage Flow in CFM to Outside(Only if Applicable) ✓ ✓
Entire New Duct System- Pass if Leakage Percentage <6% for Final. I�Pass ❑ Fail
8 [100x Line#5 / Line#2)11
TEST OR VERIFICATION STANDARDS: For Altered Duct System and/or IIVAC Equipment Change ✓ ✓
Out Use one of the following four Test or Verification Standards for compliance:
9 Pass if Leakage Percentage< 15% [100 x [ (Line#5)/ (Line#2)]] ass ❑ Fail
10 Pass if Leakage to Outside Percentage< 10%[100 x �_(Line#7)/ (Line#2)]] EIFPass ❑ Fail
Pass if Leakage Reduction Percentage>60%[100 x [_(Line#6)/ (Line#4)]] IRPass ❑ Fail
1 I and Verification by Smoke Test and Visual Inspection
12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection 91,Pass ❑ Fail
Pass if One of Lines#9 through# 12 pass Pass ❑ Fail
✓ I,the undersigned,verify that the above diagnostic test results were performed in conformance with the requirements for compliance
credit. 1, the undersigned,also certify that the newly installed or retrofit Air-Distribution System Ducts, Plenums and Fans comply with
Mandatory requirements specified in Section 150(m)of the 2005 Building Energy Efficiency standards.
Installing Subco ractor(Co. Name)OR General Contractor(Co. Name)OR Owner
V
Signature: Date: Z.
Copies to: BUILDING DEPARTMENT,HERS RATER(IF APPLICABLE)BUILDING OWNER AT OCCUPANCY
Residential Compliance Forms December 2005
INSTALLATION CERTIFICATE (Page 5 of 12) CF-6R
Site Address Permit Number
/67G i
�A
✓ El THERMOSTATIC EXPANSION VALVE(TXV)
Procedures far field verification of thermostatic expansion valves are available in RACM,Appendix R/.
✓ ✓
Access is provided for inspection. The procedure shall
� consist of visual verification that the TXV is installed on
✓
0/yes
❑ No the system and installation of the specific equipment ❑' ❑
shall be verified.
Yes is a pass Pass Fail
✓ REFRIGERANT CHARGE MEASUREMENT
Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems without
Thermostatic Expansion Valves
Outdoor Unit Serial # qlL
Location
Outdoor Unit Make
Outdoor Unit Model
Cooling Capacity Blu/hr
Date of Verification
Date of Refrigerant Gauge Calibration (must be checked monthly)
Date of Thermocouple Calibration (must be checked monthly)
Standard Charee Measurement Procedure (outdoor air dry-bulb 55°F and above):
Procedures for Determining Refrigerant Charge using the Standard,Method are available in RACM, Appendix RD2.
Note: The system should be installed and charged in accordance with the manufacturer's specifications before starting this
procedure.
Measured Temperatures
Supply(evaporator leaving)air dry-bulb temperature(Tsupply,db) OF
Return (evaporator entering)air dry-bulb temperature(Tretorn,db) OF
Return(evaporator entering)air wet-bulb temperature(Treturn,wb) °F
Evaporator saturation temperature(Tevaporator,sat) "F
Suction line temperature(Tsuclion,db) °F
Condenser(entering)air dry-bulb temperature(Tcondenser,db) °F
Su erheat Charge Method Calculations for Refrigerant Charge
Actual Superheat =Tsuclion,db—Tevaporator,sal OF
Target Superheat(from Table RD-2) OF
Actual Superheat—Target Superheat (System passes if between-5 and+5°F) OF
Temperature Split Method Calculations for Adequate Airflow
Slit Aledrod Calculation is not necersnry i Ade nate Airflow credit is taken
Actual Temperature Split =T return,db Tsupply,db OF
Target Temperature Split (from Table R133) OF
Actual Temperature Split Target Temperature Split (System passes if between- OF
3°F and+3°F or, upon remeasurement, if between -3°F and-loo°F
INSTALLATION CERTIFICATE (Page 6 of 12) CF-6R
Site Address Permit Number
Standard Charge Measurement Summary:
System shall pass both refrigerant charge and adequate airflow calculation criteria from the same
measurements. If corrective actions were taken,both criteria must be remeasured and recalculated.
