11110062 - Energy INSTALLATION CERTIFICATE CF-6R-ENV-01
Envelope—Insulation; Roofing; Fenestration (Page 1 of 3)
Site Address: Enforcement Agency: Permit Number:
� G f -� CIG A
If more than one person has responsibility for installation of the items on this certificate,each person shall prepare and sign a certificate
applicable to the portion of construction for which they are responsible;alternatively,the person with chief responsibility for construction shall
prepare and sign this certificate for the entire construction. All applicable Mandatory Measures with check boxes require to be checked to ensure
the mandatory measures have been met.
Description of Insulation
1. RAISED FLOOR 1-22-►z
Material: /Uff Brand Name: fro 7Y
Thickness(inches): - S/ , Thermal Resistance(R-Value): /q
H"§150(d):Minimum R X13 insulation in raised wood-frame floor or equivalent U-factor.
2. SLAB FLOOR/PERIMETER
Material: Brand Name:
Thickness(inches): Thermal Resistance(R-Value):
Perimeter Insulation Depth(inches):
❑ §150(1):Water absorption rate for the insulation material alone without facings is no greater than 0.3%;water vapor permeance
rate is no greater than 2.0 perm/inch and shall be protected from physical damage and UV light deterioration.
3. EXTERIOR WALL
a. Insulation Type(e.x.Butt,Loose Fill, Spray Foam)
a. Thermal Resistance(R-Value): 13
b. .Insulation Type(e.x.Batt,Loose Fill, Spray Foam) b. Thermal Resistance(R-Value):
Brand: i ca M
Spray/Loose fill)Installed Actual Thickness Spray/Loose fill)
(inches): Contractor's min installed weight/ftz lb
Manufacturer's installed weight per square foot to achieve Thermal Resistance(R-Value)
P'§150(c):Minimum R-13 insulation in wood-frame wall or equivalent U-factor.
Exterior Foam Sheathing(rigid Insulation)
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: N Brand Name: ftv &tt
Loose Fill Type: Thermal Resistance(R-Value'): _j�
Spray Foam Type: Brand Name:
Installed Actual Thickness(inches): f Y,.' Contractor's min installed weight/ft' lb
Manufacturer's installed weight per square foot to achieve Thermal Resistance(R-Value):
Rr §150(a):Minimum R-19 insulation in wood-frame ceiling or equivalent U-factor.
6. ATTIC ROOF INSULATION AND/OR ATTIC RADIANT BARRIER
Material: 13!j4l Brand Name: �'4, D-OY
Material: Brand Name:
Thickness(inches): Thermal Resistance(R-Value): 30
G §118(a): Insulation installed meets Standards for Insulating Material.
❑ §150(g):Mandatory Vapor barrier installed in Climate Zones 14 or 16.
2008 Residential Compliance Forms August 2009
- y
INSTALLATION CERTIFICATE CF-6R-ENV-01
Envelope—Insulation; Roofing; Fenestration (Page 2 of 3)
Site Address: / Enforcement Agency: Permit Number:
Zd bat
Description of R ofing Products
CRRC Product ID Manufacturer Product Roof Roof Product Initial Solar Aged Solar Thermal
Number' Information Brand/Model Type Area Sloe Weight' Reflectance Reflectance4 Emittance
❑3
❑3
❑3
1. The CRRC Product ID Number can be obtained from the Cool Roof Rating Council's Rated Product Directory at
ww.coolroofs.org/products/search.php
2. The weight in lbs per square feet of the roofing product being installed.
3. Check box if the Aged Reflectance is a calculated value using the equation below,footnote 4.
4.If the aged reflectance is not available in the Cool Roof Rating Council's Rated Product Directory then use the initial reflectance value from the
directory and use the equation(0.2+0.7( initial—0.2)to obtain a calculated aged value.
✓OCHECK APPLICABLE BOX BELOW IF EXEMPT FROM THE ROOFING PRODUCT"COOL ROOF"REQUIREMENT:
❑ The roof area covered by building integrated photovoltaic panels and building integrated solar thermal panels are exempt from the above Cool
Roof criteria.
❑ Roof constructions that have thermal mass over the roof membrane with a weight of at least 25 lb/ft2 is exempted from the above Cool Roof
criteria.
