BMCH2019-04244 ter!
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
MECHANICAL/
BMCH2O19-0424
T4ht 4 Zfv Q"
DESI EVEL ENT PA NIT
D
Ul R�T
J A N 2 9 2020
78935 HIGHWAY 111 CITY OF LA QUINTA
643020029 DE&GN & DEVELOPMENT D-PUMENT
TARGET / REPLACE ONE ROOF MOUNTED MINI SPLIT SY E
$8,000.00
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
TARGET CORP
1000 NICOLLET MALL TPN 12
MINNEAPOLIS, MN 92253
Date: 1/29/2020
Applicant: AS OR Contractor:
JAMES FIGG - LENNOX NATIONAL ACCOUNT SERVICES I LENNOX NATIONAL ACCOUNT SERVICES INC
3511 NE 22 AVE SUE 3511 NE 22 AVE
FORT LAUDERDALE, FL 33308� FORT LAUDERDALE, FL 33308
(954)745-3701
C1TYOFLAQUINTA Llc. No.:902748
DESIGN & DEVELOPMENT DEPARTMENT
---------------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9
(commencing with Section 70001 of Division 3 of the Business and Professions Code, and
my License is in full force and effect.
License Class: C20 License No.: 902748
Date: �49— a0 Co act
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.).
(_) 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 work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
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 ywLork 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: WLRC65894208
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. r
Ape `►,-, -
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.
€?afY . t4q—v _y _ 91111111111111ftApplicant or Agent).,
Date 2/c.j)2b20
Application Number: BMCH2019-0424
Property Address: 78935 HIGHWAY 111
APN: 643020029
Application Description: TARGET / REPLACE ONE ROOF MOUNTED MINI SPLIT SYSTEM
Property Zoning:
Application Valuation: $8,000.00
Applicant:
JAMES FIGG - LENNOX NATIONAL ACCOUNT SERVICES INC
3511 NE 22 AVE
FORT LAUDERDALE, FL 33308
Owner:
TARGET CORP
1000 NICOLLET MALL TPN 12
MINNEAPOLIS, MN 92253
Contractor:
LENNOX NATIONAL ACCOUNT SERVICES INC
3511 NE 22 AVE
FORT LAUDERDALE, FL 33308
(954)745-3701
Llc. No.: 902748
Detail: HVAC CHANGE OUT - SEER/80 AFUE SPLIT SYSTEM, CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. PER 2016
CALIFORNIA BUILDING CODES. , .
RCAC SR1 A72 FFF
T..r..l n..:d L.�. ..
DESCRIPTION
ACCOUNT
CITY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM
101-0000-42402
0
$40.25
DESCRIPTION
ACCOUNT
CITY
AMOUNT
HVAC CHANGEOUT - SPLIT -SYSTEM PC
101-0000-42600
0
$80.50
Total Paid for MECHANICAL CHANGEOUT 2019: $120.75
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$101.97
Total Paid for PERMIT ISSUANCE: $101.97
DESCRIPTION
ACCOUNT CITY
AMOUNT
RECORDS MANAGEMENT FEE
101-0000-42416 0
$10.00
Total Paid for RECORDS MANAGEMENT FEE: $10.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
Za Qaigra
Fir
Projec[Address: 3_5 raj
APN #:
Applicant Name: -J/k�e-S 1=I C:z
Address:
City, ST, Zip:
Telephone:
Email: J owe f. t
PERMIT # '_W_4201 ` — O L(Zt{
PLAN LOCATION:
I I Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
Rpte4ce o,,e M4i Se la �Iv,9 c
Arch/Eng Name: & s3 bgv\te.� f,�OAOtWcqc l Ll�
Address: � [ ( vv�- wo� (v_ f R 5+e 1 U-
City, St, Zip -t-e—m f e
Telephone: L($6 -
Email:)e0c9e 0c4mv _PV g eerS, cove
State Lie: $�� City Bus Lic: `
Property Owner's Name: I 0� 0 4
Address: -_�T9 3 5 V5 �IwW I
City, ST, Zip LU QUkVl+cl z C 4
Telephone: 6 0 5 Cc(- () q q d-
Email:
-SGArvW, S F 1
l6 I � Cis +Ve s� F
L/
Valuation of Project S 8 L
Construction Type: j 1
Grading:
Bedrooms: I Stories:
Occupancy:
# Units:
New Commercial / Tenant Improvements:
Total Building SF
Construction Type: Occupancy:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
STATE OF CALIFORNIA
Mechanical Systems
NRCC-MCH-E (Created 11/19)
CAI IFnRNIA FNFRr;v CnMMICVnN M
CERTIFICATE OF COMPLIANCE
NRCC-MCH-E
This document is used to demonstrate compliance for mechanical systems that are within the scope of the permit opp !cation and are demonstrating compliance using the
prescriptive path outlined in 140.4 or §141.0(b)2 for alterations.
