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05-5034 (MECH)P.O. BOX 1504' 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 05-00005034 Property Address: 56060 RIVIERA APN: 762 -021 -004 - Application description: MECHANICAL Property Zoning: . LOW DENSITY RES Application valuation: 6435 Applicant: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Architect or Engineer: air -----------------------------=-------------------- LICENSED CONTRACTOR'S DECLARATION I hereby affirm urider penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) ss and Professionals Code, and my License is in full force and effect. License Class (7200 / icense No.: 374937 OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefromand the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (_ 1 I, 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 and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). 1 _ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). I—) I am exempt under Sec. , BAP.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY 1 hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: _ Lender's Address: LQPERMIT Owner: EVA BABIC 56060 RIVIERA LA QUINTA, CA 92253 Contractor: PALM DESERT.AIR CONDITIONING 42081 BEACON HILL PALM DESERT, CA 92211 (760)346-0677 Lic. No.: 374937 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 11/14/05 ----------------------------------------------- WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: _ I'have and will maintain a certificate of consent to self -insure for workers' 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 workers' compensation insurance, as required by Section 3700 of the Labor .Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier STATE FUND Policy Number 1795546 I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and a r e �subject�workers' compensation provisions of Section 7 of the.Labor Code, I shose provisions. ate: ! (��/ licant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. 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 ilding construction, and hereby authorize representatives of thisWcoiunruppn the above-mentioned property an purposes. �Date' ature (Applicant or Agent): _ t� Application Number •05-00005034 Permit . . . MECHANICAL Additional desc . Permit Fee 33.00 Plan Check Fee .. 8.25 Issue Date . . . Valuation . . . . 0 Expiration Date 5/13/06 Qty Unit Charge Per Extension BASE .FEE' 15.00 1.00 9.0000 EA MECH FURNACE <=100K. 9.00 1.0.0 9..0000 EA MECH B/C <=3HP/100K BTU 9.00 Special Notes and Comments REPLACE 1 4 -TON AIR CONDITIONING & HEATING SYSTEM. SEAL ALL ACCESSIBLE DUCT WORK Fee summary Charged Paid Credited Due Permit Fee Total 33.00 .00 .00 33.00 Plan Check Total 8.25 .00 .00 8:25 Grand Total 41.25 .00 .00 41.25. LQPERMIT , Bin # '� ' • r ' - City ,of La .Quints Building & Safety.Division . . P.O. Box 1504, 78-495'Calle Tampico ., La Quinta,"CA 92253 - (760),.777-7012,—. Building Permit-Application and Tracking.Sheet w . Permit.# Project Address:Owner's to C.rvD � U/ Name: A. P. Number:. r y Address j-6, 0(rd �(v/ Legal Description: Contractor: City,-ST, Zip: .44'_au/;6� G4 9 Z25 3 Telephone: %( Address: 42 -.'os Iwfi 'a Project Description City, ST, Zip--?a Telephone:' &o 34.007-7 r State Lic. # : -74 1 Q 3 i City. Lic. #: • Arch., Engr., Designer:' Address: City, ST, Zip: r Telephone: • Construction Type: Gccupancy:. State Lic. #:. Name of Contact Persona ' Project type (circle one): New Add.'ii Alter +Repair Demo.. Sq. Ft.: #Stories: #Units: } Telephone # of Contact Person: } Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal 'Req'd Rec'd TRACKING s�- PERMIT FEES. ' Plan Sets Plan Check submittedr l Item . ' Amount Structural Calci. Reviewed, ready for corrections . , Plan CheckDeposiu Truss Calcs.' > Called Contact PersonPlan Check Balance Energy Calcs. Plans picked up Constructibn Flood plain plan Plans resubmitted Mechanical Grading.plan "' 2nd Review,: ready for corrections/issue.." Electrical Subcontactor List :,' Called Contact Person Plumbing - Grant Deed Plans picked up H.O.A. Approval Plans resubmitted Grading " IN HOUSE:- ''" Review, ready for corrections/issue Developer hnpact Fee J Planning Approval" Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue . School Fees " ' 'r Total Permit Fees PALM DESERT AIR CONDITIONING & HEATING CO. Lie. 1374937 "Where Quality Counts Since 1979!" 