BRER2017-005378-495 CALLE TAMP ICO D
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
Applicant:
WILLIAM MCCREA
52230 AVENIDA MENDOZA
LA QUINTA, CA 92253
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that 1 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: License No.:
Date:
Contractor:
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).:
(({-Ns 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.).
(4d , 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
Cont actors' State License Law.).
C am exempt under Sec. B.&P.C. for this reason
O/ate-�— 2� (r7-
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:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Owner:
Application Number:
BRER2017-0053
Property Address:
52230 AVENIDA MENDOZA
APN:
773273002
Application Description:
MCCREA / 2390SF RE -ROOF ENTIRE DWELLING WITH.SHINGLES
Property Zgning:
a
Application Valuation:
$3,000.00
Applicant:
WILLIAM MCCREA
52230 AVENIDA MENDOZA
LA QUINTA, CA 92253
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that 1 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: License No.:
Date:
Contractor:
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).:
(({-Ns 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.).
(4d , 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
Cont actors' State License Law.).
C am exempt under Sec. B.&P.C. for this reason
O/ate-�— 2� (r7-
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:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations: .
I have and will maintain a certifica-•e of consent to self -insure for workers'
compensation, as provided for by Section 37CO 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 perfo mance of the work for which this permit is
issued. My workers' compensation insurance: carrier and policy number are:
Carrier: Polity Number: _
certify that in the performance ofthe work for which this permit is issued, I
shall not employ any person in any manner sc 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.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMIAAL 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 ordirances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the above-
mentioned property for inspection purposes. //,��� /1/
Date 4 /9" Signature.(Applicant_or-A)sVgentV/L
Date: 5/25/2017
Owner:
(—
WILLIAM MCCREA
w
52230 AVENIDA MENDOZA
1
LA QUINTA, CR 92253
a
LU
C=)
N
z I—
W
0i
Contractor:
LM
a
OWNER BUILD=R
®
a
O o
�o
�
U �
z
CD
®
CD
Llc. No.:
CO
LU
C:1
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations: .
I have and will maintain a certifica-•e of consent to self -insure for workers'
compensation, as provided for by Section 37CO 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 perfo mance of the work for which this permit is
issued. My workers' compensation insurance: carrier and policy number are:
Carrier: Polity Number: _
certify that in the performance ofthe work for which this permit is issued, I
shall not employ any person in any manner sc 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.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMIAAL 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 ordirances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the above-
mentioned property for inspection purposes. //,��� /1/
Date 4 /9" Signature.(Applicant_or-A)sVgentV/L
Y
Application Number:
BRER2017-0053
Property Address:
52230 AVENIDA MENDOZA
APN:
773273002 .
Application Description:
MCCREA/ 2390SF RE -ROOF ENTIRE DWELLING WITH SHINGLES
Property Zoning:
Application Valuation:
$3,000.00
Owner:
WILLIAM MCCF.EA
52230 AVENIDA MENDOZA
LA QUINTA, CA 92253
Date: 5/25/2017
Applicant:. Contractor:
WILLIAM MCCREA OWNER BUILDER
-52230 AVENIDA MENDOZA
LA QUINTA, CA 92253
Llc. No.:
--------------------------------------------------------------------------------------------
Detail: RE -ROOF ENTIRE DWELLING WITH SHINGLES [CRRC: 0890-0002] 2016. CALIFORNIA ENERGY CODE
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT CITY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00,.
DESCRIPTION
ACCOUNT
CITY
AMOUNT
RE -ROOF - EA ADDITIONAL 1,000 SF
101-0000-42404
0
$12.16
DESCRIPTION
ACCOUNT
CITY
AMOUNT
RE -ROOF - FIRST 2,000 SF
101-0000-42404
0
$51.68
DESCRIPTION
ACCOUNT
CITY
AMOUNT
RE -ROOF - FIRST 2,000 SF PC
101-0000-42600
0
$103.36
Total Paid for RE -ROOF: $167.20
DESCRIPTION
ACCOUNT
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE.
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
Bin #
City of LA Quint
'a
&r Safety Division
78-495 Calle Tampico.
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: �-2.-L30 AVGA) 11?A ME.VOo7-A
Owner's Name: , jLLj 1\4,
A. P. Number: J rtInt-
Address: �� 2 3 C7 I -� P•tUv pZ,4
Legal Description: 440-'-4F_ 2 �S 1 I /LiJ C
City, ST, Zip: (A �,ti ria � A Z z S- 3
Contractor: J i\i� 2 — 3U I L
Telephone: Phone:
Address:
Project Description:
City, ST, Zip:.
p
E Pt-AC � I� CSo SW/A) <L
Telephone: hone
(j'
� uN
State Lic. # :
City Lic. #..
n�
�/
2 C —OD / 0 000� .
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone: ele h
one
State Lic. #
Construction n
o Type: ecu an7'
P P ��
aProJect type
New Add' Alter aDemo
Name of Contact Person: (J j LL I Af-A . ,1 C
Sq. FtO� Q
# Stories: # Units:
Telephone # of Contact Person: 2S? i, yG(, .. 8 j
Estimated Value of Project. Q Q 0 .
