11050048 - Energy CF-6R -�� A
INS-rALLATION CERTIFICATE (Page 1 of 12) CF-6R
Site/Address Permit Number
caltrryt d,� cu erhn-o (A- c - F 10,50t;L
Installa[ion-certificates(CF-6R);are'.req fired for each and every dwelling unit. When the installation of measures that require
field verification anddiagnostic 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-6R(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 10-1 03 a . am
WATER HEATING SYSTEMS: G
Distribution _
CEC Certified Type If ft of Rated Input External
Heater Mfr Name& (Std,Point- Recirculation, Identical (kW or TankVolume Efficiency Standby Insulation
.
Type Model Number Of-USCICLLCL Control Tv e S steins Mull r)1 (gallons) EP,RE)Z Loss(%)' R-valuer
h 0 O C. .
1 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 healers(rated input of greater than 75,000 But/hr),list
Recovery(RE),Thermal Efficiency,Standby Loss and Rated 1hput. For instantaneous gas water heaters,list Thermal
Efficiency and Rated Input.
2. R-12 external insulation is mandatory for storage water heaters with ari energy factor of less than 0.58.
Kitchen Piping: , •'6,.::Y{`;•'' '^r:�.
If indicated on the CF-IR,all hot water piping?3/4 inches in,diameter that ams from the hot water source to the kitchen
fixtures is insulated.
Faucets S Shower Heads: '
All faucets and showerheads installed are certified to the Energy Commission,pursuant to Title 24. Part 6, Section I 11.
Central Water Beating in Buildings with Nlultiple Dwelling Units(required for prescriptive)
✓ 1.
❑AII 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(1) 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 tune control or a time/temperature
control
es
✓ Ly' 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 Efficiency Standards for residential'buildings;=d;3) equipment that meets or exceeds the appropriate
requirements for manufactured devices(from the Appliance Efcienay Regidariais or Part 6),where applicable.
Installing Subcontractor(Co. Name) OR General
Contractor(Co. Name) OR Owner fDN�TWTW-J
Signature: r Darr. �G 7
Copies to: 13 UILDI DEPAwrjNIE:VT,HERS RATER(IF APPLICA ISLE) BUILDING OWNER AT OCCUPANCY
Residential Compliance Forms September 2005
INSTALLATION CERTIFICATE (Page 2 of 12) CF-612
Site Address Pennit Number
10�/D CuldPlt CIE- c 17e1filvw c. l Ilol�`Colel
An installation certificate is required to be posted at the build ng site or made available for all appropriate inspections.(The
infonrratiorrprovided 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:
Manufacturer/Brand
Name Total
t t Quantity of Area Exterior
(GROUP LIKE Product U factor Product SHGC #of Like Product Square Shading Device Contracrus/Location/
Item RODUCTS) (5 CF.IR value)2 (SCF-IRvaluc) panes (ontionao Feet oroverhan¢ Special Features
1. Pec J Ut 0 • 2 10
2. AiLW
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
q Use values from a fenestration product's NFRC label. For fenestration products without all.NFRC label,use the default
values from Section 116 of the Energy Efficiency Standards.
r> Installed U-factor must be less than or equal to values from CF-1R:Installed SHGC must be less than or equal to values
from CF-I R,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-I R. If using default table
SHG,C..values from §116 identify whether tinted or not.
✓ LJ 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 tower SHGC than that specified in the certificate of
compliance(Form CF-I R) 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
OR Window Distributor
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 4pril 3005
INSTALLATION CERTIFICATE (Page 3 of 12) CF-6R
Site Address Permit Number
10 yio cal0e�-t At- (opeI-voto Cd `v oiy� to 004
An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (The
information provided on this fomt 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(x).
H VAC Sl'S'I'E1N1S:
Heating Equipment
CEC Certified hf
N of
Equip Type Name
and Modell Haicicncy
Ideneicol (AFUC,etc.) Duct Duct or Heating Heating
Location Piping Load Capacity
(pkg. heat pump) Number SvStems (2CF-tR value) attic,etc. R-value Btu/hr (BluJhr)
&P'( ` 5.5 N lrt t t
Coaling Equipment
Efficiency CHC Certified Mfr. #of i Duct Cooling Cooling
Equip Type Name and Model Identical (SEER or EER)' Lwadon Duct Load Capacity
( kt:. heat pump) Number Systems (2CF-IR value) attic,etc.) R-value (Btu/hr) (Bndhr)
G� Wr OV-6 Nll) AC�Ir
1. >symbol reads greater than or equal to whit.is indicated on the MIR value.
