BPLB2015-0047LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 {commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my License is in full force and effect:
License Class: C36 D35. C20 C10 B License No.: 896899
Dat, -5 1 w. C_�Contracto`
�r
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjur ,that I am exempt from t Contractor's State
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair
any structure, prior to its issuance, also requires the applicant for the permit to file a
signed statement that he or she is licensed pursuant to the provisions of the
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3
of the Business and Professions Code) or that he or she is exempt therefrom and the
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a
permit subjects the applicant to a civil penalty of not more than five hundred dollars
($500).:
(_J I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for sale.
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
apply to an owner of property who builds or improves thereon, and who does the work
himself or herself through his or her own employees, provided that the improvements
are not intended or offered for sale. If, however, the building or improvement is sold
within one year of completion, the owner -builder will have the burden of proving that
he or she did not build or improve for the purpose of sale.).
( ) I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
(I I am exempt under Sec. B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the performance
of�A,�
b�e work for which this permit is issued.
11tave and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this permit
is issued. My workers' compensation insurance carrier and policy number are:
Carrier: _ Policy Number:
_ I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, if I shoulbecome subject to the
workers' compensation provisions of Section 3700 of th abor Code, I shall f hwith
comply wit thoseFTOSECUREWORKERS'COMINSATION
. .
Datte S 30Applicant:WARNING: AILUCOVERAGE S UNLAWFUL,
AND SHALL SUBJEOYER TO CRIMINNALTIES AND CIVIL INES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,00 ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose
request and for whose benefit work is performed under or pursuant to any permit
issued as a result of this application , the owner, and the applicant, each agrees to, and
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
employees for any act or omission related to the work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is
not commenced within 180 days from date of issuance of such permit, or cessation of
work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws r ating to building
construction, and hereby authorize representatives of this city to a upon the above.
mentione prop rty for inspection purposes. `
30 !
Dae,,: 3 Signature (Applicant or Agent):
VOICE (760) 777-7125
78-495 CALLE TAMPICO
D
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253
COMMUNITY DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 3/30/2015
Application Number: BPLB2015-0047
Owner:
Property Address: 78730 CASTLE PINES DR
DOYLE
APN: 770080009
78730 CASTLE PINES DRIVE
Application Description: DOYLE PEPLACE (1) 40 GALLON
GAS
LA QUINTA, CA 92253
��----�J
Property Zoning:
Application Valuation: $450.00
C:)
ca
Q
o
Applicant:
Contractor:
C
LU
g a
AMERIPAN INC DBA COMPLETE MECH
AMERIPAN INC DBA COMPLETE
MEC CQ
p
77564 COUNTRY CLUB DR #368 B
77564 COUNTRY CLUB DR #368 Bv
PALM DESERT, CA 92211
PALM DESERT, CA 92211
��
z
(760)972-8068
g
Llc. No.: 896899
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 {commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my License is in full force and effect:
License Class: C36 D35. C20 C10 B License No.: 896899
Dat, -5 1 w. C_�Contracto`
�r
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjur ,that I am exempt from t Contractor's State
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair
any structure, prior to its issuance, also requires the applicant for the permit to file a
signed statement that he or she is licensed pursuant to the provisions of the
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3
of the Business and Professions Code) or that he or she is exempt therefrom and the
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a
permit subjects the applicant to a civil penalty of not more than five hundred dollars
($500).:
(_J I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for sale.
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
apply to an owner of property who builds or improves thereon, and who does the work
himself or herself through his or her own employees, provided that the improvements
are not intended or offered for sale. If, however, the building or improvement is sold
within one year of completion, the owner -builder will have the burden of proving that
he or she did not build or improve for the purpose of sale.).
( ) I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
(I I am exempt under Sec. B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the performance
of�A,�
b�e work for which this permit is issued.
11tave and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this permit
is issued. My workers' compensation insurance carrier and policy number are:
Carrier: _ Policy Number:
_ I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, if I shoulbecome subject to the
workers' compensation provisions of Section 3700 of th abor Code, I shall f hwith
comply wit thoseFTOSECUREWORKERS'COMINSATION
. .
