BSIG2014-1020VOICE (760) 777-7125
78 495 CALLE TAMPICO � O�iD 4 Qum&
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 10/17/2014
Application Number: BSIG2014-1020
Owner:
Property Address: 78370 HIGHWAY 111 130
POINT HAPPY REALTY
APN: 604050068
8665 WILSHIRE BLV STE 410
c
Application Description: (1) ILLUMINATED CHANEL SIGN "WEIGHT LOSS"
BEVERLY HILLS, CA 92253
X
Property Zoning:
O
Application Valuation: $1,700.00
o
c
E;
Applicant:
Contractor:
m Q
�
PD GROUP DBA SIGNARAMA
PD GROUP DBA SIGNARAMA
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iv
41945 BOARDWALK SUITE L
41945 BOARDWALK SUITE L
v y
o
PALM DESERT, CA 92211
PALM DESERT, CA 92211
(760)776-9907
Llc. No.: 830131
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
gqClas.DD42 C45 License No.: 830131
Dater/v / Contractor/
U �
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 am exempt from the 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).:
(_) 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 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
Lender's
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 the ork for which this permit is issued.
•I have 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 should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply Vthose rovisions.
Date: % I Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION C ERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN 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 relating to building
construction, and hereby authorize representatives of this city to enter upon the above-
mentioned prope for inspection purposes.
Date: Signature (Applicant or Agent):
FINANCIAL INFORMATION
DESCRIPTION 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 for BUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
DEVICES, FIRST 20
101-0000-42403
0
$24.17
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
DEVICES, FIRST 20 PC
101-0000-42600
0
$24.17
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for ELECTRICAL: $48.34 $0.00
TOTALS:00
Bin #
Permit #
�� �'
Project Address: ? �-3Oev
Qty Of La Quinto
Building 81: Safety Division
P.O. Box 1504, 78 495 Calle Tampico .
La Quints, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Owner's Name: o �l.�l la w e -j
A. P. Number:
-L1 S�
Address: IH -70 du^u\ 21 t ? d
Legal, Description:
City, ST, Zip: L, -ZZ jr- 7
Contractor:i ,
Telephone:
Address:
Project Description: L
City, ST, Zip:
Telephone:
`
State Lic. # : 3t� I
City Lic.'#t
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
Constru ction Type: Occupancy:
State Lic. #:.'...".."."...'..'.
..........
ect hPa circle one): New Addn Alter Re air
Demo
P
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: /
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
p
I
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cala.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for correctionstissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Decd
Plans picked up
S.M.I.
Ii.O.A. Approval
Plans resubmitted
Grading
IN IiOUSE:-
'`" Review, ready for correctionslissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
`: a +✓ , .. / I '
October 15, 2014
Mr. Bill Sigurdsen
Sign*A*Rama
41945 Boardwalk
Palm Desert, CA 92211,
SUBJECT: SIGN PERMIT APPLICATION 2014-1046:
Body Image — Point Happy Center
Dear Mr. Sigurdsen:
The Community Development Department has reviewed and approved your request for one (1)
building -mounted business identification sign for Body Image, located at 78411 Highway 111,
within the Plaza La Quinta Center. The sign is approved as proposed and subject to the
following Conditions:
1. This sign permit grants one building -mounted illuminated business identification sign on
the building's south tenant fagade, to read as "WEIGHT LOSS". The sign shall not
exceed 9.1 square feet, and shall be designed and placed in conformance with the sign
graphics on file with this application (Exhibit A, enclosed).
2.
'The applicant is requited to obtain a building permit prior to the placement of sign on the
building. The Building Division can be reached at (760) 777-7012.
Should you have any questions or need additional information please feel free to contact me at
(760) 777-7125.