I�nc
lude both SEER and EER if compliance credit for high EER air conditioner is claimed.
✓ 03 I, the undersigned, verify that equipment listed above is: 1) is the actual equipment installed, 3)equivalent to or
more efficient than that specified in the certificate of compliance (Foran CI'-I 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 @I.Ticiency Regulations or Pan 6),where applicable.
Installing Subcontractor(Co. Name)OR General
Contractor(Co. Name)OR Owner l)�I�.Uel� n� (oYl.fj�}�r�:f7•i1�
Signature: Date: 7(
t
Copies to: BUILDINC DEPARTMENT,ITERS RATER(IF APPLICABLE)BUILDINC OWNER AT OCCUPANCY
Residential Compliance Forms April 2003
INSTALLATION CERTIFICATE (Page 4 of 12) CF-6IZ
Site Address Permit Number
10/ I I J' a- C 5-0i I (,,Soo Ltj-
INSTALLER COMPLI:A CE STATEMENT FOR Ducr LEAKAGE
INSTALLER COMPLIANCE STATEMENT
The building was: ✓ ❑Tested at Final ✓ a 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 between the register boot and the interior finishing
wall are properly scaled.
❑ If the house rough-in duct leakage test was conducted without an air handler installed, inspect the connection points between the
air handler and the supply and return plenums to verify that the connection points are properly sealed.
UInspect all joints to ensure that no cloth backed rubber adhesive duct tape is used on new ducts.
✓ ❑ DUCT LEAKAGE REDUCTION
Procedures for field vert ication and diagnostic resfimq of air distribution sysreuis are available in RA 01 A i pend&RC4.3
NEW CONSTRUCTION:
Duct Pressurization Test Results(CFM Q 25 Pa) Measured 1_-'r
Values .rValues
I Enter Tested Leakage Flow in CFM: -
Fan Flow:Calculated(Nominal: ✓ ❑Cooling ✓❑ t seating)or✓❑Measured
2 if Fan Flow is Calculated as 400 cfnt/ton x number of tons or as 21.7 cfm/(kBtu/hr)x Heating ��
Capacity in Thousands of Btu/hr,enter total calculated or measured fan flow in CFM here: ✓ ✓
00
Pass if Leakage.Percentage< 6% for Final or<4%at Rough-in without•air handle:
3 100 x Line# 1)/ Line#2) ❑ Pass ❑ Fail
ALTERATIONS: Duct System and/or IIVAC Equipment Change-Out
Enter Tested Leakage Flow in CFM from Pre-'fest of Existing Duct System Prior to Duct
4 System Alteration and/or Equipment Change-Out. (oil
Enter Tested Leakage Flow in CFNI from Final Test of New Duct System or Altered Duct
5 System for Duct Svstent Alteration and/or Equipment Chan•c-Out. 15�
Enter Reduction in Leakage for Altered Duct System
6 r (Line#4) Minus (Line#5) - (Only if Applicable)
7 Enter Tested Leakage Flow in CFM to Outside(Only if Applicable) I ✓ ✓
Entire New Duct System- Pass if Leakage Percentage <6% for Final.
s ❑ Pass ❑ rail
100 x Line# 5)/ Line#2
'PEST OR VERIFICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change- �/ s/
Out Use one of the following four Test or Verification Standards for compliance:
9 Pass if Leakage Percentage< 15% 1100 x [ 5'0 (Line#5)/ U (Line#2)]] /s-o 0 Pass ❑ Fail
10 Pass if Leakage to Outside Percentage< 10% [100 x L_(Line#7)/_ (Line#2)]] ❑ Pass ❑ Fail
Pass if Leakage Reduction Percentage>60%[100 x [(Line#6)/ (Line#4)]] El Pass ❑ Fail
I 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 ❑ Pass ❑ Fail
Pass if One of Lines#9 through# 12 pass0 Fail
✓ DT.�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 l50(m)of the 2005 Building Energy Efficiency standards.
Installing Subcontractor(Co.Name)OR General Contractor(Co. Name)OR Owner
Otvwe
Signature: Date:
•7�/' .ZU1/v
Copies to: BUILDING DI Ali•I•MENT,HERS IGVITR(IF APPLICABLE) BUILDING OWNER AT OCCUPANCI'
Residential Compliance Forms December 2005
INSTALLATION CERTIFICATE (Page 5 of 12) CF-6R
Site Address Permit Number
1f!�QOtk-�
✓
'61ERil70STATIC EXPANSION VALVE (1'XV)
Pr9c&1uresjbrficld verification of thermostatic expansion valves are available in RACM,Appendix Rl.