Datte S 30Applicant:WARNING: AILUCOVERAGE S UNLAWFUL,
AND SHALL SUBJEOYER TO CRIMINNALTIES AND CIVIL INES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,00 ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose
request and for whose benefit work is performed under or pursuant to any permit
issued as a result of this application , the owner, and the applicant, each agrees to, and
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
employees for any act or omission related to the work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is
not commenced within 180 days from date of issuance of such permit, or cessation of
work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws r ating to building
construction, and hereby authorize representatives of this city to a upon the above.
mentione prop rty for inspection purposes. `
30 !
Dae,,: 3 Signature (Applicant or Agent):
DESCRIPTION
FINANCIAL INFORMATION
ACCOUNT QTY
AMOUNT
PAID
PAID DATE
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA; $1.00 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
WATER HEATER/VENT
101-0000-42401
0
$12.09
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
WATER HEATER/VENT PC
101-0000-42600
0
$7.25
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY.
Total Paid for PLUMBING FEES: $19.34 $0.00
TOTALS:00
Description: DOYLE PEPLACE (1) 40 GALLON GAS
Type: PLUMBING Subtype: Status: UNDER REVIEW
Applied: 3/30/2015 SKH
Approved:
Parcel No: 770080009 Site Address: 78730 CASTLE PINES DR LA QUINTA,CA 92253
Subdivision: TR 25389-2 Block: Lot: 9
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $450.00 Occupancy Type: Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: WATER HEATER CHANGE OUT - 40GALLON/GAS [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL
INSPECTION. 2013 CALIFORNIA BUILDING CODES.
Printed: Monday, March 30, 2015 11:11:59 AM 1 of 2 CRWYSTEMS
CONTACTS
NAME TYPE
NAME
ADDRESSI
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT
AMERIPAN INC DBA COMPLETE
MECH
77564 COUNTRY CLUB
DR #368 B
PALM DESERT
CA
92211
CONTRACTOR
AMERIPAN INC DBA COMPLETE
MECH
77564 COUNTRY CLUB
DR #368 B
PALM DESERT
CA
92211
OWNER
DOYLE
78730 CASTLE PINES
DRIVE
I LA QUINTA
CA
92253
Printed: Monday, March 30, 2015 11:11:59 AM 1 of 2 CRWYSTEMS
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT REMARKS NOTES
PLUMBING FINAL" BLD
CLTDI
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID- ATE
RECEIPT #
CHECK #
METHOD
PAID BY
BY
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
Total Paid forBU1LDING STANDARDS ADMINISTRATION $1.00 $0.00
BSA:
PERMIT ISSUANCE
1 101-0000-42404
1 0
$91.85
$0.00
Total Paid forPERMIT ISSUANCE: $91.85 $0.00
WATER HEATER/VENT
101-0000-42401
0
$12.09
$0.00
WATER HEATER/VENT
101-0000-42600
0
$7.25
$0.00
PC
Total Paid for PLUMBING FEES: $19.34 $0.00 ,
TOTALS:•0
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED
DATE DATE
RESULT REMARKS NOTES
PLUMBING FINAL" BLD
ATTACHMENTS
Printed: Monday, March 30, 2015 11:11:59 AM 2 of 2 CRWYSTEMS
Bin #
City of La Quinta
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
r
Project Address: 36 PS%Lt� %N6-5
Owner's Name:
A. P. Number:,
Address: 7 30 P3%,�tye5
Legal Description:
City, ST; Zip: N%
CP r L
Contractor: Mpp � V
✓
Telephone:
e hone•
Address: 2 ZcW N119 G►7
Project Description:
City, ST, Zip: e4CS�0-% 644
T ne•
ele h 0
P 9 Z
State Lic. #:
City Lic. #:
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
PaneY•
Consfrac n Type: Occupancy:
State Lic. #:
S
Repa
d' Alter Demo
r ' w Ad n R
P o ect a circle one): New P
J tYP � )
Name of Contact Person:
Sq. Ft.:
# Stories:
nits:
Telephone # of Contact Person:
Estimated Value of Proj
APPLICANT: DO NOT WRITE BELOW THIS LINE
/t
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cafes.
