11020013CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10750 JOHNSON AVE I CONTRACTOR: PAULSON LEE I PERMIT NO: 11020013 I
OV"NER'S NAME: PAULSON LEE
L ER'S PHONE: 4086917735.
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic.#
Contractor
Date
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self -insure for Worker's
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 Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
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. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Date
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1, 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 & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
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 Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
I certify that in the performance of thework for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked. pi,
APPLICANT CERTIFICATION
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
the above mentioned property for inspection purposes. (We) agree to save
inify and keep harmless the City of Cupertino against liabilities, judgments,
,_.s, and expenses which may accrue against said City in consequence of the
granting of this per Additionally, the applicant understands and will comply
with all non -poi sou a regulations per the Cupertino Municipal Code, Section
9.18. %,—
Date A 4 —V I —tr
20315 THELMA AVE
SARATOGA, CA 95070
DATE ISSUED: 06/01/2011
PHONE NO:
BUILDING PERMIT INFO: BLDG ELECT PLUMB
MECH F RESIDENTIAL F COMMERCIAL f—
JOB DESCRIPTION: CONSTRUCT 2 STORY 2,380 SQ FT LIVING SPACE, 407 SQ
FT PATIO, 452 SQ FT ATTACHED GARAGE TOTAL: 3,237
SQ FT -SANITARY IS SUNNYVALE'S JURISDICTION.
Sq. Ft Floor Area: I Valuation: $360000
APN Number: 37531006.00 ( Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:Date:4,,
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Date:12L __�o / — / )
CONSTRUCTION LENDING AGENCY
I hereby affitm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professiona
a
FIL
12Wr12
INSTALLATION CERTIFICATE (Page I of 12) CF -6R
Site Address
♦ & a oh d O -A dol
Pcnmit NUnlher
Bi0.)-0013
Installation certificates (CF -611) are required'tor each Ind every dwelling unit. \Then the installation of measures that require
field vcrif ication and dial-mostic testing is conlplctc, the huildcr or the builder's subcontractor shall cclnl)llcte diagnostic
testing and the procedures specified in this section. When the installation is complete. the builder or the builder's
UbC0lllraCU11'shall ConlpletC 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 dia nostiC tcstiMI. Per Section 10-Ill1(a).
WATER HEATING SYSTEMS:
M.- .
I For small gas storage (rated input of less than or equal to 75,000 Btu/hr), electric resistance and heat pump water
heaters, list Energy Factor (EF). For large gaff storage water heaters (rated IllpUt 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 nlandatory for storage water heaters with an energy factor of less than 0.55.
Kitchen Piping:
If indicated on the CF - IR, all hot water piping> 3/4 inches in diameter that runs from the hot water sOurCC to the kitchen
fixtures is insulatCd.
Faucets & Shower Heads:
All faucets and showcnccads installed are Certified to the Energy Conlnlission, pursuant to Title 24, part 6, Section I 11.
Central Water Heating in Buildings with Midtiple Dwelling Units (I-Cquircd for prescriptive)
NIS- ❑An hot water piping in plain circulating loop is insulated to requirCnicnts of § 150(1)
❑Central hot water systems servin; six or lever dwelling units which have (I ) less than 25' of distributiOn piping
Outdoors: (2) zero distribution piping underground: (3) no recirculation Punlp: and (4) insulation ot1 distribution piping
that meets the requiI-Cnlents Of Section 150(j)
❑Central hot water systems serving more than 6 chvclling units - prescncc Of cithcr a time COntrol or a time/temperature
Control
✓ ❑ I, the undersigned, verify that equipment listed above illy signatUrC is: 1) the actual equipment installed: 2)
c(juivalcnt to or more Cflicicnt than that specified in the certificate of compliance (Form CF -I R) submitted fOr compliance
With the Encs �lr G%/iciencr Slambi-tiv for residential buildings: and 3) equipment that meets or exceeds the appropriate
rcquircnlcnts for manufactured devices (from the Applimice FI icienev Re.,ululitms or part 6), where applicable.
Installing SubcOnu-aCulr (Co. dame) OR General
Contractor (Co. Name) OR Owner
ROh
Signature: --7L-7
Date: S �2
I For small gas storage (rated input of less than or equal to 75,000 Btu/hr), electric resistance and heat pump water
heaters, list Energy Factor (EF). For large gaff storage water heaters (rated IllpUt 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 nlandatory for storage water heaters with an energy factor of less than 0.55.
Kitchen Piping:
If indicated on the CF - IR, all hot water piping> 3/4 inches in diameter that runs from the hot water sOurCC to the kitchen
fixtures is insulatCd.
Faucets & Shower Heads:
All faucets and showcnccads installed are Certified to the Energy Conlnlission, pursuant to Title 24, part 6, Section I 11.
Central Water Heating in Buildings with Midtiple Dwelling Units (I-Cquircd for prescriptive)
NIS- ❑An hot water piping in plain circulating loop is insulated to requirCnicnts of § 150(1)
❑Central hot water systems servin; six or lever dwelling units which have (I ) less than 25' of distributiOn piping
Outdoors: (2) zero distribution piping underground: (3) no recirculation Punlp: and (4) insulation ot1 distribution piping
that meets the requiI-Cnlents Of Section 150(j)
❑Central hot water systems serving more than 6 chvclling units - prescncc Of cithcr a time COntrol or a time/temperature
Control
✓ ❑ I, the undersigned, verify that equipment listed above illy signatUrC is: 1) the actual equipment installed: 2)
c(juivalcnt to or more Cflicicnt than that specified in the certificate of compliance (Form CF -I R) submitted fOr compliance
With the Encs �lr G%/iciencr Slambi-tiv for residential buildings: and 3) equipment that meets or exceeds the appropriate
rcquircnlcnts for manufactured devices (from the Applimice FI icienev Re.,ululitms or part 6), where applicable.
Installing SubcOnu-aCulr (Co. dame) OR General
Contractor (Co. Name) OR Owner
ROh
Signature: --7L-7
Date: S �2
Copies to: BUILDING DEPARTMENT. HERS RATER (IP APPLICABLE) MAL.DIN(; OWNER AT OCCUPANCY
Rcshkvithd ("uniplimice Fords Sepleinher 21)05
INSTALLATION CERTIFICATE (Page 2 of 12) CF -6R
Site AddressI PCI'nlll NUOIlIcl•
t c)7 ohn o, Aux Cl tb_P),4,r-to CA //v>'00/ Z
An installation certificate is required to be posted (It the building site or made availaljlc for all appropriate ins coigns. The
inf0rolati0n provided On this farm is rcquircd) After c0111plC60 11 Of final inspection, a copy must he provided to the building
clCarunCnt (upon request) and the building owner at occupancy, per SCCti011 10-103(a).