Access is provided for inspection.The procedure shall '
`f consist of visual verification that the TXV is installed on
✓ ID Yes ❑ No the system and installation of the specific equipment J�ail shall be verified.
1 .
Yesisa ass Pass
✓ ❑ REFRIGERANT CHARGE MEASUREMENT
Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems without
i Thermostatic Expansion Valves
1 Outdoor Unit Serial #
Location
Outdoor Unit Make
Outdoor Unit Model
Cooling Capacity . - Btu/hr
Date of Verification
j Date of Refrigerant Gauge Calibration (must be checked monthly)
1+ Date of Thermocouple Calibration (must be checked monthly)
t Standard Standard Charye Measurement Procedure'(outddor"aiF"drv-bulb�55 F and above)Measurement Procedure'(outdoor"airdrv=bulb�55 F and above):
Procedures jar Determining Refrigerant Charge using the Standard Method`ore'available in RACM,Appendix RD2.
Note:The system should be installed and charged in accordance with the manufacturer's specifications before starting this
j ..procedure.
t '
i'
Measured Temperatures
Supply(evaporator leaving)air dry-bulb temperature(Tsupply,db) OF
�I Return (evaporator entering) air dry-bulb temperance(Tretum, db) OF
it ,_
ti Return (evaporator entering)air wet-bulb temperature(Tretorn,wb) F
3{ Evaporator saturation temperature(Tevaporator,sat) OF
�+ Suction line temperature(Tsuction,db) - qF
Condenser(entering)air dry-bulb temperance(Tcondenser;db)' OF
r
i{ • Su erheat Charge Method Calculations for Refrigerant Char e
jActual Superheat =Tsuction, db—Tevaporator,sat OF
I� Target Superheat(from Table RD-2) °F
Actual Superheat—Target Superheat (System passes if between'-5 and+5°F) °F
Temperature Split Method Calculations for Adequate Airflow
S lit Method Calculation is not necessary i Ade uate Air ow credit is idken
Actual Temperature Split =T return,db Tsupply,db
'i
fTarget Temperature Split(from Table RD3) °I'
Actual Temperature Split Target Temperature Split (System passes if between- OF
3°F and+3°F or,upon remeasurement, if between -3°F and-100°F
f:
Residential Compliance Forms April 2003
,''-. - j'l6i.Z--' r+YMi4Ci^r^,y .'•^*^ —�C.�.. - �"�'TR `RSoa ""s^ f
('-� D}: 'rya'
,
INSTAL ATION CERTIFIC TE 'y " $ *-
gi(rag�6oiz) CF 6R
� i Sit_YAddre�ss �. , �' t�?�y fin M'i y ? 4PemnNumber
��d � ..xefite_IL+.z;-, j7 ti+-Y%t{` � at fi ' '.'L.c�'t 4°.i_..f�.�:. t. .: ' + 1 y;-_, p Q•p4�r"j
F
Stan
.ddarnd CH-arge�Measurement
eas ureeuml•ent Summar'
umm a
shallysu. corrective
2+�qi
Mibothic�igcraruIch6"flt*ni7.i7Plt�nt
ss
efactsertae
iieasnts coecnvewac sure,t� and reca
ndrecalculated,
ti6-i�Fritena,f�oriiihc�'�arfi'c ,0
;
1 t -
4 i✓ 'fO Yes zcN f O Noe 'S stem Passes{y'ai +'#CttKn"�
•a3(g'j .k 4 •Ei
ry#u Jk ' }��'w.a J�Sr�3 GNS�'., w s�•z. T dF
Y }Alterna�te�Cha}g Measu-rem�nt Proicedtire (outd3 2ouor r dry-bt t below 5
F,gyx FNote 1The ssystem•sshoald be+mstalled and charged in accordance with the,mantifachlrerls spectficatiops'land n stall'er,
P rIx+ �s rr�iabc+-'s3vx d k z�.