Sincerely,
Wallace Nesbit
Principal Planner
c: Building Division
78-495 Calle Tampico �. La Quinta I California 92253 760.777.7000 www.La-Quinta.org
°CWEIGHT LOSS
[Ruminated
Acrylic Faced Channel Letters
Depth: 5'
Face Color: Red
Retum Color. Black
Trim Cap Color. Black
Mounting: Bads
Standoff: Flush
I L.E.D. Color. Red
BUILDING & SAFETY DEPT.
i APPROVED
FOR CONSTRUCTION
L r "' TF L�L� BY_1��
APPROVED BY Pi.ANNING DEPARTMENT
BY DATE 1or!�� <
EXHIBIT A -
CASE NO. IA z0i-r- r®y&
CHANNEL LEIlEII & LIGHT BOX SECTION
NIE04W R MiNATE D LED. R R ALIX4TAlM
TO"
C w ACRYLIC FACES
a6ca,eer LOW VOLUIGE WIRE
sAscx� ❑ WIRE NUTS
r EACH LETTER FASTENED BY A
&94Bt1JM OF 4 #10 SCREM
WITH STUCCO APPROVED
! ANCHORS
12VM LF U
DRWR #6 SHEET MELAL SCREW
ALLVVN1 MEMO= 10 IE SFALEDY MM L61ED SWM �A V
UL48
NEG FA
ELEMMAL DE 2010
IFr-9GN 5 FNENDED TO 6E INSTALLED N ACCOKDANCE VM REOMEAAENTS OF
ARI ICLE WO ON 1HE NM IONA L ELECIPW OXE A'@ Olt OIHBL ArrLCAELE LOCM CDCE5.
CHANNEL LETTER CONNECTION DETAIL
i FOWER
U.L. LISTED AND LABELED
COMPLIES WITH 2013 CA ELECTRIC CODE, ARTICLE 600
AND LAYOUT, REL®LSNYn SM.AI:t• N�QTf579AJTYW REGARD
T0000 tECTOoESWANDDWF THE COLORSSNOW/AREOIK,Y
REPRESENTATIVE OF ACTUAL PMS COLOR CALL OUTS. FINAL COLOR WILL
SEMATCHEOAS CLOSERS POSSIBLE COMMENSURATE KITH
AAW$TEMALALS USED.
zs-Z,!17Es8ED rrE7(Acav3plTOF�srACN A1M�L U,/
OCT 07 2014
CITY OF LA fYUTNITr,
COMMUNITY `-tj=i.(')ompgrr
Rontap: 25 lLear W
RreMpno
a:
ad Jones Body Image u.760��
senls
Address:
78370 Hwy. 111. Ste 130
TOM SWape 9.1 S.F.
La Ossita, CA. 92253 South ELEVATION
SIGN*A * RANA Contractor's Lie # 630131 C45, C6111D42
Dwg. No.: 68226 Rev.: 1
Date: 10-01-14
41-945 Boardwalk, Workers Comp. ts17
Palm Desert CA -.-9224+—
PH 760-776-99D7 • FX 760-776-9844 L&' F'00604t
5a►espersorr BS
SalespDesigerson:
:
BUILDING & SAFETY DEPT.
i APPROVED
FOR CONSTRUCTION
L r "' TF L�L� BY_1��
APPROVED BY Pi.ANNING DEPARTMENT
BY DATE 1or!�� <
EXHIBIT A -
CASE NO. IA z0i-r- r®y&
CHANNEL LEIlEII & LIGHT BOX SECTION
NIE04W R MiNATE D LED. R R ALIX4TAlM
TO"
C w ACRYLIC FACES
a6ca,eer LOW VOLUIGE WIRE
sAscx� ❑ WIRE NUTS
r EACH LETTER FASTENED BY A
&94Bt1JM OF 4 #10 SCREM
WITH STUCCO APPROVED
! ANCHORS
12VM LF U
DRWR #6 SHEET MELAL SCREW
ALLVVN1 MEMO= 10 IE SFALEDY MM L61ED SWM �A V
UL48
NEG FA
ELEMMAL DE 2010
IFr-9GN 5 FNENDED TO 6E INSTALLED N ACCOKDANCE VM REOMEAAENTS OF
ARI ICLE WO ON 1HE NM IONA L ELECIPW OXE A'@ Olt OIHBL ArrLCAELE LOCM CDCE5.
