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X.'-01.0 - t -V-6
STATE OF CALIFORNIA
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
CALIFORNIA ENERGY COMMISSION
CECT CF2R-nu-w-,Reviwd .rr r
CERTIFICATE OF INSTALLATION
CF2R-ALT-05-E
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
(Page 1 of 10)
Project Name:
Enforcement Agent,
Q� to
Pmmit Nomber: iryF. 1
Dwelling Address: (I rl) �
C_l
'� cl
cit, Nrte+0 r) C 1-
ll
Z1, code 77 2
This compliance document is only applicable to simple alterations that do not require HERS
with a HERS Provider Data Registry.
HERS verification is required, a CF1R-ALT-01 shall first be registered
Alterations to Space Conditioning Systems that are exemptfrom HERS verification requirements may use the CFIR-ALT-05 and CF2R-ALT-05 Compliance Documents. Possible exemptionsfrom duct
leakage. testing include: less than 40 ft of ducts were added or replaced; or the existing duct system was insulated wlth asbestos; or the existing duct system was previously tested and possed by a
HERS Rater. If space conditioning systems are altered and are not exempt from HERS verification, then a CF1R-ALT-02 must be completed and registered with a HERS Provider Data Registry.
Alterations that utilize close Cell Spray Polyurethane Foam (ccSPF) with a density of 1.5 to less than 2.5 pounds per cubic foot having an R -value other than S.8 per inch, or open Cell Spray
Polyurethane Foam (ocSPF) with a density of 0.4 to less than 1.5 pounds per cubic foot having an R -value of 3.6 per inch, shall complete and register a CF1R-ALT-01 with a HERS Provider Coto
Registry.
If more than one person has responstbilityfor installation of the items on this certificate, each person shall prepare and sign a certificate applicable to the portion of construction for which they are
responsible. Alternatively, the person with chief responsibilityfor constructlon shall prepare and sign this certificate for the entire construction. All applicable Mandatory Measures shall be met.
A. General Information
01
Project Name:
�� Q�
G
02
Date Prepared:
03
Project Location:
liq �Ja�,�
04
Building Front orientation (deg):
13 c)
05
CA City:
S-
06
Nu mber of Dwelling U nits with Additions:
j
07
Zip Code:
1 Z ll
08
Fuel Type:
09
Climate Zone:
10
Total Conditioned Floor Area (ftp) (Addition):
Ono
11
Building Type:
i� r -c— K �-t
12
Slab Area (ft'):
V>1
13
Project Scope:
CA Building Energy Efficiency Standards- 2016 Residential Compliance July 2017
STATE OF CALIFORNIA
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
CAI IFORNIA FNFRGY COMMISSION
OtGOY'Lb(-HLI-u5-t Revised 07ii7
MR -ALT -05-E
CERTIFICATE OF INSTALLATION
03
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
(Page 6 of 10)
Prclect Name:fnfortement
Agency:
Permll Number:.
20-IZ1
09
10
11
Dwelling Address:
City ^ QQ 1
Zip Code Z
Fenestration
L. Fenestration/Glazing
01
02
03
04
05
06
07
08
09
10
11
12
Tag/ID
Manufacturer/
Brand
Fenestration
Area (ft)
Orientation
Chromogenic
U -factor
Source
SHGC
Source
Fenestration
Type
Exterior Shading
Devices
(Describe)
Comments/Special Features
L 5 Ce ,U
t o2
�raM
f�
5
N C-
M. Fenestration/Glazing—Additional Requirements
01 For existing buildings the U -factor and SHGC values should be the same or better than the required Energy Commission prescriptive requirements.
02 Temporary labels should not be removed until verified by the building inspector.
03 The fenestration product manufacturer's installation specifications shall be followed when installing these products. The space between the fenestration product and
rough opening shall be completely filled with insulation. If batt insulation Is used, it is cut to size and placed properly around the fenestration product.
The responsible person's signature on this compliance document affirms that all applicable requirements in this table have been met.
CA Building Energy Efficiency Standards- 2016 Residential Compliance July Lull
STATE OF CALIFORNIA
Proscriptive Residential Alterations That Do Not Require HERS Field Verification
M1AI IFnOAaA FNFROY COMMISSION
CEC-CF2R-ALT-0S-E Revised 07/i
- ----
CF2R-ALT-OS-E
CERTIFICATE OF INSTALLATION
Documentation Author Name: -
1
1 N�iv
Documentation Author Signature:
(Page 10 of 10)
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
�; /' / - � CEA/HERS CertlflcatlonIdentification llFeppllcablel:
Address: �tyl
bb f-.rkt 'C
Protect Name: Enforcement Agenry:
Petmlt Number:
CItV
pvrelling Address: 1 � d� �
....... p,
IZ `ZS
L R {Gl
1. The Information provided on this Certificate of Installation is true and correct.
1 a) a responsible person eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction,
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certificate of Installation documentation is accurate and complete.
Documentation Author Name: -
1
1 N�iv
Documentation Author Signature:
Documeutatlon Author Company Name: 1 y 1
I L'`n GOf
Date Signed: 7/17/2p7CJ
�; /' / - � CEA/HERS CertlflcatlonIdentification llFeppllcablel:
Address: �tyl
bb f-.rkt 'C
CI
city/state/zip:�a Phnne: _ `y,
ff��
RESPONSIBLE PERSON'S DECLARATIONSTATEMENT
I certify the following under penalty of perjury, under the laws of the State of California:
1. The Information provided on this Certificate of Installation is true and correct.
1 a) a responsible person eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction,
2. am either:
or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Installation, and attest to the declarations In this statement,
or b) I am an authorized representative of the responsible person and attest to the declarations In this statement on the responsible person's behalf.
devices Installation) identified on this Certificate of Installation conforms to all applicable codes and
3. The constructed or Installed features, materials, components or manufactured (the
regulations and the Installation conforms to the requirements given on the Certificate of Compliance, plans, and specifications approved by the enforcement agency.
the building Issued for the building, and made available to the -
4. 1 will ensure that a registered copy of this Certificate of Installation shall be posted or made available with permit(s)
Inspections. I that a registered copy of this Certificate of Installation is required to be included with the documentation the builder provides
enforcement agency for all applicable understand
to the building owner at occupancy.
Responsible Builder/Installer Name: pesponsl6le Builder/Installer Signature:
�(�.R Vs-�rt L
Company Name: (InX111ng5ubcontractor or General Contractoror Builder/Owner) Position With Company (Title). (�I�
V J Qi rfd/a ! �M'Cr-b
('�: n of //' .I
CSLG cense: n�
Address; 3`�t. 7`, J4 �l
Phone
city/state/zip: E)CIVIa Il,a 1/j �� /�� Phone tQ_I ' o5 -96? - Date Signed;
,'1, yI/
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
CA Building Energy Efficiency Standards- 2016 Residential Compliance July 2017