7 x, ;nfication shall be;documented on Ce 6R bore s�artmg h s/procedurelf outdoor air tlry bulb is*55;§F or aboveymstaller <?%
""'"�<`�;'Lshrall,use the Standafd Charge[vl_easure 101
.-K. ' r � tfE„Y7t, id4.,r7 = r�• ' ?� �' �:'1 ''4 'f' . y , ,44 Pro zeduresjoorDeiermmmgRejngerpnl1!7 rgeung the lternale Method are avarlable,m�RACM,VAp4p„endcr D s .t=g�;;' _ , -w
1 tr Wei h-Ili Char to Method for Refrt Brant Chn e�
Mx
< .fi >~ :4ctual liquid line lc`ttgth�i',t, -t� ,, _. -`` Ma= r V�r 'e'! ,} ,
V -+-_ v
9 al Manufacttiier's Standard liquid line length '}�" b` �,�r f t?•A{ y;;.1`c ft, r 1 ti� v -;,
Difference(Actual t Standard) _ 'n 2 c IAY l_ I' r .. . - g t
t4 Manufacturer s correcnoq(ounces per foot) izrdiff6en6e:mdrngt6' —jounces
YPjnu rti`c4 �i %ut
�� �1(+ add)(- t remove),
. a '!._ ..
iji•�Nl.. t - L S'7
$,ra�S r�'• fa4 lfiai' -Y��,•�T� '3.j f .t �, ,tt t{_f�K'".t '4� 7�tt 4-.
fr'tr �+..' ..i+ ;6r� r r,� �• a , .+ .71.bd rt' �. wr ,I- � i , I
�(s'7V x •fMeasuiedAlrflowMethodforAdeiiatefAFflowxVerificahonYavailablemRACMA enkiRD2.6
Calculated A rflow Cooling Capacity(Btu/hr) 7t�X(p'033°(cfm/Btu"hr) G �` Y, .:CFM
t .r
1,-Measured Airflow is L11Y :ZiCFM(Mcasured.aiiflowymushtie greater than the calculated airflow)...-.-,
ia.."�'. ....s'6T .�St=�Y.•t'ra. •.
Y �'}' 1 >�ti� �.•� 4 T \'^!.•yam jar '� ,h_LL >t,•. Y ',x
�'r- fit• '^Raley tie Mid mire
_ fAltetnaTe Chazgc Measurement ummary�i�r: - "' 7�"1{(,"':•1�,` + ? _ 3'p�
...• * _ q
. ,%� tiSystem shall.pass both refr gerant charge ana adiquate airflow calculat oxn�ic�nferya�f o Sthe same.measurements'if, y `
<7>4rcorrective actions were taken both cntei=ia must beremeasured�and recalculaiedfi;.,n;:„�.ir+rc�;. " 'rt Q ,`�Lr•
4iS�3v 4' V
{{ �v f ✓ "O Yes l 'Cl NoJ sSvsiem Passest't ir �'�Cc ci 4 'a ryr d rn�+
.tl1, -r
Onstallli- Subcontractor(Co Name)OR'Genera
s + x (Contractor(Co`Name)OR Owner,
SignattlrY`� Date
? C
{ a.'.arc! � vaLLvi•F��'V 'f ._ cS• ' f �.f;
'YhrT ,l 'St'1c.
i Ri.,,;y`> Copies to.BUILDING DEPA RTII7 ENT HERS R xTER(II'APPLICABLE)tBUILDINC ORNER AT OCCUPANCY*,
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' J4 Residential Complionce Fomes
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INSTALLATION CER'nFICATE (Page 7 of 12) CF-6R
Site Address Permit Number
Il0—0o'-F�
MISCELLANEOUS CREDITS
✓ ❑ DIAGNOSTIC SUPPLY DUCT LOCATION,SURFACE AREA AND R-VALUE
Procedures forfeld verification and diagnostic testing for this group compliance credits are available in RACM,Appendix RC,RE S RFI.
✓ ❑ LESS THAN 12 LINEAL FE T OF SUPPLY DUCT OUTSIDE Oh CONDITIONED SPACE
COMPLIANCE CREDIT
✓ ❑Yes I ❑No Less than 12 lineal legit ofsupply duct outside ofconditioned splice.
Yes to this compliance credit is a piss ✓ ❑ Pass ✓ ❑ Fail
✓ ❑ SUPPLY DUCTS LOCATED IN CONDITIONED SPACE COMPLIANCE CRIiD1'1'
✓ ❑ Yes I ❑ No I Ducts are located within the conditioned volume of buildin .
