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
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
Date Picker Icon
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
AM/PM Option
until
until
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
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
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INVOICE
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SIGNED CONTRACT
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NOTES
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