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09-0259 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 09-00000259 Property Address: 54165 AVENIDA JUAREZ APN: 774-193-020-8 -000000- Application description: MECHANICAL Property Zoning: COVE RESIDENTIAL Application valuation: 5990 Tiht 4 4 Qum& - Applica�/ Architect or Engineer: �J✓� A BUILDING & SAFETY DEPARTMENT BUILDING PERMIT -------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with \Section 70001 of Division 3 of the Busines)nd rofe sionals Code, and my License is in full force and effect. License Class: 20-C38 License No.: 510566 Date— —CO Contractor: 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 therefrom and 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 _ 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 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.). 1 _ 1 I am exempt under Sec. - , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I 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 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 3/19/09 Owner: ELSNER BRYAN G 54165 AVENIDA JUAREZ LA QUINTA, CA 92253 ( D 4 Contractor: MAR 19 2009 H AND H AIR CONDITIONING J 74991 JONI DRIVE, #20 CITYOFLgQUINTi4 PALM DESERT, CA 92260 FIAIANCEp�pr (760)340-3088 LiC. No.: 510566 -----------------------------------------------— 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 ENDURANCE REINS Policy Number WEN003665502 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 agree that, if I should becomes ject to the workers' compensation provisions of Section X700 of the Labor Code, 1 sl 1 f twi comply with those provisions. Date: 19��\ Applicant: WARNING: FAILURE TO SECUR WO ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 1$100,0001. 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. i. 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. 1 agree to comply with all city and county ordinances and state laws relating to building constructs , and ereby authorize representatives of this2 c nt to enter upon the above-mentioned property for in ec n p ses. Daty;J1Signature (Applicant or Agent): LQPERMIT , Application Number . . . . . 09-00000259 Permit MECHANICAL Additional desc . . Permit Fee . . . . 33.00 Plan Check Fee 8.25 Issue Date . . . . Valuation 0 Expiration Date 9/15/09 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 9.0000 EA MECH B/C <=3HP/100K BTU 9.00 ---------------------------------------------------------------------------- Special Notes and Comments REPLACEMENT OF EXISTING EQUIPMENT @ HI -EFFICIENCY HEAT PUMP & AIR HANDLER @ PURON REFRIIGERANT. 15 SEER HEAT PUMP 12.5 SEER CONDENSER./ 8.5HSPF HEATING HANDLER. ---------------------=------------------------------------------------------ Other Fees . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited ----------------- Due ---------------------------------------- Permit Fee Total 33.00 .00 .00 33.00 Plan Check Total 8.25 .00 .00 8.25 Other Fee Total 1.00 .00 .00 1.00 Grand Total 42.25 .00 .00 42.25 LQPERMIT , Bin # City of La Quinta Building a Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: I �� Owner's Name: A. P. Number: , Address: �� ✓�r' �_� Legal Description: p� y Contractor: 1, 4 Address: `j City, ST, Zip:U� 1 �� I -r0 I Telephone: 2 Project Description: City, ST, Zi - L-�C%� — 71 A IS Telephone: State Lic. # Arch(Engr., Designer: n /C Address: City, ST, Zip: Telephone: State Lic. #: Name of Contact Person: Construction Type: Occupancy: Project type (circle one): New Add'n 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- • Reed .• • TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cales. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Energy Cales. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2id Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''' Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees �l. �NTrAr Project are CJ HcOvet a''' ration Author ! d� �� �7�f(� . Bvtao,s gc,c,t ': . . ..Tele Play pk /Date Canplianco Method (Pry five P )>r,Otdc�ioat� Cliff iatezone _ `r 0 Alterz,ativt: Component Pe M W �tgaxy Use only g Method(d,ock om) C p Package C and Package D = — D (Alternative) Por Padeage D Ah rewire HI= � fad vitrification and/or d' ernat,ve see APPetldix.B Tabic'1 S -CP -14 o tong ( CF -I R page 3). ALMF Total cbr,d,t,onod �rArca(CFA) MaximUta AllowCd A M West Facing F !^fie Ckr"ling Height: aximum Allowed -'oral Fc 4•� � IMd+cts Pcc Table 151-6.6r ISI -C..