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanica:
Grading plan
tad 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:-
"d 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 Trees
T44f 4 4 auk& -
P.O. Box 1504
:LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPERTY OWNER'S PACKAGE
(760)777-7012
FAX (760) 777-701 1
Disclosures & Forms for Owner -Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER.
Dear Property Owner:
An application for a buildrn permit has been submitted in your name listing yourself as the builder . of the property
improvements specified at ,R R 30 /i \/CAVO^ tAtUJL-)o -z.A (,A QU I AJTA CA
We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your
responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner -Builder. We will not issue a building permit until you have read, initialed your understancing of each provision,
signed, and returned this form to us at our official address indicated. An agent of the owner carnot execute this notice
unless you, the property owner, obtain the prior approval of the permitting authority:
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
rDIRECTIONS: Read and initial each statement below to signs you understand or verify this informaticn. _
v Lt 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as
an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person
and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those
injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers
on my property.
2. I understand building permits are not required to be signed by property owners unless they are responsible for the
construction and are not hiring a licensed Contractor to assume this responsibility.
IA%H3. I understand as an "Owner -Builder" I am the responsible spo party of record on the permit. I understand that I may protect
myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or ier name instead of my
own.
(em 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
wM 5. I understand if I employ or otherwise engage anypersons, other than California licensed Contrac-:ors, and the total value
of my construction is at least five hundred. dollars ($500), including labor and materials, I may be considered an "employer"
under state and federal law.
kk16. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal
government, withhold payroll taxes, provide workers' compensation disability insurance; and contribute. to unemployment
compensation for each "employee. I also understand my failure to abide by these laws
risk. may subject ne to -serious financial
tMT I understand under California Contractors' State License Law, an Owner -Builder who builds' -igle-family residential
structures cannot legally Build them with the intent to offer them for sale, unless all work is' performed by licensed
subcontractors and the number of structures does not exceed four within any calendar year, or all of he work is performed
under contract with a licensed general building Contractor.
iVM
8. I. understand as an Owner -Builder if I sell.the property for which this permit is issued, I may be held liable for any
financial or personal injuries 'sustained by any subsequent owner(s) that.result from any latent construction defects in the
workmanship or materials.
WM 9.. I understand I may obtain more information regarding my, obligations as an "employer" from the Internal Revenue
Service, the United States Small -Business Administration, the California Department of Benefit Payments, and the California
Division of Industrial Accidents. I also understand I may contact the California .Contractors' State License Board (CSLB) at 1-
800-3217CSLB (2752) or www.cslb.ca.gov.for more information about licensed contractors.
W M10. I am aware of and consent to an Owner -Builder building permit. applied for in my name, and understand that I am the
party legally, and financially responsible for proposed construction activity at the following address:
saa30 AVfyn/li� M.;nti7o LA a�►,�-A rA `7z --s-3
VM__ 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
applicable laws and requirements that govern Owner -Builders as.well as employers.
12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
have provided on this form Licensed contractors are regulated by, laws designed to protect the public. If you contract with
someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss
you may sustain as a result of a complaint. Your only remedy against. unlicensed Contractors may be.in civil court. It is also
important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working
on your property, you may be held liable for damages. If you obtain a permit as Owner=Builder and. wish to hire Contractors,
you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner and returned to
the agency responsible for issuing the per,.mit. Note: A copy of the property owner's driver's license, form notarization, or
other verification acceptable to the agency is required to be presented when the permit is issued to verify the property
owner's signature.
Signature of property owner Date: 22— MA -1 T�
Note: The following Authorization- Form is required to be completed by the property owner only when designating
an agent of the property owner to apply for a construction permit for the Owner -Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize
the following person(s) to act as my agent(s) to apply for, sign; and file, the documents necessary, to obtain an Owner -Builder
Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent: Tel No
Address of Authorized Agent:
I declare under penalty of perjury that I am the property owner for the address listed above and I personally f lied out the above
information and certify its accuracy. Note: A copy of the.owner's driver's license, form notarization, or other verification
acceptable to the -agency is required to be presented when. the permit is issued to verify the property owners signature.
Property Owner's Signature: Date:
STATE OF CALIFORNIA '
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
CEG-CFIR-ALT-05-E (Revised 04/16) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-05-E
Prescriptive Residential Alterations That Do Not Require HERS Field Verification Page 1 of 3
Project Name: S /Z Date Prepared: -
This compliance document is -only applicable to simple alterations that do not require
with a`HERS Provider Data Registry.