✓ Yes I ❑ No Sstem Passes
Alternate Charge Measurement Procedure (outdoor air dry-bulb below 55°F)
Note: The system should be installed and charged in accordance with the manufacturer's specifications and installer
verification shall be documented on CF-6R before starting this procedure. If outdoor air dry-bulb is 55 OF or above, installer
shall use the Standard Charge Measure Procedure:
Procedures for Determining Refrigerant Charge using the Alternate Method are available in RACM, Appendix RD3.
Wei gh-In Charging Method for Refrigerant Charge
Actual liquid line length: R
Manufacturer's Standard liquid line length: fl
Difference(Actual—Standard): fl
Manufacturer's correction(ounces per foot) x difference in length =_ounces
(+-=add)(-=remove)
Measured Airflow Method for Adequate Airflow Verification available in RACM, Appendkv RD2.6
Calculated Airflow: Cooling Capacity(Btu/hr) X 0.033 (cfm/Btu-hr)= CFM
Measured Airflow is CFM (Measured airflow must be greater than the calculated airflow).
Alternate Charge Measurement Summary:
System shall pass both refrigerant charge and adequate airflow calculation criteria from the same measurements. If
corrective"actions were taken, both criteria must be remeasured and recalculated.
✓ 10 Yes 10 No I Svslem Parser
Installing Subc ntractor(Co. Name)OR General
Contractor(C . me)OR Owner 17vv¢ � draw
Signature: Date:
Copies to: BUILDING DEPARTMENT,ITERS RATER(IF APPLICABLE)BUILDING OWNER AT OCCUPANCY
INSTALLATION CERTIFICATE (Page 7 of 12) CF-61k_
Site Address Permit Number
O/
MISCELLANEO CREDITS
✓ 13/DIAGNOSTIC SUPPLY DUCT LOCATION,SURFACE AREA AND R-VALUE
Proce�du/sreforfreld verification and diagnostic testingfor this group compliance credits are available in Rt CA1,Appendix RC RE&RH.
✓
13/LESS THAN 12 LINEAL FEET OF SUPPLY DUCT OUTSIDE OF CONDITIONED SPACE
COPLIANCE CREDIT
✓ es ❑Nu Less than 12 lineal feet of supply duct outside of conditioned space.
Yes to this compliance credit is a pass ✓ lErPass ✓ ❑ Fail
i
✓ SUPPLY DUCTS LOCATED IN CONDITIONED SPACE COMPLIANCE CREDIT
✓ I EIYes 1 ❑ No I Ducts are located within the conditioned volume of building.
Yes to this compliance credit is a ass ✓ Pass ✓ ❑ Fail
Duct System Design verification is required for a compliance credit for the following:
1. Supply duct surface area reduction
2. Buried supply ducts on the ceiling
3. Deeply buried supply ducts
✓ ❑ DUCTSYSTEM DESIGN VERIFICATION
✓ ITYes ❑ No Adequate airflow verified
✓ M"Yes ❑ No The duct system design plan meets the requirements specified in RACM, Appendix RE,Section
REA.2
✓ YYes ❑ No The duct system design plan exists on building plans
✓ Yes ❑ No Duct sizes,duct system layout and locations of supply&return registers match the duct system
design plan
Yes to all is a pass ✓ Pass ✓ ❑ Fail
✓ ❑ SUPPLY DUCTS SURFACE AREA REDUCTION COMPLIANCE CREDIT
R-4.2 R-6.0 R-8.0
Crawl Deeply Duct Surface Surface Surface
Attic Space Basement Covered Covered Other Diameter Area Area Area
Total Surface Area for Each R-Value=
✓ Yes No tches Performance's CF-I R? ✓
Yes to all is a pass Pass Fail
✓ ❑ BURIED DUCTS ON THE CEILING COMPLIANCE CREDIT
Yes ❑ No Buried Ducts on the Ceiling
Yes ❑ No Verified I ligh Insulation Installation Quality ✓ ✓
Yes to ducts stem design,supply duct surface area reduction and this compliance credit is a pass ErPass ❑ Fail
✓ ❑ DEEPLY BURIED DUCTS COMPLIANCE CREDIT
Yes ❑ No Deeply Buried Ducts
ID/Yes ❑ No Verified High Insulation Installation Quality ✓ ✓
Yes to ducts stem design,supply duel surface area reduction and this compliance credit is a ass ass ❑ Fail
Copies to: BUILDING DEPARTMENT,HERS RATER(IF APPLICABLE) BUILDING OWNER AT OCCUPANCY
INSTALLATION CERTIFICATE (Page 8 of 12) CF-GR._ ,
Site Address Permit Number
✓❑ FAN WATT DRAW
Procedures for measuring the air handler watt draw are available in RACM,A endir RE3.2.
