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CIER I Ir ICA I h Or COMP LIAA U.L: RESIDENTIAL (Lae I of 3) C&M
M-OAl
Project Title', Dat2,
Project Addre Building
ildin #
Plan Check / Date
Field Check / Date
r-nlOrCeMent Agency Use only
GENERAL INFORMATION,
Total Conditioned Floor Area
Average Ceiling Height: ft
Conditioned Slab Floor Area
A,OP-4-9ft2
, Z4� ft2
Building Type: J,/_
Single Family L,-Addition
(check one or more)
Multi -Family Existing -Plus -Addition
Front Orientation:
kL9_rb / South East /, West / All Orientations
I
Number of Stories
(input front orientation in degrees from True North and circle one).
Number of Dwelling Units:
Floor Construction Type: (Slab iaised Floor (circle one or both)
RADIANT BARRIER (required in climate zones 2,4,8-15) Required for this submitta//yes no
Component
Type
Wall
Frame Type
wd = wood
stl = steel
WD
Cavity
Insulation
R-Value
SheathingTotal
Insulation
R_Value
R-
Value'
Assembly
U-Factors
Location/Cormnents
(attic, garage, typical, etc.)
Wall
Roof
Roof
Floor
Floor
Slab
rEdge.
� — - —V .—I VW I\ V diu-, allu t-.NsuiLluly U-ractor are not Murrea lor g woog-tramed, wall that meets cavity R-value
insulation requirements for the Prescriptive Package.
FENESTRATION
Qllfliv_ n-4—
Fenestration
L/TXpe/Pos.
Front
Orien-
tation
Area
ftz
Fenestration
U-Factor
Fenestration
SHGC
Exterior
Shading Att.
Overhangs/
Fins
2-4
Front
—
Left
Left
Left
Rear
3z_
Rear
E_
Right
Skylight
-Skylight
Compliance Forms
August
MM
M
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 3 of 3) C&IR
4: -1
IIIA-Ile
Project Title Date
COMPLIANCE STATEMENT
This certificate of compliance lists the building features and performance specifications,needed.to comply with
Title 24, Parts I and 6.of the California Code ofReplations, and the administrative regulations to implement
therri. This certificate has been signed by the individual withoverall design responsibility. When this certificate
of compliance is sub mlitted for a single buildi4plan to be. built in multiple Orientations, any shadingfeature that
is varied is indicated in the Special Features/Remarks section. The undersigned recognize that compliance using
duct sealing and TXVs requires installer testing and certification and field verification by an approved HERS
rater.
Resigner or Owner (per Business and Professions Code) Documentation Author
Name:
V /V Name:
Title/Firm: Title/Firm: Allva_ pk47vo
Address: AV
Address: 1/0 clko
0-7a rA '77 0)
Telephone: Telephone:
N, Lic
(si tore) ZOIN
(date) (sigiratur7e el (date)
Enforcement Agency
- ?
Title:
Agency:
Telephone: --- 7
(si atur /a,,
Compliance Forms
August 2001 A-4
CERTIFICATE OF COMPLIANCE: RESIDENTIAL (Page 2 of 3) C&IR
VA"t-1614,17-NI,
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6 Z!�
Project Title
7 19 e4 PR,
Date
HVAC SYSTEMS
Note: Input hydronic or combined hydronic data under Water Heating Systems, except Design
Heating Load.
