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08040169 ENERGYINSTALLATION CERTIFICATE . (Pagel of 12) CF -6R Site Address Permit Number An installation certificate is required to be posteb 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). WATER HEATING SYSTEMS: Distribution CEC Certified Type Heater Mfr Name & (Std, Point- TyDe Model Number of -Use, etc) if # of Rated Input Recirculation, Identical (kW or Tank Volume Control Type Systems Btu/hr)I(gallons) External Efficiency Standby Insulation (EF, RE)2 Loss (%)2 R-value2 Date: 1 0 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 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 mandatory for storage water heaters with an energy factor of less than 0.58. Kitchen Piping: If indicated on the CF -1 R, 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) �6LJAll hot water piping in main circulating loop is insulated to requirements of § 1500) ❑Central hot water systems serving six or fewer dwelling units which have (I) less than 25' of distribution piping outdoors; (2) zero distribution piping underground; (3) no recirculation pump; and (4) insulation on distribution piping that meets the requirements of Section 1500) [:]Central hot water systems serving more than 6 dwelling units - presence of either a time control or a time/temperature control l —'>U I, 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 -1R) submitted for compliance with the Energy Efficiency 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 Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner RV VVI g� Sign Date: Copies to: BUILDING DEPART, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 2 of 12) CF -6R I Site Address Permit Number N G 01 An installation certificate is required to be posted $t 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/GLAZIN.G: Item Manufacturer/Brand Name (GROUP LIKE RODUCTS t t Product U -factor Product SHGC # of (_< CF -1 R value) Z (<_CF -I R value) Z Panes Total Quantity of Like Product (Optionao (Options Area Exterior Square Shading Device Comments/Location/ Feet or Overhang Special Features 1. I VN CNNf 0\ 0� • O i— Window Distributor a 2. 4 ay.sz w.q..l Item #s Signature Date Installing Subcontractor (Co. Name) OR 3. General Contractor (Co. Name) OR Owner 4. Item #s Signature Date Installing Subcontractor (Co. Name) OR (if applicable) 5. General Contractor (Co. Name) OR Owner OR Window Distributor 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. tl Use values from a fenestration product's NFRC label. For fenestration products without an NFRC label, use the default values from Section 116 of the Energy Efficiency Standards. Z) Installed U -factor must be less than or equal to values from CF -IR. Installed SHGC must be less than or equal to values from CF -IR, or a shading device (exterior or overhang) is installed as specified on the CF -IR. Alternatively, installed weighted average U -factors for the total fenestration area are less than or equal to values from CF- l R. If using default table SHGC values from § 116 identify whether tinted or not. ✓ U 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 certificate of compliance (Form CF -1R) submitted for compliance with the Energy Efficiency Standards for residential buildings; and 3) the product meets or exceeds the appropriate requirements for manufactured devices (from Part 6), where applicable. Item #s Signature Date Installing Subcontractor (Co. Name) OR (if applicable) General Contractor -(Co. Name) OR Owner 4::j3 1:�-,5OR Window Distributor 4 ay.sz w.q..l Item #s Signature Date Installing Subcontractor (Co. Name) OR (if applicable) General Contractor (Co. Name) OR Owner OR Window Distributor Item #s Signature Date Installing Subcontractor (Co. Name) OR (if applicable) General Contractor (Co. Name) OR Owner OR Window Distributor Copies to: Building Department, HERS Rater (if applicable) Building Owner at Occupancy Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 3 of 12) CF -6R Site Address Permit Number 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 Equip Type (pkg. heat um CEC Certified Mfr. Name and Model Number # of Identical Systems(?!CF-IR Efficiencyt (AFUE, etc.) value) Duct Location (attic, etc.) Duct or Piping R -value Heating Load (Btu/hr) Heating Capacity (Btu/hr) (r) a 0— -�-c 9'ak p I l C P- & t/ a t Cooling Equipment Equip Type (pkg. heat um CEC Certified Mfr. Name and Model Number # of Identical S stems Efficiencyt (SEER or EER) (zCF-IR value) Duct Location attic, etc. Duct R -value Cooling Load (Btuft) Cooling Capacity (Btu/hr) 2 y fi-ova ok 3 t 1. > symbol reads greater than or equal to what is indicated on the CF -IR value. Include both SEER and EER if compliance credit for high EER air conditioner is claimed. V' 1011, 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 -1 R) submitted for compliance with the Energy Efficiency 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 Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner t n.. g Cly' Signa