FENESTRATION/GLAZING:
Item
Manufacturer/13rancl
Name
(GROUP LIKE
RODUCTS)
Product tidactorl
('-CF-IR ��aluc) -
Product SIIGC I
(<_CF -IR vaL1
�0-
_ of
P:mcs
Total
orl:antily of
Like Product
(Cluinm,n
Ajea
Square
reel
r\Icrior
Shading Devicc Shading
orOverhanu
Special features
I .
Mil gard/Tuscany
0.3>I).'_5
2
1
?9.37
Z
Front
2.
Mil W'dffuSc.1ny
0.33
o.27
1
OR Window Distributor
13.50
2
Front
3.
Mil gaIII fI'usCany
0.35
0.2;
2
1
22.5
2
L.CI't/Dinner
4.
Mil Bard/Munlccitu
0.35
0.23
1
1
22.5
2
L.CII/t_iardell
5.
Mil gardlTuscany
0.33
0.24
1
1
5
2
L OVDinncrlfransom
6.
IV1il Bard/Woodclad
0.37
0.22
2
1
48
2
Back Dour
7.
1Vf,l'ard11 LISCMlV
0.35
0.23
2
2
40
2
luck/Family
8.
Mll,'arll%ILISCaIIy
0.32
0,21
I
1 2
25
2
1 RI'ht/SILILly
9.
MilgardffuSCany
0.330.23
2
2
48
2
Master&taara c
10.
Mil garLUfusCany
U. 32
0.21
1
3
14
2
Master & Bed 1
1 I.
Mil M1'dll'uscam
0.35
().23
2
1
16
2
Master 13.1111
12.
lVli1g.11'dfl_USCdmw
0.35
0.25
2
1
Is
2
13CLI 1
13.
1 Mil',Mrdlfuscam'
0.»
0.33
2
1
7
13CLI 2
14.
Millard/TUSC IV
0.32 1
0.21
1
1
2
Bed 2
15.
Mil gardllllScam'
0.33 1
0.27 1
1
1
10
2
Slair
II Use values front a fenestration product's NFRC label. For fenestration products without an NFRC lahel, Use the default
value; from Section 116 of the Cnergy Efficiency Standards.
Installed U-IaCIOr must be less than or equal to value; from CF -1 R. Installed SHGC must be less than Or equal to valucS
from CF -I R. Or a shading device (exterior Or overhang) is installed as specified on the CF -I R. Alternatively, installed
weighted average U -tactors for the total fcnestratiOn area are less than Or equal to valucS from CF -IR. If using (Icftult table
SHGC values from § 116 identify whether tinted or not.
✓ LYJ I, the undersigned, verify that the fenestration/glaring listed above my sigmaturc: I ) is the actual fenestration
product installed: 2) is equivalent to or has a lower U -factor and lower SHGC than that specified in the certificate of
compliance (Form CF -I R) submitted for compliance with the Enei-gr E/%icieurt .S7uncln1-c%S lilt residential buildings: and
3) the product meets Or CSCCeds the appropriate requirCnlCllLS fOr manufactured devices (Gone Part 6), where applicable.
Item #s
Signature Date
Installing Subcontractor (Co. Name) OR
(II appllCablC)
General COntJCtor (Co. Name) OR Owner
0 1� I Z
l
OR,LLindot Distributor
�� t, �
(`fin
�✓�
Item =s
Sign: our Date
Install`i'nlg Subco1lu•actO1- (Co. Nanlc) OR
(ifapplicable)
General Contractor (Co. Name) OR Owncr
OR Window Distributor
Item #s
Signature Date
Installing SubcOnuractor (Co. Name) OR
(ifapplicahlc)
General Contractor (Co. Name) OR Owncr
OR Window Distributor
Copies lo: Building Department . HERS Rater (if applicable) Building Owner at Occupancy
Resitlwiul C,)m1)1im)ev Fu ins Alwil =(lllj
An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (The
inloniiation provided on this form is required) After completion of Final inspection, a copy must be provided to the building
deporttment (upon request) and the building owner at occupancy. per Section 10-103(a).
HVAC SYSTEMS:
llemint; F_gnipment
F -quip Type
(pkg. heal )
Cf_C Certified til}.
Na,nc incl Model
Number
= of"f_rriciency
Identical
sy;tens
I
(AFUE. etc.)
(?CF -IR value)
purl
I_ucauon
(allic.Cie.)
Duel or
Piping
R -value
I leating
Load
Miu/hr)
I Icating
Capacily
ttJnl
tutu/hrl
zz
AAa
Ceiolh�q Egaipment
( quip Type
( k,,.heat tlml)
CFC Ccrtifial nut;.
Fame and Model
Number
= of
Identical(s
systems
rrrcieney
,
f.f:R or EER)
(?CF - IR value)
Duct
1-ocatiun
ianic.cic.)
DUCI
R -value
cooling
Load
(r;tnmr)
Cooling
Capacity
(fim/hrl
1. > symbol reads ,,rewcr thou or cgrccrl io when is incliccrlecl (m the CF- IR ruhre.
Include both SEER and EER if compliance credit for high EER air conditioner is claimed.
✓ 21 11111C undcrsignecl, verify that equipment listed above is: I ) is the actual equipment installed. ?) equivalent to or
more cl'ficicnt than that specified in the certificate of compliance (form CF - IR) submitted Ibr compliance with the
Ener;fir ficiencr SwItC IRIc for residential buildings, and 3) equipment that meets Or exceeds the appropriate
rcquircments for manufactured devices (from the Applirnrce E%/icicwc;r Re,gulcition.c or part G), where applicable.
Installing SUbC0I1LraCt0l- (Co. Name) OR General
Contractor Na
—rV / ` 9 L V /J �
/7
(Co. c) OR Owner
Signalurc:
Date: Q `
Copies lo: BUILDING DEPAR-FNIENT, 111:125 RATER (IP APPLICABLE) BUILDING OWNER AT OCCUPANCY
Re,•iclenti,rl Compliemee Forms April 2(1/1.]
INSTALLER COMPLIAN
STATEMENT
INSTALLER COMPLIANCE STATEMENT
The building WaS: ✓ ❑Testecl at final ✓ ❑ Tested at Rough -in
INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE FOR NEW DUCTS:
❑ Remove at least one supply and one return register, and Verify that the spaces bCt\VCCn the register boot and the interior finishing
wall arc properly scaled.