✓ Method For Fan Watt Draw Measurement
RE3.2.1 Portable Walt Meter Measurement
Q RE3.2.2 Utilit Revenue Meter Measurement
Measured Fan Wall Draw Watts
Measured Fan Flow enter total cfm from airflow verification cfin
/ Enter results of Walls/cfm Watts/cfm
✓ ✓
✓ Yes ❑ No Measured fan watt/cfm draw is equal to or lower than the / ❑
fan watl/cfm draw documented in CF-I R [�
Yes is a pass Pass Fail
✓ ❑ ADEQUATE AIRFLOW VERIFICATION
Procedures for measuring the air ow are available in RACM, Appendix RE3.1.
✓ Method For Airflow Measurement
RE4.1.1 Diagnostic Fan Flow Using Flow Capture Flood
RE4.1:2 Diagnostic Fan Flow Using Plenum Pressure Matching
RE4.1.3 Diagnostic Fan Flow Using Flow Grid Measurement
D Yes ❑ No Duct design exists on plans
Measured Airflow: Total cfm
Rated Tons cfm/ton cfm/ton
✓ Yes ❑ No Measured airflow is greater than the criteria in Table RE-2 ✓ ✓
r ❑
Yes is a pass Pass Fail
✓ ❑ MAXIMUM COOLING CAPACITY
Procedures or determining in inuan cooling load ca)acily are available in RA CM.A endir RF3.
1 ✓ Yes ❑ No Adequate airflow verified(see adequate airflow credit)
2 ✓ Yes ❑ No Refrigerant charge or TX V
3 ✓ Yes ❑ No Duct leakage reduction credit verified
4 es ❑ No Cooling capacities of installed systems are<_to maximum cooling
capacity indicated on the Performance's CF-I R and RF-3.
If the cooling capacities of installed systems are>than maximum ✓ ✓
5 ✓ Yes ❑ No cooling capacity in theCF-I R,then the electrical input for the
installed systems must be<_to electrical input in the CF-I R. t ❑
Yes to I,2,and 3;and Yes to either 4 or 5 is a pass Pass Fail
✓❑ HIGH EER AIR CONDITIONER
Procedures or verification are available in RA CM,Appendix Rl.
I ✓ Yes ❑ No EER values of installed systems match the CF-IR
2 ✓ Yes ❑ No Fors lits stem, indoor coil is matched to outdoor coil ✓ ✓
3 `' Yes ❑ No Time Delay Relay Verified(If Required) ❑
Yes to I and 2;and 3 If Require is a ass Pass Fail
Installing Subco actor(Co. Name)OR General
Contractor(C . a e)OR Owner W' � �1Y
Signature: Date: Z- 1b- �2
Copies to: BUILDING DEPARTMENT,IIERS RATER(IF APPLICABLE) BUILDING OWNER AT OCCUPANCY
INSTALLATION CERTIFICATE (Page 9 of 12) CF-6R
Site Address Permit Number
42 i / / ti✓
An installation certificate is required to be posted at the building site or made available for all appropriate inspections.(The
information provided on this form is required) After completion of final inspection,a copy must be provided to the building
department(upon request)and the building owner at occupancy,per Section 10-103(a).
BUILDING ENVELOPE LEAKAGE DIAGNOSTICS
✓ ❑ ENVELOPE SEALING INFILTRA'T'ION REDUC'T'ION
Procedures for field verification and diagnostic testing of envelope leakage are available in RA CAI,Appendix RC.
Diagnostic Testing Results
,-✓-,/ ✓ Building Envelope Leakage(CFM C3a 50 Pa)as measured by Rater:
1 1,� ❑ Measured envelope leakage less than or equal to the required level from
Yes No CF-IR?