1 42-081 BEACON HILL • PALM DESERT, CA 92211 T: (760) 346-0677 • F: (760) 346-5200 E: INFO@PALMDESERTAC.COM Job Address EVA BABIC 56-060 RIVIERA LA QUINTA, CA 92253 PGA (760) 564-9091 JOB ORDER JOB NO.: NO. OF DAYS: SALES DATE: INSTALLATION DATE: COMFORT ADVISOR: ROBERT POWELL --� LEAD:-- —_--- .. - - -� '10/12/2005-1 11/15/2005 Job Notes INSTALL AN ADDITIONAL T -STAT AND PRE CHARGE LINE SErBUILDING UINTA OF LA Q & SAFETY DEPT• PpR®VE,DR CONST DATE. L& - Quantity Manufacturer Ton(s) SEER EER HSPF AFUE. ARI # Ref. I Conf. I Location 1 LENNOX 3.5 13.00 11.00 1 X0.0 400800 R-4 LOA SAC GROUND -----.._..------ -.......... _.__....-- - ....._... -.......... ...._..._...... ....- ._....... ---- --- TXV: EIFactory Installed W Field Installed Part No. L Filter Size _ Filter Type -... ---.._..._.._...__.......... ....._-.._---------- -._.......... ............... ............. _............ .... _.. ....... _..:..._......... 7L51 I L3 ---- ESF Thermostat Manufacturer & Model 1WHITE ROGERS #1F80-261 Model / Serial Numbers Tasks System'1 Task Model Number Serial Number . L5-CUAC-42 LC42/60Y2CP 6005K2805,7 L5 -FCU -48 G60UH-48B-090X 5905D25821 T-WRIHICP NONE@ i FOR AUTHORIZED Package Qty Parts Com H.E. Investment DELUXE 1 5 10 0 $3,284.00 DELUXE 1 5 0 20 $2,997.00 1 1 0 0 $254.01 JOB SUB-TDTAQ $6,535.01 UTILITY REBATE: 75.00 MANUFACTURER REBATE: $100.00 OTHER:j $0.00 TOTAL INVESTMENT:1 $6,435.01 DEPOSIT:1 $0.00 AMOUNT DUE UPON COMPLETION:1 $6,435.01 AMOUNT FINANCED: $0.00 _ DATE: PALM DESERT AIR CONDITIONING & HEATING COMPANY CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 1 of 5) CF -1R Project Title Date �� Building Permit # - - •+ - •. P ct A d essCA • a Plan Check'/ Date _,•� Documentation Author ��} Telephone ?Field Check'/ Date Compliance Method (Prescriptive)a:-;;�,'• c, ti 1 7 Climate/?e Enforcement Agency Use Only r • t , ✓ ❑ Alternative Component Package Method: Packaee C and Packaee D choicesreoui For PackaQe•D;Alternative see A'DDendix.B IT b GENERAL INFORMATION Total Conditioned Floor Area (CFA) fe Average Ceiling Height: ft one) C A-" D D (Alternative) S rater field verification and/or diaenostic testin¢ -C Footnotes 7-14 Maximum Allowed West Facing Fenestration Products Per Table 151-B or 151-C ---- (5% X CFA) Maximum Allowed Total Fenestration Products Per Table 151-B or 151-C ----(20% X CFA) ftZ CF -1R ftZ ✓Building Type: (check one or moreX Single Family Multifamily Addition Alteration (If adding fenestration fill out WS -4R, Fenestration Maximum Allowed Area Worksheet and see Section 8.3.2 for Additions and 8.3.3 for Alterations.) Number of Stories: Number of Dwelling Units: Floor Construction Type: Slab/Raised Floor (circle one or both) Front Orientation: North / South / East / West / All Orientations (input front orientation in degrees from True North and circle one). ✓ ❑ RADIANT BARRIER (required in climate zones 2, 4, 8-151 OPAQUE SURFACES INCLUDING OPAQUE DOORS Component Type (Wall, Roof, Floor, Slab Edge, Doors) Frame Type (Wood or Metal) Cavity Insulation R -Value Assembly U - factor (for wood, Continuous metal frame and Insulation mass R -Value assemblies Joint Appendix IV Reference Roof Radiant Barrier Installed Yes or No Location Comments (attic, garage, typical, etc. 1) See Joint Appendix IV in Section IV.2, IV.3 and IVA, which is the basis for the U -factor criterion. U -factors can not exceed prescriptive value to show equivalence to R -values. Residential Compliance Forms April 2005 CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 2 of 5) CF -1R Project Title FUL Date // p FENESTRATION PRODUCTS — U -FACTOR AND SHGC ✓ ❑ FENESTRATION MAXIMUM ALLOWED AREA WORKSHEET WS-4R—must be ir_cluded for New Construction, Additions and Alterations. Fenestration #/Type/Pos. (Front, Left, Rear, Right, Sk li ht Orien- tation, N, S, E, W(ft') Exterior Shading/Overhangsb Area U -factor SHGC ✓ box if WS -3R is U-factor2 Source SHGC' Sources included 7 ow .Gb 13 ❑ 13 13 1) Skylights are now included in West -facing fenestration area if the skylights are tilted to the -vest or tilted in any direction when the pitch is less than 1:12. See § 151(f)3C and in Section 3.2.3 of the Reside.itial Manual 2) Enter values in this column are either NFRC Rated value or from Standards default Table 1 -6A. 3) Indicate source either from NFRC or Table 116A, 4) Enter values in this column from NFRC or from Standards Default Table 116B or adjusted SHGC from WS -3R. S) Indicate source either from NFRC or Table 116B. } 6) Shading Devices are defined in Table 3-3 in the Residential Manual and see WS -3R to calc slate Exterior Shading devices. 