15070174CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20371 STEVENS CREEK BLD
CONTRACTOR: LEE'S SIGNS
PERMIT NO: 15070174
OWNER'S NAME: WDV PROPERTIES
845 E 10TH ST
DATE ISSUED: 07/24/2015
OWNER'S PHONE: 6502093232
OAKLAND, CA 94606
PHONE NO: (510) 452 -1420
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑
C 1 �bba
"LSUSHI & GRILL" - INSTALL NEW ILLUMINATED
License Class Lic. #
CHANNEL LETTER SIGN ON FRONT EXTERIOR WALL
//
L lOLw L W 7Xiiq
(EXISTING 20 AMP CIRCUIT)
Contractor _1 Date
I hereby affirm that 1 am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self - insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
Sq. Ft Floor Area:
Valuation: $2450
performance of the work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
APN Number: 31626090.20371
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 S FROM LAST CALLED INSP CTI N.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the�tr:�rV
a ou
granting of this permit. Additionally, the applicant understands and will comply
V
Issued by: "r V �+ Date:
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
�2
RE- ROOFS:
Signature Date
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
OWNER- BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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 & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self - insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date: ��2
permit is issued.
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 Worker's
Compensation laws of California. If, after making this certificate of exemption, I
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
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. (We) agree to save
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
1 understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
Signature Date
CUPERTINO
SIGN PERMIT APPLICATION tvi�l�-•
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building(cDcupertino.orr
PROJECT ADDRESS /^ 2-1-0371 ���� �� �� //� �� - APN k 6 �� IRo
OWNER NAME LGI.V{Y�J V✓ I�jI�,L �PHj01/NE� /S' "�%Cj_ 3•- 32 E-MAIL AY.QaC�D�P.A{�1 D "fires, COIF►
STREET ADDRESS�J�O A t. /� ID �` CITY, STATE, ZIP J _ s (!/� //�!L l l�( gZ/oa FAX
CONTACT NAME rr j PHONE �(0,�7 _�D(/�IC�JS L(-E-MA[LT.�C�ee Z® LLI��t!1777'1
STREET ADDRESS QL CITY. STATE, ZIP
❑ OWNER ❑ OWNER- BUILDER ❑ OWNER AGENT PS CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER of LICENSE TYPE � BUS. LIC #
SS b l
COMPANY NAME L,08 _f (1/ J � E-MAIL FAIYVO )9 _b / j O 7 l
�j
STREET ADDRESS t j5 CITY, STATE, ZIP PHONE(o) 4
ARCHITECT/ENGINEER LICENSE NUMBER BUS. L1C 9
COMPANY NAME
STREET ADDRESS
E -MAIL
CITY, STATE, ZIP
FAX
PHONE
IDESCRIPTION OF WORK Jew �i_ h n/f , _ rr 4S �4^ nd "4,- I
USE OF ❑ SFD or Duplex ❑ Multi - Family ILLUMINATED SIGN TYPE NO. OF SIGN AREA VALUATION
STRUCTURE: Commercial (YIN) (CODE) SIGNS (SQ.FT.) ((S))�
SIGN TYPE CODES: 2,5 ] �/ - o-U
B - BANNER SIGN
BL - BLADE SIGN
D - DEVELOPMENT ID SIGN
M
P
SP
- MONUMENT (GROUND) SIGN
- PROJECTING SIGN
- SPECIAL EVENT BANNER
DI - DIRECTIONAL SIGN
T
- TEMPORARY
E - ELECTRONIC W
- WALL SIGN
READERBOARD
VR
- WINDOW SIGN
TOTAL VALUATION:
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construQtion. IIaauth ize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: — i/� G _ Date:
We;,„
SUPPLEMENTAL INFORMATION REQUIRED �`. �,w.�;�, �9?�Ti�75E -4zi bow;�r'oo i✓ f, :`
Site Plan
Elevations
Sign Details - including UL listing(s) applicable
Structural Calculations (if applicable)
Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
SignApp_2011.doc revised 03116111
CITY OF CUPERTINO 15C)401 -74
FEE ESTIMATOR - BUILDING DIVISION
SIGN TYPE
ADDRESS: 20371 Stevens Creek Blvd
DATE: 07/24/2015
REVIEWED BY: PAUL
2,1017 ('hcc1,
APN: 316 26 090
BP #:
'VALUATION: 1$2,450
'PERMITTYPE: Building Permit