Called Contact Person
Plan Check Balance
Title 24 Cafes.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2p. Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS
CEC-CFIR-ALT-01-E Revised 06/14 CALIFORNIA ENERGY COMMISSION nac!w
CERTIFICATE OF COMPLIANCE CF1R-ALT-01-E
Prescriptive Residential Alterations (Pagp 1 of 4)
Project Name: 7A 7 3 b A,, -7a fNrs /Z._ I ,A yllv7�' G 2.L S3 Date Prepared: ? 30 JS—
A. GENERAL INFORMATION
01
A=*
01
Project Name:
02
Date Prepared:
03
Project Location: P57 (, 11vr,,s
04
Building Front drieri4ationt(deg or cardinal):
05
CA City: P w[V7O
06
Number of Alf ered;pwelling Units: r, �
07
Zip Code: Z tS3
08
Fuel Type:
09
Climate Zone:
10
Total,Coriditibn'ed Floor -Area (ft2p'
11
1 Building Type
12
SIab,Area'(ft2) A
13
Project Scope:Imo`
' W� ",n
B. BUILDING INSULATION DETAILS (Section 150.2(b)1) 4MA —
01
02
03
04
05
06 _ �"�'1n� 07 084 1%09
10
11
Tag/ID
Assembly Type
Frame
Type
Frame
Depth
(inches)
Frame
Spacing
(inches)
(,
a &111�
ff Proposed t4 V'r +1
Required
Comments
,Continuous G
Cavity InR-value
R -value ,U=factor
ppendixJA4
Reference
LI -Factor
Table, Cell
Deck
Insula iso
Solar Aged Solar Thermal SRI Aged Solar Thermal SRI
Reflectance Reflectance Emittance (Optional) Reflectance Emittance (Optional)
v I"k2o'
NOTES
.% s4t wr 101;� el 1P
C. ROOF REPLACEMENT (Prescriptive Alteration, S on1150.2(b)1H ) �-kN\
01
02
03
04 ,
05\,
06
t070V 08 09 10 it 12 13
R -value lue
it
Proposed Minimum Required
Method of
Compliance
Roof
Pitch
Exception
CRRC Product ID
CNC' t tu,
rber
�,gr`oduct Type _
Deck
Insula iso
Solar Aged Solar Thermal SRI Aged Solar Thermal SRI
Reflectance Reflectance Emittance (Optional) Reflectance Emittance (Optional)
NOTES
• Roof area covered byb ildl g integrated phot)"aic panels and solar thermal panels are exempt from the above Cool Roof requirements.
• Liquid field applied coatings,must comply with\installation criteria from section 110.8(i)4.
Registration Number: Registration Date/Time: HERS Provider:
CA Building Energy Efficiency Standards - 2013 Residential Compliance June 2014
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS o
CEC-CF1R-ALT-01-E Revised 06/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-01-E
Prescriptive Residential Alterations (Page 2 of 4)
Project Name: 7 $ 73A �7lrr UPJ Lkt1v113 GA 07 Z2_ S"3 Date Prepared: 3 TU I /f -
D. FENESTRATION/GLAZING AREAS ALLOWED (Section 150.2(b)1) _,F;161
01 02
04y�
03
Alteration Type Orientation
Maximum Allowed ft2 Comm'er)ts
�r
A � _ M \k V�
i►. ov
E. FENESTRATION/GLAZING PROPOSED AREAS AND EFFICIENCIES (Section 1S0.2(b)1) lkt:# W
A0V4k,
y�
01
02
03
04
05
06
07
08
09
1
1
12
13
14
15
}�NVILCombined
Orientation
Area
Area
Nee
Maximum'
Exterior
SHGC
Tag/
Fenestration
Frame
Dynamic
N, S, W, E, or
Removed
Added
,'Added
Allowed
Shading
from
ID
I Type
Type
Glazing
1 Roof
ft2
ft2 ,
Area ft2
♦*
_ Ll factor
LI -factor
I Source
SHGC
Source
Device
CF1R-ENV-03
<'
V'I
r� v
a
Net AddedWesf c ng eF nestration Areai
b
Existing + AddaFene Fenestration Area
c
MaximumAllowed West-facing=Fenestration Area
d
Is West -facing Fenestration Area,< M(`axixiiijmuum"Allowed W♦eestt'ffa�ng Fenestration;
e
i - Eat., i Xr i� `�i "
Net Added Fe` estration Area (all o'IL, " ai. ons)
fEz�sting
+Added;Fenestration Area (all�oi'ientations)
g,
Maximum Allowed Fenestration Area (all orientations)
h
Is Existing + Added -Fenestration Area <`rMaximum Allowed Fenestration Area (all
A orientations)
Registration Number: Registration Date/Time: HERS Provider:
CA Building Energy Efficiency Standards - 2013 Residential Compliance June 2014
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS - Hca
CEC-CFIR-ALT-01-E Revised 06/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-01-E
Prescriptive Residential Alterations (Pale 3 of
Project Name: 2973DO As7G6 fNGs ,A IJ11N.7A gZZ�3 Date Prepared: 3 30 �
F. SPACE CONDITIONING(SC) SYSTEMS — HEATING/COOLING (Prescriptive section 150.2(b))�
01 02 03
Y
Dwelling Unit Name Dwelling Unit CFA (Ft2) Comnts,
WCOMtFtiii
G. WATER HEATING SYSTEMS (Section 150.2(b)1G) \,�Av
01
02
03
04
05
06
07
08
U9��'��
10
(171 %)
v12
13
14
15
Water Heating
to the Space
of
Water
Name ,�
,,,<fdentification or Name
Conditioning System(s)?
