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BMCH2016-0076Applicant: LA QUINTA AIR CONDITIONING'& HEATING INC P 0 OX 557 LA QUINTA, CA 92247 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- C20/ License No.: 902029 Date: ! - —Contractor: -- - OWNER -BUIL ER DECLARATION I hereby affirm under penalty of perjury that I 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).: (1 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.). ( ) 1, 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 workfor which this permit is issued (Sec. 3097, Civ. C.). Lender's N Lender's Contractor: 'LA QUINTA AIR CONDITIONING & HEATING INC P O OX 5S7 LA QUINTA, CA 92247 (760)837-9344 Llc. No.: 902029 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 work 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 with those provisions. i 1_11Date: Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 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 lating to building construction, and hereby authorize representatives of thocit e to on the above -menti ned roperty for inspection purposes.; Date: �� ,'Signature (Applicant orAgent) VOICE (760) 777-7125 78-495 CALLE TAMPICO D FAX (760) 777-7011COMMUNITY LA QUINTA, CALIFORNIA 92253 DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 4/4/2016 y Application Number: BMCH2O16-0076 -Owner: Property Address: 80375 POMELO MOUNTAIN VIEW COUNTRY CLUB APN: y 777010009 _ 80375 POMELO Application Description: MOUNTAIN VIEW COUNTRY CLUB / HVAC CHANGE OUT LA QUNTA, CA 92253 Property Zoning: Application Valuation: $5,600.00 Applicant: LA QUINTA AIR CONDITIONING'& HEATING INC P 0 OX 557 LA QUINTA, CA 92247 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- C20/ License No.: 902029 Date: ! - —Contractor: -- - OWNER -BUIL ER DECLARATION I hereby affirm under penalty of perjury that I 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).: (1 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.). ( ) 1, 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 workfor which this permit is issued (Sec. 3097, Civ. C.). Lender's N Lender's Contractor: 'LA QUINTA AIR CONDITIONING & HEATING INC P O OX 5S7 LA QUINTA, CA 92247 (760)837-9344 Llc. No.: 902029 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 work 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 with those provisions. i 1_11Date: Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 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 lating to building construction, and hereby authorize representatives of thocit e to on the above -menti ned roperty for inspection purposes.; Date: �� ,'Signature (Applicant orAgent) r FINANCIAL INFORMATION DESCRIPTION ;, , ' `6 s ACCOUNT - QTY F AMOUNT,' PAID 7E `'a 'PAID DATE: BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 4/4/16 PAID BY Ili THODA ;RECEIPT # ; ';; %a CHECK # CLTD BYA. ,F, . , LA QUINTA AIR CONDITIONING & H CHECK R14443 . 307 MFA Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $1.00 "''' ACCOUNT } `QTY AODESCRIPTION ' ` PAID DATE .,�_• ,$ o' HVAC CHANGEOUT - SPLIT -SYSTEM 101-0000-42402 0 $72.52 $72.52 4/4/16 r w 'PAID BY . * ;METHOD ; RECEIPT #{ R r' CHECK # CLTD BYE t .Y. LA QUINTA AIR CONDITIONING & H CHECK R14443 307 MFA =DESCRIPTION 3 s' , .ACCOUNT a.,__� rn i AMOUNT y ° " ` _ > M: ,.PAID.4,� , PAID DATE' .: ti• HVAC CHANGEOUT - SPLIT -SYSTEM PC 101-0000-42600 0 $36.26 $36.26 4/4/16 ,PAID BY '. } METHOD u RECEIPT # a ` Y CHECK # k �' CLTD BY A�?`-< :'iy U f+ LA QUINTA AIR CONDITIONING & H CHECK R14443 307 MFA Total Paid for CHANGEOUT: •$108.78 - $108.78 t DESCRIPTION Vit.'!.`. ACCOUNT, x QTY $°AMOUNT " '4a PAID PAID u . �W -DATE PERMIT ISSUANCE 101-0000-42404 0 $91.85 $91.85 4/4/16 E' ?PAID BY ;T METH . s RECEIPT# CHECK #u°CtTD BY " I s r LA QUINTA AIR CONDITIONING & H CHECK R14443 307 MFA Total Paid for PERMIT ISSUANCE: $91.85 $91.85 TOTALS:• A Description: MOUNTAIN VIEW COUNTRY CLUB / HVAC CHANGE OUT Type: MECHANICAL Subtype: Status: ISSUED Applied: 4/4/2016 MFA Approved: 4/4/2016 MFA Parcel No: 777010009 Site Address: 80375 POMELO LA QUINTA,CA 92253 Subdivision: TR 30357 Block: Lot: 188 Issued: 4/4/2016 MFA Lot Sq Ft: 0 Building Sq Ft: 0 ` Zoning: Finaled: Valuation: $5,600.00 Occupancy Type: Construction Type: Expired: 10/1/2016 MFA No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: HVAC CHANGE OUT IN LADIES LOCKER ROOM - 13.5 SEER/80AFUE SPLIT SYSTEM [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES. FINANCIAL