— • '� D Biu'ld' educts PerTi+ble ISa• l or ISI•C� CFA) ung,yp (ocic ortc a more)_ s. (�'� X CFA) - ------ Wadding Bion fRi-" W tr,gleFarn,7y_ Multi _ ft Nvm for Additions and $33 foe Fencsbratioq Mnucunuin AUo�redArra.Wai- Aiterat,on ben ofStoriex ) and sec Section 83.2 - -Floor ��ioa 7)'P---� Number of Dwelling Unite Front Qriea -- -- SiabJttised Floor) ration:' (Circle one or Noah and .* Noah/ Sowli /F.aA/ West /All C), iwt t; (Uput fiat' orrwtation is ftrom from True IrbRADUNT 13ARR MtR bed. in dimatc j, 4 S-1 OPA' UE SURFACES OLUDiNG OPA ilE DOO �poncAt ape (Wall ... Frame Assembly u .Slab FdFg�, TypeCavictor ty Cootinuorts• fWDOd,(for Jo,at ItuofRa�arrt Luulation Appendix • Barrier :Doors or M R-Ya2ue R �e � � . IV 7 Loc:ationtor��. . asblie stallod Reference Yes orNo (arc' l' I) Sctloint.APpendix.IV in Section IV exceed pnscriptive. value to .2.. V.3.and' IV.4, �vhii show equivalernec to R -values:. Residential Compliance Forms CERTIFICATE OF COMPLIANCE: RESZllEiV'I'ZAI, of4) C&IR . . Project Title • Date FENESTRA'I70N PRODUCTS U FACTOR ANh etrCr• ✓ ❑ FENESTRATION MAXIMUM Additions and Alterations.. ALLOWED AREA WORKSHEET WS4R —must be included-for New Construction, Fenestration -�ype/Pos. (Front, Lek Orien- - Rear, Right Exterior . Area S light)nt SP VII' iJ=factor SHE3C Shading/Overfrangsa? U-factor . Source' SHGC4 S box if WS-3R is Boum included 13 13 ❑ • 1) Slulithts are now' - • - - ❑ - ' utcluded in West facing fenestratibn area if the s li ❑ when the pitch is less than 112. See -§ 151-(f)3C and in are tilted to the west• or tilted in any direction 2) Errtervalues in this column ar a either NFRC Rated Section 32,3 of the Resideatial.I�faztuat 3) In6cate source either fiom NFRC or Table 116A, valae or from Standards default Table 116A. 4) . Enter values in this column from NFRCCor fivm Standards Default Table 116B orad ...-5) Indicate source either from NFRC. or Table 116B. Jed S1iG1CC from WS-3R 10 Shading Devices are defined in Table 33 in the Residential Manual and see WS-3R to calculate 7) See Section 32.4. in the Residential Manual Exterior shading devices. H'C'AC SYSTEMS H ting Equi eat Minimum. Distil ution. TYpe and Capacity Efficita lxat boner etc AbVE or lacy , Typo and. Location Dud or Piping Thermostat c� ducts atti ere. R-Value Configuration it or Coolrng•Equipmtat • Minimum Type and Capacity' Efficiency Dudoc t.Lation Dud Thermostat Cons Heat rtl ever sEM.or1FR S R-Value guration o it or e Residential Compliance Forms March 2005 CERTIFICATE OY( Date SEALED bUCTS and TM or Alternative Measures A'signed CF -4R Form must be provided to the buil wired. g department for each home for which the following, are .� •, uistribution .Numberinput iK raccor or External e. 'in (kW.or anCapacity Thermal ' Standby' Insulation Btu/hr ions Efficien -Loss. % R -Value I. For small gas storage water heaters rated in Pump water heaters, list fine Factor. P' .of less than .or eq to 75,000 Btu/hr), eIecic resistan Btu/hr), list Rated Input, Recovery $fiicFor larThegas storage warm Efficiency d erf (ratedLoss: F of 5, and beat p greater than 75,000 1 heaters; list Rated Input and Thermal Efficiencies, Standby or instantaneous gas water Bes o(kitchen lines>_ 3/4 inches).All hot water i or greater in diameter shall be thermal ly.insulated as specified by the heating 0 Source G) 2 Atort 150 (j2 Bf � �� Residential Compliance Forms' Marvh'2005 CERTIFICATE OF C OMPLIANcEi,RESIDENTIAL. (page 4 of4) CF-IR- �, ; � Project Title • Date SPECIAL FEA .,. TUREs NOT RE LIMING ]HERS VERIFICATION ada Indicate which special features are p of this project 1 he list below on extra sheets if neces resod five method. ....y. represents special f ]Feature. eatures relevant to the C1 Metal Framed -Walls R uired Form's if a 'livable .Dtion ❑ Radiant Barriers CF -IR. escri ❑ Exterior Shades CF -1R WS -4R ❑ : Cool Roof. N/A; Attach CRRC Label to. ❑ Dedicated Hydronic H Forms' stem eating. Performarioe Calculation uir+ed• Atiadr Run to Forms, - q Combined Hydropic System ' Perlbrmance Calallation ❑ R uu,ed•.Attach Run to Forms. . Gas Cooling Performance Calculation ❑ Buried Ducts R Indic�tc on buildin .13. I{itchen'Pipe Insulation See law. 5.62 Distribution :in Residential.Tvual. []' Multiple Water Heaters per See Table 5-13 or use - Dwelling.Unit Performance Calculation and " ❑. Central Water Heating System -attach Run to Forms. l SW in Multi le Perforanance Calculation and Dwel ' attach Run to Forms, . . • : ❑ Non=NAECA Large Water - . Heater CF_IR ❑ Indirect Water Heater : Table 5=13 or use - Performance Calculation and attach Run to Forms ❑ ..Instantaneous Gas Water H See Table 5-13.or use. ' Performance Calculation and' attach Run to Form ❑ Solar Water HeatingSee'I'abIt 5=13 or use System Performance Calculation and attach.Run to Forms ❑ ' Wood Stove Boiler Performance Calculation and attach Run to Forms SPECIAL,.FEAT` UIEtiIVG IILRS add extra sheets if necesszrv) Indicate to.the RATER YERLFXCATiON verification. 