7) See Section 3.2.4 in the Residential Manual. .HVAC SYSTEMS Heating Equipment Type and Capacity fumace heat pump,boiler, etc. Minimum Efficiency AFUE or HSPF Distribution Type and Location Duct or Piping Themtostat Configuration ducts attic etc..R-Value Type slit or package) 7 ow .Gb Cooling Equipment Type and Capacity (A/C, heat pump, evap. cooling) Minimum Efficiency Duct Location Duct Thermosta_ Configuration SEER or EER attic, etc. R -Value Type (split or acka e Q 7 ow .Gb Residential Compliance Forms . April 2005 SEALED DUCTS and TXVs (or Alternative Measures) A signed CF -4R Form must be provided to the building department for each home for which the following. are required. CK I Sealed Ducts all climate zones Installer testing and certification and HERS rater field verification required.) TXVs, readily accessible (climate zones 2 and 8-15 only) ❑ Installer testing and certification and HERS Rater field verification required.) Refrigerant Charge (climate zones 2 and 8-15 only) (Installer testing and certification and HERS Rater field ❑ verification required.) OR ❑ IAlternative to Sealed Ducts and Refrigerant Charge /TXVs (See Package D Alternative Package Features for Proiect Climate Zone in the RM Appendix B Table 151-C, Footnotes 7-14. %Jn For additions and alteFations, duct systems that are not documented to have been previously ❑ sealed as confirmed through field verification and diagnostic testing in accordance with procedures in the Residential ACM Manual and duct systems with more than 40 linear feet in unconditioned spaces shall meet the requirements of Section 150(m) and duct insulation requirements of Package D. WATER HEATING SYSTEMS ❑ Check box if system meets criteria of a "Standard" system. Standard system is one gas-fired water heater per dwelling unit. If the water heater is a storage type, 50 gallons is the maximum capacity and recirculation system is not allowed. Check box when using Preapproved Alternative Water Heating table, Table 5-4 in Chapter 5 in the Residential ❑ Manual. No water heating calculations are required, and the system com lies automatically. Check box if system does not meet criteria of "Standard" system, and does not comply with the Preapproved ❑ Alternative Water Heating table. In this case, the Performance Method must be used and must be included in the submittal. Check box to verify that a time control is required for a recirculating system pump for a system serving multiple ❑ units stems serving sm ve wuning, unit Energy Tank Rated T Factor' or External Water Heater Distribution Number (kW or Cap A ;S:d�by' Insulation T e/Fuel Type Type in System Btu/tu al% Efficienc Loss % R -Value -^--� � ..F., ..A stem serving mu.0 ie uwc...0 u....o Energy Tank Rated I Tank Factor' or External Water Heater Distribution Number ut (kWuor Capacity Thermal Standby' Insulation Tvoe Type in System Btuft) (gaeons Efficienc Loss % R -Value -^--� � ..F., ..A 1) For small gas storage water heaters (rated inputs of less than or equal to /:5,000 ntuwnr), electric rww.ain.., .— heat pump water heaters, list Energy Factor. For large gas storage water heaters (rated input of greater than 75,000 Btu/hr), list Rated Input, Recovery Efficiency, Thermal Efficiency and Standby Loss. For instantaneous gas water heaters, list Rated Input and Thermal Efficiencies. Pipe Insulation (kitchen lines >_ 3/4 inches) All hot water pipes from the heating source to the kitchen fixtures that are 3/4 inches or greater in diameter shall be thermally insulated as specified by Section 150 0) 2 A or 150 0) 2 B. Residential Compliance Forms April 2005 CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 4 of 5) CF -1R Project Title 6V4— BQ,fJe, _ Date ////J/ps SPECIAL FEATURES NOT REQUIRING HERS VERIFICATION (add extra sheets if necessaryl Indicate which special features are part of This project. The list below represents special features relevant to the Prescriptive ✓ Feature . Required Forms if applicable) Description ❑ Metal Framed Walls 'CF -1R` ❑ Radiant Barriers CF -1R ❑ Exterior Shades WS -4R - N/A; Performance Calculation ❑ Cool Roof Required. Attach CRRC Label to Forms. Dedicated Hydronic Heating Performance Calculation ❑ System Required; Attach Run to Forms. Performance Calculation . ❑ Combined Hydronic System Required; Attach Run to Forms. N/A; Performance Calculation ❑ Gas Cooling f Required. ❑ Buried Ducts • N/A; Indicate on buildingplans. See Section 5.6.2 Distribution ❑ Kitchen Pipe Insulation Systems in Residential Manual See Table 5-13 or use Water Heaters Per Performance Calculation and LDwelling Unit attach Run to Forms. Water Heating System Performance Calculation andMulti le Dwellings attach Run to Forms. ❑ Non-NAECA Large Water CF 4R Heater See Table 5-13 or use ❑ Indirect Water Heater Performance Calculation and attach Run to Forms See Table 5-13 or use ❑ Instantaneous Gas Water Heater Performance Calculation and attach Run to Forms See Table 5-13 or use ❑ Solar Water Heating System Performance Calculation and attach Run to Forms Performance Calculation and. • E Wood Stove Boiler attach Run to Forms SPECIAL FEATURES REOUIRING HERS RATER VERIFICATION -' _-L__L .J.. ....F ..FAL.. r4 ons 1PPlI vPrifiratinn aUU extra SllccLJ a uc.ca�ai iuuavaw �....... ...