INFORMATION Printed: Monday, April 04, 2016 8:04:36 AM 1 of 2 w-SYSTEiUS CHRONOLOGY CONDITIONS CONTACTS NAMETYPE> ; , NAMEy '" ADDRESSi -' q CITY : STATE ZIP NEY a HO -J FAX EMAIL APPLICANT LA QUINTA AIR CONDITIONING & P 0 OX 557 LA QUINTA CA 92247 HEATING INC ' CONTRACTOR LA QUINTA AIR CONDITIONING & P O OX 557 LA QUINTA CA 92247 i HEATING INC OWNER MOUNTAIN VIEW COUNTRY CLUB 80375 POMELO LA QUNTA CA 92253 FINANCIAL INFORMATION Printed: Monday, April 04, 2016 8:04:36 AM 1 of 2 w-SYSTEiUS DESCRIPTION ACCOUNT QTY =AMOUNT PAID PAID DATE RECEIPT # GHECK # METHOD PAID BY CLTD ". BY >, BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 4/4/16 R14443 307 CHECK LA QUINTA AIR MFA CONDITIONING & H Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $1.00 BSA: HVAC CHANGEOUT - 101-0000-42402 0 $72.52 $72.52 4/4/16 R14443 307 CHECK LA QUINTA AIR MFA SPLIT -SYSTEM CONDITIONING & H HVAC CHANGEOUT - 101-0000-42600 0 $36.26 $36.26 4/4/16 'R14443 307 CHECK LA QUINTA AIR MFA SPLIT -SYSTEM PC CONDITIONING & H Total Paid for CHANGEOUT: $108.78 $108.78 PERMIT ISSUANCE 101-0000-42404 0 $91.85 $91.85 4/4/16 R14443 307 CHECK LA QUINTA AIRCONDITIONING MFA & H Total Paid for PERMIT ISSUANCE: $91.85 $91.85 TOTALS:i INSPECTIONS PARENT PROJECTS BOND INFORMATION ATTACHMENTS Printed: Monday, April 04, 2016 8:04:36 AM 2 of 2 rM SYSTEMS Iain # Permit # Project Address. OV 32 5- City of. La Quin ta Building &r Safety Division 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012' Building Permit Application and Tracking Sheet Pd -T . Owner's Name: tm—&Ai vie47 vie;Tc. A. P. Number: Address: �� �� 0 *t&t a Legal Description: City, ST, Zip: Contractor://V€ �`Telephone: »"' Address: , o 5 S 'Project Description: �,n q City, ST, Zip: �, t� j h nc• TelePo . -a 7 7D s Lgfl l L State Lic. # : '(, 0� City Lie #t Arch., Engr., Design r: Address: City., ST, Zip: Telephone: State Lic. # • Construction s on TYP e• Occupancy: Project tYPa (circle cle one • New Add'n Alter r Re air Demo Namef ct 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 Item Amount Structural Cates. Reviewed, readyfor corrections Plan Check Deposit Truss Cafes. Called Contact Person Plan Check Balance Title 24 Cales. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. 11.0. A. Approval Plans resubmitted Grading IN HOUSE:- '"! Review, ready for correct ions/issuc 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 MECHANICAL SYSTEMS CEC-NRCC-MCH-01-E Revised 05/15 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-MCH-01-E Mechanical Systems (Page 1 of 4) Project Name: 80-375 Pomelo, La Quinta, CA 92253 oateP"Ore" 03/21/2016 x� A. MECHANICAL COMPLIANCE FORMS & WORKSHEETS (check box if worksheet is included) For detailed instructions on the use of this and all Energy Efficiency Standards compliance forms, refer to the 2013 Nonresidential Manual Note: The Enforcement Agency may require all forms to be incorporated onto the building plans. YES NO Form/Worksheet # Title ® ❑ NRCC-MCH-01-E (Part 1 of 3) Certificate of Compliance, Declaration. Required on plans for all submittals. ® ❑ NRCC-MCH-01-E (Part 2 of 3) Certificate of Compliance, Required Acceptance Tests (MCH -02A to 11A). Required on plans for all submittals. ❑ ® NRCC-MCH-01-E (Part 3 of 3) Certificate of Compliance, Required Acceptance Tests (MCH -12A to 18A). Required on plans where applicable. ❑ M NRCC-MCH-02-E (Part 1 of 2) Mechanical Dry Equipment Summary is required for all submittals with Central Air Systems. It is optional on plans. ❑ X NRCC-MCH-02-E (Part 2 of 2) Mechanical Wet Equipment Summary is required for all submittals with chilled water, hot water or condenser water systems. It is optional on plans. ❑ X NRCC-MCH-03-E Mechanical Ventilation and Reheat is required for all submittals with multiple zone heating and cooling systems. It is optional on plans. ❑ 1 ® NRCC-MCH-07-E (Part 1 of 2) Power Consumption of Fans. Required on plans where applicable ❑ 1 ® NRCC-MCH-07-E (Part 2 of 2) JPower Consumption of Fans, Declaration. Required on plans where applicable CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance STATE OF CALIFORNIA MECHANICAL SYSTEMS CEC-NRCC-MCH-01-E (Revised 05/15) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-MCH-01-E Mechanical Systems (Page 2 of 4) Project Name: 80-375 Pomelo, La Quinta, CA 92253 Date Prepared: 03/21/2016 B. MECHANICAL HVAC ACCEPTANCE FORMS (check box for required forms) Test Performed By: ROBERT BACHUS Designer: This form is to be used