1�EItS Rater which credits are part of this project and need Feature Duct Sealin R uired'Forms fa livable ' Descri tion ❑ Refri erant Char a CF4 art 4 of 12 ❑ nermostatic Ez anion Valve CF -6R art 5 of 12 CF -6R art 6 of 12 Residential Compliance Forms March 2005 INSTALLATION CERTMCATE I of 12) Sino Address/ �1' �J�ar�o riata i.napec-6.in i,lstallation aertifioate is required to be posted at the building Hite or rnadri available farnap 4 Prov ided to the buildinix in'1formation provided on this forn, isd the buildinrequ�eowoe at ocaulanon.o'i'r 8 coofinal n 10.1 or �Y do nrcmant u on rc► q+ t >in _ A aierrinunan 11 of ttecod lap t CEL' Cordifloi 'type !f tkw or Tank VDlumn tl�ut�r t�1PrNnhtaS (Sid.Polm- Rnclrculntion. IQentloAt a Maddl NOW OHJ Castrol 9 a 9 te►no Isruihr 1 — Sgrarnal . . offlolenci+ 9mndby� insul.Of 1 For small gas storage (rated input of less than oequ�w t4/, �OheaC00 H s (ratede nput ofctria sgreater than 9S,0O0 etultir), list l heaters, list )Anergy Factor (8F). For larsa gaC.cssraad Bared Tn For Instill gas wa4er heaters, llst'1"he Raoovery (RE), Thermal8fficienoy, Standby P Et't'lctonoy sand Rated Input. 2. iZ,.12 external insulation is mandatory for storage wator hoot with an energy Pbctor of legs than 0.58, 1(lteheu Piping: If indicated on the CTS' -1 R, all hot water piping _> 314' ea in diameter that runs from the hot water sotrct e to ire kiteneln . iixrut'ed is insulated. nutrts & Shawver iileed9:ursu4nt to Title, 24, part b, Section 111. All fl;ueets and sl�owerheads installed are c 'fled' o the )aver Commission, p Cautrul Water Heating In Buildings wit 'Multiple Dwelling Units (required for prescriptive) CYAII hot water /darstigned, aim a' culrlting loop is insulated to requieer�anfs of §IS O(j) 414 (Catttral hat ws s ving six orfewer-dwelling units which kava (1) lass th ns atio� cn di�fi�►r min P"ng outdoors; i?) zerpiping underground; (3) na recirculation pomp; and (4) ' t11nt meats the reof Section 15(10) ❑Cane al hat Aa serving mora than 6 dwelling units - presence of either a time control or a tttttaltempertiuura control ✓ rj 1', the verify that equipment listed abovo my signaturco s' 1) ttile actual Submitted for Cquipment cpmpl dnae equivalent so mora et3Ycleat*an that specitled in the cortifirato of campltan (F ,,frith the 6 orgy Effldenay Standards for residential buildings; and 3) equipmaat that meets or exoeod�tahblappropriate requirements for manufaiaured devicas (flnm the Appllaned,► l iciency Regulatlads or }'art 6), when°c app 1711stalling Subcot►tre=r (Co. Nkn� ) Olt Contractor (CO,1�#4) OR Owner' t 2 Di --o b"I K16 .�� Ca ins to: BUf LDING DEPARTMENT, HERS 1RATERW Al;PLICA LB ilii) BUILDING OWNER AT OCCUPAINCY p April 2005 INSTALLATION CERTMICATE permit Number Site Ad3ras9 uDA n installaiian cardficate is raqulrod to b po Attar omd at the �+lation of final 1 peotlonns eavaitsal opy mGtsPbeprovidropriate e,forialllcdto the building 3110 Or MAd infvrmation provided on this foiln is requ ) A ciap«ranant (upon request) and tha building owner at oco6rpatiey, Per Section 10-103(a). ltrf, +'s'Y'Y ATION/GLAZINC'; -- — ,QT. lvlan►l faetw�ar/Brand Name �l (GROUP LIK1x Pmd�p1J-(hotori I`�ODUCT ' (sCl+•1TZvuluo @ruduut5H4Cs 5CP-IRv tup i/ of �g s Total uuntity u(' I.II:aAwAtlor p !1099 1 Area ldquoro Rear E>iter'o ehadN1a pcvlco C glm �) Feur aaQ� a Ovorhur��-- _.r----...-_— -^- 1. -- 3. 4. . 5._- 6. b, 13, 77- 4111, 11:1. " Use values from s fenestration product's NFRC Mel. values from Section 116 of'the Energy Efficiancy St 6103 from CF- I R. Inytullod SHOC must be 1018 than or aqual to valuos rhang) i3 installed as 3pvcilic4 on -rho C -F -1R•, Altarnittiv*, installed ion area nr4 lovas than or equalta valttos from CF -1R. if using dtfaulr mblo or not. fenestmation products without an NERC label, 1480 the ddfault �1 instilled U -tactor muss be lass than or aclist to from CF•1R, or a shading device (exterlor or q 'weighted Ilvet'aga U-faotors for the total fon S S140C. values from § 116 idamify whoEheyfinte V 0 I, Tho undersigned, verll� t I [lit ionasCration/glaz(ng listad Above my signature: 1) is rllfr actual fenestrODR product installed; 2) Is equivalont 'o or has a lower U-ftTCTor and 1pwer SHaG than that aFecitlod in the oe ltict a of comp]i6uTce (lyorm GF -1'R) subl fled lar compliance with then9:rgy �,�tviency Sranc'lq� tis for residential buildings; sad 3) the produce masts 9]> axone