BSIG2016-001078-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
4 44"
COMMUNITY DEVELOPMENT DEPARTMENT
Application Number: BSIG2016-0010
Property Address: 79450 HIGHWAY 111 STE 168
APN: 600390003
Application Description: FOSS RESALE HOUSE SIGN
Property Zoning:
Application Valuation:
Applicant:
GRAPHIX SIGN CO
395 BROADWAY AVENUE STE 6
EL CENTRO, CA 92243
I
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: C45 License No.: 1010673
t� Date:Lctor: C rel
OWNER-BUILDERDECLARATION
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 y^
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, 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 Fier 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 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 I am exempt under Sec. . B.&P.C. for this reason
Date:
Owner:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/14/2016
AIR 4.2v �0.FQU01,11TA,
IGHWAY 111 STE-168 CA 92253
CITY OF LA QUINTA
Y DEVELOPMENT DEPARTMENT11
Contractor:
GRAPHIX SIGN CO
395 BROADWAY AVENUE STE 6
EL CENTRO, CA 92243 .
(760)370-3032
Llc. No.: 1010673
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 wit those rovisions.
Date: t' Applicant: C
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 coorrr�
CONSTRUCTION LENDING AGENCY I agree to comply with all city and county ordinances and state laws relatin �Yuil 'rS9
I hereby affirm under penalty of perjury that there is a construction lending agency for construction, and hereby authorize representatives of this city to a Le upon t
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). above -me tinnedrroperty for inspection purposes.
Lender's Name: <5 Date: Signature (Applicant or Agent):
Lender's
DESCRIPTION
FINANCIAL ••
ACCOUNT
•
QTY . AMOUNT'.
PAID'
PAID DATE.
DEVICES, FIRST 20
101-0000-42403
0 $24.17
$24.17
4/14/16
PAID 6Y
METHOD
RECEIPT# :,:
CHECK.#
CLTD BY <
FIRSTSIGNS
DEBIT
R14762
BSIG2016-0010
MFA
DESCRIPTION,.
- 'ACCOUNT
QTY
AMOUNT
PAID".
PAID.DATE
,DEVICES, FIRST 20 PC
101-0000-42600
0
$24.17
$24.17
4/14/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
FIRSTSIGNS
DEBIT
R14762
BSIG2016-0010
MFA
Total Paid for ELECTRICAL: $48.34 $48.34
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PA16
PAID DATE
WALL/AWNING SIGN, FIRST
101-0000-42404
0
$24.66
$24.66
4/14/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
FIRSTSIGNS
DEBIT
R14762
BSIG2016-0010'
MFA
DESCRIPTION
ACCOUNT
QTY.
AMOUNT
PAID
PAID DATE
WALL/AWNING SIGN, FIRST PC
101-0000-42600
0
• $87.02
$87.02
4/14/16
PAID BY,
METHOD
RECEIPT #
CHECK #CLTD
BY.
FIRSTSIGNS
DEBIT
R14762
BSIG2016-0010
MFA
Total Paid for SIGN: $111.68 $111.68
TOTALS:.0 .0
Description: FOSS RESALE HOUSE SIGN
CONDITIONS
Type: SIGN
Subtype: - Status: ISSUED
Applied: 4/14/2016 MFA
Approved: 4/14/2016 MFA
Parcel No: 600390003 Site Address: 79450 HIGHWAY 111 STE 108 LA QUINTA,CA 92253
Subdivision: PM 31172
Block: Lot: 3
Issued:
Lot Sq Ft: 0
Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $0.00
Occupancy Type: Construction Type:
Expired: 10/11/2016 MFA
No. Buildings: 0
No. Stories: 0 No. Unites: 0
APPLICANT.
Details: (1) CHANNEL LETTER LED SIGN [FOSS RESALE HOUSE] SIGN PERMIT NO. SA2016-0010 [MF] 2010 ENERGY, 2013 CALIFORNIA
BUILDING CODES.
EL CENTRO
CA
ADDITIONAL SITES
CHRONOLOGY
CONDITIONS
NAME TYPE
NAME
ADDRESSI
CONTACTS
CITY
STATE
ZIP
PHONE
FAX
EMAIL
APPLICANT.