❑
[['tile house rough -in duct leakage test was conducted without an air handler installed, inspect the connection pointS hCt\VCCn the
air handler and the SupPly and return Plenums to Verify that the connection points are properly scaled.
❑ Inspect all joints to CnSurc that no cloth backed rubher adhesive duct WPC IS used fill 110V (111C/S.
✓ ❑ DUCT I_F,AKA(::F REDUCTION
Procedurec_lor Diehl verilicutinn and dimunostic• (eating Mair distribution sivems are available in RACI L Annendir RCC 3
NEW CONSTRUCTION:
Duct Pressurisation Test Results (CPM c"u ?; Pa)
MeasuredValues
I
F.ntcr Tcstcd Leakage flow in CFNI:
Fan Flow: Calculated (Nominal: ✓ ❑ Cooling ✓ ❑ Heating) or ✓ ❑ Measured
I f Fan Flow is Calculated as 400 clip/ton x number of tons or as 21 .7 cfm/(kl31u/hr) x Heating
Capacity in ThouSandS of 13tL1/hr, enter total calculated or measured fan flow in CFM herr.
`� ✓
Pass it Leakage Percentaoc < NA for Final or <4% at R01.11111 -ill without air handle:
100 xL (Linc ` 1) / (Linc r ?)
❑Pass ❑fail
ALTERATIONS:
Duct System and/or HVAC Equipment Change -Out
Entcr Tested Leakage Flow in Cf NI from Pre -Test of Existing Duct System Prior to Duct
4
System Alteration and/or E(luipnpcnt Change -Out.
I=nter Testccl Leakage flow in CFM from Final Test ol'New Duct System or Altcrcd Duct
Svstem for Duct System AhUallon and/or EC LIi,mCnt Chance-OLIt.
Filter Rccluction in Leakage For Altered Duct Systcnt
6
(Liner 4) Minus (Linc': 5) — (Ooh- if -Applicable)
7
Enter Tested Leakage flow in C'FNI to Outside (Only if Applicable)
✓ ✓
Entire New Duct System - Pass if Leakage Percentage < 6' o fir final.
5
l0(1 x (Line r i) / Linc # Z)
❑pass ❑fail
TEST OR VERIFICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change-
✓ ✓
Out Use one of the following four Test or Verification Standards for compliance:
q
Pass if Leakage Pcrcenutgc < 15'%o [100 x [ (Linc r 5) / (Line r 3)JJ
❑ Pass ❑ Fail
I(1
Pass il'Leaka-C to OLIISIdC Percentage < 10';4 [100 x L-- (Line r 7) / (Linc z)JJ
❑Pass ❑fail
Pass if Lcakage Reduction Perccnta �c> 60"X, [100 x I # G) / (Linc r 4)JJ
I I
_(Line
and Verification by Smoke Test and Visual Inspection
❑ Pass ❑ Fail
12
Pass if Sealing of- ll Accessible Leaks and Verification by Smoke Test and Visual Inspection
11 Pass ❑ fail
Pass if One of Lines # 9 through # 12 pass
❑ Patiti ❑ Fall
✓ ❑ I, the undcrsil'ned, Verify that the above diagnostic• test reSultS were perloniied in conformance with the rcquircmcnLc liar comPliancc
crcclit. I, the undcrsicaped, also certify that the nc\Vly installed or retrofit Air -Distribution Systcnt Ducts, PlcnumS and Fans comply with
\Mandatory requirenpcntS SPccifred in Section 150 (np) of the 3005 Building Energy Efficiency standards.
Installing Suhcontractor (Co. Name) OR Gencral Contractor (Co. Name) OR Owner
sIgnalr
lle.: Datc:
Copies to: BUILDING DEPART\II NT, HERS RATER 01: API'I_ICABLF) BUILDING OWNER AT OCCUPANCY
ReSiclential Compliance Forms December 2005
INSTALLATION CERTIFICATE (Page 5 of 12) CF -612
Site Address ) Permit NLImhCI•
D I ib i r/10 ,11�z 11D>oo /3
✓ ❑ THF,RNIOSTATIC EXPANSION VALVE (TXN,)
Prrn;c'durc.a /i>r
A. -Id vcri/icoliuu i /'!hc'rnru.ciniic erpan.Viml rahV(-'S arc UIVilahle in RAC'A'1. ,41)pendix Rl.
✓ ✓
✓ RFFRIGFRANT CHARGE MEASURENIFNT
Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems withOut
Thermostatic f•cnansicni Valves
OULClOOr Unit Serial
Access is provided for inspection. The procedure shall
✓
��ll COnsist Of Visual verification that the TXV is installed on
Outdoor Unit Make
I�l'es ❑ No the system and installation Of the specific equipment ❑
Outdoor Unit Model
shall be verified.
Cooling Capacity
Yes is a pass I Pass 1 Fail
✓ RFFRIGFRANT CHARGE MEASURENIFNT
Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems withOut
Thermostatic f•cnansicni Valves
OULClOOr Unit Serial
"F
Location
°F
Outdoor Unit Make
"F
Outdoor Unit Model
"F
Cooling Capacity
13tu/hr
Date of Verification
°F
Date Of RClrigcrant GauWc Calibration
(must be checked monthly)
Date Of ThermOCOuple Calibration
(must be checked monthly)
Standard Chase Measurement Procedure (Outdoor air dry-bulb 55°F and above):
Pro(,edla•c'.c /ur Delel-minis, Rc'/i'i c'rortl C/rrn;;e' usirrg, /he Standard :11c,thud arc tn'ailvhle in RMC i1•l..4ppendix RD'.
Note: The system should be installed and charged in accordance with the manufacturer's specifications before starting this
prOCCClure.
Measured Tenincratures
Supply (evaporator leaving) air dry-bulb temperawre (Tsupply. db)
"F
Rcumi (evaporator entering) air dry-bulb temperature (Tretorn, db)
°F
RCLUrn (CVapOratOr entering) air wet -bulb tcntPerature (Tretorn, \vh)
"F
Evaporator saturation tempCratta•c (Tevaporator. sat)
"F
SUCti011 line tcmperattn•c (TSUC1i0n, db)
"F
Condenser (entering) air dry-bulb temperature (Tcondenser, clb)
°F
u 1CncCat Charge Method CaleUlati011S for Refrigerant Charge
Actual Superheat = TSUCIiOn, db — Tevaporator, sat "F
Target SupcncCal (from Table RD -2) "F
Actual Superheat — Target Superheat (System passes if between -5 and +5°F) "F
Temperature Split Method C:a1CtllatiOnS for Adequate Airflow
.Srrlir ('nh-w1a6ms it nnr Harr cc:u r H, J,/, u.n r:,
ACtUal Temperaturc Split = T return, db Tsupply, db
"F
Target Temperature Split (from Table RD3)
"F
Actual Temperature Split Targct TemperatUre Split (System passes if between -
3°I- and +3°F Or. a On remeasurement, if between -3°F and -100 F)
°F
Recidewiirl Compliance Forms Alwil 200.i
Standard Charge MCasurentcnt Summary:
SvSlcm shall pass both refrigerant charge and adequate airflow calculation Criteria from the Same
measywcments. I f corrective actions were taken, both criteria must be rcmcastu-cd and recalCulatccl.