CHANNEL LETTER CONNECTION DETAIL
i FOWER
U.L. LISTED AND LABELED
COMPLIES WITH 2013 CA ELECTRIC CODE, ARTICLE 600
AND LAYOUT, REL®LSNYn SM.AI:t• N�QTf579AJTYW REGARD
T0000 tECTOoESWANDDWF THE COLORSSNOW/AREOIK,Y
REPRESENTATIVE OF ACTUAL PMS COLOR CALL OUTS. FINAL COLOR WILL
SEMATCHEOAS CLOSERS POSSIBLE COMMENSURATE KITH
AAW$TEMALALS USED.
zs-Z,!17Es8ED rrE7(Acav3plTOF�srACN A1M�L U,/
OCT 07 2014
CITY OF LA fYUTNITr,
COMMUNITY `-tj=i.(')ompgrr
719 -3-70 Al w �Z /I/, Sic /30. 1-9. . C:,_ S_3
3. Specific Liehting Source Method of Compliance
Certificate of Compliance and Field Inspection Energy Checklist
Complete this part if there are signs using the Specific lighting source method of compliance. (Complete part 2 of this Certificate
of Compliance if there are signs using the maximum allowed lighting power method of compliance)
A
B
C
D
E
OPTIONAL
Specific light source used for
Symbol
ENERGY VERIFIED
compliance
Field Inspector
or
Description
label
Shall include only lighting
Check that Sign
Code
(see instructions
technologies listed below
Complies
below)
List all that apply
N ^^—L to l
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
A
Symbol or code used on the plans (when plans are required) and other documents.
B
A narrative description of the sign, or location of sign on the building; and the location of sign on construction documents
C
OPTIONAL - Check this box only if this sign has a permanent, pre-printed, factory -installed ENERGY VERIFIED label, confirming that this sign
complies with the Section 140.8 of the California 2013 Title 24, Part 6 Standards, using the Specific Lighting Source Method of Compliance. The
only labels that will be recognized for this purpose are ENERGY VERIFIED Certification Marks authorized by Underwriters Laboratories (UL) or
other Product Certification Body accredited to ISO/IEC Guide 65 by the American National Standards Institute in accordance with ISO/IEC
17011. Surveillance by the Accredited Certification Body shall be an ongoing annual inspection program carried out by a Type A Inspection body
in accordance with ISO/IEC 17020. For signs with such an ENERGY VERIFIED label, column 'D' is not required to be filled out. Note: Using an
ENERGY VERIFIED label is an optional method to validate compliance. An ENERGY VERIFIED label is not needed for compliance.
Specific Light Source Compliance Method. The sign(s) identified above use only the following lighting technologies:
List all applicable numbers (1 through 9) that apply in column D above for each row.
1
High pressure sodium lamps
Metal halide lamps that are pulse start or ceramic served by a ballast that has a minimum efficiency of 88 percent or
2
greater. Ballast efficiency is the measured output wattage to the lamp divided by the measured operating input wattage
when tested according to ANSI C82.6-2005.
Metal halide lamps that are pulse start that are 320 watts or smaller, are not 250 watt or 175 watt lamps, and are served by
3
a ballast that has a minimum efficiency of 80 percent.
Ballast efficiency is the measured output wattage to the lamp divided by the measured operating input wattage when tested
according to ANSI C82.6-2005.
Neon or cold cathode lamps with transformer or power supply efficiency greater than or equal to a minimum efficiency of 75 percent
D
4
when the transformer or power supply rated output current is less than 50 mA. The ratio of the output wattage to the input wattage is at
100 percent tubing load.
Neon or cold cathode lamps with transformer or power supply efficiency greater than or equal to a minimum efficiency of 68 percent
5
when the transformer or power supply rated output current is 50 mA or greater. The ratio of the output wattage to the input wattage is at
100 percent tub ng load.
6
Fluorescent lighting systems meeting one of the following requirements: A. Use only lamps with a minimum color rendering index (CRI) of
80; or B. Use only electronic ballasts with a fundamental output frequency not less than 20 kHz.
