The URL can be used to link to this page

BSIG2018-000278-495 CALLE TAMPICO C& 0 4 VOICE (760) 777-7125 LA QLIINTA, CALIFORNIA 92253 FAX (760) 777-7011 DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 1/31/2018 Permit Type/Subtype: SIGN/ Owner: Application Number: BSIG2018 0002 e �� HARSCH INV REALTY Property Address: 78383 HIGHWAY 111 "'/°°°a� 121 SALMON ST4TH FL APN: 604050059 RTLAND, OR 92253 Application Description: MONGOLIAN GRILL SIGN FEB Property Zoning: U 5 2018 Application Valuatiori: $3;100.00 DESIGN OF LA QllINTA ESIGN AN D Applicant: EV„•LOPp�I.E.WDEp Contractor: PD GROUP. DBA SIGNARAMA ARTMENTPD GROUP DBA SIGNARAMA . 41945 BOARDWALK SUITE L 41945 BOARDWALK SUITE L PALM DESERT, CA 92211 PALM DESERT, CA 92211 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: D42 5p License No.: 8300 3,3 Date: Z O Contractor:•-6� OWNER -BUILDER 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).: (_) 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 (See. 3097, Civ. C.). Lender's Name: Lender's Address: (760)776-9907 Llc. No.: 830131 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: ACE AMERICAN INSURANCE COMPANY Policy Number: RWCC64396857 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 thhose rovislons. Date: r/ /J, 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.relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. Date: J�� / ' Signature (Applicant or Agent): Date: 1/31/2018 Application Number: BSIG2018-0002 Owner: Property Address: 78383 HIGHWAY 111 HARSCH INV REALTY APN: 604050059 1121 SALMON ST 4TH FL Application Description: MONGOLIAN GRILL SIGN PORTLAND, OR 92253 Property Zoning: Application Valuation: $3,100.00 Applicant: Contractor: PD GROUP DBA SIGNARAMA PD GROUP DBA SIGNARAMA 41945 BOARDWALK SUITE L 41945 BOARDWALK SUITE L PALM DESERT, CA 92211 PALM DESERT, CA 92211 (760)776-9907 Llc. No.: 830131 Detail: ILLUMINATED CHANNEL LETTER SIGN FOR MONGOLIAN GRILL. PER 2016 CALIFORNIA BUILDING CODE. FINANCIAL •R • DESCRIPTION ACCOUNT • QTY AMOUNT BSAS SB1473 FEE . 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT QTY AMOUNT DEVICES, FIRST 20 101-0000-42403 0 $3.25 Total Paid for ELECTRICAL: $3:25 DESCRIPTION ACCOUNT 1 QTY AMOUNT RECORDS MANAGEMENT FEE 101-0000-42416 0 $10.00 Total Paid for RECORDS MANAGEMENT FEE: $10.00 DESCRIPTION ACCOUNT QTY AMOUNT WALL/AWNING SIGN, FIRST 101-0000-42404 .0 $53.06 Total Paid for SIGN: $53.06 DESCRIPTION ACCOUNT QTY AMOUNT TECHNOLOGY ENHANCEMENT FEE* 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 TOTALS: $72 r 0 W .... .......... ._ c;r:v( �,ff n r:n:".r:UT-- _.............. PERMIT#C� PLAN LOCATION: Project Address:-� f� 1. Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech APN #: c , Telephone: <6 -71k/ _ Patio/Porch SF Email: C` ,J ( Df/LN1a r Applicant Name: �,� , yyt ti State Lie: 3 / City Bus Lie: q7 g 1 Address: State Lie: City Bus Lie: City, ST, Zip; Telephone:5 Email: .�I LLQ o �� j Valuation of Project $ �l Contractor Name: �6� J N New SFD Construction: Address: L-11 rj'ys .�G� G Conditioned Space SF .City, St, Zip r% Lam. �� Cts) l Garage SF Telephone: <6 -71k/ _ Patio/Porch SF Email: C` ,J ( Df/LN1a r Fire Sprinklers SF State Lie: 3 / City Bus Lie: q7 g 1 Arch/Eng Name: Construction Type: Occupancy: Address: Grading: City, St, Zip Construction Type: Occupancy: Telephone:. Bedrooms: Stories: # Units: Email: State Lie: City Bus Lie: Property Owner's Name: f-�c✓L S� New Commercial / Tenant Improvements: Address: 713 -_3 f U, 1 l Total Building SF. . City, ST, Zip Z-1 v2s ' Construction Type: Occupancy: Telephone: ' Email:,:: 78495 CALLE TAMPICO LA QUINTA, CA 922.53 760-777-7000 # Submittal Req'd Ree'd Plan Sets Structural Calcs Truss Calcs Title 24 Calcs Soils Report Grading Plan (PM 10) Landscape Plan Subcontractor List s Grant Deed HOA Approval School Fees Burrtec Debris Plan Planning approval Public Wotks approval Fire approval City Business License 24" L White w/ printed permagross 141.5" MONGOLIM Red acrylic faces Black trim and returns Red'LED trim Acrylic Faced Channel Letters Depth: 3.5" Aluminum Thickness: .040 12„ Acrylic Thickness: 1/8" Face Color: Red acrylic White acrylic w/ permagloss print 14 ■lNIMILJ&II on Return Color: Black Trim Cap Color: Black Mounting: Back Standoff: Flush L.E.D. Color: Red White on can box UINTA SA; ETY DEPT. 'D i "JONSTRUCTION CHANNEL LETTER & LIGHT BOX SECTION 5".040 ALUMINUM INTERNALLY ILLUMINATED L.E.D. RETURNS WALL iy TRIMCAP HOUSE POWER—* DISCONNECT SWITCH 12VOLT L. E. D. DRIVER �— ACRYLIC FACES L.E.D. MODULE TANCI LOW VOLTAGE WIRE WIRE NUTS CH LETTER FASTENED BY A NIMUM OF 4 #10 SCREWS TH STUCCO APPROVED IORS #8 SHEET METAL SCREW ALL WALL PENETRATIONS TO BE SEALED WITH UL LISTED SILICONE SEALANT U.L. 48 NEC ELECTRICAL CODE 2014 THIS SIGN IS INTFNDFD TO BE INSTALLED IN ACCORDANCE WITH RFOl11RFMFNTS OF ARTICLE 600 ON TNF NATIONAI FI FCTRIC cnr)F AND OR OTHER APPLICABI F I OCAI COnES THIS INCI I IDFS PRnPFR (7ROLINDING AND BONDING OF THE SIGN. CHANNEL LETTER CONNECTION DETAIL 12VOLT L.E.D. DISCONNECT SWITCH ► r� DRIVER y -� rL.