07-3236 (MFD5) CF-6R InstallationCERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 7 of 8) CF-4R
Project Title: La Quinta Dune Palms Quality Insulation Date; 1/20/2008
oject Address: 47-795 Dune Palms Rd Bld# 8300 La Quinta CA 92253 Builder Name:
Builder or Installer Contact:
HERS Rater:
Kevin Rasmus
Certifying Signature: /
Firm:
Street Address:
Telephone: I Permit or Plan No.
Telephone: Sample Group No.
619-251-7982 Not Sam
Date: Sample House No.
HERS Provider:
City / State / Zip
Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE), BUILDING OWNER AT OCCUPANCY
HERS RATER COMPLIANCE STATEMENT
This house was: ✓ ® Tested ✓ ❑ Approved as part of a sample testing, but was not tested.
As the HERS rater providing diagnostic testing and field verification, I certify that the house identified on this form complies
with all applicable requirements of the "High Quality Installation of Insulation" protocols as specified in the Residential
ACM, Appendix RH and as checked on this form. Note that to PASS and receive compliance credit, NONE of the BOXES
below may be checked "No" and the first three boxes also must be checked. Check "NA" only if the item is not part of the
design of the building (i.e., single story buildings do not have rim joists or there may be no recessed can lights installed,
etc.).
✓ ® REQUIREMENTS FOR "HIGH QUALITY INSTALLATION OF INSULATION" COMPLIANCE CREDIT
✓ ❑ The building is wood frame construction with wall stud cavities, ceilings, and roof assemblies insulated
with mineral fiber or cellulose insulation in low-rise residential buildings.
✓ ® Description of insulation, (CF-6R, formerly IC-1) signed by the installer stating: insulation manufacturer's
name, material identification, installed R-values, and for loose -fill insulation: minimum weight per square
foot and minimum inches.
✓ ® Installation Certificate, (CF-6R) signed by the installer certifying that the installation meets all
applicable requirements as specified in the High Quality Insulation Installation Procedures
(ACM, Appendix RH).
✓FLOOR
❑
❑
®
All floor joist cavity insulation installed to uniformly fit the cavity side -to -side and end -to -end
YES
No
NA
®
❑
❑
Insulation in contact with the subfloor or rim joists insulated
YES
No
NA
❑
❑
®
Insulation properly supported to avoid gaps, voids, and compression
YES
No
NA
✓WALLS
®
❑
❑
Wall stud cavity insulation uniformly fills the cavity side -to -side, top -to -bottom, and front -to -back
YES
No
NA
®
❑
❑
No Gaps
YES
No
NA
®
❑
❑
No voids over 3/4" deep or more than 10% of the batt surface area.
YES
No
NA
®
❑
❑
Hard to access wall stud cavities such as; corner channels, wall intersections, and behind
YES
No
NA
tub/shower enclosures insulated to proper R-Value
®
❑
❑
Small spaces filled
YES
No
NA
®
❑
❑
Rim -joists insulated
vES
No
NA
Is
❑
❑
I
Wall stud cavities caulked or foamed to provide an air tight envelope.
YES
No
NA
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page 7 of 8) CF-4R
Project Title: La Ouinta Dune Palms Quality Insulation Date:
112012008.
oject Address: 47_795 Dune Palms Rd Bld# 8300 La Quinta CA 92253 Builder Name:
Builder or Installer Contact: Telephone: Permit or Plan No.
CVHC 800-689-4663 07-323,
HERS Rater: Telephone: Sample Group No.
Kevin Rasmu en CCNKR350475 619-251-7982 Not Sam
Certifying Signature: Date: Sample House No.
1/20/2008 Not Sam
Firm: HERS Provider:
So Cal HERS Raters CHEERS R
Street Address: _I City / State / Zip
Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE), BUILDING OWNER AT OCCUPANCY
HERS RATER COMPLIANCE STATEMENT
This house was: ✓ ® Tested ✓ ❑ Approved as part of a sample testing, but was not tested.
As the HERS rater providing diagnostic testing and field verification, I certify that the house identified on this form complies
with all applicable requirements of the "High Quality Installation of Insulation" protocols as specified in the Residential
ACM, Appendix RH and as checked on this form. Note that to PASS and receive compliance credit, NONE of the BOXES
below may be checked "No" and the first three boxes also must be checked. Check "NA" only if the item is not part of the
design of the building (i.e., single story buildings do not have rim joists or there may be no recessed can lights installed,
etc.).