7
Light emitting diodes (LEDs) with a power supply having an efficiency of 80 percent or greater;
Single voltage external power supplies that are designed to convert 120 volt AC input into lower voltage DC or AC output, and have a
8
nameplate output power less than or equal to 250 watts, shall comply with the applicable requirements of the Appliance Efficiency
Regulations (Title 20).
9
Compact fluorescent lamps that do not contain a medium screw base sockets (E24/E26).
E
This page doubles as a field inspection checklist.
Field Inspector Notes:
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014
Project Address: . D G./ ., , j) ! ��G ) O� 9.
Location of Sign Outdoor Signs O Indoor Signs �l
Phase of Sign Construction jgCNew Signs O Sign Alterations
Type of Lighting Control Akot?)cs-6, ®..New lighting Controls O Replaced Lighting Controls O Not Installing Lighting Controls
This Certificate of Compliance includes the following components (check all that apply)
Mandatory Measures (Lighting Controls) O Maximum Allowed Lighting Power O Specific Lighting Sources
1. Mandatory Sign Lighting Controls
NOTES:
1. The some responsible person may install both the sign lighting power and the sign lighting controls, or a different responsible
person may install the sign lighting controls than the responsible person installing the sign lighting power.
2. 'The Mandatory Measures (sign lighting controls) are required for compliance with the sign lighting Standards. If the person
responsible for installing the sign lighting power is not also responsible for the sign lighting controls, then the owner of the sign,
general contractor, or architect shall be responsible to have the sign lighting controls installed.
3. - If more than one person has responsibility for compliance, each responsible person shall prepare and sign a Certificate of
Compliance and an Installation Certificate applicable to the portion of construction for which they are responsible, alternatively,
the person with chief responsibility for construction shall prepare and sign the Certificate of Compliance Declaration Statement
for the entire construction.
la. Statements of Responsibility: Any person signing the Certificate of Compliance Declaration Statement on this NRCC-LTS-01-E
shall complete Part la. Check Yes or No for all of the following statements:
l
1 have responsibility for installing the sign lighting controls
(Yes, complete parts la and lb of this form O No, complete part la of this form
There are no existing sign lighting controls and I will be installing compliant sign lighting controls
2
Yes O No
are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls
3
[There
Yes O No
There are existing sign lighting controls that do not comply with the applicable provision of §110.9 and §130.3 and I will be
4
installing compliant sign lighting controls
O Yes ANo
There are existing sign lighting controls that do not comply with the applicable provision of §110.9 and §130.3 and someone
5
else will be responsible to install compliant sign lighting controls
O Yes XNo
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014
1b. Mandatory Sign Lighting Controls
If the person signing the Certificate of Compliance Declaration Statement on this NRCC-LTS-01-E is responsible for complying with
the sign lighting control requirements, that person shall answer all of the following questions:
If there are construction documents, indicate where on the building plans the
mandatory measures (sign lighting control) note block can be located:
§130.3(a)1. All indoor sign lighting is controlled with an automatic time -switch control or astronomical time- Y❑ NN❑A
� N
switch control.
§13O3(a)2A. All outdoor sign lighting is controlled with a photocontrol in addition to an automatic time- Y a ❑A
2 switch control, or an astronomical time -switch control.
EXCEPTION to Section 130.3(a)2A: Outdoor signs in tunnels, and signs in large permanently covered outdoor y❑ NA
areas that are intended to be continuously lit, 24 hours per day and 365 days per year.49,
§1303(a)2B. All outdoor sign lighting that is ON both day and night is controlled with a dimmer that provides
the ability to automatically reduce sign lighting power by a minimum of 65 percent during nighttime hours. Y N NA
3 Signs that are illuminated at night and for more than 1 hour during daylight hours shall be considered ON both ❑ ❑
day and night.
EXCEPTION to Section 130.3(a)2B: Outdoor signs in tunnels and large covered areas that are intended to be Y❑ NA
Fhaving
d both day and night.