Yes I ❑ NO I Svstctn Passes
Alternate Charge Measurement Procedure (Outdoor air clry-bulb below ;; "F)
Note: The systetit Should be installed and charged in accordance with the nxmuf:ICturcr'S specifications and installer
veriliCation shall be documented on CF -6R before starting this PrOCCdurc. If outdoor air dry-bulb is 55 OF or above. installer
Shall uSC the Standard Charge MCasure PI-tICCCIUI-C:
Pruc:cclrrre.c /ur Derc•r-mhiin,, Re/i igcranl Char;,e itch{", the Ahernalc rLlcrlt,acl arc arailnhlc in RACA4. Appendix RD 3.
Weigh -In Char,in, Method Ior Refrigerant Char,c
ACual liquid line length: F n5 Il
hlanufacturer'S Standard liquid line length: ft
Diflcrcnce (ACtual — Sutndard): ft
N'IanuftcturCr'S correction (OLInCCS per foot) s difference in length = ouneeS
(+ = add) (- = remove)
lc;tsurcd An -flow Method for Adequate Airflow Verification available in RACAA. Appendix RD2.6
Calculated Airflow: Cooling Capacity (13tu/111-) X 0.033 (cfm/13ttt-hr) = CFNI
\Measured Airllow is _1 Z&.0—CFN1 (measured airflow muss he grCater than the CACulatcct ,tirflOw).
Alternate Charge mcasurcmcnt Sullmat-V:
System Shall Pass both reli-igcrant charge and adequate airflow calculation criteria from the same mcaSuremCnts. If
correcti/c actions were taken, both criteria must be remeasured and rccalCulated.
✓ 19l'cs I ❑ No I si-slem Pascoe
ln-,talling SubCOnu-aWlor (Co. Name) OR General
�5
Contractor (Co. va)le) OR Owner
Oct (�/ — ✓�-C�
Signature:
Datc:
Copies to: BUILDING DEI':%RT\'IENT. HERS RATER 01: APPLICABLE') BUILDIN(; O\1NER AT OCCUPANCY
Reciclenlial Compliance Forms April 200 i
MISCELLANEOUS CREDITS
✓ ❑ DIAGNOSTIC SUPPLY DUCT LOCATION, SURFACE AREA AND R -VALUE
l'roccbu r ' /i r /irld lvri/ic'alion cmd diagnnrsrlc lee1h7_/(r lhis grmlp compliance credils w c available in RACN1 Appendix RC. RE d'• Rll.
✓ ❑ LESS THAN 12 LINEAL FEET OF SUPPLY DUCT OUTSIDE OF CONDITIONED SPACE
COMPLIANCE CREDIT
✓ ❑)'es I ONO I Less than 13 lineal tcet of supply duct uutsicic ofconditionccl space.
Yes to this compliance credit is a pass I ✓ ❑ Pass I ✓ ❑ Fail
✓ ❑ SUPPLY DUCTS LOCATED IN CONDITIONED SPACE COI\IPLIANCF, CREDIT
✓ ❑ Yes 1 ❑ No I Ducts are located Within the conditioned Volume of building.
Yes to this cont liance crcclit is a pass ✓ ❑ Pass ✓ ❑ fail
Duct System Design Verification is required fora compliance credit for the following:
I. Supple duct surface arca reduction
2. Buried supply ducts on the ceiling
3. Deeply buried supply ducts
✓ ❑ DUCTSYSTEM DESIGN VERIFICATION
✓
❑ Yes
❑ No
Ade<uate airflow Verilicd
✓
❑ Yes
❑ No
The duct System design plan meets the requirements specified in RACM. Appendix RE. Section
R E.4.?
✓
❑ Yes
❑ No
The duct system design plan exists on huilding plans
✓
❑Yes
❑ No
Duct sires. duct system layout and lOCatiOnS of supply LK' return registers match the duct system
deli m plan
Yes to all is a pass ✓ ❑ Pass ✓ ❑ Fail
✓ ❑ SUPPI.Y DUCTS SURFACE AREA REDUCTION COMPLIANCE CREDIT
Attic
Crawl
Space
Basement
Deeply
Covered Covered Other
R-4.2
Duct Surface
Diameter Arca
R-0.0
Surface
Area
R-8.0
Surface
Area
❑
❑
❑
❑ ❑ ❑
❑ Pass
❑ Fail
❑
❑
❑
❑ ❑ ❑
❑
❑
❑
❑ ❑ ❑
❑
❑
❑
❑ ❑ ❑
❑
❑
❑
❑ ❑ ❑
Total Surface Area lin• Each
R -Value =
✓ ❑
Yes I
❑ No aches
Perli,rmanec's CF- I R?
✓
✓
Yes to all is a pass
❑ Pass
❑ Fail
✓ ❑ Rl1RIFD DlICTSi ON TNF (-FII INC.COi\IPI IANCFF ('RG nIT
✓ ❑ DEEP[-)' BURIED DUCTS Cn141P1_IANCF CREDIT
✓
❑ Yes
11 No
Buried Ducts on the Ceiling
✓
❑ Yes
❑ No
Verified High Insulation Installation QualitV
✓
✓
Yes to clue[ SVStenl design, Supply duct surface arca reduction and this compliance credit is a pass
❑ Pass
❑ Fail
✓ ❑ DEEP[-)' BURIED DUCTS Cn141P1_IANCF CREDIT
✓
❑ Yes
❑ No
Deeply Buried Ducts
✓
❑ Yes
❑ No
Verified High Insulation Installation Quality
✓
✓
YcS to duct system desi_ni. sup Iv duct surface arca reduction and this compliance credit is a Pass
❑Pass
❑ Fail
Copies to: BUILDING DEP:\It"fD'll:N I', HERS RATER (IF APPLICABLE) 131ALDING OWNER AT OCCUI'ANC)'
Reside whit CWnlplitmee rol•nls ,-April • 00j
✓❑ FAN WATT DRAW
Prucedilr•es la- nieosurhig rhe air handler lean ch-mv are (weiilahle in RA Cr1•l..a,)mvidi.r RE3.2.