by the designer and attached to the plans. Listed below are all the acceptance tests for HVAC systems. The designer is required to check the applicable boxes for all acceptance tests that apply and list all equipment that requires an acceptance test. All equipment of the same type that requires a test, list the equipment description and the number of systems. Installing Contractor: The contractor who installed the equipment is responsible to either conduct the acceptance test them self or have a qualified entity run the test for them. If more than one person has responsibility for the acceptance testing, each person shall sign and submit the Certificate of Acceptance applicable to the portion of the construction or installation for which they are responsible. Enforcement Agency: Plancheck — The NRCC-MCH-01-E form is not considered a completed form and is not to be accepted by the building department unless the correct boxes are checked. Inspector - Before occupancy permit is granted all newly installed process systems must be tested to ensure proper operations. Test Description MCH -02A MCH -03A MCH -04A MCH -05A MCH -06A MCH -07A MCH -08A MCH -09A MCH -10A MCH -SSA Demand Hydronic Equipment # of Outdoor Single Zone Air Economizer Control Supply Fan Valve Leakage Supply Water System Automatic Requiring Testing Units Air Unitary Distribution Controls Ventilation VAV Test Temp. Reset Variable Flow Demand Shed or Verification Duds (DCV) Control Control 4 TON 1 M W IM ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 0 0 ❑ ❑ O ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 11 C, ❑ ❑ ❑ ❑ ❑ ❑ ❑ CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 SPATE OF CALIFORNIA MECHANICAL SYSTEMS CEC-NRCC-MCH-01-E Revised 05/15 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-MCH-01-E Mechanical Systems (Page 3 of 4) Project Name: Date Prepared: 80375 Pomelo, La Quinta, CA 92253 03/11/2016 C. MECHANICAL HVAC ACCEPTANCE FORMS (check box for required forms) Test Performed By: Robert Bachus Designer: This form is to be used by the designer and attached to the plans. Listed below are all the acceptance tests for HVAC systems. The designer is required to check the applicable boxes for all acceptance tests that apply and list all equipment that requires an acceptance test. All equipment of the same type that requires a test, list the equipment description and the number of systems. Installing Contractor: The contractor who installed the equipment is responsible to either conduct the acceptance test them self or have a qualified entity run the test for them. If more than one person has responsibility for the acceptance testing, each person shall sign and submit the Certificate of Acceptance applicable to the portion of the construction or installation for which they are responsible. The following tests require a Enforcement Agency: Plancheck—The NRCC-MCH-01-E form is not considered a completed form and is not to be accepted by the building department unless the correct boxes are checked. Inspector - Before occupancy permit is granted all newly installed process systems must be tested to ensure proper operations. Test Description MCH -12A MCH -13A MCH -14A MCH -ISA MCH -16A MCH -17A MCH -18A Equipment # of Fault Detection & Automatic Fault Distributed Energy Thermal Energy Supply Air Requiring Testing units Diagnostics for DX Detection & Storage DX AC Storage (TES) Temperature Reset Condenser Water ECMS or Verification Units Diagnostics for Air & Systems Systems Controls Reset Controls Zone ❑ ❑ ❑ ❑ D ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ D ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ D ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 SKATE OF CALIFORNIA MECHANICAL SYSTEMS CEC-NRCC-MCH-01-E (Revised 05/15) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-MCH-01-E Mechanical Systems (Page 4 of 4) Project"ame:80-375 Pomelo, La Quinta, CA 92253 DatePrepared:03/21/2016 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: ROBERT BACHUS Documentation Author Signatur : company:AHP TESTING Signature Date: 03/21/2016 Address: 74998 COUNTRY CLUB DR. 220-420 CEA/ HERS Certification Identification (if ap icablel: C20O 95 City/State/Zip:PALM DESERT, CA 92260 Phone: 760-851-8648 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: Responsible Designer Signature: Company: Date Signed: Address: License: City/State/Zip: Phone: CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015