To apply Liquid Field Applied Coatings,the coating must be applied with a minimum dry mil thickness of 20[nils across the entire roof surface and
meet minimum performance requirements listed in§118(1)3 and Table 118-C. Select the applicable coating
❑Aluminum-Pigmented Asphalt Roof Coating ❑Cement-Based Roof Coating ❑Other
✓ ❑CRRC-1 Label Attached to CF-6R
(Note if no CRRC-1 label is available,this compliance method cannot be used and another method is required to meet compliance).
FENESTRATION/GLAZING
Product # Total Quantity Add.Exterior Comments/
Manufacturer/Brand Name U- Product of NFRC of Like Product Area Shading Dev. Location/Special
Item (GROUP LIKE RODUCTS) factor] SHGC' Panes Certified'2 (O tionao ft2 or Overhang Features
1 .24 .3 1� Yes 2 30
2 ZY .3a 3R
3 ti4en .,>0 .21 YtS A
4 �N C:�- S YO
5 20
6
7.
8.
1. Use values from a fenestration product's NFRC Certified Label.For fenestration products without an NFRC label,use the default values from Section 116,Table
116-A and 116-B of the 2008 Energy Efficiency Standards.
2.NFRC Label Certificates shall not be removed until the building inspector has vert ied the efficiency.Enter Yes or No.
116(a)1:Doors and windows between conditioned and unconditioned spaces designed to limit air leakage.
C9"§116(a)2 and 3:Actual fenestration products installed are equivalent to or have a lower U-factor and/or a lower SHGC than that specified on
the Certificate of Compliance(Form CF-1R).
Ai§116(a)4:Fenestration products(except field-fabricated windows)have a label listing the certified U-Factor,certified Solar Heat Gain
Coefficient(SHGC),and infiltration that meets the requirements of§10-1 1 1(a)
104117:Exterior doors and windows weather-stripped;all joints and penetrations caulked and sealed.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-6R-ENV-01
Envelope—Insulation; Roofing; Fenestration (Page 3 of 3)
Site Address; 6Enforcement Agency: Permit Number:
rat , t 1 1 1111004 -DP1
DECLARATION STATEMENT
• I certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and correct.
• I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction,or an authorized representative
of the person responsible for construction(responsible person).
• I certify that the installed features,materials,components,or manufactured devices identified on this certificate(the installation)conforms
to all applicable codes and regulations,and the installation is consistent with the plans and specifications approved by the enforcement
agency.
• I reviewed a copy of the Certificate of Compliance(CF-1 R)form approved by the enforcement agency that identifies the specific
requirements for the installation. I certify that the requirements detailed on the CF-1R that apply to the installation have been met.
• I will ensure that a completed,signed copy of this Installation Certificate shall be posted,or made available with the building
permit(s)issued for the building,and made available to the enforcement agency for all applicable inspections. I understand that a
signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building
owner at occupancy.
Company N (Installing Subcontractor or General Contractor or Builder/Owner)
X7L L C� .��� i
Responsible Person's Name: Responsible Person's Signature:
t
11Y
U
CSLB
License: Da
a igned: Position With Company(Title):
1077
2008 Residential Compliance Forms August 2009
Y
INSTALLATION CERTIFICATE CF-6R-LTGO1
Residential Lighting (Page 1 of 3
Site Address: Enforcement Agency: Permit Number:
4� oNr� l CX7 6Q.
1.Kitchen Lighting
Does project include kitchen lighting?
AYes,complete section 1 ❑No,go on to section 2
Yes §150 3:The wattage of permanMtl,y installed luminaires(lighting fixtures)has been determined asspecified by§130(d).
❑Yes M No §150(k)3:In the kitchen,are there electrical boxes finished with a blank cover or where no electrical equipment has been
installed,and where the electrical box can be used for a luminaire or a surface mounted ceiling fan?If yes,the following row must also be es:
❑Yes ❑NA Wattage has been calculated as 180 watts of low efficacy lighting per blank electrical box.
§150(k)8 Kitchen Lighting must comply with either method(a),(b),or(c)below:
Oe (a)All high efficacy luminaires
1�0Yes,complies because only high efficacy luminaires have been installed in the kitchen.
❑ No,complies with method b or(c).
(b)>50%watts used by high efficacy luminaires
❑ Yes,complies because at least 50%of the installed watts are from permanently installed high efficacy luminaires
as demonstrated in the table below:Total A>Total B.
Ef No,complies with method a or(c).
Fill out the following table if complying with either method(b)or(c).