✓ Method For Fan Wart Draw Measurement
❑ RF -3.2.I Portable \Vast Meter McasurcMCnL
❑ RF3.2.2 Utility RCVCnLIC Mcier Mcasurcmcnt
MeaSLIred Fan \\raft Draw
i\'iCajtlred Fan Flow (enter total clip from airflow verification)
rnLCr I'CAdIS Of \\'atS/cfill
❑ RE4.1.1 Dia"nostic Fan Flow Using Flow Ca tUre Hood
RE4.1.? Dialnostic Fan Flo\\' USin, Plenum PI-CSSLII-e Matchin,
RF4.1.3
✓ ❑ Yes
❑ No
MeasureCI fall wat/clip Ch-aw is equal t) or In\VCI' than the
fan wattleIm draw CIOCLII11CI1LCCI in CF - I R ❑
❑
Duct dcsiL;n exists on P11111S
✓
Yes is a pass Pass
I Fail
✓ ❑ ADEQUATE AIRFLOW VERIFICATION
Procedure.,; /br- ruea.rnrin.t; the e ir/lall are available in RAC•A•l. Auvendix RE i.1.
✓ Method For Airflow i\ieasurement
✓
❑Yeti
❑ RE4.1.1 Dia"nostic Fan Flow Using Flow Ca tUre Hood
RE4.1.? Dialnostic Fan Flo\\' USin, Plenum PI-CSSLII-e Matchin,
RF4.1.3
Diagnostic Fan Flo\\, Using: Flow Grid Nleasurcmcnt
'CS
❑ No
cs ❑ No
Duct dcsiL;n exists on P11111S
✓
❑ Yes
No
MCaSlll-Cd /\il-n O\\':
4
✓
❑ Yes
Rated Tons cfmiton
Coolie, capacities of installed SystcmS arc <_ to maximum cooling;
capacity indicated on the Pcrfonnanec's CF -I R and RF -3.
✓
R 1'es
✓
✓
✓ ❑ Ycs ❑ No 1%'iCaSnl-Cd ait-AO ' is greater than the criteria in Table Rf_•-?
Yes is a ,ass
Pass
Fail
✓ I\IAXIMUM COMING CAPACITY
Prorm-elurcc/;)I-dc'In•rnliuinnnulvillllnuc)slim illRJr•A-1 Jnnnn,/irPF'
Watts
cfitt
Watts/C1,111
Total cfm
C1,111/toll
I
✓
❑Yeti
❑ No
IVICq LIa LC all -I10\\' \'CI-Illed (SCC adequate airflow credit)
Date:
✓
'CS
❑ No
RCh-Igerant char'g'e (it- TX
3
✓
❑ Yes
No
Duct leakage reduction credit verified
4
✓
❑ Yes
❑ No
Coolie, capacities of installed SystcmS arc <_ to maximum cooling;
capacity indicated on the Pcrfonnanec's CF -I R and RF -3.
✓
R 1'es
❑ No
If the cooling capacities of installed systems are > than maximum ✓ ✓
cooling capacity in the CF -I R. Lhcn the electrical input for the
installed S StemS must be <_ to electrical in gut in the CT- I R. ❑
Yes to I, ?, and 3: and Yes to either 4 or i is a pass
Pass
Fail
✓❑ I-IIGI-1 EER AIR CONDITIONER
PrI ee'dtrr-es 1i)r• ner•iliceitiun erre mvilahle in RAC",14 A) Iendix Rl.
I ✓ ❑ Ycs ❑ No GER ValucS of installed SVStcmS match the CF- I R
3 ✓ 0 Yes ❑ No For Split SyStcm• indoor coil is matched to OULCloor coil ✓ ✓
✓ ❑ Yes ❑ No Time Delay Relay Verified (IfRcyuircd) ❑
Yes to I and ?: and 3 (If RC(uircd) is a pass Pass I Fail
Installing Subcontractor (Co. Name) OR Gencral
Contract,or Nan ) OR Owner
771
signaLLn-c:
Date:
Copies to: BUILDING DFAIAR -TIENT, HERS It:\ I I:It (If APPLICABLE) BUILDING O\\'N RAT OCCUI'ANC1'
Resicic•nricll Cemiplianc..e Fln-Ins April ?11/15
INSTALLATION CERTIFICATE (Page 9 of 12) CF -612
Site Address Pennit Number
/ D %41Vfci ► h So K ke IA q <-O., (/ I /i o -n 0/
An installation certificate is required to be posted at the building site or nlncle available for all appropriate inspections. (The
information provided on this fim•n, is rc(juircd) Alter completion of final inspection, a copy must be provided to the building
department (upon request) and the building owner at occupancy, per SCCtiOn 10-103(x).
BUILDING ENVELOPE LEAKAGE DIAGNOSTICS
✓ ❑ ENVFLOPE SFAIANG INFILTRATION REDUCTION
Proccclnrc•s fi _fide/ verification cruel diggit( .wic rc•sfhr ,., u/'euve/opc lcukm,,c ore (it ailcrhle in RAC ill, Appemli., RC.
Diagnostic Testing Results
Installing Subcontractor (Co. Namc) OR General
✓
✓
Building Envelope Leakage (CFM cu i0 Pa) as measured by Rater:
Signature: �n /
1
❑
❑
Measured envelope leakage less than or equal to the required level from
Yes
No
CF -1 R?
❑
2.
Is Mechanical Ventilation she,wn as required ol, the CF -I R?
Yes
No
,.t
❑
❑
I f Mechanical Ventilation is required on the CF- I R (`)'cs' in line'_). has it
Yes
No
been installed?
E]E3
Check this box 'yes' if mechanical ventilation is rCquircd ('Yes' in line 2)
2b.
and ventilation fan wal.LS are no rcatcr than shown on CF -I R.
Yes
No
Nlcasurcd Watts =
❑
E3greater
Chn
Check this box '`VCS- il',Casurcd building infiltration (CFM @�v if► Pal is
3.
than the CFM a) 50 values shown lin• an SLA of 1.5 oil CF- I R
Yes
No
(If this box is checked no, mechanical ventilation is required.)
Check this box -'vcs" if measured building infiltration (CPM @ �O Pa) is
4.
❑
❑
less than the CFM @) 50 values shown for an SLA of 1.5 on CF -I R,
Yes
No
mechanical ventilation is installed and 11OUSC pressure is greater than minus
i Pascal with all exhaust fans o .eratirng.