Yes to this compliance credit is a pass 1 ✓ ❑ 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
✓ ❑
DUCT SYSTE.M DESIGN VERIFICATION
✓ ❑ Yes ❑ No Adequate airflow verified
✓ ❑ Yes ❑ No The duct system design plan meets the requirements specified in RACM,Appendix RE,Section
RE.4 2
✓ ❑ Yes ❑ 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? R-6.0 R-8.0
Crawl Deeply Duct Surface Surface Surface
Attic Space Basement Covered Covered Other Diameter Area Area Area
❑ ❑ ❑ ❑ ❑ ❑
u u U u U U
U U u u U U
❑ ❑ ❑ ❑ ❑ ❑
❑ a ❑ ❑ ❑ ❑
❑ o ❑ ❑ ❑ ❑
Total Surface Area for Each R-Value=
✓ C Yes 1 ❑ No itches Performance's CF-I R? ✓ ✓
Yes to all is a pass L Pass ❑ Fail
✓ ❑ BURIED DUCTS ON THE CEILING COMPLIANCE CREDIT
❑ Yes ❑ No I Buried Ducts on the Ceiling
❑ Yes ❑ No I Verified I ligh Insulation Installation Quality ✓ ✓
Yes to ducts stem design,supply duct surface area reduction and this compliance credit is a pass 10 Pass 10 Fail
✓ ❑ DEEPLY 13URILD DUCT'S COMPLIANCE CREDIT
✓ ❑ Yes ❑ No Deeply Buried Ducts
✓ ❑ Yes I ❑ No I Verified High Insulation Installation Quality ✓ ✓
Yes to duct system design,supply duct surface area reduction and this compliance credit is a pass ❑Pass 1 ❑ Fail
Copies to: BUILDING DEPAIYrD1ENT, HERS RATER(IF APPLICABLE)BUILDING OWNER AT OCCUPANCY
Residential Compliance Forms April 2005
INSTALLATION CERTIFICATE (Page S of 12) CF-6R
Site Address Permit Number
00 l'
V 1 FAN WA•T-1-DRAY
Procedures for measuring the air handler wait draw are available in RACjW, A en dix RE3.2.
✓Method For Fan Watt Draw Measurement
❑ RE3.2.1 Portable WattMeter Measurement
❑ RE3.2.2 Utility Revenue Meter Measurement
Measured Fan Watt Draw Watts
Measured Fan Flow enter total cfnt from airflow verification crnt
Enter results of Watts/cfm Wans/cfm
✓ ❑ Yes ❑ No Measured fan watt/efin draw is equal to or lower than the
fan watt/chn draw documented in CF-I R ❑ ❑
Yes is a mss Pass Fail
✓ ❑ ADEQUA'T'E AIRFLOW VERIFICATION
Procedures formeasuring the air low are available in RACM.Appendix RE3.1.
✓ Method For Airflow Measurement
❑ RE4.1.1 Dia nostic Fan Flow Using Flow Capture Hood
❑ RE4.1.2 Diagnostic Fan Flow Using Plenum Pressure Matching
❑ RE4.1.3 Diagnostic Fan Flow Using Flow Grid Measurement
❑ 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 ✓ ✓
❑ ❑
Yes is a toss Pass Fail
✓ ❑ MAXINIUM COOLING CAI'ACI. Y
Procedures for determining marimum cooliug fond cn aciry are available in RACb/, Appendly RF3.
I ✓ 1 ❑ Yes 1 ❑ No Adequate airflow verified(see adequate airflow credit)
2 ✓ ❑ Yes ❑ No Refrigerant charge orTXV
3 ✓ ❑ Yes ❑ No Duct leakage reduction credit verified
4 ✓ ❑ Yes ❑ No Cooling capacities of installed systems arc:9 to maximum cooling
capacity indicated on the Performance's CF-IR and RF-3.
If the cooling capacities of installed systems are>than maximum ✓ ✓
5 ✓ ❑ Yes ❑ No cooling capacity in the CF-IR,then the electrical input for the
installed systents must be 5 to electrical in ut in the CF-IR. ❑ ❑
Yes to 1 2 and 3 and Yes to either 4 or 5 is a pass Pass Fail
✓❑ HIGH EER AIR CONDITIONER
Procedures for verilicarion are available in RACM,Appendix Rl.
