AG Project Completion Form Checklist
HOMEOWNER INFORMATION
FULL NAME
First Name
Last Name
PHONE NUMBER
-
Area Code
Phone Number
IS THE PERSON ABOVE THE OWNER?
YES
NO
OWNER INFO
OWNER FULL NAME
First Name
Last Name
OWNER PHONE
-
Area Code
Phone Number
INCENTIVE RECIPIENT
CONTRACTOR
HOMEOWNER
UTILITY INFORMATION
WHICH PROGRAM?
EUC
TEN
ELECTRIC PROVIDER
SCE
LADWP / OTHER CITY
SCE ACCOUNT NAME
SCE ACCOUNT #
LADWP ACCOUNT NAME
LADWP ACCOUNT #
GAS PROVIDER
SoCal Gas
LGB&O
SOCAL GAS ACCOUNT NAME
SOCAL GAS ACCOUNT #
LGB&O ACCOUNT NAME
LGB&O ACCOUNT #
BUILDING INFORMATION
ADDRESS
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
YEAR BUILT
NUMBER OF STORIES
NUMBER OF BEDROOMS
NUMBER OF OCCUPANTS
CONDITIONED FLOOR AREA (FT²)
FT²
FOUNDATION TYPE
SLAB
BASEMENT
CRAWL
HVAC SYSTEM
CENTRAL DUCTED HEATING AND COOLING SYSTEM
CENTRAL DUCTED HEATING SYSTEM
WALL FURNACE
IS HVAC SYSTEM A HEAT PUMP?
YES
NO
WATER HEATING FUEL TYPE
GAS
ELECTRIC
TANKLESS
TEST IN
REQUESTED TEST IN DATE
-
Month
-
Day
Year
REQUESTED TEST IN APPT TIME (REQUIRES A 3 HOUR WINDOW)
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
until
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
ASBESTOS ABATEMENT NEEDED
YES
NO
**WILL NEED FORM FOR ABATEMENT CERTIFICATE**
ATTIC INSULATION?
NO
YES
**WILL NEED FORM FOR ATTIC INSULATION**
SELECT MEASURES
DUCT SEALING
≤ 10% = $250
≤ 6% = $650
DUCT INSULATION
≥ R - 8 = $550
CENTRAL AIR CONDITIONER
≥ 15 SEER = $750
CENTRAL FURNACE
≥ 92% = $600
≥ 95% = $700
WALL FURNACE
≥ 70% = $400
ATTIC INSULATION
≥ R - 38 = $550
≥ R- 44 = $650
GAS STORAGE & WATER HEATER
EF ≥ 0.67 = $350
EF ≥ 0.70 = $450
GAS TANKLESS WATER HEATER
EF ≥ 0.82 = $900
ELECTRIC WATER HEATER
EF ≥ 2.00 = $400
DOCUMENTATION
INCENTIVE APPLICATION
INVOICE
SIGNED CONTRACT
NOTES
SUBMIT FORM
CONSULTANT E-MAIL
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