aha appropriate roquiraments for manufactulT devices (from fart 6), where applisAltle. �Icam #s I Signaturz (u applicable) 11aal #s Signature (if applicable) ' IC6111 #5 • � (61'3pplicable) Signantre Datil Inst SWbconTracfor (Co. Name) OR• General Contractor (Co, Name) OR Dwndr CA Window Distributor Data In9ta11ing St1b0ot1rract0r (Co. NAme) OR General Contractor (CO. NMD) Ott Own("r OR Window Distributor Tn! RuIltilnt 09PI M -Ont, rI1CY2S Anter (IP a installing Subcontractor (Co. Name) UK General Contractor (CO, Alame) OR Owner OR Window Distribt4wr Building Ownor at Occupancy •(Page 3 ,��f 1CF-6R ) CFr R ! INSTALLATION �CfYjffl i'YC,�T� ParntitNumber ,site Address l ra note lnii ecdons. ('Th,e An installation aertiticata to required to be posted at he building of final in hnd eotioneoa py must e for bo provldod to the building igbrmatton provided on this form is regal ) deparmient (Lipon request) and the building owner at occupancy, par Section 10- 103(a), Hv-4LC SYSTEMS. ,�,y�qulp,nenl Egtjip Type {�!; . heuc un CAP --P 1 ER - Equip 'pipe CSS CeRIEed iwf• Effiuionay ° (9F�R or Fst3[l)t EYi9ulanoy (A'Ug, 0"*) Duut t.aoatlun Nameuad Model+ [dantlaal S stem9 ?CP-IQvalac Hula oto. umber G�ti �7q.3oo 1 �S_ sty A�iC :T /x'12 ��vT�Gvtz l'8C L`ertifad Nit}. Effiuionay ° (9F�R or Fst3[l)t Name Rod Model (dant a S Stoma tCG� 1 R valla) Number quotor I Houdns Haattn� Piping load caP�tn' &.% lFiiu/hrl V, 4. Z- t� -/ ------- j-� Coaling Coaling pact Loud apuniry Looution Mot ,n-n.ri 121"thr)_ z yz o0o Sl2 000 1. symbol reads greatdr than or equal to who! Is IndJotrted an rhe CF IR valt+o. > include both SER. and Elft if oornpliance oredit for high F.ER, air conditiontsr is claimed. E J ❑l I, file undersigned, verify that equipment listed above is, l) is the actual equipment instulled, 2) equivalent coThe or tinore eftieiont than that specified in the eertiftcate of compliance (uipmentp that mee sI R)trtor excs ds Phfor e ppropriate Bnargy 9fficlenCY Standards for residontlai buildings, and 3) aq P r6quiremants for manufactured devieos (Nom the Appllarics Vciency Regallatlo+1s or Part. 6), whore applicable, installing Suboontmctor (Co. Marne) ORoeneml �. Contractor ( o, ttma) OR Owner Sign ° �t:upies to: BUILDING D>t>,l'AYt7'MGNT, HERSitAT)Glt(l�' AIPplI�ICAt1Llt) gU114DtNC OWNER AT OCCUPANCY - �I nt11 ?DUS 4 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 1 of 1) CF4R Project Address l Elsner, Bryan ] 54165 Ave. Juarez / La Quinn / CA / 92253 t Bider / Insmner H&H Air Condtiomng Balder / Installer Contact Hugb Hoard Telephone 7603403088 Plan Number / Permit Number e —a. HERS Rater Thomas Ube& - CIBIBjERSO ID 4CCN26429061 Telephone 7603655492 Sample Group Number 6 Comptlasee Method ptive) Climate Zone 15 Com$ Salntti Date Sample Horse Number Firm - Tom Lobmk Repair HERS Provider CIHjEP91RISO Address 8487 Deer Trail CityNtatelzip Yucca Valley ICA /92284 Copies to: BUILDER, HERS PROVIDER AND BUILDING DEPARTMENT HERS RATER COMPLIANCE STATEMENT This house was: / Tested As the HERS rater providing diagnostic testing and field verification, I certify that the house identified on this foam complies with the diagnostic tested compliance requirements as checked on this form. The HERS tater must check and verify that the new distribution system is felly ducted and correct tape is used before a CF -4R may be released on every tested building. The HERS rater must not release the CF -4R until a properly completed " and signed CF -6R has been received for the sample and tested buildings. v( The installer has provided a copy of CF -6R (hrstallation Certificate). 0 New Ducts are felly ducted CLe., does not use building cavities as plenums or platform returns in lieu of ducts). C3 New ducts with cloth backed, robber adhesive duct tape is installed, mastic and draw bands are used in combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. V THERMOSTATIC EXPANSION VALVE (TXV) Proce&rrs for freld ver anion oflhennastatic m pmuion valves mr available in RA CM, Appendir Rl. System # 1 ,/Yes ❑ No Access is provided for inspection. The procedure shall oonsist of visnal verification that the TXV is installed on the system and installation of the specific equipment shall be verified. Yes is a pass �/ Pass O Fail Residential Compliance Forms Generated by CjHXjE[RjS® http:/Avww.oi]EERS.org December 2005 a L'd , Z6b9-99`~09L Noego� wol d6b:£0 60 OZ JEN INSTALLATION CERTIFICATE (Page 4 of 12) CF -6R Site Address _ / /, Permit Number INSTALLER COMPLIANCE STATEMENT FOR DUCT LEAKAGE INSTALLER COMPLJANCE STATEMENT The building was: ✓Tested at Final ✓ ❑ Tested at Rough -in