2. ❑ Is Mechanical Ventilation shown as required on the CI'-I R?
Yes No
2a Q' ❑ If Mechanical Ventilation is required on the CF-I R('Yes' in line 2),has it
Yes No been installed'?
Check this box `yes' if mechanical ventilation is required(`Yes' in line 2)
2b. ❑ and ventilation fan walls are no greater than shown on CF-I R.
Yes No Measured Watts=
11 greater
this box "yes"if measured building infiltration(CFM @ 50 Pa) is
3. greater than the CFM @ 50 values shown for an SLA of 1.5 on CF-I R
Yes No If this box is checked no, mechanical ventilation is required.)
Check this box "yes"if measured building infiltration(CFM @ 50 Pa)is
4 [� ❑ less than the CFM @ 50 values shown for an SLA of 1.5 on CF-1 R,
Yes No mechanical ventilation is installed and house pressure is greater than minus
5 Pascal with all exhaust fans operating.
Pass if.
a. Yes in line I and line 3,or ✓ ✓
b. Yes in line I and line2,2a,and 2b,or
c. Yes in line I and Yes in line 4. ❑
Otherwise fail. Pass Fail
✓ ISI,the undersigned,verify that the building envelope leakage meets the requirements claimed for building leakage
reduction below default assumptions as used for compliance on the CF-I R. This is to certify that the above diagnostic test
results and the work I performed associated with the testis) is in conformance with the requirements for compliance credit.
(The builder shall provide the Ii ERS provider a copy of the CF-6R signed by the builder employees or subcontractors
certifying that diagnostic testing and installation meet the requirements for compliance credit.)
Test Performed
Installing S(be t ct (Co. Name)OR General
Contractor Co ane) r r R Ow �l!1vc Ivl �
Signature: Date:
Copies to: BUILDING DEPARTMENT,ITERS RATER(IF APPLICABLE), BUILDING OWNER A'r OCCUPANCY
INSTALLATION CERTIFICATE (Paa 10 of 12) CF-6R
Site Address Permit Number
Insulation Installation Quality Certificate
✓ LGI Description of Insulation,(CF-611, formerly IC-1)signed by the installer stating: insulation manufacturer's name,
material identification,installed R-values,and for loose-fill insulation: minimum weight per square foot and minimum
inches
✓ i! Installation meets all applicable requirements as specified in the High Quality Insulation Installation Procedures
(ACM,Appendix RH)
✓ FLOOR
❑ ❑ All floor joist cavity insulation installed to uniformly fit the cavity side-to-side and end-to-end
Ye No NA
❑ ❑
YNo NA Insulation in contact with the subfloor or rim joists insulated
e
❑ ❑ Insulation properly supported to avoid gaps, voids,and compression
Yes No NA
✓ WALLS
❑ ❑ Wall stud cavities caulked or foamed to provide an air tight envelope
Yes No NA
Q_ ❑ ❑ Wall stud cavity insulation uniformly fills the cavity side-to-side,top-to-bottom,and front-to-back
Yes No NA
❑ ❑ No gaps
Yes No NA
❑ ❑ No voids over 3/4"deep or more thari 10%of the batt surface area.
Ye No NA
❑ ❑ Hard to access wall stud cavities such as;corner channels,wall intersections,and behind
Yes No NA tub/shower enclosures insulated to proper R-Value
ET ❑ ❑ Small spaces filled
Yes No NA
❑ NA❑
Yes No Rim joists insulated
❑ ❑ Loose fill wall insulation meets or exceeds manufacturer's minimum weight-per-square-foot
Yes No NA requirement
✓ FtOOFICEILING PREPARATION
❑ ❑ All draft stops in place to form a continuous ceiling and wall air barrier
Yes No NA
Ey ❑ ❑ All drops covered with hard covers
Ye No NA
El All draft stops and hard covers caulked or foamed to provide an air tight envelope
Yes No NA
❑ ❑ All recessed light fixtures IC and air tight(AT)rated and sealed with a gasket or caulk between the
Yes No NA housing and the ceiling
❑ ❑ Floor cavities on multiple-story buildings have air light draft stops-to all adjoining attics
Yes No NA
ILI ❑ ❑ Eave vents prepared for blown insulation-maintain net free-ventilation area
Yes, No NA
❑ ❑ Knee walls insulated or prepared for blown insulation
Yes No NA
❑ ❑ Area under equipment platforms and cat-walks insulated or accessible for blown insulation
Ye No NA
❑ ❑ Attic rulers installed
Yes No NA
INSTALLATION CERTIFICATE (Page 11 of 12) CF-6R
Site Address Permit Number
9
✓ ROOF/CEILING BA'I'TS
10, ❑ ❑
Yes No NA No gaps
❑ ❑
Ye No NA No voids over'/, in.deep or more than 10%of the ball surface area.