3. Demand Responsive Electronic Message Center Control. An Electronic Message Center (EMC) y N N/A
ew connected lighting power load greater than 15 kW has a control installed that is capable of ❑ ❑4the lighting power by a minimum of 30 ercent when receiving a demand response signal.N to Section 130.3(a)3: Lighting for EMCs that is not permitted by a health or life safety statute, Y NAA
ordinance, or regulation to be reduced by 30 percent.
Field Inspector Notes:
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June /viv
2 Maxjmum Allowed Lighting Power Method of Compliance
Certificate of Compliance and Field inspection Energy Checklist
Complete this part if there are signs using the maximum allowed lighting power method of compliance. (Complete part 3 of
this Certificate of Compliance if there are signs using the Specific lighting sources method of compliance)
A
B
C
D E F G
H
I
i
Symbol
Description of the Sign
OPTIONAL – Energy
Verified Label (see
Allotted Watts
Design Watts
Complies
YEN
Filed Inspector
Check that sign
Or Code
Instructions below)
complies
^
0
o
-tea
'
a��
C
°J•O�–,°
/t
vt
_
>_ m
3
3
N
Q
C E",
3 N
y C
N
wO
I 11
�
O
Q
~O
F- 3
0
✓
Vol
❑
q.
►Z
oi.1
So
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
A
Symbol or code used on the
plans (when plans are required) and other documents.
8
A description of the sign, or location of sign on the building; and the location of sign on construction documents.
OPTIONAL - Check this box only if this sign has a permanent, pre-printed, factory -installed, ENERGY VERIFIED label, confirming that the
sign complies with the Section 140.8 of the California 2013 Title 24, Part 6 Standards, using the Maximum Allowed Lighting Power
method of compliance. The only labels that will be recognized for this purpose are ENERGY VERIFIED Certification Marks authorized by
Underwriters Laboratories (UL) or other Product Certification Body accredited to ISO/IEC Guide 65 by the American National Standards
C
Institute In accordance with ISO/IEC 17011. Surveillance by the Accredited Certification Body shall be an ongoing annual inspection
program carried out by a Type A Inspection body in accordance with ISO/IEC 17020. For signs with such an ENERGY VERIFIED label,
columns'D'through Tare not required to be filled out. Note: Using an ENERGY VERIFIED label is an optional method to validate
compliance. An ENERGY VERIFIED label is not needed for compliance.
D
The sign area insquare feet.
E
List "I" if the sign is internally illuminated. List "E" if the sign is externally illuminated.
F
Allowed watts per square foot. Enter 12 if the sign is listed as "I" in column E. Enter 2.3 if sign is listed as "E" in column E.
G
Multiply the square footage in column D times the allowed Lighting Power Density (LPD = watts) in column F.
H
Show the total installed watts in the sign, as determined according to the applicable provisions of §130(c).
1
Enter Y if the number in column H Is less than orequal to the number in column G. Otherwise, the sign does not comply.
i
This page doubles as a field inspection checklist.
Field Inspector Notes:
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014
rl -, _. ,eJ.,,. /I I _ C 1-7 n f:_ n - 4_
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014
DOCUMENTATION AUTHOR'S 0 CLARA ON STATEMENT
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
LL
iSignature
_3
i N �,� -
Date: /
obfL
Address:
`f 1CN5- BofkiepW SU (7-6
CEA/ HERS Certification identification (if a plies lel:
City/State/Zip: C
PEsc�T �iZZ(\
Phone:
?(�6-71
RESPONSIBLE PERSON'S DECLARATION STATEMENT
I certify the following under penalty of perjury, under the laws of the State of California:
1. The information provided on this Certificate of Compliance is true and correct.
2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design
identified on this Certificate of Compliance (responsible designer).
3. 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 California Code of
Regulations.
4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information
provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement
agency for approval with this building permit application.
5. 1 will ensure that a completed signed 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 for all applicable inspections. I understand that a completed signed copy of this
Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name:
Zc��crL �o��s
Responsible Designer Signature:
(
Company:
�
Date Signed:
r12�,�t
Address: 1 Y IJ 0 A .T E /
'I (
Ucense: #, 830
CItY/State/ZIP: PA �.✓� pE 5 QZT '�lZ Z ('
Phone: (Dd —
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014