✓ ® REQUIREMENTS FOR "HIGH QUALITY INSTALLATION OF INSULATION" COMPLIANCE CREDIT
✓ ® The building is wood frame construction with wall stud cavities, ceilings, and roof assemblies insulated
with mineral fiber or cellulose insulation in low-rise residential buildings.
✓ ® Description of insulation, (CF-6R, formerly IC-1) signed by the installer stating: insulation manufacturer's
name, material identification, installed R-values, and for loose -fill insulation: minimum weight per square
foot and minimum inches.
✓ ® Installation Certificate, (CF-6R) signed by the installer certifying that the installation meets all
applicable requirements as specified in the High Quality Insulation Installation Procedures
ACM Appendix RH .
✓FLOOR
❑
❑
®
All floor joist cavity insulation installed to uniformly fit the cavity side -to -side and end -to -end
YES
No
NA
®
❑
❑
Insulation in contact with the subfloor or rim joists insulated
YES
No
NA
❑
❑
®
Insulation properly supported to avoid gaps, voids, and compression
YES I
No
NA
✓WALLS
®
❑
❑
Wall stud cavity insulation uniformly fills the cavity side -to -side, top -to -bottom, and front -to -back
YES
No
NA
®
❑
❑
No Gaps
YES
No
NA
®
❑
❑
No voids over 3/4" deep or more than 10% of the batt surface area.
YES
No
NA
®
❑
❑
Hard to access wall stud cavities such as; corner channels, wall intersections, and behind
YES
No
NA
tub/shower enclosures insulated to proper R-Value
®
❑
❑
Small spaces filled
YES
No
NA
®
❑
❑
Rim -joists insulated
ES
No
NA
®
❑
❑
Wall stud cavities caulked or foamed to provide an air tight envelope.
YES
No
NA
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING Pa a 8 of S CF-411
"eject Address 47_795 Dune Palms Rd. Bid# 8300 La Quinta, CA 92253
Builders Name
CVHC
✓Roof/Ceilin Pre
®
❑
❑
All draft stops in place to form a continuous ceiling and wall air barrier.
YES
No
NA
®
❑
❑
All drops covered with hard covers
YES
No
NA
®
❑
❑
All draft stops and hard covers caulked or foamed to provide an air tight envelope
YES
No
NA
®
❑
❑
All recessed light fixtures IC and air tight (AT) rated and sealed with a gasket or caulk between
YES
No
NA
the housing and the ceiling
®
❑
❑
Floor cavities on multiple -story buildings have air tight draft stops to all adjoining attics
YES
No
NA
❑
❑
®
Eave vents prepared for blown insulation - maintain net free -ventilation area
YES
No
NA
❑
❑
®
Knee walls insulated or prepared for blown insulation
YES
No
NA
❑
❑
®
Area under equipment platforms and cat -walks insulated or accessible for blown insulation
YES
No
NA
❑
❑
®
Attic rulers installed
YES
No
NA
`.00f/Ceilinq Batts
❑
❑
No Gaps
YES
No
NA
®
❑
❑
No voids over 3/4 in, deep or more than 10% of the batt surface area.
YES
No
NA
®
❑
❑
Insulation in contact with the air -barrier
YES
No
NA
®
❑
❑
Recessed light fixtures covered
YES
No
NA
❑
❑
®
Net free -ventilation area maintained at eave vents
YES
No
NA
VRoof/Ceiling
Loose Fill
®
❑
❑
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
YES
No
I NA
Loose -fill insulation meets or exceeds manufacturer's minimum weight and thickness requirements
for the target R-value. Target R-value . Manufacturer's minimum required
weight for the target R-value (pounds -per -square -foot). Manufacturer's
❑
❑
®
minimum required thickness at time of installation . Manufacturer's minimum
YES
No
NA
required settled thickness . Note: To receive compliance credit the HERS rater
shall verify that the manufacturer's minimum weight and thickness has been achieved for the
target R-value. (CF-6111 only)
INSTALLATION CERTIFICATE (Page 2 of 12) CF-6R
Site Address Permit Number
47-795 Dune Palms Rd, La Quinta, Ca BLDG - 8300 07-3236
An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (Tile
information provided on this form is required) After completion of final inspection, a copy must be provided to the building
department (upon request) and the building owner at occupancy, per Section 10-103(a).