HJ
PRIMARY
USE. Sign
P/ ! '11'. I J. 1 Z.'c
PENTAMATION
PERMIT TYPE: 1 CEAP
WORK
"I.SUSHI & GRILL" - Install new illuminated channel letter si n on front exterior wall (Existing 20 Am
SCOPE
Circuit)
SIGN TYPE
FEE ID
Phw)b. a) fi'fx c1
QTY
2,1017 ('hcc1,
SIGN FEE
IESIGN Elec. Permit Fee: IEPERMIT
Wall Sign, Electric
1SIGNWELEC
Other Elea Insp. 0.0 $48.00
1
P/ ! '11'. I J. 1 Z.'c
$286
Permit Fee:
$286.00
Suppl. Insp. Fee-(F) Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$48.00
PME Permit Fee:
$48.00
Con so oc
Work Without Permit? 0 Yes (F) No
$0.00
TOTALS:
$0.00
Travel Documentation Fee: ITRAVDOC
$286.00
Strong Motion Fee: IBSEISMICO
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These Pees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11 -053 Eff' 7/1/13)
9v h 1P/o/I
Phw)b. a) fi'fx c1
# Branch Circuits 1 $48.00
2,1017 ('hcc1,
IESIGN Elec. Permit Fee: IEPERMIT
Suppl. PC Fee: Q Reg. 0 OT
0.0
Other Elea Insp. 0.0 $48.00
""c ",
P/ ! '11'. I J. 1 Z.'c
% "( ( '. /wq)
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These Pees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11 -053 Eff' 7/1/13)
FEE
QTYIFEE
MISC ITEMS
2,1017 ('hcc1,
Suppl. PC Fee: Q Reg. 0 OT
0.0
1 hrs
$0.00
Phfinh." °('rl'ch
Permit Fee:
$286.00
Suppl. Insp. Fee-(F) Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$48.00
PME Permit Fee:
$48.00
Con so oc
Work Without Permit? 0 Yes (F) No
$0.00
Sign Master Plan: 0 Yes (F) No
$0.00
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICO
$0.69
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
: BT
$431.69
$0.00 TOTAL FE
$431.69
Revised: 07/02/2015
3TA'TE O'CALIFORNIA AddIhL
SIGN LIGHTING PW 1%;f01;4,
f:Fr:.NRC(:_f TR_o1- F(RavigAr1 rR/141 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE
NRCC - LTS -01 -E
Sign Lighting
(Page 1 of S)
Project Name: 7 - Pi
person may install the sign lighting controls than the responsible person installing the sign lighting power.
Date Prepared: 7 7� 1, .s�
.7 ^/�
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,
Project Address:
Location of Sign Outdoor Signs
Phase of Sign Construction New Signs
Type of Lighting Control 1204ew Lighting Controls
❑ Indoor Signs AL
❑ Sign Alterations
❑ Replaced Lighting Controls ❑ No� al i i Controls
This Certificate of Compliance includes the following components (check all that apply)
vf Mandatory Measures (Lighting Controls) ❑ Maximum Allowed Lighting Power ❑ Specific Lighting Sources
1. Mandatory Sign Lighting Controls
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.
Ia.
Statements of Responsibility: Any person signing the Certificate of Compliance Declaration Statement on this NRCC - LTS -01 -E
shall complete Part 1a. Check Yes or No for all of the following statements:
1
I have responsibility for installing the sign lighting controls
es, complete parts 1a and 1b of this form ❑ No, complete part 1a of this form
There are no existing sign lighting controls and I will be installing compliant sign lighting controls
Z
❑ Yes gN o
There are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls
3
❑ Yes KNo
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 A 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 IKNo
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014
STATE OF CALIFORNIA,
SIGN LIGHTING
'EC- NRCC - LTS 01- E(Revlsed 08/14) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC- LTS -01 -E
Sign Lighting (Page 2 of 5)
Project Name: ; Sv \Set I $ ( Date Prepared:
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 there are construction documents, indicate where on the building plans the
mandatory measures (sign lighting control) note block can be located:
§130.3(a)1. All indoor sign lighting is controlled with an automatic time - switch control or astronomical time-
Y
N
NA
1
switch control.