Comments
I
v
Water
Heater
_'1�
CHe
}
Back -Up
System
Water
Water
Heaters
Storage
Rated
Rated
Heating
g
cie ry
Exterior
Solar
Dwelling Unit DHW
Identification or
Heating
Heater
in
Volume
Fuel
Input
�Inputl
Efficiency
-jEff
Standby
Insul.
Savings
Central DHW System
System
Name
System Type
Type
system
(gal)
Type
Type,
k Value
Type;(
Loss (%)
R -Value
Fraction
Distribution Type
Distribution Type
IWNL
N P7
V
v
,�+►�
to
r.
'4
A4
H. SPACE CONDITIONING SYSTEMS AND WATER HEATING SYSTEMS IIWIVIULTIFAMILY DWELLING UNITS
,�.,��
01
02
i ' 03�,, ` �
04
05
06
Central Water Heating
� ti* ('.-"Water
Dffwelling Unit
Heating System
Dwelling Unit:
Alteration
Dwelling fUnit Total CFA
System Identification or
to the Space
Dwelling Unit Name
(it2
Name ,�
,,,<fdentification or Name
Conditioning System(s)?
Comments
Registration Number:
CA Building Energy Efficiency Standards - 2013 Residential Compliance
Registration Date/Time:
HERS Provider:
June 2014
STATE OF CALIFORNIA
RESIDENTIAL ALTERATIONS a
CEC-CF1 R -ALT -01-E Revised 06/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-01-E
Prescriptive Residential Alterations A (Pz1ge 4 of 4)
Project Name: 7t6 73t, rI✓ftV7A(!-A-Zz S-3! Date Prepared: 3 -a )
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 14.,,
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation uthor N e:
QJJN
Document Signature: y iflN
�gn
Il <kr`►
Comp
Signature Date: 3" J
Address:Q( �j
7 7,
CEA/ HERS Ce )cation Ide tification'' f applicable): '
Cit /S /Zip: /
r'� �Elr-�7 (;I 1 Z'� j'
Phone:,
R SPONSIBL PERSON'S DECLARATION STATEMENT + Z;
I certify the following under penalty of perjury, under the laws of the State of California
1. The information this Certificate Compliance is true
provided on of and correct.
i for the building design or system design identified on this Certificate of Compliance (responsible
2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsbi
designer). `�6/
3. That the energy features and performance specifications, materials, components,, and manufactured devices for the building design or system design identified on this Certificate of
Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the C ifornia Code of'Regulat ons.
wi27�
4. The building design features or system design features identified on this Certificate of Compliance are consistent a information provided on other applicable compliance documents,
worksheets, calculations, plans and specifications submitted to the enforcement agencyfo�+ pproval with this bu Old permit application.
4� �0 .� - ALNk�+.:!
5. 1 will ensure that a registered copy of this Certificate of Compliance -shall be made,available with the building permit(s) issued for the building, and made available to the enforcement agency
o%"%,y
for Compliances building
f this CCertific�at�o`f iis,re, quired'to be included with the documentation the builder provides to the
all applicabe inpections. I understand that a regisstteere�
owner at occupancy.
Responsible Designer Name:"Responsible
-...
Designer Signature:
V Y
Company: '0 }
Date Signed:
Address:
License:
City/State/Zip: A) t•-'' _
Phone:
For assistance or -questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
Registration Number: Registration Date/Time: HERS Provider:
CA Building Energy Efficiency Standards - 2013 Residential Compliance June 2014