Table(b)
Efficacy
Luminaire Type High Low Watts x Quantity High Efficacy Watts or Low Efficacy Watts
❑ ❑ x = or
❑ ❑ x = or
❑ ❑ x = or
❑ ❑ x = or
x — or
Complies with method(b)if A>B Total: A: > B:
(c)Additional Kitchen Low Efficacy Lighting
❑ Yes,complies because the kitchen lighting qualifies for additional low efficacy lighting
and as demonstrated in table in(b)(above)and the table in(c)(below)that(A+C)>B
No,complies with method(a)or(b).
Additional kitchen low efficacy lighting is available only if all of the following are true:
❑ Yes. All low efficacy luminaires in the kitchen are controlled by a vacancy sensor
Dimmer energy management control system(EMCS)or a multi-scene programmable control system.
IT Yes. Permanently installed luminaires in garages laundry rooms closets greater than 70 square feet and utility rooms are high efficacy
luminaires AND are controlled by a vacancy sensor.
Table (c)
Use 50 W for dwelling units<2,500 ftZ
From the Table in b Use 100 W for dwelling units>2,500 ftz Add Yes/No?
A B C A+C Is(A+C)>B?
2.Lighting Internal to Cabinets
Does project includes lighting i ernal to cabinets?
❑Yes, com Tete section 2 No,go on to section 3
❑Yes,§150(k)9:Permanently installed lighting internal to cabinets uses:5 20 watts of power per linear foot of illuminated cabinet.
2008 Residential Compliance Forms August 2009
t
INSTALLATION CERTIFICATE CF-6R-LTG-01
Residential Lighting (Page 2 of 3
Site Address: Enforcement Agency: Permit Number:
Czwt
3.Installed Devices and Components Have Been Certified to the Energy Commission
Does the project include any of the devices or components listed below?19 Yes,complete section 3 ❑No,go on to section 4
Yes
§119 and§150(k)7(F):Any of the following devices and components which have been installed have been certified to the Energy Commission
according to the applicable provisions of§119:All LED lighting systems that are classified as high efficacy,ballasts used in recessed luminaires,
vacancy sensors automatic off/manual on occupant sensors),dimmers,track lighting integral current limiters,and outdoor motion sensors.
4 Lighting Controls Complete section 4
En Yes ❑ NA §150(k)7A:Permanently installed low efficacy luminaires are controlled by switches separate from those controlling high
efficacy luminaires.
Ed Yes ❑ NA §150(k)7B:Exhaust fans with integral lighting systems are switched separately from lighting systems,OR have a lighting
system that can be manually turned on and off while allowing the fan to continue to operate for an extended period of time.
Yes ❑ NA §150(k)7C:All permanently installed luminaires are switched with readily accessible controls that permit the luminaires to be
manually switched on and off.
Yes ❑ NA §I50(k)7D:All lighting controls have been installed in accordance with the manufacturer's instructions.
Yes ❑ NA §150(k)7E:All lighting circuits that are controlled by more than one switch,where a dimmer or vacancy sensor has been
installed to comply with§150(k),no controls bypass the dimmer or vacancy sensor functions.
5.Luminaires (Lighting Fixtures)
D es the project include the installation of any luminaires(indoor or outdoor)?
Yes,complete section 5 ❑No,go on to section 6
E�Yes,high efficacy luminaire classification has been determined according to§150(k)1,and low efficacy luminaire classification has been
determined according to§I50(k)2.
Yes ❑ NA §I50(k)4:Fluorescent lamps rated 13 watts or greater have an electronic ballasts having an output frequency no less than 20
kHz.
❑ Yes 51 NA §150(k)5:Permanently installed night lights,and night lights integral to permanently installed luminaires or exhaust fans,
contain only high efficacy lamps meeting the minimum efficacies contained in Table 150-C and do not contain a line-voltage
socket or line voltage lamp holder,OR the night light is rated to consume no more than 5 watts of power and does not contain
a medium screw-base socket.
Yes ❑ NA §150(k)6: Lighting integral to exhaust fans,in rooms other than kitchens,meet the applicable requirements of§150(k).
❑ Yes A NA Any electrical box finished with a blank cover or where no electrical equipment has been installed,and where the electrical
box can be used for a luminaire or a surface mounted ceiling fan,has been treated as low efficacy luminaires for compliance
with§150(k).
Does the project include any luminaires that are recessed into insulated ceilings?
