BRER2019-0212STATE OF CALIFORNIA
Pi�scriptive Residential Alterations That Do Not Require HERS Field Verification
CEC-CFIR-ALT-05-E Revised 07/17; CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE
Prescriptive Residential Alterations That Do Not Require HERS Field Verification Page 3 of CF 1 R-A LT-05-E
Project Name. _
Date:?F"md:
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
I. I certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name: rlacumentation Author Signature:
Company:
Signature Date:
o fir /r1�n0. [ ,rr i l 1�, �.7 /! 9
Address: / CEA/ HERS Certification identification [if appIlcabley:
Clty/Statel2ip:
Phone:
RESPONSIBLE PERSON'S DECLARATION STATEMENT
1 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: // Responsible Designer Signature:
Company
Date Signed:
7;1
Address:
54/
City/Stata/Zkp: / /f /
Phone:
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 July 2017