^.1 HOUSE POWER MOUNTING STUCTURE U.L. LISTED AND LABELED COMPLIES WITH 2(11,6 CA ELECTRIC CODE, ARTICLE 600 Frontage: _50_ Linear Feet Customer: Telephone: 760-xxx-xxxx Jobsite: Customer Approval: +� Sti Krazy Mongolian Grill Fax: 760-xxx-xxxx Same �� Address: 78383 Hwy 111 Landlord Approval: e-;) L� . Total Signage _23.58_ S.F. La Quinta, CA 92253 North ELEVATION l So tanarama- Contractor's Lic # 830131 C45, C61/D42 DWg. No.: 88110 Rev.: 1 YOUR SIGNATURE ACKNOWLEDGES FULL APPROVAL OF DESIGN CONTENT AND LAYOUT, RELEASING SIGN'A*RAMA FROM RESPONSIBILITY IN REGARD IhO The way to grow your business. Date: 12-15-17 TO INCORRECT DESIGN AND INFORMATION. THE COLORS SHOWN ARE ONLY 41945 BOARDWALK, SUITE L Workers Comp. # 1938807 REPRESENTATIVE OFACTUAL PMS COLOR CALL OUTS. FINAL COLOR WILL BE MATCHED AS CLOSE AS POSSIBLE, COMMENSURATE WITH MATERIALS USED. Designer. GA PALM DESERT, CA 92211 PH 760.776.9907 / FX 760.776.9844 Cit LIC. # 97005491 y Salesperson: BS THIS DESIGN IS PROPRIETARY PROPERTY AND MAY NOT BE USED WITHOUT Al THE EXPRESSED WRITTEN CONSENT OF SIGN*A*RAMAL .J(ATE OF:,CALIFORNIA ~SIGN LIGHTING CEC-NRCC-LTS-01-E Revised 08/16 CALIFORNIA ENERGY COMMISSION 'qq=P' CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 1 of 5) Project Name: ) V4 0 oe t7 ` 0. / Date Prepared: . A. General Information NOTES: 1. The same responsible person may install both the sign lighting power and the sign lighting controls, or a different responsible Project Address: 2. The Mandatory Measures (sign lighting controls) are required for compliance with the sigh 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, Location of Sign Outdoor Signs ❑ Indoor Signs Phase of Sign Construction New Signs ❑ Sign Alterations Type of Lighting Control ZNew Lighting Controls ❑ Replaced Lighting Controls ❑ Not Installing Lighting Controls . This- Certificate of Compliance includes the following components (check all that apply): ❑ Mandatory Measures (Lighting Controls) ❑ Maximum Allowed Lighting Power ❑ Specific Lighting Sources 1. Mandatory Sign Lighting Controls NOTES: 1. The same 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 sigh 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 (e.g. a C•10 contractor may complete parts 1a and 1b on one compliance document and a C-45 contractor may complete parts 2a and 2b on a separate compliance document - the Responsible Designer shall submit the two compliance documents together for the some complete installation). ave responsibility for installing the sign lighting controls: Yes, I have responslbility for the sign lighting controls, and will [] No, I do not have responsibility for installing the sign lighting controls. complete parts la and lb of this compliance document Someone else will complete parts la and lb of this compliance document. la. Check Yes or No for all of the following statements: . 1 There are existing sign lighting controls that comply with the applicable provisions of §110.9 and §130.3 ❑ YesEJ No There are no existing sign lighting controls and I will be installing sign lighting controls that comply with the applicable 2 provisions of §110.9 and. §130.3 ❑ Yes ❑ No There are existing sign lighting controls that do not comply with the applicable provisions of §110.9 and §1303 and I will be 3 installing sign lighting controls that comply with the applicabfe of §110.9 and §130.3 ❑ Yes No CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance August 2016 STATE OF CALIFORNIA SIGN LIGHTING CEG-NRCC-LT5-U1-E(Revised 06116) CALIFORNIA ENERGY COMMISSION -4&W' CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 2 of 5) project Name: 6- Prepared: t lb. 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 _T there are construction documents, indicate where on the building plans the mandatory measures (sign lighting control) note block can be located: 1 §130.3(a)1. All indoor sign lighting is controlled with an automatic time -switch control or astronomical time- N NA switch control. LO ' O §130.3(a)2A. All outdoor sign lighting is controlled with a photocontrol in addition to an automatic time- Y N NA 2 switch control, or an astronomical time; switch control. A 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. O X §130.3(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 659/6 during nighttime hours. Signs that Y 'N NA 3 are illuminated at night and for more than 1 hour during daylight hours shall be considered ON both day and O . O night. EXCEPTION to Section 130.3(a)2B: Outdoor signs in tunnels and large covered areas that are intended to be Y NA illuminated both day and