Ef Yes,complete the rest of section 5 ❑No,go on to section 6
It Yes,§I50(k)12: Luminaires that are recessed into insulated ceilings meet all of the following conditions:
Yes,are listed,as defined in§101,for zero clearance insulation contact(IC)by UL or other nationally recognized testing/rating
laboratory,and
Yes,have labels that certify the luminaires are airtight with air leakage less than 2.0 CFM at 75 Pascals when tested in accordance
with ASTM E283(Exhaust fan housings are not required to be certified airtight),and
th Yes,are sealed with a gasket or caulk between luminaire housings and the ceiling,and all air leak paths between conditioned and
unconditioned spaces have been sealed with a gasket or caulk.(including all exhaust fan housings),and
EJ Yes,allows ballast maintenance and replacement to be readily accessible to building occupants from below the ceiling without
requiring the cutting of holes in the ceiling.
6.Indoor Lighting(any indoor room that is not a kitchen)
Dies the project include permanently installed luminaires in any room that is not a kitchen?
Yes,complete section 6 ❑No,go on to section 7
14 Yes ❑ NA §150(k)10:Permanently installed luminaires in bathrooms,garages,laundry rooms,closets>70 ft2,and utility rooms are high
efficacy luminaires OR are controlled by a vacancy sensor.
It Yes ❑ NA §150(k)ll:Permanently installed luminaires located in rooms or areas other than in kitchens,bathrooms,garages,laundry
rooms,closets,and utility rooms are high efficacy luminaires,OR are controlled by a dimmer switch OR are controlled by
a vacancy sensor.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-6R-LTG-01
Residential Lighting (Page 3 of 3
Site Address: Enforcement Agency: Permit Number:
2064
7. Outdoor Lighting
Dos the project include any permanently installed outdoor lighting?
Yes,complete section 7 ❑No,go on to section 8
B'Yes ❑ NA §150(k)13:Luminaires providing outdoor lighting,including outdoor lighting for private patios on low-rise residential buildings
with four or more dwelling units,entrances,balconies,and porches,and which are permanently mounted to a residential
building or to other buildings on the same lot are high efficacy luminaires OR are controlled by a manual on/off switch,plus a
motion sensor not having an override or bypass switch that disables the motion sensor,plus one of the following three
additional control methods:
a. A photocontrol that does not have an override or bypass switch that disables the photocontrol;or
b. An astronomical time clock not having an override or bypass switch that disables the astronomical time clock;
or
C. Energy management controls systems(EMCS)not having an override or bypass switch that allows the
luminaire to be always on.
❑ Yes d NA Exception 2: Low efficacy outdoor luminaires used to comply with Exception 1 to§150(k)13 are controlled by an override
switch which temporarily bypasses the motion sensing function,and the motion sensor is automatically reactivated within six
hours.The luminaire is controlled by a photocontrol,astronomical time clock,or EMCS as required by Exception 1 to
§150(k)13.
❑ Yes 9 NA Exception 3: There are permanently installed luminaires in or around swimming pools,water features,or other locations
subject to Article 680 of the California Electric Code which do not need to be high efficacy luminaires.
❑ Yes 9NA §150(k)14: Internally illuminated address signs comply with§148,OR do not contain a screw-base socket and consume no
more than 5 watts of power as determined according to§130(d).
❑Yes Qf NA §150(k)15 Lighting for parking lots and carports with a total of 8 or more vehicles per site have lighting that complies with
§130,132, 134, and 147.Lighting for parking garages for 8 or more vehicles comply with§130, 131, 134,and 146.
If yes,the Nonresidential compliance forms must be submitted
8. Common areas of low-rise residential buildings
Does the project include the installation of any luminaires in common areas of low-rise residential buildings?
❑Yes,complete section 8 VNo,go on to section 9
❑ Yes,§150(k)16: Permanently installed lighting in the enclosed,non-dwelling spaces of low-rise residential buildings with four or more
dwelling units shall be high efficacy luminaires OR are controlled by occupant sensor(s)certified to comply with§119(d).
DECLARATION STATEMENT
• I certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and correct.
• I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction,or an authorized representative
of the person responsible for construction(responsible person).
• I certify that the installed features,materials,components,or manufactured devices identified on this certificate(the installation)conforms
to all applicable codes and regulations,and the installation is consistent with the plans and specifications approved by the enforcement
agency.
• 1 reviewed a copy of the Certificate of Compliance(CF-IR)form approved by the enforcement agency that identifies the specific
requirements for the installation. I certify that the requirements detailed on the CF-1R that apply to the installation have been met.