Project Name: Target #1867
Report Page: Page 1 of 8
Project Address: 78935 CA-111, La Quinta, CA 92253
JDate Prepared: 12-19-2019
A. GENERAL INFORMATION
01
Project Location (city)
La Quinta
04
ITotal Conditioned Floor Area
150
02 Climate Zone 15
05 ITotal Unconditioned Floor Area 0
03 Occupancy Types Within Project:
06 J# of Stories (Habitable Above Grade) 1
❑ Office (B) ❑✓ Retail (M)
❑ Non -refrigerated Warehouse (S)
❑ Hotel/ Motel Guest Rooms (R-1) School (F)
❑ Healthcare Facility (H)
❑ High -Rise Residential (R-2/11-3) Relocatable Class Bldg (E)
Other (Write In):
ruU►NU►ts: climate zone can be determined on the California Energy Commission's website at hffo.Z
lwww.encrAy.ca.g—ovlmapsLrenewabLeLbuildingLclimate tanes.html
B. PROJECT SCOPE
Table Instructions: Include any mechanical systems that are within the scope of the permit application and are demonstrating compliance using the prescriptive path outlined in
140.4 or §141.0(b)2 for alterations.
My project consists of (check all that apply)
;
01
02
03
Air System(s)
Wet System Components
Dry System C
entn o
❑✓ Heating Air System
Water Economizer
Air Economizer
c14 S z
0 Cooling Air System
El Pumps
Electric Resistance Heat
o� w
Mechanical Controls
Hydronic System Piping
Fan Systems
a w
�✓ Mechanical Controls
Cooling Towers
Ductwork
❑ Chillers
Ventilation Lud
❑ Boilers
❑ Zonal Systems/Terminal BO
C. COMPLIANCE RESULTS
Table Instructions:
If any cell on this
table
says "DOES
NOT
COMPLY" or "COMPLIES
with Exceptional
05
Conditions"
refer
1
to Table D. for
guidance.
01
02
03
04
06
07
08
09
System
Fans/
System
Summary
110.1
AND
Pumps
Economizers
Controls
Ventilation
Terminal Box
Distribution
Cooling
140.4 k
AND
140.4 c
AND
110.2
AND
AND
120.1
Controls
AND
120.3
AND
Towers
Compliance Results
140.4 a
11 0 2
120 2
140.4 d
140.4 I
§110.2(e)2
140.4
140.4
(See Table J)
(See Table F)
(See Table G)
(See Table H)
(See Table 1)
(See Table K)
(See Table L)
(See Table M)
Yes
AND
AND
AND
Yes
AND
AND
AND
ANDI
COMPLIES
Mandatory
Measures Compliance (See
Table Q for Details)
COMPLIES
CA Building Energy Efficiency Standards - 2019 Nonresidential Compliance: http:/Iwww,energy:;goyhitle2412019standardsl, November 2019n�O
STATE OF CALIFORNIA
Mechanical Systems
NRCC-MCH-E (Created 11/19)
CALIFORNIA ENERGY COMMISSION IS
CERTIFICATE OF COMPLIANCE
NRCC-MCH-E
Project Name: Target #1867
lReport Page:
Page 2 of 8
Project Address: 78935 CA-111, La Quinta, CA 92253
JDate Prepared:
12-19-2019
D. EXCEPTIONAL CONDITIONS
This table is auto filled with uneditable comments because of selections made or data entered in tables throughout the form.
No exceptional conditions apply to this project.
ADDITIONAL REMARKS
table includes remarks made by the permit applicant to the Authority Having Jurisdiction.
F. HVAC SYSTEM SUMMARY (DRY & WET SYSTEMS) F6
Table Instructions: Complete the following equipment schedules to show compliance with mandatory requirements found in 1§ 10.1 and 110.2 a and prescriptive requirements
found in 140.4 a 140.4 b and 140.4 k or 141.0 b 2 for alterations.