-•....�.-.... ....._.. _.__.� �- -- -- - ✓ Feature Re uired Forms if applicable) D•tscri tion Duct Sealing CF -6R part 4 of 12 Refrigerant Charge CF -6R part 5 of 12 ❑ Thermostatic Expansion Valve CF -6R part 6 of 12 Residential Compliance Forms September 2005 CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 5 of 5) CF -1R Project Titl 412 Date r COMPLIANCE STATEMENT This certificate of compliance lists the building features and specifications needed to comply with Title 24, Parts 1 and 6 of the California Code of Regulations, and the administrative regulations to implement them. This certificate has been signed by the individual with overall design responsibility. The undersigned recognizes that compliance using duct design, duct sealing, verification of refrigerant charge and TXVs, insulation installation quality, and building envelope sealing require installer testing and certification and field verification by an approved HERS rater. DesiL,ner or Owner (Der Business and Professions Code) Documentation Author Name: Name ` Title/Fimt: 24— aAf Title/Firm: Address: Addre011 �f Telephone: Telephone: D� 3 License #: 3 3 Cala (signature) (date) I (signature) (date) Enforcement Agency Name: Comments: Title Agency: Telephone: (signature / stamp) date Residential Compliance Forms April 2005 '&-k: TION CERTIFICATE 1 of 12) CF -6R Permit Number ..installation certificate is required to be posted at the but 'ng site or made avail a 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 If # of Rated Input External Heater Mfr Name & (Std, Point- Recirculation, Identical (kW or Tank Volume Efficiency Standby Insulation Type Model Number of -Use etc) Control Type Systems Btu/lu)'(gallons) EF, RE) Loss % 2 R-value2 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 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 -1R, 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) ❑All 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 a time/temperature control ✓ ❑ 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 Signature: Date: Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 2 of 12) CF -6R Site Address r , _ Permit Number 1 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 pro-ided to the building department (upon request) and the building owner at occupancy, per Section 10-103(a). FENESTRATION/GLAZING: Item Manufacturer/Brand Name (GROUP LIKE RODUCTS) Total i i Quantity of Area Exterior Product U -factor Product SHGC # of Like Product Square Shading Device Comments/Location/ (<_ CF -1 R value) Z <_CF -1R value)2 Panes O tions Feet or Ov-,rhang Special Features (if applicable) General Contractor (Co. Name) OR Ow•ier 2. OR Window Distributor 3. Signature Date Installing Subcontractor (Co. Name) OR 4. General Contractor (Co. Name) OR Ow -ler 5 OR Window Distributor 6. Ake 7. Signature Date Installing Subcontractor (Co. Name) OR_ 8. General Contractor (Co. Name) OR Owier 9. OR Window Distributor 10. 11. 12. 13. 14. 15. i� 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. 2) 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 -1R, or a shading device (exterior or overhang) is installed as specified on the CF -1R. Alternatively, installed weighted average U -factors for the total fenestration area are less than or equal to values from CF -1R. If using default table SHGC values from § 116 identify whether tinted or not. ✓ ❑ I, the undersigned, verify that the fenestration/glazing listedabove 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 -IR) 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 Ow•ier OR Window Distributor Item #s Signature Date Installing Subcontractor (Co. Name) OR (if applicable) General Contractor (Co. Name) OR Ow -ler OR Window Distributor Item #s Signature Date Installing Subcontractor (Co. Name) OR_ (if applicable) General Contractor (Co. Name) OR Owier OR Window Distributor Copies to: Building Department, HERS Rater (if applicable) Building Owner at Occupancy Residential Compliance Forms April 