• I will ensure that a completed,signed copy of this Installation Certificate shall be posted,or made available with the building
permit(s)issued for the building,and made available to the enforcement agency for all applicable inspections. I understand that a
signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building
owner at occupancy.
Compan'Name: (Installing Subcontractor or General Contractor or Builder/Owner)
(17 L (f
Respon le Person's Name: Responsible Person's Signature:
CI.� 4
CSLB License: Date Sjgne Position With Company(Title):
2008 Residential Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-6R MECH-04
Space Conditioning Systems,Ducts and Fans (Page 1 of 2
Site Address: Enforcement Agency: Permit Number:
Space Conditioning Systems
Heating Equipment
Duct
Efficiency Location
Equip (AFUE, (attic,
Type ARI #of etc.)1'3 crawl- Heating Heating
(package- CEG Certified Mfr.Name Reference Identical (zCF-1R space, Duct Load Capacity
4
heat um and Model Number Number 2 Systems value etc. R-value ta/hr) (Btu/hr
Cooling Equipment
Efficiency Duct
Equip (SEER Location
Type and EER) (attic,
(package #of 1'3 crawl- Cooling Cooling
heat CEC Certified Mfr.Name ARI Reference Identical (>_CF-1R space, Duct Load Capacity
um and Model Number Number 2 Systems value 4 etc. R-value (Btu/hr) (Btu/hr
AA- I Ca Ogle-e 3 3 13.0 .,G 60 5&,,
2kA138 360W34o a
1.If project is neiv construction, see Footnotes to Standards Table 151-B and Table 151-C for duct ceiling alternative
compliance.
2.ARI Reference Number can be found by entering the equipment model number at http://wiviv.aridirectory.org/arilac.php#
3.Listed efficiency on this page must be greater than or equal(>_)to the value shoum on the CF-1 R form.
4. When CF-1R is reference it is also applicable to the CF-IR, CF-IR-AA or CF-IR-ALT
L BOXES MUST BE CHECKED TO BE A VALID FORM
[�
§110-§113:HVAC equipment is certified by the California Energy Commission.
§150(h):Heating and/or cooling loads calculated in accordance with ASHRAE,SMACNA,or RCCA.
§150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of§112(c).
P"§1500)2:Pipe insulation for cooling system refrigerant suction,chilled water and brine lines meets minimum
requirements of Table 150-B and4ineludes a vapor retardant or is enclosed entirely in conditioned space.
2008 Residential Compliance Forms August 2009
.INSTALLATION CERTIFICATECF=6R=MECH-04
S02kce_.'C6nditioning Systems,Ducts and Fans :."(Pa e 2 of 2
Site Address: Enforcement Agency: Permit Number.
Ducts and Fans
§150(m):Duct and Fans
1.All air-distribution system ducts aqd plenums installed,sealed and insulated to meet the requirements of CMC
Sections 601,602,603,604;.605 and Standard 6-5;supply-air and return-air ducts and plenums are insulated to a
minimum installed level of R-4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic,tape
or other duct-closure system.that meets the-applicable requirements of UL 181,UL 181A,or UL 181B or aerosol
sealant that meets the requirements of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch,the
combination of mastic and either mesh or tape shall be used;and
d1.Building cavities,support platforms for air handlers,and plenums defined or constructed with materials other
than seai€d sheet metal,duct board or flexible duct shall not be.used for conveying conditioned*, Building cavities
and support p a2�f may contain ducts. Ducts installed in cavities and support platforms shall not be compressed to
cause reductions in the cross-sectional area of the ducts.
2D.Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive
dilct.tapes unless such tape is used in combination with mastic and draw bands.
7.Exhaust fan systems have back draft or automatic dampers.
8.Gravity ventilating systems serving conditioned space have either automatic or readily accessible,manually
operated dampers.
9.Protection of Insulation.Insulation shall be protected from damage,including that due to sunlight,moisture,
equipment maintenance,and wind.Cellular foam insulation shall be protected as above or painted with a coating that is
water retardant and provides shielding from solar radiation that can cause degradation of the material.
10.Flexible ducts cannot have porous inner cores.
DECLARATION STATEMENT
• I certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and correct
• I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction,or an authorized
representative of the person responsible for construction(responsible person).
• I certify that the installed features,materials,components,or manufactured devices identified on this certificate(the installation)
conforms to all applicable codes and regulations,and the installation is consistent with the plans and specifications approved by the
enforcement agency.