❑ ❑
Ye No NA Insulation in contact with the air-barrier
❑ ❑
Ye No NA Recessed light fixtures covered
❑ ❑ Net free-ventilation area maintained at eave vents
Yes I No NA
✓ ROOF/CEILING LOOSE-FILL
Yes No NA Insulation uniformly covers the entire ceiling(or root)area from the outside of all exterior walls.
Yes No NA Baffles installed at eaves vents or soffit vents- maintain net free-ventilation area of cave vent
❑ ❑
Yes No NA Attic access insulated
❑ ❑
Yes No NA Recessed light fixtures covered
❑ ❑
Ye No NA Insulation at proper depth—insulation rulers visible and indicating proper depth and R-value
❑ ❑ Loose-fill insulation meets or erceeds man facturer's minimum weight and thickness requirements
Yes No NA for the target R-value. Target R-value . Manufacturers mininnrm required
weight for the target R-value (pounds-per-square-fool). Manufacturers
minimum required thickness at time of installation . Manufacturers minimum
required settled thickness . Note: To receive compliance credit the HERS rater
shall verify that the manufacturers mhuintum weight and thickness has been achieved for the target
R-valure. CF-61?only
DECL PION
✓ I hereby certify that the installation meets all applicable requirements as specified in the Insulation Installation
Procedures.
Installing Subcontract (Co. Name)OR General
Contractor(Co. Nart)OR Owner (JCe t^$J / 6�
Signature: Date: L _ L 2
Copies to: BUILDING DEPARTMENT,HERS RATER(IF APPLICABLE), BUILDING OWNER AT OCCUPANCY
INSTALLATION CERTIFICATE (Page 12 of 12) CF-6R
Site Address Permit Number
e i e- .
County Subdivision 61 1 1Lot Number
Description of Insulation (Formerly IC-1 Form)
L RAISED FLOOR
Material Brand Name
Thickness (inches) Thermal Resistance(R-Value)
2. SLAB FLE�R}METER \
Material M=w 4 w Brand Name
Thickness (inches) Thermal Resistance(R-Value)
Perimeter Insulation Depth(inches)
3. EXTERIOR WALL
Frame Type (,(J!)KJ
A. Cavity Insulation
Material Brand Name
Thickness (inches) Thermal Resistance(R-Value)
B . Exterior Foam Sheathing
Material az,; W� Brand Name
Thickness (inches) Thermal Resistance (R-Value)
4. FOUNDATION WALL
Material Brand Name
Thickness(inches) Thermal Resistance(R-Value)
5. CEILING
Batt or Blanket Type Brand Name
Thickness(inches) Thermal Resistance(R-Value)
Loose Fill Type Brand
Contractor's min installed weight/ft' Ib Minimum thickness inches
Manufacturer's installed weight per square foot to achieve Thermal Resistance(R-Value)
6. ROOF
Material i! Brand Name
Thickness t es) Thermal Resistance(R-Value)
Declaration
*' MPI"hereby certify that the above insulation was installed in the building at the above location in conformance with the
current Energy Efciencv Standards for residential buildings(Title 24,Pari 6,California Code of Regulations)as indicated
on the Certificate of Compliance,where applicable.
Item#s �) Si a urg Date Installing Subcontractor(Co.Name)OR
(if applicable) j / General Contractor(Co. Name)OR Owner
OR Window Distributor
Item#s 6 Sin tut Date Installing Subcontractor(Co. Name)OR
(if applicable) General Contractor(Co. Name)OR Owner
OR Ntindow Distributor
Item#s a Si t e Date Installing Subcontractor(Co. Name)OR
(if applicable) General Contractor(Co. Name)OR Owner
j OR Window Distributor