Dry System Equipment Sizing (includes air conditioners, condensers, heat pumps, VRF, furnaces and unit heaters)
01 1 02 1 03 1 04 1 05 1 06 07 1 08 09 1 10 11
Equipment Sizing per Mechanical
Schedule (Btu/h)
140.4 a&b)
Cooling Output2,3
Load Calculations3,4
Heating Output2,3
Name or
Equipment Category per
Equipment Type per
Smallest Size Su pp'
Available
Sensible
Total
Total
Item Tag
Tables 110.2
Tables 110.2 & Title 20
Per
§140.4 (a) Rated Heating
Per
Rated
Heating
Sensible
Design
(kBtu/h) (kBtu/h) Output
Design
(kBtu/h)
Load
Cooling
Load
(kBtu/h)
(kBtu/h)
(kBtu/h)
(kLoad
ICU/FCU17
Unitary heat pumps
Air cooled, split (1 phase)
Yes
12,000 12J,000
12,000
12,000
12,000
12,000
12,000
1 FOOTNOTES: Equipment shall be the smallest size, within the available options of the desired equipment line, necessary to meet the design heating and cooling loads of the
building per 140.4 a . Healthcare facilities are excepted.
2 It is common practice to show rated output capacity on the equipment schedule. Sensible cooling output comes from specification sheet tables.
31f equipment is heating only, leave cooling output and load blank. If equipment is cooling only, leave heating output and load blank.
°Authority Having Jurisdiction may ask for load calculations used for compliance per 140.4 b .
Table Continued
CA Building Energy Efficiency Standards - 2019 Nonresidential Compliance: httpJLwww_,energy.ca.goy/title24/2019standards November 2019
STATE OF CALIFORNIA
Mechanical Systems
NRCC-MCH-E (Created 11/19)
CALIFORNIA ENERGY COMMISSION 0
CERTIFICATE OF COMPLIANCE NRCC-MCH-E
Project Name: Target #1867
lReport Page: Page 3 of 8
Project Address: 78935 CA-111, La Quinta, CA 92253
jDate Prepared: 12-19-2019
Dry System Equipment Efficiency (other than Package Terminal Air Conditioners (PTAC) and Package Terminal Heat Pumps (PTHP))
01
02
03
04
1 05
06
07
08
09
Name or
Item Tag
Size Category
(Btu/h)
Heating Mode
Min Efficiency
Required per
Tables_ 1101 2
Title 20
Cooling Mode
Rating Condition
("F)
Efficiency Unit
HSPF
Design
Efficiency
Efficiency Unit
SEER
Min Efficiency
Required per
Tables 110.21
Title 20
Design
Efficiency
CU/FCU17
<65,000
8.2
10.5
14
21.5
PUMPS
Section Does Not Apply
H. FAN SYSTEMS & AIR ECONOMIZERS
This Section Does Not Apply
I. SYSTEM CONTROLS
W
Table Instructions: Complete the following Table to demonstrate compliance with mandatory controls in 110.2 and 120.2 and prescriptive controls in 140.4
and (n) or
requirements in §141.0(b)2E for altered space conditioning systems.
01 02 03 04 05 06 07 1
08
09
Conditioned Thermostats
Floor Area Shut -Off Isolation Zone Demand Response
Supply Air
Window
System Name System Zoning §110.2(b) & (c)1, Controls Controls
Beingft Served 110.12 and 120.2 b
Temp. Reset
Interlocks per
120.2 a or §141.0(b)2E 120.2 a 120.2
(
140.4
140.4 n
z NA: 7 day per NA: Single NA: PTAC, PTHP, Rm
CU/FCU-17 single zone <_ 25,000 ft Setback Thermostat
NA: Single
NA: No
operable
§120.2(e)1 Zone AC, HP
Zone
windows
'FOOTNOTES: Gravity gas wall heaters, gravity floor heaters, gravity room heaters, non -central electric heaters, fireplaces or decorative gas appliances, wood stoves
are not
required to have setback thermostats.
* NOTES: Controls with a * require a note in the space below explaining how compliance is achieved.