2005 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 Efficiencyt (AFUE, etc.) zCF-I R value) Duct Location attic, etc. Duct or Piping R -value Heating Load Btu/hr Heating Capacity Btu/hr Cooling Equipment Equip Type q P yP (pkg. heat um CEC Certified Mfr.. Name and Model Number # of Identical Systems Efficiency t (SEER or EER) zCF-IR value) Duct Location attic etc. Duct R -value Cooling Load Btu/hr(Btu/hr) Cooling Capacity 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. ✓ ❑I I, the undersigned, verify that equipment listed above is: 1) is the actual equipment installed, 2) equivalent to or more efficient than that specified in the certificate of compliance (Form CF -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 Signature: Date: Copies to: BUILDING DEPARTMENT, HERS RATER (]IF APPLICABLE) BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 INSTALLER COMPLIANCE STATEMENT FOR DUCT LEAKAGE INSTALLER COMPLIANCE STATEMENT The building was: ✓ ❑Tested at Final ✓ ❑ Tested at Rough -in INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE: ❑ 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 sealed. ❑ If the house rough -in duct leakage test was conducted without an air handler installed, inspect the cc rinection points between the air handler and the supply and return plenums to verify that the connection points are properly sealed. ❑ Inspect all joints to ensure that no cloth backed rubber adhesive duct tape is used ✓ ❑ DUCT LEAKAGE REDUCTION Procedures for field verification and diagnostic testing of air dktrihation .cuctomc aro a,,,»iahto ;n R.dCM a endix ars NEW CONSTRUCTION: Duct Pressurization Test Results (CFM @ 25 Pa) Measured t Values I Enter Tested Leakage Flow in CFM: Fan Flow: Calculated (Nominal: -4 Cooling ✓ ❑ Heating) or ✓ ❑ Measured 2 If Fan Flow is Calculated as 400 cfin/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: �' () ✓ 3 Pass if Leakage Percentage<_ 6% for Final or <_ 4% at Rough -in: O ❑ pas Fail 100 x Line # 1 / Line # 2)11 ALTERATIONS: Duct System and/or HVAC Equipment Change -Out 4 Enter Tested Leakage Flow in CFM from Pre -Test of Existing Duct System Prior to Duct System Alteration and/or Equipment Change -Out. Enter Tested Leakage Flow in CFM from Final Test of New Duct System or Altered Duct ' 5 System for Duct System Alteration and/or Equipment Change -Out. Enter Reduction in Leakage for Altered Duct System 6 Line # 4 Minus Line # 5 —(Only if Applicable) 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) ✓ �/ Entire New Duct System - Pass if Leakage Percentage15 6% for Final or <— 4% at Rough -in 6/� 8 100 x Line # 5 / Line # 2 / 0 PasreFai1 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: 9 Pass if Leakage Percentage <— 15% [100 x [ (Line # 5) / (Line # 2)]] ❑ Pass ❑ Fail 10 Pass if Leakage to Outside Percentage :5 10% [100 x [—(Line # 7) / (Line # 2)]] ❑ Pass ❑ Fail Pass if Leakage Reduction Percentage >_ 60% [100 x L_(Line # 6) / (Line # 4)]] 11 and Verification b Smoke Test and Visual Inspection ❑pass ❑Fail 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 ass ❑Pass ❑Fail ✓ U I, the undersigned, verify that the above diagnostic test results were performed in conformance wits the requirements for compliance credit. I, the undersigned, also certify that the newly installed or retrofit Air -Distribution System Ducts, Plenums and Fans comply with Mandatory requirements specified in Section 150fXn) of the 2005 Building Energy Efficiency standards. (Co. Name) OR General OR Owner Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 ✓ ❑ THERMOSTATIC EXPANSION VALVE (TXV) Procedures for field verification of thermostatic expansion valves are available in RACM, Appendix RI. ✓ ✓ Access is provided for inspection. The procedure shall consist of visual verification that the TXV is installed on ✓ ❑ Yes ❑ No the system and installation of the specific equipment ❑ ❑ shall be verified. Yes is a pass I Pass I Fail ✓ ❑ REFRIGERANT CHARGE MEASUREMENT Verification for Required Refrigerant Charge and Adequate Airflow for Split System Space Cooling Systems without Thermostatic Exnansion Valves Outdoor Unit Serial # OF Location OF Outdoor Unit Make OF Outdoor Unit Model OF Cooling Capacity Btu/hr Date of Verification Ho Date of Refrigerant Gauge Calibration (must be checked monthly) Date of Thermocouple Calibration (must be checked monthly) Standard Charge Measurement Procedure (outdoor air dry-bulb 55°F and above): Procedures for Determining Refrigerant Charge using the Standard Method are available in RA CM, Appendix RD2. Note: The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. Measured Temperatures Supply (evaporator leaving) air dry-bulb temperature (Tsupply, db) OF Return (evaporator entering) air dry-bulb temperature (Treturn, db) OF Return (evaporator entering) air wet -bulb temperature (Treturn, wb) OF Evaporator saturation temperature (Tevaporator, sat) OF Suction line temperature (Tsuction, db) Condenser (entering) air dry-bulb temperature (Tcondenser, db) -f-- Ho Sunerheat Chaise Method Calculations for Refrigerant Charge Actual Superheat = Tsuction, db — Tevaporator, sat °F Target Superheat (from Table RD -2) OF Actual Superheat — Target Superheat (System passes if between -5 and +5°F) OF Temperature Split Method Calculations for Adequate Airflow Snlit Methnd Calrulntinn i.c not noro.c.cnru if Adonvnto .4irilnuw rrodil i� t.". Actual Temperature Split = T return, db Tsupply, db OF Target Temperature Split (from Table RD3) OF Actual Temperature Split Target Temperature Split (System passes if between - 3°F and +3°F or, upon remeasurement, if between -3°F and -100°F of Residential Compliance Forms April 2005 INSTALLATION CERTIFICATE (Page 5 of 12) CF -6R Site Address Permit Number Standard Charge Measurement Summary: System shall pass both refrigerant charge .and adequate airflow calculation criteria from the sane measurements. If corrective actions were taken, both criteria must be remeasured and recalculated. ✓ ❑ Yes ❑ No System Passes Alternate Charge Measurement Procedure (outdoor air dry-bulb below 55 T) Note: The system should be installed and charged in accordance with the manufacturer's specifications and installer verification shall be documented on CF -6R before starting this procedure. If outdoor air dry-bulb is 55'F or above, installer shall use the Standard Charge Measure Procedure: Procedures for Determining Refrigerant Charge using the Alternate Method are available in RACM, Appendix RD3. Wei h -In Charging Method for"Refri erant Charge Actual liquid line length: ft Manufacturer's Standard liquid line length:. ft Difference (Actual— Standard): ft Manufacturer's correction (ounces per foot) x difference in length = ounces (+ = add) (- = remove) ✓leasured Airtlow Method for Adequate Airflow Verification available in RACM, Appendix RD2.6 Calculated Airflow: Cooling Capacity (Btu/hr) X 0.033 (cfm/Btu-hr) = CFM Measured Airflow is CFM (Measured airflow must be greater than the calculated airflow). Alternate Charge Measurement Summary: System shall pass both refrigerant charge'and adequate airflow calculation criteria from the same measurements. If corrective actions were taken, both criteria must be remeasured and recalculated. ✓ ❑ Yes 111 No I System Passes Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner Signature: Date: Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 MISCELLANEOUS CREDITS ✓ ❑ DIAGNOSTIC SUPPLY DUCT LOCATION, SURFACE AREA AND R -VALUE Procedures for field verification and diagnostic testing for this group compliance credits are available in RACM, Appendix RC, RE & RH. ✓ ❑ LESS THAN 12 LINEAL FEET OF SUPPLY DUCT OUTSIDE OF CONDITIONED SPACE COMPLIANCE CREDIT ✓ I ❑Yes I ❑No I Less than 12 lineal feet of supply duct outside of conditioned space. Yes to this compliance credit is a pass ✓ ❑ Pass ✓ ❑ Fail ✓ ❑ SUPPLY DUCTS LOCATED IN CONDITIONED SPACE COMPLIANCE CREDIT ✓ ❑ Yes 10 No I Ducts are located within the conditioned volume of building. Yes to this compliance credit is a pass ✓ ❑ 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 SYSTEM 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 I ❑ No I Duct sizes, duct system layout and locations of supply & return registers match the duct system design plan Yes to all is a pass I ✓ ❑ Pass I ✓ ❑ Fail ✓ U SUPPLY DUCTS SURFACE AREA REDUCTION COMPLIANCE CREDIT Attic Crawl Space R-4.2 Deeply Duct Surface Basement Covered Covered Other Diameter Area R-6.0 Surface Area R-8.0 Surface Area ❑ ❑ ❑ ❑ ❑ ❑ ✓ Yes to ducts stem design, supply duct surface area reduction and this compliance credit is a pass ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 1 ❑ I ❑ ❑ ❑ Total Surface Area for Each R -Value = ❑ Yes I ❑ No 4tches Performance's CF -1R? ✓ ✓ Yes to all is a pass ❑ Pass ❑ Fail ✓ ❑ BURIED DUCTS ON THE CEILING COMPLIANCE CRFniT ✓ ❑ DEEPLY BURIED DUCTS COMPLIANCE CRF,nIT ❑ Yes ❑ No Buried Ducts on the Ceiling ❑ Yes ❑ No Verified High Insulation Installation Quality ✓ ✓ Yes to ducts stem design, supply duct surface area reduction and this compliance credit is a pass ❑ Pass ❑ Fail ✓ ❑ DEEPLY BURIED DUCTS COMPLIANCE