• I reviewed a copy of the Certificate of Compliance(CF1R)form approved by the enforcement agency that identifies the specific
requirements for the installation: I certify that the_requirements detailed on the CF-1R that apply to theinstallation have been met.
• I will ensure,that a completed,signed copy,of this Installation Certificate shall;be posted;or made available with the building
permit(s)issued for the building,and made available to;the enforcement agency for all applicable inspections. I understand
that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to
the building owner at occupancy.
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
Responsible Person's Name:, Responsible Pe' n's Signature:
CSLB License: Date Si ed: Position With Company(Title):
7 1� 3
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-6R-MECH-01
Domestic Hot Water (Page 1 of 2
Site Address: Enforcement Agency: Permit Number:
2c�6a: a,l 111 da Gan
Lj
1. WATER HEATING SYSTEMS:
Distribution Rated
CEC Type If #of Input(kW Tank Standby
Heater Certified Mfr Name&Model (Std,Point-of- Recirculation, Identical or Volume Efficiency Loss
Type Number Use etc) Control Type Systems Btu/hr)t (gallons) (EF,RE)' (%)t
STd.
NqP�
Note 1:For small gas storage(rated input less than or equal to 75,000 Btulhr),electric resistance and heat pump water heaters,list
Energy Factor(EF).For large gas storage water heaters(rated input of greater than 75,000 Btulhr),list Recovery Efficiency(RE),
Thermal Efficiency,Standby Loss and Rated Input. For instantaneous gas water heaters,list the Thermal Efficiency and Rated Input.
2. Mandatory Measures
�K§
OMPLY-ALL BOXES MUST BE CHECKED
10-§113:Water heaters,showerhead and faucets are certified by the California Energy Commission.
§1500):Water System Pipe and Tank Insulation.And Cooling Line Insulation
1. _Storage tank insulation
Lrld,/ A.Storage gas water heaters rated with an Energy Factor no greater than the federal minimal standard are
externally wrapped with insulation having an installed thermal resistance of R-12 or greater;and
B.Unfired storage tanks or other indirect hot water tanks have R-12 external insulation or R-16 internal
insulation where the internal insulation R-value is indicated on the exterior of the tank.
2. Water piping and cooling system line insulation thickness and conductivity
First 5 feet of hot and cold water pipes closest to water heater tank,non-recirculating systems,and entire
/ length of recirculating sections of hot water pipes are insulated per Standards Table 150-13;and
D/ Pipe insulation for steam hydronic heating systems or hot water systems>15 psi,meets the requirements of
Standards Table 123-A.
Insulation is protected from damage,including that due to sunlighf,'moistUe,equipment maintenance,and
wind.
§15 1(f)81):If indicated on the CF-1R,all hot water piping that runs from the hot water source to the kitchen fixtures is
insulated per Standards Table 150-13.
2008 Residential Compliance Forms August 2009
u.
INSTALLATION CERTIFICATE CF-6R-rdECH-01
DoW-estW o-i Water a e•2 of 2
Sife Addressi Enforcement Agency: Permit Number:
2042-7-
3.
042 3. Central Water Heating in Buildings with Multiple Dwelling Units(required for prescriptive)
TO COMPLY-ALL BOXES MUST BE CHECKED
El A-11 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 time control or'd
time/temperature control
DECLARATION STATEMENT
• I certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and correct.
• I am eligible under Division 3 of the Business:and Professions Code to accept responsibility for construction,or an authorized,
representative of the person responsible for construction(responsible person).
• I certify that the installed features,materials,components,or manufactured devices.identified on this certificate(the installation)
conforms to all applicable codes and regulations,and the installation is consistent with the plans and specifications approved by the
enforcement agency.
• I reviewed a copy of the Certificate of Compliance(CF-1R)form approved by the enforcement agency that identifies the specific
requirements for the installation. I certify that the requirements detailed onIthe CF-1R that apply to the installation have been met.
• I will ensure that a completed,signed copy of this Installation Certificate shall be posted,or made available with the building
permit(s)issued for the building,and made available to the enforcement agency"for all applicable inspections. I understand
that a signed,copy of this Installation Certificate is required to,be included with the documentation the builder provides to
the building owner at occupancy.
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
Responsib a Pei-son's Name: Responsible Person's Signature:
LB License: Dat" Signed. Position With Company(Title):
NO
2008 R ential Compliance Forms August 2009