Pass if:
it. Yes in line I and line 3, or
✓
✓
b. Yes in line I and line2. 2a, and 2b, or
Yes in line I and Yes in line 4.
Elc.
Otherwise fail.
I Pass
Fail
✓ 2 1• the undersigned• vctil'\, that the building envelope leakage meets the rCgUll-C111CntS 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
rMlItS, and the work I performed associated with the test(s) is in conformance with the requirements for compliance credit.
(The builder shall provide the HERS provider a copv of the CF -(,R signed by the builder employees or subcontractors
ccrtilying that dia,nostic testing and installation meet the requirCIM11LS Rn compliance credit.)
Test Perlormcd
�5
/7-1
Installing Subcontractor (Co. Namc) OR General
Contractor (Co. Na ,c) OR Owner
Signature: �n /
Date: 97_
Copies to: Btill-DING UI-:P:\RT.,ME,.NT, HERS RATER (IF AITLICABI ), BUILDING OWNER AT OCCUPANCY
Residerrrial Compliance Forms April 200
COAS"'T' BUILDING PRODUCTS
A
Cafi;ot-nia Enpyyy "tar Homo--; Program
INSTALLATION CERTIFICATE CF -6R
ermit
1-1 . S to Address 10 .5 .0 0 . JOHN . ,,NAV.-.. ,,.JPF.RT,M0--r Number
7 . i Oo /I � 1 - i
121 MI ci)Jc. - sp,cateciin
,,' FLOOR
0El
YES
A
NIA
All floc) joist cavity insulatic-r instill&'l to Uniformly f;i ;he c=-viiy Eic:e-to-side and artd-tc-enrj
COAS"'T' BUILDING PRODUCTS
A
Cafi;ot-nia Enpyyy "tar Homo--; Program
INSTALLATION CERTIFICATE CF -6R
ermit
1-1 . S to Address 10 .5 .0 0 . JOHN . ,,NAV.-.. ,,.JPF.RT,M0--r Number
7 . i Oo /I � 1 - i
121 MI ci)Jc. - sp,cateciin
,,' FLOOR
WALLS
Z
0El
YES
NO
NIA
All floc) joist cavity insulatic-r instill&'l to Uniformly f;i ;he c=-viiy Eic:e-to-side and artd-tc-enrj
rl
1:1
J
For licni-s hmv.,tt.eai cnwjilioned .:nd ex!eiior spaces insulated floors above garitoes at d
Y E S
NO
N//*,\
cantilevered floois'i. air bander ir-stalled at aoy exposed edges Of iI-.5LII--id0I" 011d insulation in5tallod I,.;
Cl
D
0
Maimain pe-rinanorit cantac! with air barriers (e.g., sub -flour aw.] 5hetuuck ceiling o: soffiQ
Y E S
N0
NIA
([hernial bypass cherl:-11-t - cornpliance optional Unlil,lulv I 20C-&;
0
0
F1-
YES
NO
IWA
Cnnlilf:ve.md floor hunting cunpleledy filled v.,;Ih in-milaimn or insulation in parmaneni contact the
10
I. smpliar.cc optional LHuntilJUI'l 20018
uhf:o�-i ithein-ol bypass che-o',J:m - co
J71
M
E)
No vnicj-3 ov':�f 3M- doe'] or (y.r-Io Ilan of the bzmll arta)
YES
NO
R'A
Insu:,tion in -conzact the air-Z-arrie-i—
z
13
EJ
Fo; floors over P=iages of vtcr, [huo is an a:r space 1--tw5en :1*.e in!;oll-itloo
YES
NO
N/A
a:id the iirn i6st (1)nnd:o;sI'- insulated,
YES
NO
N/A
Insolation oropeily suppnried to avo:d gaps. voids, and
slabs in dimate I and 15) ha%- til least 751',,o of the s! -al) --Wqc; ims.ilalvd.
WALLS
Z
0El
YES
NO
N,A
vjall st-il cavincs ca:in,.cv 'j, fcxnecl tc pfc-vide an all t;ght efivelope.
U
YES
NO
N/A
Trp and I)r,'iom plat", co-,lintiou, cr orar..nns I)I17sCIk.f1.fIqnr1 scalr;d.
Cl
D
0
Y E S
N0
NIA
levan stucl cay.ty insul.10011 Uri(CMI;y61IS;he C-Wilv sJe-lo-side.:np-to--:?ol:ont, and front-tf:i-bad,
0
0
0
YES
N 0
N/A
i%lo cnr-s
10
NO
1 14 /A
No vnicj-3 ov':�f 3M- doe'] or (y.r-Io Ilan of the bzmll arta)
IJ
Toll
ovl�
I;1i'l to acces-, ,';Iilri Sij& -,.g '-jjq frillelS• ill-cjSCCjjoIIZ alta I?811111Ci U.11?
YE
t\
w
shoef 1-MG-DEUres ui.�uiated;c- 11roper
i'ES
R1
YES
I Z.
YES
Z
YES
YES
0.7
YES
2
YES
[a
YES
F -T
YES
10,
YES
in,
YES
Iii
YES
0
0
A;lin mid tIke figllt s1WI insulation supported J:at it v. -ill stay j;F-iin.,ai.=rilly ill cc:FlTact LN it') :he
NO
YES
NO
N/A
[--1
A,r barrier on lhct attic side Of ifI*LIl.IWd1 lkfv,,a v.,.tll,,, i -I C.lillliln. zone --. 1 .;fill IC, (jero)m:,,,.ft ,(:zcl in nit other
NC)
N/A
Rii:, :B: I ild" loists I list Ila I cd, Air b nn ir7 011. khP In I, ri--,r side. of the rim (h Ind, jOie! i I) RL I In fin: I
YES
NO
WA
Clinljle ZollF.,S 1 .-1111 iS
NIA
0
1:1
_-_-
Loosc till wall iris,,jkition 111MMIUM
YES
NO
N/A
In,.-,-nllsl:f.)n of air-Cqh: barriers inr adje.illif;f) vaunt or urlrord:liroorl space. innhiding all
k-11
0
0
All dial; stool and held CDV6N: C,101kPO ar 1`1_,,!:r(-(1 tO )pr ov,Ccvxr Ociiit r;n%,i4-)pp (-harmn] bypass
Yl -:.'S
I NO
NIA
Insulation i -i cc-nt:,rlvjilli r^r "ill - D'"If,
ff--,[
-1ol
I --I
mill-, l.leiviv.1 i;liuvieis ! ltwt;
YES
I NO
N/A
Attic and 51(Vligi-t Sllclft� iIISL.I-Pted to n mini itim 13-1f1
i'ES
R1
YES
I Z.