CRF,nIT Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 ❑ Yes ❑ No Deeply Buried Ducts ❑ Yes ❑ No Verified High Insulation Installation Quality ✓ ✓ Yes to ducts stem design, supply duct surface area reduction and this compliance credit is a pass ❑Pass ❑ Fail Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 I INSTALLATION CERTIFICATE (Page 3 of 12) CF -6R Site Address �j Permit Numbe- ✓❑ FAN WATT DRAW Procedures or measuring the air handler watt draw are available in RA ✓ Method For Fan Watt Draw Measurement ❑ RE3.2.1 I Portable Watt Meter Measurement ❑ RE3.2.2 I Utility Revenue Meter Measurement RE3.2. Measured Fan Watt Draw Measured Fan Flow enter total cfm from airflow verification Enter results of Watts/cfm RE4.1.1 Diagnostic Fan Flow Using Flow Capture Hood ✓ ❑ Yes ❑ No. Measured fan watt/cfm draw is equal to or lower than the fan watt/cfm draw documented in CF -1R ❑ - ❑ ❑ RE4.1.3 Yes is a pass I Pass Fail ✓ ❑ ADEQUATE AIRFLOW VERIFICATION Prncedara.c fnr m noirino tha nirflnw nra m,nilnhla in RAI -Ad A,,.,a.,.li, JJF2 I ✓ Method For Airflow Measurement ❑ RE4.1.1 Diagnostic Fan Flow Using Flow Capture Hood ❑ RE4.1.2 Dia nostic Fan Flow Using Plenum Pressure Matching ❑ RE4.1.3 Diagnostic Fan Flow Using Flow Grid Measurement ❑ Yes ❑ No Duct design exists on plans capacity indicated on the Performance's CF -1R and RF -3. Measured Airflow: If the cooling capacities of installed systems are > than maximum ✓ ✓ Rated Tons cfm/ton ✓ ❑ Yes ❑ No cooling capacity in the CF -1R, then the electrical input for the ✓ ❑ Yes ❑ No . Measured airflow is greater than the criteria in Table RE -2 installed systems must be 5 to electrical input in the CF -1R. ❑ ❑ Yes is a pass Pass Fail Watts cfm Watts/cfm Total cfm cfm/ton ✓❑ HIGH EER AIR CONDITIONER Procedures for ver* (cation are available in RA CM, -Appendix RI. 1 ✓ ❑ Yes ❑ No EER values of installed systems match the CF -1R 2 ✓ ❑ Yes ❑ No Fors lit system, indoor coil is matched to outdoor coil 3 ❑ Yes ❑ No Time Delay Relay Verified (If Required) Yes to 1 and 2; and3 If Require C is a pass Pass Fail Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner Signature: Date: pies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 ✓ ❑ MAXIMUM COOLING CAPACITY Procedures or del ining maximum cooling load ca aci are available in RACM Appendix RF3. 1 ✓ ❑ Yes ❑ No Adequate airflow verified (see adequate airflow credit) 2 ✓ ❑ Yes ❑ No Refrigerant charge or TXV 3 ✓ ❑ Yes ❑ No Duct leakage reduction credit verified 4 ✓ ❑ Yes ❑ No Cooling capacities of installed systems are <_ to maximum cooling capacity indicated on the Performance's CF -1R and RF -3. If the cooling capacities of installed systems are > than maximum ✓ ✓ 5 ✓ ❑ Yes ❑ No cooling capacity in the CF -1R, then the electrical input for the installed systems must be 5 to electrical input in the CF -1R. ❑ ❑ Yes to 1, 2, and 3; and Yes to either 4 or 5 is a pass Pass Fail ✓❑ HIGH EER AIR CONDITIONER Procedures for ver* (cation are available in RA CM, -Appendix RI. 1 ✓ ❑ Yes ❑ No EER values of installed systems match the CF -1R 2 ✓ ❑ Yes ❑ No Fors lit system, indoor coil is matched to outdoor coil 3 ❑ Yes ❑ No Time Delay Relay Verified (If Required) Yes to 1 and 2; and3 If Require C is a pass Pass Fail Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner Signature: Date: pies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (The information provided on this form is required) After completion of final inspection, a copy must be provided to the building department (upon request) and the building owner at occupancy, per Section 10-103(a). BUILDING ENVELOPE LEAKAGE DIAGNOSTICS ✓ ❑ ENVELOPE SEALING INFILTRATION REDUCTION Procedures for field verification and diagnostic testing of envelope leakage are available in RA CM, Appendix 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 -1R? ❑ ❑ 2. Is Mechanical Ventilation shown as required on the CF -1R? Yes No 2a ❑ ❑ If Mechanical Ventilation is required on the CF -1R (`Yes' in line 2), has it Yes No been installed? ❑ ❑ Check this box `yes' if mechanical ventilation is required (`Yes' in line 2) 2b. and ventilation fan watts are no greater than shown on CF -IR. Yes No Measured Watts = ❑ ❑ Check this box "yes" if measured building infiltration (CFM @ 50 Pa) is 3. greater than the CFM @ 50 values shown for an SLA of 1.5 on CF -1R Yes No If this box is checked no, mechanical ventilation is required.) Check this box "yes" if measured building infiltration (CFM @ 50 Pa) is 4 ❑ ❑ less than the CFM @ 50 values shown for an SLA of 1.5 on CF -1R, Yes No mechanical