Distribution
Heating Equipment Minimum Type and Duct or
Heat Pump
Type (furnace, beat Efficiency Location Piping
Thermostat Configuration
pump, etc.) (AFUE or HSPF) (ducts, attic, etc.), R-Value
Type (split or packaEe)
Cooling Equipment Minimum Duct
Heat Pump
Type (air conditioner, Efficiency Location Duct
Thermostat Configuration
heat 12ump, evap. coolinSEERJ (attic, etc.) R-Value
,e
Ty2e (split or package)
SEALED DUCTS and TXVs (or Alternative Measures)
El Sealed Ducts (all climate zones)
(Installer testing and certification and HERS rater field verification required)
0 TXVs, readily accessible (climate zones 2 and 8-15 only)
(Installer testing and certification and HERS Rater or field verification required)
0 Refrigerant Charge/Air Flow (climate zones 2 and 8-15 only)
(Installer testing and certification and HERS Rater or field verification required)
OR
0 Alternative to Sealed Ducts and TXVs (see Package C or D Alternative Package
Features for Project Climate Zone)
Climate Zone Window SHGC Window U-Factor SEER
Heating
WATER HEATING SYSTEMS
Energy External
Rated' Tank
Factor or Tank
Water Heater Distribution Number Input (kW Capacity
Recovery Standby' Insulation
Tv-pe Type in System or Btu/hr Wations)
Efficiency Loss (%) R-Value
1. For small gas storage water heaters (rated inputs of less than or equal to 75,000 Btu/hr), electric resistance, and 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 and Standby Loss.
For instantaneous gas water heaters, list rated input and recovery efficiencies,
SPECIAL FEATURES (add extra sheets if necessary). Package C and D: TXVs, Sealed Ducts, Radiant
Barriers (see installation requirements for radiant barriers in Section 8.13 of the 2001 Residential Manual).
Package C: thermal mass (thermal mass type, covering, thickness, and description).
A ft0V1,9C-RAP1A-& AA-Afla_, Z Wllcc
Compliance Forms August 2001 A-3
MANDATORY MEASURES CHECKLIST: RESIDENTIAL (Page 1 of 2) M&M
Note: Lowrise residential buildings subject to the Standards must contain these measures regardless of the compliance approach used.
Items marked with an asterisk (*) may be superseded by more stringent compliance requirements listed on the Certificate of
Compliance. When this checklist is incorporated into the permit documents, the features noted shall be considered by all parties as
minimum component performance specifications for the mandatory measures whether they are shown elsewhere in the documents
or on this checklist only.
Instructions. Check or initial applicable boxes when completed or enter N/A if not ar)nlicable-
DESCRIPTION
DESIGNER
ENFORCEMENT
Building Envelope Measures:
§150(a): Minimum R-19 Ceiling insulation.
/5-,
§150(b): Loose fill insulation manufacturer's labeled R-Value.
§150(c); Minimum R-13 wall insulation in wood framed walls or equivalent U-Factor in metal frame walls
�does not apply to exterior mass walls).
§150(d): Minimum R-13 raised floor insulation in framed floors.
§1500): Slab edge insulation -water absorption rate no greater than 0.3%, water vapor transmission rate no
greater than 2.0.peniVinch.
§ 118: Insulation spccified.or installed meets insulation quality standards. Indicate type and form.
§ 116-17: Fenestration Products, Exterior Doors, and Infiltration/Exfiltrafion Controls
1. Doors and windows between conditioned and unconditioned spaces designed to limit air leakage.
2. Fenestration products (except field -fabricated) have label with certified U-Factor, certified Solar Heat
Gain Coefficient (SHGC), and infiltration certification.
3. Exterior doors and windows weatherstripped; all joints and penetrations caulked and sealed.
§ 150(g): Vapor barriers mandatory in Climate Zones 14 and 16 only.
150(f): Special infiltration barrier installed to comply with § 151 meets Commission quality standards,
§150(e): Installation of Fireplaces, Decorative Gas Appliances and Gas Logs.
1. Masonry and factory -built fireplaces have:
a. Closeable metal or glass door
b. Outside air intake with damper and control
c. Flue damper and control
2. No continuous burning gas pilot lights allowed.
Space Conditioning, Water Heating and Plumbing System Measures:
§ I 10-§ 113: HVAC equipment, water heaters, showerheads and faucets certified by the Commission.
§ 150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA or ACCA.
§150(i): Setback thermostat on all applicable beating and/or cooling systems.
§ 1500): Pipe and tank insulation
1. Storage gas water beaters rated with an Energy Factor less than 0.58 must he externally wrapped with
insulation having an installed thermal resistance of R-I 2 or greater,
2. First 5 feet Of Pipes closest to water heater tank, non -recirculating systems, insulated (R-4 or greater)
3. Back-up tanks for solar system, unfired storage tanks, or other indirect hot water tanks have R-12
external insulation or R- 16 combined interrial/external insulation.