YES
Z
YES
YES
0.7
YES
2
YES
[a
YES
F -T
YES
10,
YES
in,
YES
Iii
YES
0
0
A;lin mid tIke figllt s1WI insulation supported J:at it v. -ill stay j;F-iin.,ai.=rilly ill cc:FlTact LN it') :he
NO
NIA
drywall
0
[--1
A,r barrier on lhct attic side Of ifI*LIl.IWd1 lkfv,,a v.,.tll,,, i -I C.lillliln. zone --. 1 .;fill IC, (jero)m:,,,.ft ,(:zcl in nit other
NC)
N/A
zoritit'.
0
0
IAIZIII,-, of ;Ijjp -1(,sp ti for I IVAC -nd ! of %valof headrig equipment, Ilia; cGmt-uslion air
NO
NIA
ven:inq. hisulaled W (lit? saint. R-viillut a.s :galls
El
171
YES
NO
NIA
In,.-,-nllsl:f.)n of air-Cqh: barriers inr adje.illif;f) vaunt or urlrord:liroorl space. innhiding all
the following: Air-holit barrie.is ir. contact with 1".o:.Ii tll(e imeJof filiff P.,deflol, si(;(! of in all of
All dial; stool and held CDV6N: C,101kPO ar 1`1_,,!:r(-(1 tO )pr ov,Ccvxr Ociiit r;n%,i4-)pp (-harmn] bypass
YES
these i,i climate Zones I and 'i6 (recomnlended in 911 other c-lirnatc zones",
0
0
1,10
NIA
mill-, l.leiviv.1 i;liuvieis ! ltwt;
0
1❑D
of criulk beiwoon the housm..-) and t -i= ci-ilma
NO
N,1A
bVAIL heWnd firc-places,
0
0
NO
Ido
N/A
l;isulatect x.ti-_ slowing and veiticol walls
13
0
NO
NIA
,.;lir, 1.-neewalls
El
D
IN] 0
N
Skyiiqht shafiv.,a!s
NO
NIA
lnlc-!,ect:or, of I)orch and rocils and extericr walls
1\10\
/A
s s(. s
D
0
coll..e.cavity com ' pleiely filled v.,itll iri-wlqllr!ri of ink -Am framing.Mcd and air Larrier
1\1 0
N /A
7ior fraw(l
installed at cxtefioi edce of insLl . adon in ilimm
v/ ROOF / CEILING, 1"REPARATION
M_
EJ
0
YES
I NO
NIA
A I draft stops in pla•_e :o tarot a crn:inuoos cr..ilinn and wall alt bet r:r
21
D
0
YES
NO
N/A
All caollpe.d ceiling=- and soffits covered :villI 11,11 d Cove lre-
YES
1,10
NIA
Air e (if oplit-A ViAll IW', 0I (AUI i,:)l VIZIll'-
All dial; stool and held CDV6N: C,101kPO ar 1`1_,,!:r(-(1 tO )pr ov,Ccvxr Ociiit r;n%,i4-)pp (-harmn] bypass
YES
NO
F,x ' tui,�.� Iii.,31 pt�welrsle 11),2 cifing IC aowl lir tight :AT) iaie.d and s.Dalcd :.,ith i. gm;kel
All 1:(jlil .-
0
YES
NO
i H/A
of criulk beiwoon the housm..-) and t -i= ci-ilma
1771
YES
NO
1,U , r.
kno-. l_.kIiidifIq', have air light draft '.:tC'IJS to all miloilling attic?
a
❑
❑
YES
ISI
YES
ISI
YES
n
1'i=S
0
_YES
IYES
NO
❑
NO
❑
IIN0
n
NO
❑
h10
NO
0
N0
NLA
:n_e:valls and skylight shaft" ills i•lsulalc:6 or orepaled for bin':;n insulation an air harrier insialled or
OV
❑
❑
tree olliL. slit= of in311;nleci kneev: IIs i;: clip:ate Zones 'I anJ :u (reconv-)ended h� all other climate
YES
NO
NI!',
;.r,nrnurnrs top a.nd ho!trlm plates or blocking het teen lass medlars installed lostili,-Am
❑
❑
suPperlcd so that it wilt not fall dax'n b, eithc-r fitting to lir, fiLmling. st pling it. p:,h;u vji'.h Inhlinlal
YES
NO
N/A
r:�mpi2951gn, r.f using other suj:pert such a:: nea'rq
rrf
r_I
u
_
YES
NO
1 N/A
era umJQI eq�°ion:en! platforms and rat -walks insulated or IrCC5S'hl,D for blev:n iris. :tion
fel
❑
❑
-----• ------ —..---
YES
N0
N/A
Attir, I j ers installed
F_I
❑
❑
r..L'ir, access or drol;-cig•.:n slsir ineul;t,eii e; Ih ir;;llation, fits snugly in the framed
YES
N
NIA
All peae:raiions ttrough the air barrier f:.d:e SrSaletl wi!h r.:u!Ik, fn:irn ci tape:
✓ ROOD / CEILING BAT i S
LJ:YES
L� �CJSE•FILL
YES
ISI
YES
ISI
YES
n
1'i=S
0
_YES
IYES
NO
❑
NO
❑
IIN0
n
NO
❑
h10
NO
0
N0
NLA
Nout;i;;
OV
❑
❑
—
YES
NO
NI!',
Flo voids o`re '_! .:ncii deep or mon= than 103o of the bill Burl=ce area
❑
❑
1`ES
IVC
NM
Irs.dati n in tc,r,;a 1 -i
Q 1'„ '::111' 111 illi Il:lli li?t
lief
❑
ID
_
YES
1\10
Irl/A
PeC.ESSCd light fi::ulras ar:•ored ::ilh insulation
O
❑
❑
YES
N0
NIA
Gifilcs installed <:l r.:a'n vs-nis or silf.l vr:nis to nlnintnin net free `:enClalion area
F_I
❑
❑
r..L'ir, access or drol;-cig•.:n slsir ineul;t,eii e; Ih ir;;llation, fits snugly in the framed
YES
NO
NIA
opening, and fully caskeled for an sirtlgh fit
I_ I
C✓I
❑
1rJhole-t.ouse fans have an irlsulatecl wear Ifial is gaskelOd or sealed to Isle (U)JiMin,:7 frunr either 11::-
YES
NO
NIA
attic side or c_'iiing side of the fan
ROOF / CEILING
L� �CJSE•FILL
YES
ISI
YES
ISI
YES
n
1'i=S
0
_YES
IYES
NO
❑
NO
❑
IIN0
n
NO
❑
h10
NO
0
N/!'