GRAPHIX SIGN CO
395 BROADWAY
AVENUE STE 6
EL CENTRO
CA
92243
(760)578-5039
CHARLIE@FIRSTSIGNS.
NET
CONTRACTOR
GRAPHIX SIGN CO
395 BROADWAY
" AVENUE STE 6
EL CENTRO
CA
92243
(760)578-5039
CHARLIE@FIRSTSIGNS.
NET
OWNER
CEASAR
79450 HIGHWAY 111
STE 108
LA QUINTA.
CA
92253
(760)578-5039
FINANCIAL INFURIVIA I ION
Printed: Thursday, April 14, 2016 1:18:58 PM 1 of 2 R _
SYSTEMS
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
CLTf)
BY
DEVICES, FIRST 20
101-0000-42403
0
$24.17
$24.17
4/14/16
R14762
BSIG2016-
DEBIT
FIRSTSIGNS
MFA.
0010
DEVICES, FIRST 20 PC
101-0000-42600
0
$24.17
$24.17
4/14/16
R14762
BSIG2016-
DEBIT
FIRSTSIGNS
MFA
0010
Total Paid for ELECTRICAL: $48.34 $48.34
WALL/AWNING SIGN,
101-0000-42404
0
$24.66
$24.66
4/14/16
R14762
BSIG2016-
DEBIT
FIRSTSIGNS
MFA
FIRST
0010
WALL/AWNING SIGN,
101-0000-42600
0
$87.02
$87.02
4/14/16
R14762
BSIG2016-
016-
DEBIT
FIRSTSIGNS
MFA
FIRST PC
0010
Total Paid for SIGN: $111.68 $111.68
TOTALS:.0$160.02
INSPECTIONS
PARENT PROJECTS
BOND INFORMATION
Printed: Thursday, April 14, 2016 1:18:58 PM 2 of 2 CR
srsreMs
Bin #
City of La Quinta
Building U Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet •
Permit #
Project Address: LA V O
Owner's Name:
A. P. Number:
Address ��
Legal Description:
City, ST, Zip:
�..1
Contractor:
c or:
G �- 4C, S �
Tele7
Address: 3 v 1 _
—�
City, ST, Zip: �. q
Project Description: lnG 1
' r
T ele ne
h 0
P —170-1
�3
...................................:.:::::::::.::::.
State Lic. # : �
City Lie. #t
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
i
Con tr
s uction Type: Pe: Occu ane Y:
P
a
St te Lic. #:
Project a 'n dd
e A Alter Repair air Demo
J h'P (circle cle one• New
Name of Contact Person: L ci L Z
-,
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: cw u
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"" Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
'Plumbing
Grant Deed
Plans picked up
S.M.I.
I{.O.A. Approval
Plans resubmitted
Grading
IN IiOUSE:-
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 Fees
STATE OF CALIFORNIA
SIGN LIGHTING
CEC-NRCC-LTS-01-E Revised 06/14
CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE
NRCC-LTS-01-E -
Sign Lighting
(Page 1 of 5)
Project Name: ( O
\
Date Prepared: L,
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.
Project Address:
If more than one person has responsibility for compliance,each responsible person shall prepare and sign a -Certificate of
Location of Sign MOutdoor Signs '. ❑ Indoor Signs
Phase of Sign Construction New Signs ❑ Sign Alterations
Type of Lighting Control 9New 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
Mandatory Sign Lighting Controls
-1.
NOTES:
1.
The'some 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 sign 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.
1a.
Statements of Responsibility: Any person signing the Certificate of Compliance Declaration Statement on this NRCC-LTS-01-E
shall complete.Part la. Check.Yes or No for all of the following statements:
1
I have responsibility for installing the sign lighting controls
Yes, complete parts la and lb of this form ❑ No, complete part la of this form
2
There are no existing sign lighting controls and I will be installing compliant sign lighting controls
Yes ❑ No
3
here are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls
❑ Yes VNo
There are existing sign lighting controls that do not comply with the applicable provision of §110.9 and §130.3 and I will be
4
installing compliant sign lighting controls
❑ Yes No
There are existing sign lighting controls that do not comply with the applicable provision of §110.9 and §130.3 and someone
5
else will be responsible to install compliant.sign lighting controls
❑ Yes 1�1,No'
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014
STATE OF CALIFORNIA
SIGN LIGHTING
o-
CEC-NRCC-LTS-01-E(Revised 06/14) GALIf UKNIA tNtKUY GUMMIbWUN '
CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E
Sign Lighting (Page 2 of 5)
Project Name:C I Date Prepared:
1b. 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 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-
Y N
switch control.