night. §130.3(a)3. Demand Responsive Electronic Message Center Control. An Electronic Message Center (EMC) having a new connected lighting power load greater than. 15 kW has a control 'installed that is capable of Y N 4 reducing the lighting power by a minimum of 30% when receiving a demand response signal. O O EXCEPTION to Section 130.3(a)3: Lighting for EMCs that is not permitted by a health or life safety statute, Y NA ordinance; or regulation to be reduced by 30%. O Field Inspector Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance August 2016' STATE OF CALIFORNIA SIGN LIGHTING CEC-NRCC-1-TS-01-E(Revised 08116) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 3 of 5) Project Name: Date Prepared: 2, Mandatory Sign lighting Measures I have responsibility for installing the sign lighting El Yes, I have responsibility for the sign lighting, and will complete ❑ No, I do not have responsibility for installing the sign lighting. Someone parts 2a and 2b of this compliance document I else will complete parts 2a and 2b of this compliance document. 2a. Maximum Allowed Lighting Power Method of Comp�iance 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 2b 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 J OPTIONAL.— S mbol or y Description of the Sign Energy Verified Label (see Allotted Watts Design Complies Field Inspector Code . instructions Watts Y/N Check that below) Sign Complies O N m 4 M C v i m x 3�ni °'o c o N v C aE,•E y Sc ° u u a ..r v Q - A H 3 a O • U i-AN�..I�.-rev ❑ z3:� � +z 2r� �' ❑ 5.� ❑ 0 ; ❑ ❑, 0 I ❑ ❑ 0 I ❑ ❑ 0 I ❑ ❑ o ❑ ❑ 0 ❑ ❑ 0 I ❑ ❑ 0 ❑ O 0 ❑ .A Symbol or code used on the plans (when plans are -required) and other documents. B A description of the sign, or location of sign on the buildin • 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 2016 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 C 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, columns 'D' through 'I' are notrequired 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 in square 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). I Enter Y if the number in column H is less than or equal to the number in column G. Otherwise, the sign does not comply. J This page doubles as a field inspection checklist. Field Inspector Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance August 2016 STATE OF,CALIFORNIA SIGN LIGHTING CEC-NRCC-LTS-01-E(Revised 08/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting(Page 4 of 5) Project Name:. Date Prepared: r. Z4. 3pearic Lignung source Metnocl 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 ENERGY Specific light source used for Symbol VERIFIED compliance Field Inspector or Description label Shall include only lighting Check that Sign Code (see technologies listed below Complies instructions (List all that apply) below) // ❑ ❑ 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 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 2016 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 C (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% or greater.. 2 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 3 served by a ballast that has a minimum efficiency of 80%. 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. D Neon or cold cathode lamps with transformer or power supply efficiency greater than or equal to a minimum efficiency of 75% when 4 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% tubing load. Neon or cold cathode lamps with transformer -or power supply efficiency greater than or equal to a minimum efficiency of 68% when 5 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% tubing 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% 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 I. Regulations (Title 20). 9 1 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 - 2016 Nonresidential Compliance August 2016 STATE OF CALIFORNIA o[GN LIGHTING CEC-NRCC-LTS-01-E Revised 08/16 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E Sign Lighting (Page 5 of S) Project Name: q' l Date Prepared: / 1 7 /2— DOCUMENTATION I` 2Z— DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this. Certificate of Compliance documentation is accurate and complete. Documentation Author Name: ') / y f Documentation Author Signature: Company: Signature Date: Address: ) CEA Certification'ldentificatl n (if appli able): City/State/Zip: ' �' C., v✓1 P_J-tft.� C.,. • �i 2-'Z 1 l Phone:. RESPONSIBLE PERSON'S DECLARATION STXfiEIVIENT 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 ell 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 ttW bui)ding owner ajioccupancy. Responsible Designer Name: Responsible Designer Signature: Company: Date Signed: Address: License: City/State/Zip: Phone: �� J �-7 Z-9' L/ O CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance August 2016