— ❑
NIA
❑
N/A
❑
N/A
❑
NIA
N/A
'1
In si lat on unifou•tl`; rovers Cr: enlre ceiling for roof) area fru!n lilt- oulsid�- of all @)aerigi ::•ails
--
Dafflcs iris:allcc I; cavo vents o! soffit vents to maintain nel Iree venWwiun area
Alli- nom:es5 oi stai; inSUlitgrf 'Mth perfmlli; ntlV a;t:) hdri Insidalion fits Fnwdv in tnG 4-rlined
opening and ruby ria l:eted for an ninighl flf lit
;`hgle-house fan, have an irsulated cover th:a is gasketad w seale:l to ,:ie Opening from v ither ilia
attic silo ur the ogainc side of Ilse Ian
--
h�rfsz-..ri light fi:.fuses r.ovFrnri vAli ins dalion
Insulation ;: orop-zr depth - irsul_!icn r.tlars visible :,flet in•:ii a!inil proper depte. ar.d R -value
------------•---
Lnase-;ill insu at:n:i me -els ore,xc.eNds nl i-trfactcrcr's r-inimurn weinl:l and Ihickr;aas regt.iremanl for
Ill- target R-valuo. Taract R-valnc .'lanufaclurr'S ni•nimum required weight for t lr. tal_gal R-
valt.c (pound,-;;ar-sgtrere-fool'. fi'iarn:(achlrPr; n,inin,um req lirec Ih cl:ncss it ;in a or
PJ?%\ instill t -nn {inches) W.:-Inufactumf.s mirin:rnn ie..r,l;J!ed se(llr 8 Ihirkness (inc.-les".
v I"ENETRATIONS
Cc= MIVION WAILS) BETWEEN WEEN DWELLING UNITS
❑
❑
11ucl shaft oponicgs h: uncxicnicned space fully sealecl with sold U'loclunq ani: any remaining gaps
_YES
N 0
IVIA
sea.ed V:ilh r.;ulk Of seal::nt
I'I
❑
❑
(ip .iiinfls around Ilue ?hall; lolly <.enle;l ,;i:h snli•;I l;lor,!•:inq rn flashin.'In, ,and any rem -lining ,laps
sea' :c wilh (•rP-rmtcci caulk ai seNnn:: Gornbustion dearrnc= he-lwean flue nrid compost ) e maleria's
YFS
NC)
NIA
properly closed with LIL-a.arioved metal collars
rl
❑
❑
Firma 311 ,1:1 op.=rrng, NF secdet: wilh soiO alvcking ar rlashings. and ary reniaining caps seaiej :Jlh
YES
NO
N/A
caulit. cr sealant
1 _ ,0
S
1N 0
IV ;,
Pr nr:lia:inn::."win ;:firing scalc';I tci:h :;aul or srala:nt
Cc= MIVION WAILS) BETWEEN WEEN DWELLING UNITS
3.7. 3 nECI_ARATION
I hereby cer-ifv that the JnstaNal cn nle_ts all applicable r-3 quire iems as Sc'-•clrled In Ills Quality Insulation I-slal.:16.111 Checklist
P: nredm cs•.
Installing sui:cunhnr.•oi (C'u Jane) UIQ Uenera!
conaacloi (Co. Ha:ne)
aturc: JUIAN BA! IER I(ir211Zl: 1
\'1an
6", Al Shaft .!all (;br'irilpn %vall and strudilral framing I:Iv.ean cwelling units) f01`�
)'ESS
110
1 N/A
scaled at all cm -dor b:,undary cordNons J
3.7. 3 nECI_ARATION
I hereby cer-ifv that the JnstaNal cn nle_ts all applicable r-3 quire iems as Sc'-•clrled In Ills Quality Insulation I-slal.:16.111 Checklist
P: nredm cs•.
Installing sui:cunhnr.•oi (C'u Jane) UIQ Uenera!
conaacloi (Co. Ha:ne)
aturc: JUIAN BA! IER I(ir211Zl: 1
1 a Ott:'
Gi�•i;rai
l;7l)(1 C;n,drn C;:,i;: I)ri�•r•, Str,l,:• lul,lin. U.4
L'Ixa•:
INSULA T ION CERTIFICATE
131,61CIers: 1'AULSON LLL Permit Number: / `�% �?17 ID /
Site Address: -'110;•I_50 JOHNSON AVE. CUPERTINO --Y-- -
111,5111atioll
GZII
Project Name:;: L.I'h101•IN:•1C)N /1V1::. NO
17escription of Inaulatioll (Fornrcrrly IC -1 For1�1)
I RAISED FI-OOR
Material BATTS Brand Name KNAU1=__ _ _
Thickness (ir•ches)� 6.25" Thermal Resistance +;R -Value) 11-19
_ FLOOR OVER GARAGE
SignatU10
Material BATTS
Brand Name KNAUF
-
Thickness G.2.5"
Thermal Resistance (R -Value)
R -1c
P@I'Inletri'r InSUIaiiOn Det?ill (inches,
3 EXTERIOR kAJALL
Frame Type
A. Cavity Insulation
Material BATTS
Brand Name KNAUF
_
_
Thickness (inches) 5.5"
Thermal Resistance (R -Value)
R-21
B E;;tonor Foarn Sheathing
Material
Brand Name
_
-thickness (inches)
Theirnal Resistance (.R-V-1Ue)
4 FOUNDATION WALL
Materia
Brand Name
_
Thickness
Thermal Resistance (R -Value)
-
5 CEILING
Batt or Blanket Type 1'3ATT_
Brand Name KNALIF
Thickness (inchesi
Thermal Resis.ance (R -Value)
R-38
_12."
Loose Fill l`ype
Brand Narne
Contractors min Installed weighaf12 Ib
10inimu11) Thirl:ness
Inches
_ _
fvlanufaCturer's installed w-- ight per square foot to achieve'l herrnal P,esistancc.
(R -.vas ue)
6 [ROOF
Material
Brand Name
Thickness
Thermal Resistance (R-Valuc)
Do0aration
' I hereby certif,,- t'iat the abcve insulation vras installed in the building at the above loca'ion in conformance with the
current Enel'i v l=fficienl Slarxiarcfs for rc— .idenr_c: bui dings (title 24, Part 6. California Case of Regulations) as
indicates cn the Certificate of Compliance, where applicable.
tern 's ---
SignatU10
Date
Installing Subcontractor (Co. earn ) OR Genera Contra dor -
S
J.1 LLJ.AN -13AU- 1Z
612412011
C(MIST BUILDING PROwe'rs