EX. System 1: SA Temp Reset: Exempt because zones compliant with 140.4 d EXCEPTION 1 to 140.4
CA Building Energy Efficiency Standards - 2019 Nonresidential Compliance: http-//www.eneMy.ca•goy/title24/2019standards November 2019
STATE OF CALIFORNIA
Mechanical Systems
NRCC-MCH-E (Created 11/19)
FiCATE OF COMPLIANCE
:t Name: Target #1867
:t Address: 78935 CA-111, La Quinta, CA 92253
J. VENTILATION AND INDOOR AIR QUALITY
This Section Does Not Apply
K. TERMINAL BOX CONTROLS
This Section Does Not Apply
L. DISTRIBUTION (DUCTWORK AND PIPING)
This Section Does Not Apply
M. COOLING TOWERS
This Section Does Not Apply
Page:
Prepared:
CALIFORNIA ENERGY COMMISSION
N RCC-MCH-E
_ Page 4 of 8
12-19-2019
N. DECLARATION OF REQUIRED CERTIFICATES OF INSTALLATION ig
Table Instructions. Selections have been made based on information provided in previous tables of this document. If any selection needs to be changed, please explain why in
Table E. Additional Remarks. These documents must be provided to the building inspector during construction and can be found online at https://www.energy.co.gov/
YES I NO
r0-
RCI-MCH-01-E - Must be submitted for all buildings.
DECLARATION OF REQUIRED CERTIFICATES OF ACCEPTANCE
Form/Title
Field Inspector
Pass I Fail
❑ 1 ❑
Table Instructions: Selections have been made based on information provided in previous tables of this document. If any selection needs to be changed, please explain why in
rable E. Additional Remarks. These documents must be provided to the building inspector during construction and can be found online at https.11www.eneray.ca.gov/
YES I NO
Form/Title
Field Inspector
Pass I Fail
CA Building Energy Efficiency Standards - 2019 Nonresidential Compliance: htt.ener .ca. pyltitle2412019standards November 2019
STATE OF CALIFORNIA
Mechanical Systems
NRCC-MCH-E (Created 11/19)
CERTIFICATE OF COMPLIANCE
i
CALIFORNIA ENERGY COMMISSION
N RCC-MCH-E
'Project Name: Target #1867 Report Page: Page 5 of $
eject Address: 78935 CA-111, La Quinta, CA 92253 IDate Prepared: 12-19-2019
NRCA-MCH-02-A Outdoor Air must be submitted for all newly installed HVAC units.
('
Q
Note: MCH02 A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing
❑
❑
activities overlap.
NRCA-MCH-03-A Constant Volume Single Zone HVAC
C
0
NOTE: This form does not automatically move to "Yes". If Constant Volume Single Zone HVAC Systems are included in the
❑
❑
scope, permit applicant should move this form to "Yes".
NRCA-MCH-04-A Air Distribution Duct Leakage
NRCA-MCH-05-A Air Economizer Controls
NRCA-MCH-06-A Demand Control Ventilation Systems Acceptance must be submitted for all systems required to employ
C^
(0-
❑
❑
C
(0-
❑
❑
('
(j
demand controlled ventilation (refer to §120.1(c)3) can vary outside ventilation flow rates based on maintaining interior
❑
❑
carbon dioxide (CO2) concentration setpoints.
NRCA-MCH-07-A Supply Fan Variable Flow Controls
NRCA-MCH-08-A Valve Leakage Test
NRCA-MCH-09-A Supply Water Temperature Reset Controls
NRCA-MCH-10-A Hydronic System Variable Flow Controls
NRCA-MCH-11-A Automatic Demand Shed Controls
NRCA-MCH-12-A FDD for Packaged Direct Expansion Units
NRCA-MCH-13-A Automatic FDD for Air Handling Units and Zone Terminal Units Acceptance
NRCA-MCH-14-A Distributed Energy Storage DX AC Systems Acceptance
C
%
❑
❑
C
(f
❑
❑
C
C0-
❑
❑
C^
Ci
❑
❑
i
(�
❑
❑
C
(0-
❑
❑
C
(0-
❑
❑
A
NOTE: This form does not automatically move to "Yes". If Distributed Energy Storage DX AC Systems are included in the scope,
❑
❑
permit applicant should move this form to "Yes".
NRCA-MCH-15-A Thermal Energy Storage (TES) System Acceptance
C
NOTE: This form does not automatically move to "Yes". If Chilled Water Storage, Ice -on -Coil Internal Melt, Ice -on -Coil External
Melt Ice Harvester, Brine, Ice -Slurry, Eutectic Salt, Clathrate Hydrate Slurry (CHS), Cryogenic or Encapulated (Ice Ball) Systems
❑
❑
are included in the scope, permit applicant should move this form to "Yes".