INSTALLER VISUAL INSPECTION AT FINAL CONSTRUCTION STAGE FOR NEW DUCTS: �] Remove at least one supply and one return register, and verify that the spaces 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 connection 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 on new ducts. ✓ ❑ DUCT LEAKAGE REDUCTION Procedures for field verification and diagnostic testing of air distribution systems are available in RA CM_ Annendir RCd_ 3 -------- --- --- NEW CONSTRUCTION: (Co. Name) OR General Contractor (Co. Name) OR Owner Duct Pressurization Test Results (CFM @ 25 Pa) Measured,' Si Values 4; ..lF. 1 1 1 Enter Tested Leakage Flow in CFM: t #1 J31"1 Fan Flow: Calculated (Nominal: ✓ M Cooling ✓ ❑ Heating) or ✓ ❑ Measured 2 If Fan Flow is Calculated as 400 cfrn/ton x number of tons or as 21.7 cfm/(kBtu/hr) x Heating / ��D Capacity in Thousands of Btu/hr, enter total calculated or measured fan flow in CFM here: `t ✓ ✓ 3 Pass if Leakage Percentage < 6% for Final or < 4% at Rough -in without air handle: ❑ pass ❑ Fail 100 x Line # 1 / Line # 2)11 ALTERATIONS: Duct System and/or HVAC Equipment Change -Out "a,' Enter Tested Leakage Flow in CFM from Pre -Test of Existing Duct System Prior to Duct 4 System Alteration and/or Equipment Change -Out. CFh 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 Chan a -Out.. , Enter Reduction in Leakage for Altered Duct System < I' 4 6 Line # 4 Minus ine # 5 —(Only if Applicable) 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) ✓ ✓ Entire New Duct System - Pass if Leakage Percentage < 6% for Final. 8 100 x [_(Line # 5 / Line # 2)11 ❑Pass ❑Fail TEST OR VERIFICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change- ✓ Out Use one of the following four Test or Verification Standards for compliance: 9 Pass if Leakage Percentage < 15% ['100 x [ (Line # 5) / (Line # 2)]] ass 13Fail 10 Pass if Leakage to Outside Percentage < 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 by Smoke Test and Visual Inspection 13 Pass E3 Fail 12 Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection ❑ Pps ❑Fail Pass if One of Lines # 9 through # 12 pass . ass ❑ Fail S• ✓ UI, the undersigned, verify that the above diagnostic test results were performed in conformance with 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 150 (m) of the 2005 Building Energy Efficiency standards. Installing S4upcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner �'f Si Date: �g Copiel to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY Residential Compliance Forins December 2005 3 1jive, '4l-LA7CiON CERTWICATIE Site Address PatgiS of iD 'lam Number 2-6q V J3 THER OSTATW EXPANSION VALVE (TXV) proceduresf Prf field verjficatjon of lhermaglatio expansion vphwx are available In RA CH, Appendix A.ccesaaai providefor 1n tion, Th�)( procedUTO si►a11 consist of visual verification that the V is instaliad on ,/ a Yas i3 No i�he system and installation of the apoaif' o equipcnant Q � shall be verified. d [3 Rc Fj11GZRANT CHARGE 1VIIEASMMUN'T VCy.rification for Requited Refrigerant Charge and Adequate Airflow for SAlit Syetom Space Coaling Sysrams without T1'LarsnAST%tio Ex an9ion Valves Outdoor Unit Serial # Locai�ion Outdoor Unit lvlaka Qutdoor Unit Model- Cooling Capacity Btulhr Date of Verflicarlon Elaut of RaCrigarant Gauga Calibratlon (must be clucked monthly) Dale of Thermocouple Calibration (must be ch+ickedtnonThly) yd:tut rdl ,�}wr a type eed (outdoor 'r dr 'bL'bS 1F bo oc<<diu esu fur D$ra� rrririing �igfjgg'w.ant Charge slsing the S� mdard � olhod cite uvallabla (n RgCNJ, �(pp9ndix RX, Note, The system sbouid be installed and charged in acaordAnca with the specifications specifications befiore starting this pr�cedwa. �, irca Te»> erilCU1'da uF Supply (avaporator (saving) air dry-bulb tonipert►ture (Taupply, db) ° fteturn (avaporarw"entering) air dry-bulb tom oraturo (Treturn, db) °F iZorurrt (aysporutor antoring) sir wet -bulb remporature (Trolu n, Wb) of Evaporator saturation temperaturo (Tevaporator, sat) OF Suction fine temparature (Tsucdop, db) OF Condenser (antaring) air dry-bulb temperarura (Tcondenser, db) iperhaat Charge Method Calculations for ROM9 Rut ClIT29 4F Actual SupUbeat - Tsuction, db--Tevaporator, sat OF _! argef Su'pau'heac (from Table IW -2) , �. 