4. All buried or exposed piping insulated in recirculating sections of bat water systems.
5. Cooling system piping below 55° F insulated.
6. Piping insulated between heating source and indirect hot water tank.
Compliance Forms August 2001 A-5
MANDATORY MEASURES CHEC-KLIST: RESIDENTIAL(Page 2 of 2)MF-lR
Note: Lowrise residential buildings subject to the Standards must contain these measures regardless of the compliance approach used,
Items marked with an asterisk (*) may be superseded by more stringent compliance requirements listed on the Certificate of
Compliance, When this checklist is incorporated into the permit documents, the features noted shall be considered by all parties as
ininimum component performance specifications for the mandatory measures whether they are shown elsewhere in the documents
or on this checklist only.
Instructions: Check or initial applicable boxes when completed or enter N/A if not applicable.
DESCRIPTION
DESIGNER
ENFORCEMENT
Space Conditioning, Water Heating and Plumbing System Measures: (continued)
§150(m); Ducts and Fans
1, All ducts and plenums installed, sealed and insulated to meet the requirement of the 1998 CMC Sections 601,
603, 604, and Standard 6-3; ducts insulated to a minimum installed level of R-4.2 or enclosed entirely in
conditioned space. Openings shall be sealed with mastic, tape, aerosol sealant, or other duct -closure system
that meets the applicable requirements of UL 181, UL 181 A, or UL 181 B. If mastic or tape is used to sea]
openings greater than 1/4 inch, the combination of mastic and either mesh or tape shall be used. Building
cavities shall not be used for conveying conditioned air. Joints and seams of duct systems and their
components shall not be sealed with cloth back rubber adhesive duct tapes unless such tape is used in
combination with mastic and drawbands.
2. Building cavities, support platforms for air handlers, and plenums defined or constructed with materials
other than sealed sheet metal, duct board or flexible duct shall not be used for conveying conditioned
air. Building cavities and support platforms may contain ducts. Ducts installed in cavities and support
platforms shall not be compressed to cause reductions in the cross -sectional area of the ducts.
3. Joints and seams of duct systems and their components shall not be sealed with cloth back rubber
adhesive duct tapes unless such tape is used in combination with mastic and drawbands.
4. Exhaust fan systems have back draft or automatic dampers,
5. Gravity ventilating systems serving conditioned space have either automatic or readily accessible,
manually operated dampers,
6. Protection of Insulation. Insulation shall be protected from damage, including that due to sunlight,
moisture, equipment maintenance, and wind but not limited to the following: Insulation exposed to
weather shall be suitable for outdoor service e.g., protected by aluminum, sheet metal, painted canvas,
or plastic cover. Cellular foam insulation shall be protected as above or painted with a coating that is
water retardant and rovides shieldin Pram solar radiation tliat can cause de radation of the material
§ 114: Pool and Spa Heating Systems and Equipment,
I. System is certified with 78% thermal efficiency, on -off switch, weatherproof operating instructions, no
electric resistance heating and no pilot light.
2. System is installed with:
a. At least 36" of pipe between filter and heater for future solar heating.
b. Cover for outdoor pools or outdoor spas.
3. Pool system has directional inlets and a circulation pump time switch.
§ 115: Gas fired central furnaces, pool heaters, spa heaters or household cooking appliances have no
continuously burning pilot light. (Exception: Non -electrical cookina appliances with pilot < 150 Btu/hr)
§ 118 (f): Cool Roof material meet specified criteria
Lighting Measures:
I 50(k) L: Luminaires for general fighting in kitchens shall have lamps with an efficacy of 40 lumenstwatt
or greater for general lighting in kitchens. This general lighting shall be controlled by a switch on a readily
accessible liEliting control -Panel at an entrance to the kitchen.
§ l50(k)2.:• Rooms with a shower or bathtub must have either at least one luminaire with lamps with an
efficacy of 40 lumens/watt or greater switched at the entrance to the room or one of the alternatives to this
requirement allowed in § I 50(k)2.; and incandescent recessed ceiling fixtures are IC (insulation cover)
approved.
Compliance Forms
August 2001
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