NRCA-MCH-16-A Supply Air Temperature Reset Controls
NRCA-MCH-17-A Condenser Water Temperature Reset Controls
NRCA-MCH-18 Energy Management Control Systems
NRCA-MCH-19 Occupancy Sensor Controls
NRCA-MCH-20 Multi -Family Ventilation
(�
(i
❑
❑
i
(0-
❑
C
(:
❑
❑
C
(0-
El
ElC
(!
❑
❑
C^
(0
NRCA-MCH-21 Multi -Family Envelope Leakage
❑
n
CA Building Energy Efficiency Standards - 2019 Nonresidential Compliance: hit - www.ene .ca. ov ti Ie�4J2�19standards November 2019
STATE OF CALIFORNIA
Mechanical Systems
NRCC-MCH-E (Created 11/19)
CERTIFICATE OF COMPLIANCE
Name: Target #1867
Address: 78935 CA-111, La Quinta, CA 92253
Page:
Prepared:
CALIFORNIA ENERGY COMMISSIONUMP
NRCC-MCH-E
Page 6 of 8
12-19-2019
P. DECLARATION OF REQUIRED CERTIFICATES OF VERIFICATION
Table Instructions: Selections have been made based on information provided in previous tables of this document. If any selection needs to be changed, please explain why in
Table E. Additional Remarks. These documents must be completed by a HERS Rater and provided to the building inspector during construction. The final documents must be
created by a HERS Providers registry, but drafts can be found online at ht s:Ilwww.energy.ca�Qavltitle24j20I9standardsZ2019 complionQ documents%
YES
NO
Form/Title
Field Inspector
Pass
Fail
NRCV-MCH-04-H Duct Leakage Test
C
l:
NOTE. Must be completed by a HERS Rater
NRCV-MCH-24 Enclosure Air Leakage Worksheet
❑
❑
�-
(0—
NOTE: Must be completed by a HERS Rater
NRCV-MCH-27 High-rise Residential
❑
❑
❑
❑
NOTE: Must be completed by a HERS Rater
NRCV-MCH-32 Local Mechanical Exhaust
C
4
NOTE: Must be completed by a HERS Rater
CA Building Energy Efficiency Standards - 2019 Nonresidential Compliance: http. www. n r , a. ov title24 2 standards November 2019
STATE OF CALIFORNIA
Mechanical Systems
NRCC-MCH-E (Created 11/19)
CERTIFICATE OF COMPLIANCE
Project Name: Target #1867
Project Address: 78935 CA-111, La Quinta, CA 92253
MANDATORY MEASURES DOCUMENTATION LOCATION
CALIFORNIA ENERGY COMMISSION
N RCC-MCH-E
rt Page: Page 7 of 8
Prepared: 12-19-2019
Table Instructions: Indicate where mandatory measures are documented in the plan set or construction documentation. For any mandatory measures that do not apply, mark
the plan sheet or construction document location as "N/A", any active cells that are left blank will result in non-compliance in Table C.
01
Compliance with Mandatory Measures documented through Yes
MCH Mandatory Measures Note Block:
Plan sheet or construction document location
M1- M2
CA Building Energy Efficiency Standards - 2019 Nonresidential Compliance: ever .ca. v e24 2019standard November 2019
STATE OF CALIFORNIA
Mechanical Systems
NRCC-MCH-E (Created 11/19)
CERTIFICATE OF COMPLIANCE
Name: Target#1867
Address: 78935 CA-111, La Quinta, CA 92253
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
George Josephs
Associated Mechanical Engineers, PLLC
1121 W. Warner Rd, Suite 107
Tempe, AZ 85284
CALIFORNIA ENERGY COMMISSION
port Page:
to Prepared:
Documentation Author Signature:
Signature Date: 12-19-2019
CEA/ HERS Certification Identification (if applicable):
Phone: 480.966.3996
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.
NRCC-MCH-E
Page 8 of 8
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.
S. I 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: George Josephs I Responsible Designer Signature:
pany : Associated Mechanical Engineers, PLLC
Address:
City/State/Zip:
1121 W. Warner Rd, Suite 107
Tempe, AZ 85284
Date Signed:
License:
Phone:
12-19-2019
31807
480.966.3996
CA Building Energy Efficiency Standards - 2019 Nonresidential Compliance: http:1LMMM,eneW.ca.pov ti ie24 1 t dards November 2019