'F ACYLIal Sppar081= Target SupeWdat (System passae if botwean -S and + Temperature Split Method Calculations for Adequate .Airflew Sctlir�blerhod Cakidation is ndr necesVu► Allo iicue.AHIM credit Is taken °F Actual Temperature Split - T return, 0 Tsupply, db aF 1 arget Temperature Split (fi•om Table RD3) wctuai Tanlperatuta SplitTargaiTcniperature Split (System passes ifbotwaan - OF 3''F and -1-30F or upon ramaasurement if berween: -9°1' and -100°P . Ra c 6 of 1z CF -6R ]t��T�Addri3sg `'�CEYtT 'TCA�� Parmitliumber Site t Standard Churg" Nle"Uamant Summary: item Shall pass lwth reiklgerant charge andndhoth cr toela must be raOw measu od and re�caiculatr�d. a ffom the "Mo neat uremonte,lP cdrrectiveactions were tel A➢•ternsite, �Lt�;ilr a lirllea�e ao deet �►� d tnracearc nca wltlr air diryte mar►uCacwrer-bulb bolaw 55 as specifi.cationn Rnd installer plate: The ystem should be installed rte bulb is 55 OF or above, Insmiler 'V :Tif+oarioa shall be doc►uuanted on CF -6R beforo sti►rting this procedure. 1'P outdoar air dry- sliall use th€� 6tEtndnrd Charge Measure Procedure- endlx.�. �i oceii1ef ebr Dater,nlneftng R•igerant Charge using ihe:llrarnaie Meihoci' etre cn�G+!Able !n s RrIChf, App t �yzi 'h-ln Chrudin Method for UfG erar►t Char s Actual liquid ling length: 1Vlanui�leturer's Standard liquid lino length: Difference (Actual—Standard); dlfPerance in 1angNi '�� ounces Manufacturer's correction (at►nca9 per foot) ,., . _... (_} y add) � = remove) 1�-JeaSurcd Airftw Method f'orAdd uata A11140w v5"I' uuu &#Pfrrv"�•.. CFM Calculated Abtlnw: Coaling Capaciry (Biu%r)______X 0.033 (efmll3tu-hr) CrM (Measured airflow must t7e greatertltan the calculated airfiow).��� Measured Airflow is �— �-----~' ..ltarnafe Charga Measurement Summary; , System shall pass bo[h rsfriperAnt charge and adequ•ato airt'law cal4 TlaCioculat edria from the aa_ easter a conci;tive actions were taken body criteria must do remeasured an eea � ❑ Yes- Q No sra� Passes ..._— ittstniling Subcontractor (Co. Name) OR Qonoral Conn acrur (Cu. Name) OR Owner pate: ' Signature, . 4WN1i<RAT OCCUPANCY To-,BLIILD114C KPARTivih'N'T, !ACRS RATER (IPAp1'L1CAgL�j I3UCL.Q1iVG r nn rj.q'e,cAvX.ALT10N CERTMCATE Sire Address ' (Page 7 of 12) CF .9wMbar :7 — %F j\v,ff>SCELLA►N-E0 US► CREDITS J� DIAG140STIC SUPPLY WCT LOCATION, SURFACE AREA ANS) R-'VALI' R endlx RC, Rfi & RN, Uf1jr.02for field verifloatton �»d cJiu$nmtla��i���P�Y UIUC�,OUTSlA� OF CONDITIONED SPAC1� ✓' 0 L>GS,S THAN 1Z LINEAL FURT ,COMPLYANCE CREWT t� Y ea ONO >Jess t)lvn 12 lineal foes of su duct ordd s sca. Yes to th s�sl�doonlolll it is a assp�Pu�� SUiE�iPLV DUCTS Y�t1CA'i'�lOr)t'�(CONpI�iQ!N-PACR COMPL+TANC�i C�WIT -., ✓ © yes. I Cl No—I_—Ducts art lona a wI�P)11 W17 wu,A4111W1+N,..-,"'... Yea to tris compliance oreclit ie a ass lyu.'t �y9t8llti )Deii a verlFicatlonis required for a nompllAnco credit for the following., i. Supply duffel surface urea radNetion Z. Buried supply ducts on the eelling . 3, IDeeply buried supply ducts ✓ [3 DUCT SYSTEM D1 9IGN VF-R1FYCATLON _.•— ✓ ❑ Yes No Ad unto airflow verified M, $ectton ✓ p Yes Q No The duct system design plan inaats the requirement4 epeelfied In RACM, App R EA.2 ✓ p Y'as ❑ No Tata ducts stem dost len exists an buildln pjAns Duct sizes, duos system layout' and locations of supply & return rgiar�w rs match the duct sy9tern V C1 Yes D No (jestplan— yes to all is a ass _ ✓ C�1 SIJPPLV (DUCTS Sjj'Rj?ACRAIRjA RUIDUMON COM.'PLrOCE CREDIT It-�1,2 it. b,A K 0 Crawl Deeply Duct Surface Surface �Ar4ae Attic space Basement _Covera Covered Other " (�lamater Area. J I L_! la "I _ Total Su4fgce Area for Each 11-'V014e = Vr y -� -✓ E Yes](I No tches 1?nrtbrmanca's CF -1 R? 'Y6a tDall Is a ass Cl Pass Li Faii ID BURIED (DUCTS ON'THE CItL(NG COMPLIANCE CRED" n Yes 0 No Burled Duots on 6)0 Ceiling .- Q Yes 0 No Ve=Hi&ulationInstallation Quality �j�1fei to duct system desim auppiy duct surface area reduction and this oQmpliance urodlt is a ase 0 DEEPLY ❑ Yes ❑ Yes 'i•as to duct s, )1E I90 DUCTS COMPLIANCE CREDIT p No Deeply Buriod Ducts Q.No Verified High fnsularion Installation ,' I d 1v. v%VkIJ, ns.wa►)TnYI%N'T_ lilEitSIdAT>�R(t1P'Ar►N[,tCA8LE)13UlIip1NG OW14ERATaccupxNCY lLY�,4 oN CERTIFICATE Adilrz3s lj VAN WATT DRAW 1� i -f n�^dclurds ar meustrrin rhr olr handler runrl drm�� a,�d available !n RA,CA11, A ani � 2 ✓ ivl.�nc��d For Fa11 �W31tt Draw Measuremen�t'.�i 13 Rl~3?,1 Porlublo Watt Nieior, easurement n RB3.2.2 Utility Rovonuo ` otcr Mteas1aromant Yap ❑ cfin draw is equftl to or lower than div No Nloasured fan watil ft�n warjaft draw dooumanted in CV -1 It Yns is w pass Pass Fail v, —71,r AIDE, QiUA.T R AIRFY,OW'VRRIF+YCAT[ON $ d 12) %C,'-b� L Wntm ufhl 'SVa,ttslcfm Total cfm cfmlton lAWA 145 , Comractor (Co. Name) OR Gwtter ignature, 1VYAXI1v UTA 'ot COOLING CAPACITY loud i sire uvallubla in RICH/ A endik RF,1. . 