FENESTRATION/GLAZING:
Item
Manufacturer/Brand
Name
LIKE
RODUCTS)
Product U-factor'
(5CF-1Rvalue)2
Product SHGC'
(_<CF-1Rvaluc)
# of
Panes
Total
Quantity of
Like Product
(Optional)
Area
Square
Feet
Exterior(GROUP
Shading Device
orOverhang
m
Coments/L.ocation/
Special Features
1.
Pella/Impervia
31
32
2
N/A
2.
_..
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
'1 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.
't Installed U-factor must be less than or equal to values from CF-I R.. Installed SHGC must be less than or equal to values
from CF-1 R, or a shading device (exterior or overhang) is installed as specified on the CF-1 R. Alternatively, installed
weighted average U-factors for the total fenestration area are less than or equal to values from CF-I R. If using default table
SHGC values from § 116 identify whether tinted or not.
✓ X 1, the undersigned, verify that the fenestration/glazing listed above my signature: 1) is the actual fenestration
product installed; 2) is equivalent to or has a lower U-factor and lower SHGC than that specified in the certificate of
compliance (Form CF-I R) submitted for compliance with the Energy Efficiency Standards for residential buildings; and
3) the product meets or exceeds the appropriate requirements for manufactured devices (from Part 6), where applicable.
Item #s
Signatur Date
Installing Subcontractor (Co. Name) OR
(if applicable)
General Contractor (Co. Name) OR Owner
S-1151 D
OR Window Distributor
Pella Windows & Doors- HSC, Inc.
Item #s
Signature Date
Installing Subcontractor (Co. Name) OR
(if applicable)
General Contractor (Co. Name) OR Owner
OR' Window Distributor
Item #s
Signature Date
Installing Subcontractor (Co. Name) OR
(if applicable)
General Contractor (Co.. Name) OR Owner
OR Window Distributor
Copies to: Building Department, HERS Rater (if applicable) Building Owner at Occupancy
Residential Compliance Forms
April 2005
INSTALLATION CERTIFICATE (Page 3 of 12) CF-6R
Site Address it Number
L91 -7 S- QVs0E � � Ro 1-;)1-;)GXus�zA a 9�Perm0-7 — 3-a36
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: Q U L fl g 3 o o
Heating Equipment
�1 c.
Equip Type
CEC Certified Mfr.
# of
Efficiency
(AFUE, etc.)
Duct
Duct or
Heating
Heating
Capacity
Name and Model
Identical
Location
Piping
Load
(pkg. heat um
Number
Svstems
(>_CF-IR value)
(attic, etc.)
R-value
(Bni/hr)
(Btu/hr)
FAN Coi t_
3 icp-x(), c
--e1''
Hor
F?,Tl0
WM HoT
31c p-ct0. G
-0'
Wprrer-
to
.A,vo
Z-2-2 -100
WRr)-L--a Col (-
3 (Z'"S Q'S
S
14 cam.
a
Cooling Equipment
Equip Type
-(pkg. heat um)
CPRiz SC--e-
CEC Certified Mfr.
Name and Model
Number
# of
Identical
Systems
Efficiency
t
(SEE or EER)
>CF-IR value)
Duct
Location
(attic, etc.)
Duct
R-value
Cooling
Load
(Btulhr)
Cooling
Capacity
(Btuthr)
Coot- ®.Nt—Y
-ay.AC843afl
ff�"
1 L4_o
p ric
tz y.---z
3000-0
5Eru1r��
"
Arica
3b o00
Do%--
CRgtej:�
1
14.0
`'
IZ8.0
46�000
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.