❑
JK
§130.3(a)2A. All outdoor sign lighting is controlled with a photocontrol in addition to an automatic time-
N
NA
switch control, or an astronomical time -switch control.
❑
❑
2
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.
❑
§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 65 percent during nighttime hours.
Y
N
NA
3
Signs that are illuminated at night and for more than 1 hour during daylight hours shall be considered ON both
❑
❑
day and 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)
Y
N
N/A
having a new connected lighting power load greater than 15 kW has a control installed that is capable of
❑
❑
4
reducing the lighting power by a minimum of 30 percent when receiving a demand response signal.
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 percent.
❑
�)
Field Inspector Notes:
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014
N
a
-STATE OF CALIFORNIA
SIGN LIGHTING.'
MUM,-
CEC-NRCC-LTS-01-E Revised 06114 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE , NRCC-LTS=01-E
Sign Lighting (Page 3 of 5)
Project Name: - Date Prepared:
2. Maximum Allowed Lighting Power Method of Compliance.
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 3 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
Symbol
Or Code
Description of the Sign
OPTIONAL — Energy
Verified. Label (see
instructions below)
Allotted Watts
Design Watts
Complies
Y N
Filed Inspector
Check that sign
complies
f6 C.
Q c E
twN +•' 3
in =w=
10,
G/ N M
3 ry
1 II
aw
W x
3�
O
Q
C
C `-•
YO tt1
f 3
(
VI
v
n
.
v°
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
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 building; and the location of sign on construction documents.
C
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 2013 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 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 '1' are 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.
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).
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.
i
This page doubles as a field inspection checklist.
Field Inspector Notes:
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014
STATE OF CALIFORNIA
SIGN LIGHTING..
MR
CEC-NRCC-LTS-01-E Revised 06/14 CALIFORNIA ENERGY COMMISSION _—x
CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E.
Sign Lighting (Page 4 of 5)
Project Name: (� Date Prepared:
L/_
3. Specific Lig ting Source Method 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
OPTIONAL
Specific light source used for
=' •. `
Field, Inspector'
Symbol
ENERGY VERIFIED
compliance
- w, -s -.
, '
Gheck that Sign
or
Description
label
Shall include only lighting
Compli6s y
Code
(see instructions
technologies listed below
-k t,
below)
List all that apply0.
: 4 : ,, •_ ,•
4
❑
4,0 L
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
C
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 2013 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 (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 percent or
2
greater: 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 served by
3
a ballast that has a minimumefficiency of 80 percent.•
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.
Neon or cold cathode lamps with transformer or power supply efficiency greater than or equal to a minimum efficiency of 75 percent
D
4
when 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 percent tubing load.
Neon or cold cathode lamps with transformer or power supply efficiency greater than or equal to a minimum efficiency of 68 percent
S
when 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 percent 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 percent 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
Regulations (Title 20).
9
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 - 2013 Nonresidential Compliance June 2014
STATE OF CALIFORNIA An
q,
SIGN LIGHTING
CEC-NRCC-LTS-01-E Revised 06/14 CALIFORNIA ENERGY COMMISSION �+
CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E
Sign Lighting ` (Page 5 of 5)
Project Name: C�7147Date. Prepared:
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certificate of ompliance documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
(r
Companyt t
Signature Date: L
[—IC
Address:
3c�
CEA/ HERS Certification Identi 'cation (i pplicable):
\. �0
City/State/Zip:/
Phone:
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:
Gln
Company : r
Date Signed:
Cc" V r
Address:
�
license:
r C
City/State/Zip: ` C n
Phone:
CA. Building Energy Efficiency Standards - 2013 Nonresidential Compliance
June 2014