7 °. vr:a+ nes %r�rynlr�it� rngxUtrurn cvalin as c+ Adequate ni'flow vcrldO (sec adequate nirFlow credit) i V Q Yas O No ❑ No Rdrigeranr charge or TX Dttet leakage reduction credit verified " ^, ✓ ❑Iles ✓ ❑Yas Q No Cooling, capsoities of lnstulled systems are 5 to miuu,num 0014 V Q Yes ❑ No capjqcjb indicated on the Performance's CV -1 It and P -F-3, ----- If the cooling capacities of instailod systems are > than maximum �/ ✓ ✓ ❑ Yes CI No cooling oapucity in the CF -1 R, then tiler electrical input'for the a installed c stems must by 5 to olectrlcal in ut in the CF -I R. Yes to ! 2 a+td 3: and Yes to eidler 4 or S is a ass Paas it ,/0 HIC. H 1ZEIR M R CONDITIONER - ;'ro�au`trres br verif crlYlvn etre ma(labla in I2.lCh! Appendix RI. i ✓ ❑ 'Yes CI No Eblt values of installed s stems match the CP -1 R ✓7 ' _ ✓ Q Yes ONO Fors lit system, indoor coil is matched to o►ttdoor coil ✓ M Yes O No Time belay Relay VorMad (if Roggired) 0 Pass Fail 'Yes to 1 grid 2' anti 3 if !te aired) is a nsa ! ll'Ubeonn�ctgr (Co Nome) Olt General lAWA 145 , Comractor (Co. Name) OR Gwtter ignature, INSTALLATION CtTIY+'YCAT� Pa s� 9 0 121 �'"' �• l ['Crmit Nti.°mast Sitz Addrzss s ailation certii1eate is required to be posted a ilia Wilding Stas ar made Availblo for all approprlato ed to The bupocoou,ilding ldin f �n to c irlForn�ation pro�nded on thisNfiortn is required) A.fior completion of �3® tion 10i 103(a). PY must be provided to The bui ng cicpartrnaut (upon request) and rhe building owner at occupancy, po -R)OILDYfNG lLN'i=L0p E m4KAGE.DIAGNOSTICS ,/_ pivi+ 11'rocadl�re� -- f 1. Yas 2. 11 Yes 24, Yes ?b. ❑ Yes and a»velcpe leakage are available In R13 - t U11!{ua}lr. *c un .-. _ SO Ps) as measured b F ✓ f3uildin Snvala o l.eak� a (GFM Q _�___ j� Mewured envelope leel,Age leas then or equal to the roguired level froitl �,,� cr•-1R9 d No 3, 1Q 4 Yes No :l ' a Yes NQ Is Moebanical Venjilation shown es required on the CF -1 R? IfMachallical Ventilation is regt1li0d on the CES -'1R (`Yoe' ,In lino 2), baa It baen inatalled? Chock this box'yes' il'meohanioal ventilation is required (`Yes' in line 2) and VOnTl sdoll fb watts are no pater than allows on CF-Measuretf Watts Clack this box `eyes' if romured building fnfl llration (CFM @ S4 Aa) is grawar than the CFM a 50 valtiea shown for an SLA of 1.5 on CF-11- (li this box is checked n meohRnieal ventilation ie re t irod) Cha41c tills boa "ye11111111111, s" tf 4611 ed building infiltration (CFM' ® 50 PA) is an SLA of 1 less Than the CFM Q 50 values 4hown for o moelaa 1041 vontilation is installed and house pressure fas gloatterer R, than minus t 5 Pascal wltb all exhaust Pens statin . Pass It a. Yes in line l and line.3, or b. Yes hi line 1 and line2, 2a, and 2b, or c, yes in line l a»d Yes in line A. Otharurise'fdll. ✓ Q ✓ 1, the undersigned, verity thetthe building envelape leelcada meets the reguiraments claimod for building IcWge raduetion below default sssumptians.As used for compliance on tlho GF -IP— This is W certify that the above diagnpstic lest r=sults and the work i peri'ormed usoclated with the tost(s) is in coicfoned b atile fthbulld0fOmployees oQ s beopntrac Drs edit, (The builder shall provide the HERS provider a copy of the Caro signed by errtifying thea diagnostic testing and installation meet the req ►tlromont3 for compliance credit.) Test Pertormetl lnstuNing Subcontractor (Co. Name) OR General Contractor (Co. game) OR Owner Signtaui= Date: �AT� (10APPLICABLE)� BillUglNG OWNER AT Occup .NCV Cotlite ea: BUILDING DEPARTMENT,>y[., . M 7171qS—T— ILYJATION CIFRTMCATE site Address .;4suvilation justailation Quality Cartificute (� I�e9Criptll)11 of 118VIAtiOn, (CF -6R. formerly IC. 1) signed by the ;riArerial identification, insralled it Yaluas, and. for 10080-0 insulation; ill Choi ll' ho lnsiallutio0 ,,cots All A.01cabla roquiracnants as apeaifled In th {AC1vt, Appendix Mi) o �; r er sta`ing: Insulation ma'nufaoturer's na11le1 lam wolght per square fQat AM MirlfttlVTR r High QluaUty Cnstrlution Installatlan prose arcs FLOOR Cr ❑ Q iavity insulation in9tall d to u»itonr►ly sit tile cavlry side-ta-gide wad an All floor joist ti -to -an Yes No NA C1 ❑ C3 Cnsulra►ion in oartact with the subi, or ar rim joists insulatsrd Yes No NA ❑ p ❑ insulationproporly supportcd Avoid gaps, voids, a.nd uamprassioa Yes MM ❑ PPall crud cavities 0,7144 orJaa,rrvcf to provide ori air tlgh! onvelApe 1:3 Yes q No NA C7. uniformly slira cav(tyside-tp-side, toB-to-bottom, and front -to- as ills [3 No NA Wall stud oavity illy ation Yes l�lo a ' i�joists insulated nary=f'tiat mnnufgcturpr's minimum rioight•p r-sQ ❑ Yas ❑ No NA Na gaps M p l7 No voids oY 314" Gepp A'r mora than 14u/u oi'the batt sucfaeo Area. intersoolxons, anti bohill^ Yes No NA saes wall stud cavitio9 such orns i ceharrriels, Well as; cRVnu C1 ❑ ❑ Hard to a Yes No NA tub/sho orenelosure9 I119215ed to MIs er M 0 13 51na spaces filled Yes No NA i� `Yas Q No ❑ NAa ' i�joists insulated nary=f'tiat mnnufgcturpr's minimum rioight•p r-sQ CJ ❑ ❑ Laos 'rill wall insulation meets or exceeds yes No NA. re uiremont ROOPCEV tVG pREpAIZATIUN ._. wall air barrier !] Q All draft stays in pt[sce to form a coyrcinuous ceiling end .