Date: <5 1 -;VS I U — Copies to: BUILDING DEPA ENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 10 of 12) CF -6R Site Address Permit Number IIns�ulation Installation Quality Certificate ✓ CI 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 ✓� 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 Yes No NA ❑ ❑ Insulation in contact with the subfloor or rim joists insulated Yes No NA ❑ ❑ Insulation properly supported to avoid gaps, voids, and compression Yes 1 No 1 NA ✓ WALLS ❑ ❑ Wall stud cavities caulked or foamed to provide an air tight envelope Yes No NA ❑ ❑ 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 than 10% of the batt surface area. Yes 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 ❑ ❑ Small spaces filled Yes No NA ❑ ❑ Rim joists insulated Yes No NA ❑ ❑ Loose fill wall insulation meets or exceeds manufacturer's minimum weight -per -square -foot Yes No NA requirement ✓ ROOF/CEILING PREPARATION ❑ ❑ All draft stops in place to form a continuous ceiling and wall air barrier Yes No NA ❑ ❑ All drops covered with hard covers Yes No NA ❑ ❑ 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 ousmg and the ceiling ❑ ❑ Floor cavities on multiple -story buildings have air tight draft stops to all adjoining attics Yes No NA ❑ ❑ 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 Yes No NA ❑ ❑ Attic rulers installed Yes No NA Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 11 of 12) CF -6R Site Address Permit Number +� ROOF/CEILING BATTS DECLARATION I hereby certify that the installation meets all applicable requirements as specified in the Insulation Installation Procedures. Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner ❑ ❑ Date: d �� Yes No NA No gaps Yes No NA No voids over 3/< in. deep or more than 10% of the batt surface area. Yes No NA Insulation in contact with the air -barrier Yes No NA Recessed light fixtures covered ClIS ❑ Net free -ventilation area maintained at eave vents Yes No I NA ROOF/CEILING LOOSE -FILL ❑ ❑ Yes No NA Insulation uniformly covers the entire ceiling (or roof) 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 eave vent ❑ ❑ Yes No I NA Attic access insulated ❑ ❑ Yes No NA Recessed light fixtures covered ❑ ❑ Yes No NA Insulation at proper depth — insulation rulers visible and indicating proper depth and R -value ❑ ❑ Loose -fill insulation meets or exceeds manufacturer's minimum weight and thickness requirements Yes No NA for the target R -value. Target R -value Manufacturer's minimum required weight for the target R -value (pounds -per -square -foot). Manufacturer's minimum required thickness at time o installation jl'��(,1 . Manufacturer's minimum required settled thickness �� i . Note: To receive compliance credit the HERS rater shall verify that the manufacturer's minimum weight and thickness has been achieved for the target R -value. CF -6R only) DECLARATION I hereby certify that the installation meets all applicable requirements as specified in the Insulation Installation Procedures. Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner 8� U Signatur Date: d �� L� Copies to: BUILDING DEPART T, HERS RATER (IF APPLICABLE), BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 12 of 12) CF -6R Site Address Permit Number 1 b County Subdivision Lot Number Thickness (inches) .3, Thermal Resistance (R -Value) 1R-1 Description of Insulation (Formerly IC -1 Form) Signature Date U:�j �t,,5_ 1(2:9 1. RAISED FLOOR Item #s Material ----h Yles(P 1 �/�2' Brand Name C�1� Q/l/1� C��' n %z _ Thickness (inches) .3, Thermal Resistance (R -Value) 1R-1 2. SLAB FLOOR/PERIMETER U (� Material Brand Name Thickness (inches) Thermal Resistance (R -Value) Perimeter Insulation Depth (inches) (if applicable) 3. EXTERIOR WALL General Contractor (Co. Name) OR Owner Frame Type A. Cavity Insulation Material-Ifte%1911 aril Brand Name Thickness (inches) '3i 1, Thermal Resistance (R -Value) B . Exterior Foam Sheathing Material 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 Celef"%tpVVt' Contractor's min installed rght/ft2 Ib Minimum thickness lA_�inches Manufacturer's installed weight per square foot to achieve Thermal Resistance (R -Value) 6. ROOF Material Brand Name Thickness (inches) Thermal Resistance (R -Value) Declaration ✓ I hereby certify that the above insulation was installed in the building at the above location in conformance with the current Energy Efficiency. Standards for residential buildings (Title 24, Part 6, California Code of Regulations) as indicated on the Certificate of Compliance, where applicable. Item #s (if applicable)General Signature Date U:�j �t,,5_ 1(2:9 Installing Subcontractor (Co. Name) OR Contractor (Co. Name) OR Owner OR Window Distributor Item #s Signature Date Installing Subcontra or (Co. Name) OR (if applicable) General Contractor (Co. Name) OR Owner OR Window Distributor Item #s Signature Date Installing Subcontractor (Co. Name) OR (if applicable) General Contractor (Co. Name) OR Owner OR Window Distributor Residential Compliance Forms April 2005