1 ft
❑ No EER values of installed systems match the CF-I R
Z ❑ No Fors lits stem, indoor coil is matched to outdoor coil ✓❑ Ido Time Delay Relay Verified(If Required) ❑ ❑
Yes to I and 2;and 3 If Re aired) is a ass Pass Fail
Installing Subcontractor(Co. Name)OR General
Contractor(Co. Name)OR Owner
Signature: Date: i
Copies to: BUILDING DEPARTMENT, ITERS RATER(IF APPLICABLE)BUILDING OWNER AT OCCUPANCY
Residenlial Compliance Forms April 2005
INSTALLATION CERTIFICATE (Page 9 of I?) Cr-6R
Site Address
Per
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 forni 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 DIAGNOS'PICS
✓ ❑ ENVELOPE SEALING INFILTRA'T'ION REDUCTION
Proceduresforfield verification and diagnostic resling of envelope leakage are available in 21014,Appendir RC.
Diagnostic Testing Results
✓ ✓ Building Envelope Leakage(CFM @ 50 Pa) as measured by Rater:
1 ❑ ❑ Measured envelope leakage less than or equal to the required level from
Yes No CF-I R?
2. ❑ ❑ Is iMcchanical Ventilation shown as required on the CF-I R?
Yes No
2a ❑ ❑ If Mechanical Ventilation is required on the CF-IR ('Yes' in line 2), has it
Yes No been installed?
Check this box 'yes' if mechanical ventilation is required('Yes' in line 2)
2b. Y❑ Eles No and ventilation fan watts are no greater than shown on CF-I R.
Measured Watts=
Check this box"yes"if measured building infiltration(CFM @ 50 Pa) is
3. Y❑ Des No greater than the CPM @ 50 values shown for an SLA of 1.5 on CF-I R
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-IR,
Yes No mechanical ventilation is installed and house pressure is greater than mints
5 Pascal with all exhaust fans operating.
Pass if:
a. Yes in line I and line 3,or ✓ ✓ I
b. Yes in line I and line?,2a,and 2b,or
c. Yes in line I and Yes in line 4. ❑ ❑
Otherwise fail. Pass Fail
✓ ❑ 1,the undersigned,verify that the building envelope leakage meets the requirements claimed for building leakage F
reduction below default assumptions as used for compliance on the CF-IR. This is to certify that the above diagnostic test t
results and the work I performed associated with the test(s) is in conformance with the requirements for compliance credit.
(The builder shall provide the FIERS 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.) '
a
Test Performed
Installing Subcontractor(Co. Name)OR General
Contractor(Co. Name)OR Owner
Signature: Date:
Copies to: BUILDING DEPARTME.N r, III-DIS RATER(1FAPPLICABLE), IIUI1,u1NC OWNrit AT OCCUPANCY
Residential Compliance Forms April 2005
INSTALLATION CERTIFICATE (Page 10 of 12) CF-61Z
Site Address Permit Number
10 10 Cct I J ; j- L 0'5 Do Ln
Insulation Installation Quality Certificate
✓rla Description of Insulation.(CF-6R, fommerly IC-1)signed by the installer stating: insulation manufacturer's name.
material identification, installed R-values.and for loose-611 insulation: minimum weight per square foot and minimum
inches
✓;q Installation meets all applicable requirements as specified in the Nigh Quality Insulation Installation Procedures
(ACM,Appendix Rl1)
✓ FLOOR
❑ ❑ All floorjoist cavity insulation installed to uniformly tit the cavity side-to-side and end-to-end
Yes N'o N'A
❑ ❑ NA
Yes No Insulation in contact with the subfloor or rimjoists insulated
❑ ❑ ❑
Yes No NA Insulation properly supported to avoid gaps,voids,and compression
✓WALLS
El 1 ❑ Cl {Val/stud cavities caulked or foamed to provide an air light envelope
Yes No NA
& ❑ 0 Wall stud cavity insulation uniformly fills the cavity side-to-side, top-to-bottom,and front-to-back
Yes No NA
g ❑ ❑ No gaps
Yes No NA
Yes
NIRL ❑ ❑
NNo voids over 3/4"deep or more than 10%of the batt surface area.