� Yes No A ❑ Q A 'NA All drags covered with lrard covers Yes 11 N 0 hard covers cauilcad or'Cnamad to provide an >iir tight envelope Yea o laA All grail stops and light fixtures iC anti air Might (AT) rr►ce d end seAled with a gasket or caulk bptwoen life 0 Ye 0 No d NA All recessed housarnin attics have. tight drift stop' to Ali trt�1 g Q 0 Floor cavitias on multiple -story buildings air Yas D 'No © NA D- Eave vantsprepared for blown iriNulaeion - maintain not free-verrtilatiou area .._ Yes Q No Q NA .0 Knee walls insulated or prepared for blown insulatlan yes lj No Q NA Areatrndar equipment platforms And cac-wQlks insulated or aecessibla for blown 1112 atlon Yes No NA Q Q Q Attic rulers installed Yes No 1J �:1�J ST.1�Y LA9Cx�l►N CERTIFICATE(Pno a 11 vi 12) �C� Srte Address Permit Number RtYL9/C1�IX�INC>aATrs Q Yes i] No ❑ NA No gAps O p No voids over % in. deep ormoro than 10% of the batt urtace area, Yap ❑ Yes C1 Na D NA Insulation in contact wirh the air-bwTier 0 4�w D Na QUuo NA 'ssad lightfixtaru covered (� D ❑ 'NA Nef fet=e-vr�nfllr�riari area maintained at m e vont? Yes No ✓ ROOF/CIGYY.Y _G LOOSE,FILL q p D insulation uniformly covers th ta'a ceiling (or roo--area from a,- outside of all exCeriar walls. Ycs No NA Baffles installed at eaves nts or soffir vents - maintain net f e-ventl]400n area Of cave vent Yes No NA ties A 0 Attic aoceNa insu'la O Yes ❑ No d NA Recessed light xtures covered Yes No 14A Tnaulatio at proper• depdt — ineuiation .urines visible and inclioating praper d©pth and lY-valuo Q A p Lons� 11117?�ilatluri irjeer.Y a excoecl? rn.onoborr�rer'a� nafniin:+m weight and thlekndss reguiremdnts ll�att'l�'aetztrer's tr��nlmttm regt�irecr< Yes No NA jbr a tar 'er R-vahie, Target R-vaho . (pprinr/s per-syagre-feet). Mtan:ifaalurer's eighr for the fargel Rvalua rjfinit�lz�n7 required lhivknas cif Hind of lnstalltitlan Nfan%&01wrer s Minimum re(lHrred settler! rhiekm au . Nate. To receive oompllanae credil fhe HERS )'peer shall verb Mar the maaWtjorarer'X rritnim-mm weight and Thickness has been achlevedfor rhe -target n valine. CF 6R an B'ECLA' ATION 0 hereby cerri•fy that the in9talic 1'on )Hoots till appllortbla requirements as specilled in rho insulation Inarallation !�; �� ci�►ras. lilsreliing Subconh aoCor (Co. Name) OR Oanaral Contractor (Co. Name) Olt Ownor Signature: pate; Copics vai BUILDING DEPARTMENT, NC'R6 RATER (Ike AY' LICABLpj, a(i(LDING OWNER, Ai OCCUPANCY 'y . o 'Ilq$TALLATION +CEWrIFICATE Site Address Tounry Subdivisiuit -dN, o1jusaumt-joaa (,iF'ortnerly IC -1 Form) I . RAISED FLOOR IVMaTarial Brand Name Thickness (Inches) Thermal Ilea ?, SLAB FLOOR/P'tIMETER� �" NlateYital Brand Na e Thickness (inches)_ .s Thermal s Perimeter lasula' don Depth (inches) ` 3- EX'TI:RIOiI WAIL Fruna Typa A. Cavity insulation M ate.64.l Thickness (inuhos) B, Exterior Foam Sheathing Nlftreri�,,l Thickness (inches) �l. FOUNDATION WALL Material Thickness (irlihes) a. CEILING I ��miirNumhe���* (R-Yalue} taricaj /BrandThermal Resistance (R•Valtse) Brand N•ama Tiaermal Resistance (R -Value) Brand Name Thmial Resistmoo (R -Value) Batt or Blanket Type � Brand Name. Thiol:iiess (inches) Thermal Resistant® (R -Value) Loose, Fill Type Brand 'Contractor's min install d wdighi/ft2 lb Niinirnuln 'thickness �lnchas Manti&Crureva indstall weight per squuro foot to achieve Thermal Resistance (R -Value) 6, ROOF lvl'ati Tial _ Brand Name Thiclmess (int s) Thermal R@slsta1100 (T%.-Va1ue) _.. 3G►,rcY�arat>iou� " 1✓ 0 t' hereby tJ'-ify that the abovo insulation was installed In the bu-ilding alt t46 abovo location in Oonfort 1106 with the ourrenr Sher Sranaards forresidantial buildings Cride, 24,- Part 6, Californla Cade ofRaj$ulations) &s indicated otl dna Cerri Cate of Compliance, when applicublo, 1Date. Ingtallln� suucgntrAgwr k",;vnu►o) v - (if apphcabla) General Contractor (Co, Namo) OR Ownor OR Window Distributor Iran #s signartwo Deto, [nstalling Subcontractor (Co,. Namo) OEC (if applicable) apmeral Contractor (Co -Name) OR Owndr' OR Window Distributor Ceam �� �, Slgnatura Aa+to (it:ipglicabla) • J • w !•nsralling Subaonnacror (Co, Namm) OR 0onaraal Contmajor (Co. Name,) OR,Owncr . OR.Window Distributor