❑
❑
§130.3(a)2A. All outdoor sign lighting is controlled with a photocontrol in addition to an automatic time-
Y
N
NA
switch control, or an astronomical time - switch control.
XI
❑
❑
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
CALIFORNIA
,CERT- lkATE'OF COMPLIANCE NRt.C- 1-TS -01 -E.
IProf Name: r SLAS /hr h _ p _ , /y(1 I Date Prepared: —4 / Z? / /
2 Mjxln]umAllowed'.L1ghtjhg Pgjye r Method of Compliance
Certificate of Compliance and Field Inspection Energy Checklist
Complete thts part if there are signs using the maximum allowed lighting power method of compliance. (Complete part 3 of
this Certificate of.Compli',nce if there are signs using the Specific lighting sources method of compliance)'
A
B
C
D
E F G
H
I
1.
Symbol ;
OPTIONAL -- Energy
Complies
Filed Inspector
Or Cane '
Descripttan of the Sign
Verified Label (see
Allotted Watts
Design Watts
YEN
Check. that sign
Instructions below)
complies
z
r
O
^
— a
a
m
c
°°
N
vi
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(p
..
`1
Q
0
c E
cu M
-a X
C O
N
t
tw
_
_
v,
�W—
—
o
f
U
a
�
❑
❑
❑
d
❑
❑
❑
o.
❑
a
A
Symbol or code used on the plans (when plans are required) and other documents.
g
A description of -the sign, Or location of sign on the building; and the location of sigh on construction documents,
OPTIONAL - Check this bow' only if this sign has a permanent, pre - printed, factory4nstalied,, ENERGY VERIFIED 4bel, confirm fig 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. Thle only labels that will be recognized for this purpose are ENERGY VERIFIED .Certifcation>Ma -rks authorized by
C
Unclerwrlters Laboratories (UL) or other Product Certification Body accredited. to ISOJIEC 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 ISOJIEC 17020. For signs with such an ENERGY VERIF(ED'Iabel,
columns 'D' through 'I' arelnot required to be filled out. Note: Using an ENERGY VERIFIED label Is an optional method to validate
cost} plJance. AnENERGY VSR1FiED label is not needed for compliance.
D
The sign area in s' uar'e feet.
E <-
ist :I" if the i n is,iFlxFrna iy illuminated. List "E" if the sign is externally, illuminated,
F
Allowed watts per square feot. 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 footag� 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.
1 j
This page doubles as a field inspection checklist.
Field I'ns ector Notes:
CA•Building Energy Efficiency Standards- 2013 Nonresidential Compliance June 2014
STATE OF CALIFORNIA
09'QN LIGHTING
CtC- NRCC- LTS-IIi -E RevIsad O6/1d CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC- LTS -01 -E
Sign Lighting (Page 4 of 5)
7roJec1 Name: f {t i ,( Date Prepared: '-7/.>—
3. Specific Lighting 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,
OPTIONAL
Specific light source used for
Symbol
ENERGY VERIFIED
compliance
or
Description
label
Shall include only lighting
Code
(see instructions
technologies listed below
f
g
below)
List all that apply?
�✓
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 VERIFItD 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 ne ded 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.
y
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 minimum efficiency 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 inimum 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 inimum efficiency of 68 percent
5
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 Junei2014
CALIFORNIA
LIGHTING
CERTIFICATE OF COMPLIANCE NRCC- LTS -01 -E
Sign Lighting (Page 5 of 5)
Project Name: Date Prepared:
r. Srtsh � & �� -f/z3 / /t—
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify.that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name: j .Tom Lh4
L—
Documentation Author Signature:
Company:
Signature Date:
Address; �n /s
CEA/ HERS Certification Identification (if applicable):
City /State/Zip: T
Phone: ���) 7m-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. 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 pystem 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 bgiiding 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:�N /
Responsible Designer Signature:
Company: 1t Q�IS Sf CC,
L�
Date Signed: ?, Z3
Address: (fir! / t,� , j -
License:
City /State/Zip:
Cg
Phone:
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014
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