✓ lJI 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
S' (�1 �E�yp�� Scp�� •G'p,,.+5� ZNeo
Signature: aD-1
Date: S A 5 „0L9
Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY
Residential Compliance Forms
April 2005
tv,Ji1I I. 1
INSTAALkTICN CERTIFICATE
I Site Address Permit Number
Installation certificates (CF-6R) are required for each and everywelling unit. When the installation of measures that require
field verification and diagnostic testing is complete, the builder or the builder's subcontractor shall complete diagnostic
testing and the procedures specified in this section. When the installation is complete, the builder or the builder's
subcontractor shall complete the CF-6R (Installation Certificate), and keep it at the building site for review by the building
department. The builder also shall provide a copy of the Installation Certificate to the HERS rater for any measures requiring
field verification and diagnostic testing, per Section I0-103(a),
WATER HEATING
CEC Certifiod . Type I if — 1 _ # of I Rawd lPput
Hearer ` Mfr Name & (Std, Point- Recirculation, Identical If (kW ° Tank Volute
External
Standby Insulation
Loss (%)2 R-valuo2
All 2-1(n
1 For small gas storage (rated input of less than or equal to 75,000 Btu/ht), 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 (RE), Thermal Efficiency, Standby Loss and hated Input, For instantaneous gas water heaters, list Thermal
Efficiency and hated Input.
2. R-12 external insulation is mandatory for storage water heaters with an energy factor of less than 0.55.
(` Kitchen Piping:
If indicated on the CF-I R, all hot water piping ? 3/4 inches in diameter that runs from the hot water source to the kitchen
fixtures is insulated.
Faucets & Shower Heads:
All faucets and showerheads installed are certified to the Energy Commission, pursuant to Title 24, Part 6, Section 111.
Central Water Heating in Buildings with Multiple Dwelling Units (required for prescriptive)
MAII 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 Sectiwt 1506)
❑ Central hot water systems serving more than 6 dwelling units - presence of either a time control or a time/temperature
control
✓ Q 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-IR) submitted for compliance
with the Energy Efciency Standards for residential buildings; and 3) equipment that meets or exceeds the appropriate
requirements for manufactured devices (from the Appliance Ef cierrcy Regulations or Part 6), where applicable.
Installing Subcontractor (Co. Name) OR General
Contractor (Co. Name) OR Owner
Signature: (1,m �u /, _ Date;
Copies to:13MI)ING DEPARTMENT, TIERS RATER (IF APPLICABLE) BUILDING OWNER AT OCCUPANCY
INSTALLATION CERTIFICATE
Sdress 0
(PAGE 10 OF 1�) CF.6R
ermi er
4� DUNE PALMS RD. BLD# 8300 7-3236 um
Insulation Installation Quality Certificate
✓ 0 Description of Insulation, (CF-6R, formely IC-1) signed by the installer stating: insulation manufacturer's name,
material identification, installed R-values, and for loose -fill insulation: minimum weight per square foot and minimum
inches
✓ E Installation meets all applicable requirements as specified in the High Quality Insulation Installation Procedures
(ACM, Appendix RH)
✓ FLOOR
0
No
0
All floor joist cavity insulation installed to uniformly fit the cavity side -to -side and end -to -end
0
No
0
Insulation in contact with the subfloor or rim joists insulated
Pes
F
PA
Insulation properly supported to avoid gaps, voids, and compression
✓ WALLS
Yes
AO
NOA
Wall stud cavities caulked or foamed to provide an air tight envelope
l es
0
0
Wall stud cavity insualtion uniformly fills the cavity side -to -side, top -to -bottom, and front -to -back
YesP
0
No gaps
Yes
Pon
�A
No voids over 3/4" deep or more than 10% of the batt surface area
No
t�7A
Hard to accesswall stud cavities such as; corner channels, wall intersections, and behind
tub/shower enclosures insulated to proper R-Value
YesM
P
PASmall
spaces filled
0
Rim joists insulated
Pnnes
R
4A
I Loose fill wall insulation meets or exceeds manufacturer's minimum weight -per -square -foot requirement
✓ ROOF/CEILING
PREPARATION
Pes
o
0
All draft stops in place to form a continuous ceiling and wall air barrier
Ps
Poo
PA
All drops covered with hard covers
Yes