LT -
Alterations to Space Conditioning Systems that are exempt from HERS verification requirements may use the CFIR-ALT-05 and CF2R- ALT -OS Compliance Documents. Possible exemptions from duct
leakage testing include: less than 40 ft of ducts were added or replaced, or the existing duct system was insulated with asbestos; or the existing duct system was previously tested and passed by a
HERS Rater. If space conditioning systems are altered and are not exempt from HERS verification, then a CFIR-ALT-02 must be completed and registered with a HERS Provider Data Registry.
Alte'rations that utilize close Cell Spray Polyurethane Foam (ccSPF) with a density of 1.5 to less than 1.5 pounds per cubic foot having an R -value other than S.8 per inch, or Open Cell Spray
Polyurethane Foam (ocSPF) with a density of 0.4 to less than 1.5 pounds per cubic foot having an R -value of 3.6 per inch, shall complete and register a CF1R-ALT-01 with a HERS Provider Data
Registry.
If more than one person has responsibilityfor installation of the items on this certificate, each person shall prepare and sign a certificate applicable to the portion of construction for which they are
responsible. Alternatively, the person with chief responsibility for construction shall prepare and sign this certificate for the entire construction. All applicable Mandatory Measures shall be met.
Temporary labels shall not be removed before verification by the building inspector.
A. General Information
01
Project Name:
—
02
Date Prepared:
/
03
Project Location:�_2Z
3 U Av6(v1 0A
04
Building Front Orientation (deg or cardinal):
05
CA City:LA
VIN
06
Number of Altered Dwelling Units:
07
Zip Code:
1 2 Z s;
08
Fuel Type:
09
Climate Zone:
I
10
Total Conditioned Floor Area (ft):
11
Building Type:
S 1 /J L ✓ti 1 ! O M !�
? l
12
Slab Area (ftp)
13
Project Scope (Select all that apply):
❑ B.'Insulation ❑ D. & E. Fenestration/Glazing - ADD ❑ G. Space Conditioning System (Heating, Cooling, Duct system) ❑ Lighting
✓❑ C. Roof Replacement ❑ D. & F. Fenestration/Glazing - REPLACE ❑ H. Water Heating System ❑ Include Mandatory Measures?
CA Building Energy Efficiency Standards - 2016 Residential Compliance April 2016
a
STATE OF CALIFORNIA
Prescriptive Residential Alterations That Do Not Require HERS Field Verification
CEC-CF1 R -ALT -05-E (Revised 04/16) CALIFORNIA ENERGY COMMISSION'S
CERTIFICATE OF COMPLIANCE CF1R-ALT-05-E
Prescriptive Residential Alterations That Do Not Require HERS Field Verification Page 2 of 3
Project Name: Date Prepared:
C. Roof Replacement (Prescriptive Alteration, Section 150.2(b)1H)
01
02
03
04
0S
06
07 08 09 ,10
11 12 13
Proposed
Minimum Required
Method of
Compliance
Roof Pitch
Exception
CRRC Product.
ID Number
Product
Type
R -value
Deck
Insulation
Initial Solar
Reflectance
Aged Solar
Reflectance
Thermal
Emittance
SRI
(Optional)
Aged Solar
Reflectance
Thermal
Emittance
SRI
(Optional)
�.�ShMI
: 1
o -000a
SNi�s�R wK r
S�iN
a
�'a
_ a
8oar
-30
7
Add Row
Delete Row-
NOTES:
• Roof area covered by building integrated photovoltaic 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.
CA Building Energy Efficiency Standards - 2016 Residential Compliance April 2016
STATE OF CALIFORNIA
Prescriptive Residential Alterations That Do Not Require HERS Field Verification `-
CEC-CFIR-ALT-05-E Revised 04/16 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-05-E
Prescriptive Residential Alterations That Do Not Require HERS Field Verification - Page 3 of 3
Project Name: Date Prepared: .
C-/2<' /'�-
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name: -
' Documentation Author Mignat
L m MCC tL_
Company:.
Signature Date:
Z�
Address:
CEA/ HERS Certification Identification (if applicable):
S -2z30 Av�.�(r 1 I'ul�i•�Joz/+
City/State/Zip:
L OL) F& 2.-t_
Phe:
rZ5'-l) Ll 6& - q-6 1
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. 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 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 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
for all applicable inspections. I understand that a registered 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:
LJ ILL 1 A M Cf_6_ _
Responsible Designer Signature:
Company:
Date Signed: .
Address:
License: `
X22-30 Ak CEJ i 0^�-
City/State/Zip:
Phone:
z
(-2 5z( - 1
For assistance or.questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300..
CA Building Energy Efficiency Standards - 2016 Residential Compliance
D
April 2016