❑ ❑ Hard to access wall stud cavities such as; comer channels,wall intersections,and behind
Yes No NA tub/shower enclosures insulated to proper R-Value
Yes N❑ N❑ Small spaces filled
❑ ❑ Rini-joists insulated
Yes No NA
�11Q ❑ ❑ Loose fill wall insulation meets or exceeds manufacturer's minimunm 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
j
No NA❑ ❑ All drops covered with hard covers
No NA
jEr ❑s No \❑ All draft stops and hard covers caulked or foamed to provide nn air tight envelope
❑ ❑ All recessed light fixtures IC and air tight(A'n rated and scaled with a gasket or caulk between the
No NA housing and the ecilin❑ Floor cavities on multi le-sto buildin s have air ti ht draft stoms to all ad oining attics
No NAprY g g IJ �'❑ ❑ Eave vents prepared for blown insulation -maintain net free-ventilation area
No NA,❑ ❑ Knee walls insulated or prepared for blown insulation
No NA❑ ❑ Area under equipment platfanns and cat-walks insulated or accessible for blown insulation
No NA❑ ❑ Attic rulers installed
No NA
Residential Compliance Forms April 2005
INSTALLATION CERTIFICATE (Nage I I of 12) CF-6R
Site Address Permit Number
/0140 Jer e talol,A q=ol OSOOf-�
✓ ROOF/CEILING BA'I'TS
❑ 1 ❑
es No NA I No gaps
❑ ❑
Yes No NA No voids over'/� in, deep or more than 10%of the batt surface area.
❑ ❑
Yes No NA Insulation in contact with the air-barrier
fA ❑ ❑
Yes No NA Recessed light fixtures covered
R ❑ ❑ Netj-ee-ventilation area maintained at cave vents
Yes No NA
✓ ROOF/CEILIiN'G LOOSGFf1.L
Yes No NA Insulation uniformly covers the entire ceiling(or roof)area from the outside of all exterior walls.
Pr ❑ ❑
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
❑ ❑
es 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 mininnun weight and thickness requirements
Yes No NA for the target R-volae. Target R-value . Manufacturers mininnun required
weight for the target R-value— (pounds-per-square-fool). ,19nm facturer's
mininnun required thickness at time of installation , Mam facmrers minimum
required settled thickness , Note: To receive compliance credit the HERS rater
shall verify that the manufacturer's mininnun weight and thickness has been achieved fur the target
R-value. (CF-6R only
DECLA,RA •ION
✓ EGII 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 UVI lll�N t� CDVIS-fVgb(10Vi
Signature: "� Date:
711(-126j L
Copies to: 13UlLD O DEPARTN]LN'r, 1113RS RA"1'EIi(IPAPPLICABI,li), BUILDING ONVNIO? AT OCCUPANCY
Residential Compliance.Forms April 2005
IN'S'TALLATION CERTIFICATE (Page 12 of 12) CI'-6R
Site Address Permit Number
10 4tf0 Ca[0 , dr- t r0In-C�"i�
County Subdivision Lot Number
Description of Insulation (Formerly IC-1 Form)
I. RAISED FLOOR
Material Brand Name
Thickness (inches) Thermal Resistance(R-Valuc)
2. SLAB FLOOR/PERINIETER
Material C041iXek2 Brand Name
Thickness (inches) " Thermal Resistance (R-Valuc)
Perimeter Insulation Depth (inches)
3. EXTERIOR WALL
Frame Type I k +
A. Cavity Insulation
Material Brand Name
Thickness (inches) Thermal Resistance(R-Valuc) Q-t
B . Exterior Foam Sheathing
Material Brand Name
Thickness (inches) Thermal Resistance(R-Value)
4. FOUNDATION WALL
Material LOvjt 'e,f:2 Brand Name
Thickness (inches) Thermal Resistance (R-Value)
5. CEILING
Batt or Blanket Type_P oyica� Brand Name
Thickness(inches)_} " Thermal Resistance (R-VIIIIIe) R-�O
Loose Fill Type Brand
Contractor's min installed wcight/R1 Ib Minimum thickness inches
Manufacturer's installed weight per square foot to achieve Thernud Resistance (R-Value)
6. ROOF
Materialf l lP. I 1 -hrlri 1 %f v4v Brand Name _�gru�.�e
Thickness(inches^ V Thermal Resistance(R-Value)
Declaration
✓ IS 1 hereby cenify that the above insulation was installed in the building at the above location in conformance with the
current Energy Efcienev Srondords for residential buildings(Title 24, Pan 6,California Code of Regulations)as indicated
m
on the Certificate of Copliance,where applicable.
Item#s Signature Date Installing Subcontractor(Co. Name) OR
(if applicable) General Contractor(Co.Name)OR Owner
— �Lu OR Window Distributor
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
Residential Compliance Forms April 2005