All draft stops and hard covers caulked or foamed to provide an air tight envelope
Pn�
s
TSo
n❑
IJ/A
All recessed light fixtures IC and air tight (AT) rated and sealed with a gasket or caulk between the
housing and the ceiling
Yes
PoPs
tEA
Floor cavities on multiple -story buildings have air tight draft stops to all adjoining attics
Mo
1 4A
Eave vents prepared for blown insulation - maintain net free -ventilation area
Ys
El
�A
Knee walls insulated or prepared for blown insualtion
Ps
Po
4A
Area under equipment platforms and car -walks insulated or accessible for blow insulation
0
NR
Attic rulers installed
Residental Compliance Forms April 2005
'INSTALLATION CERTIFICATE (PAGE OF �ZJ cF-6Fi Address
. /-795 DUNE PALMS RD. BLD# 8300 Permit Number
✓ ROOF CEILING BATTS
Yes
0
No gaps
Yes
No voids over 3/4" deep or more than 10% of the batt surface area
l es
Flo
6
1 Insulation in contact with the air -barrier
Yes
Y
N/A
Recessed light fixtures covered
l es
i
Net free -ventilation area maintained at eave vents
✓ ROOF/CEILING LOOSE -FILL
�sTR
IEA
Insulation uniformly covers the entire ceiling (or roof) area from the outside of all exterior walls
Ps
R
6
Baffles installed at eaves vents or soffit vents - maintain net free-ventilationa rea of eave vent
1'es
11,
6
Attic access insulated
`es
R
6
Recessed light fixtures covered
l es
R
6
Insulation at proper depth - insualtion rulers visible and indicating proper depth and R-Value
Ye
No
No
N/A
Loose -fill insualtion meets or exceeds manufacturer's minimum weight and thickness requirements for the
target R-value. Target R-value . Manufacturer's minimum required weight for
the target R-value (pounds -per -square -foot). Manufacturer's minimum
required thickness at time of installation . Manufacturer's minimum required settled
thickness . Note: To receive compliance credit the HERS rater shall verify that the
manufacturer's minimum weight and thickness has been achieved for the target R-value. (CF-6R only)
DECLARATION
✓ 0 1 hereby certify that the installation meets all applicable requirements as specified in the Insulation Installation
Procedures
Installing Subcontractor (Co. Name) OR General
Contractor Co. Na Owner
MASCO CONTRACTOR SERVICES
Si nature. ) &_
Date:
Copies to: BUILDING DEPARTMENT, HERS RATER (IF APPLICABLE), BUILDING OWNER AT OCCUPANCY
Residental Compliance Forms April 2005
'5I ALLATION CERTIFICATE
-795 DUNE PALMS RD. BLD# 8300
Subdivision: La Quinta Dune Palms
Description of Insulation (Formerly IC-1) Form)
1 RAISED FLOOR
Material N/A
Thickness (inches)
2 SLAB FLOOR/PERIMETER
Material N/A
Thickness (inches)
Perimeter Insulation Depth (Inches)
3 EXTERIOR WALL
Frame Type WOOD 2 X 6
A. Cavity Insulation
Material FIBER GLASS INSULATION
Thicness (inches) 5.5 INCHES
B. Exterior Foam Sheathing _
Material
Thicness (inches)
FOUNDATION WALL
Material N/A
Thickness (inches)
E 12 OF 12
wmit Number
-3236
Brand Name
Thermal Resistance (R-value)
Brand Name
Thermal Resistance (R-value)
Brand Name CERTAINTEED
Thermal Resistance (R-value)
Brand Name
Thermal Resistance (R-value)
Brand Name
Thermal Resistance (R-value)
5 CEILING
Batt or Blanket Type BATT Brand Name CERTAINTEED
Thickness (inches) 12 INCHES Thermal Resistance (R-value)
Loose Fill Type Brand
Contactor's min installed weight/ft lb Minimum thickness
Manufacturer's installed weight per square foot to achieve Thermal Resistance (R-Value)
Number 8300
inches
R-21
R-38
GF-6R
6 ROOF
Material N/A Brand Name
Thickness (inches) Thermal Resistance (R-value)
DECLARATION
✓ El hereby certify that the abouve insulation was installed in the building at the above location in conformance with the
current Energy Efficiency Standards for residential buildings (Title 24, Part 6, California Code of Regulations) as indicated
on the Certificate of Compliance, where applicable.
Item #s
(if applicable)
Signature Date
Installing Subcontractor (Co. Name) OR
General Contractor (Co. Name) OR Owner
3,5
`'� C' ��� r (
OR Window Distributor
MASCO CONTRACTOR SERVICES
Item #s
Signature Date
Installing Subcontractor (Co. Name) OR
(if applicable)
General Contractor (Co. Name) OR Owner
OR Window Distributor
n #s
Signature Date
Installing Subcontractor (Co. Name) OR
applicable)
General Contractor (Co. Name) OR Owner
OR Window Distributor
Residental Compliance Forms April 2005