ventilation is installed and house pressure is greater than minus .5 Pascal with all exhaust fans operating. Pass if: a. Yes in line 1 and line 3, or ✓ ✓ b. Yes in line 1 and line2, 2a, and 2b, or c. Yes in line I and Yes in line 4. ❑ ❑ Otherwise fail. Pass Fail ✓ 111, the undersigned, verify that the building envelope leakage meets the requirements claimed for building leakage reduction below default assumptions as used for compliance on the CF -1R. This is to certify that the above diagnostic test 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 HERS provider a copy of the CF -6R signed by the builder employees or subcontractors certifying that diagnostic testing and installation meet the requirements for compliance credit.) Test Performed Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner Signature: Date: Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE), BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 Insulation Installation Quality Certificate ✓ ❑ Description of Insulation, (CF -611, formerly IC -1) signed by the installer stating: insulation marufacturer'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 ❑ Yes ❑ No ❑ NA 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 ✓ WALLS ❑ ❑ ❑ Wall stud cavities caulked or foamed to provide.an air tight envelope Yes No NA ❑ Yes ❑ No ❑ NA Wall stud cavity insulation uniformly fills the cavity side-to-side, top-to-botto•r, and front -to -back ❑ Yes ❑ No ❑ NA No gaps ❑ y Yes ❑ No ❑ NA No voids over 3/4" deep or more than 10% of the batt surface area. ❑ ❑ ❑ 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 ❑ Yes ❑ No ❑ NA Small spaces filled ❑ Yes ❑ No ❑ NA Rim -joists insulated ❑ ❑ ❑ Loose fill wall insulation meets or exceeds manufacturer's minimum weight -per -square -foot Yes No NA I requirement ✓ ROOF/CEILING PREPARATION Yes 00 No NA 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.enve:ope ❑ ❑ ❑ All recessed light fixtures IC and air tight (AT) rated and sealed with a gasket or caulk between the Yes No NA housing and the ceiling ❑ Yes 0 No 0, NA 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 q NA Area under equipment platforms and cat -walks insulated or accessible for blown insulation ❑ Yes ❑ No ❑ 1 NA Attic rulers installed Residential Compliance Forms April 2005 ✓ ROOF/CEILING BATTS ❑ ❑ ❑ Yes No NA No gaps ❑ ❑ ❑ Yes No NA No voids over % in. deep or more than 10% of the batt surface area. ❑ ❑ ❑ Yes I No NA I Insulation in contact with the air -barrier ❑ ❑ ❑ Yes No NA Recessed light fixtures covered ❑ ❑ ❑ 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 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 -fool). Manufacturer's minimum required thickness at time of installation Manufacturer's minimum required settled thickness . Note: To receive compliance credit the HERS rater shall verb 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 Signature: Date: Copies to: BUILDING DEPARTMENT, TIERS RATER (IF APPLICABLE), BUILDING OWNER AT OCCUPANCY Residential Compliance Forms April 2005 Description of Insulation (Formerly IC -1 Form) Item #s . (if applicable) Signature Date ' 1. RAISED FLOOR Item #s Material Brand Name Thickness (inches) Thermal Resistance.(R-Value) 2. SLAB FLOORIPERIMETER Material Brand Name Thickness (inches) Thermal Resistance (R -Value) Perimeter Insulation Depth (inches) (if applicable) 3. EXTERIOR WALL General Contractor (Co. Name) OR Cwner Frame Type ' A. Cavity Insulation Material Brand Name Thickness (inches) Thermal Resistance (R -Value) B . Exterior Foam Sheathing Material Brand Name Thickness (inches) Thermal Resistance (R -Value) . 4. FOUNDATION WALL Material t Brand Name Thickness (inches) Thermal Resistance (R -Value) 5. CEILING Batt or Blanket Type Brand Name Thickness (inches) Thermal Resistance (R -Value) Loose Fill Type Brand Contractor's min installed weight/ft2 lb Minimum thickness 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 crnformance with the current Energy Efficiency Standards for residential buildings (Title 24, Part 6, California Code of Regu ations) as indicated on the. Certificate of Compliance, where applicable. Item #s . (if applicable) Signature Date ' Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Cwner OR Window Distributor Item #s Signature Date Installing Subcontractor (Co. Name) OR (if applicable) General Contractor (Co. Name) OR Cwner OR Window Distributor Item #s Signature Date Installing Subcontractor (Co. Name) OR (if applicable) General Contractor (Co. Name) OR Cwner OR Window Distributor Residential Compliance Forms 2005