B25-0443 - 31781 CAMINO CAPISTRANO 201AFINAL08/25/2025
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--------------------------------------------
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958513WAY OF LIFE/ AM PM CONSTR. INC.31781 CAMINO CAPISTRANO #107SJC, CA 92675
1
Dianna Flores
From:Gomez, Ruben <RubenGomez@ocfa.org>
Dianna FloresTo:
RE: B25-0443 SJC Souvenir Shop - Landlord LetterSubject:
Tuesday, July 15, 2025 4:23 PMSent:
[The e-mail below is from an external source. Please do not open attachments or click links from an
unknown or suspicious origin.]
External Sender - From: ("Gomez, Ruben"
<RubenGomez@ocfa.org>)
This message came from outside your orga
nization.
Hi Dianna,
Thanks for taking my call earlier. The existing fire sprinkler coverage will be adequate. Thank you for
checking! Please let me know if you have any other questions. Have a great afternoon.
From: Dianna Flores <dflores@sanjuancapistrano.org>
Sent: Tuesday, July 15, 2025 4:17 PM
To: Gomez, Ruben <RubenGomez@ocfa.org>
Cc: Building Division <building@sanjuancapistrano.org>
Subject: FW: B25-0443 SJC Souvenir Shop - Landlord Letter
Mimecast Attachment Protection has deemed this file to be safe, but always exercise caution when opening files.
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Hi Ruben,
It was speaking to you over the phone.
Per our conversation, can you please confirm that the existing fire sprinkler system is adequate for
the Souvenir Shop per Tim’s email below?
Thank you!,
Dianna Flores
Permit Technician
City of San Juan Capistrano
32400 Paseo Adelanto
San Juan Capistrano, CA 92675
O: 949-443-6359
2
www.sanjuancapistrano.org/Building
From: Tim Algier <tim.algier@gmail.com>
Sent: Tuesday, July 15, 2025 2:55 PM
To: Building Division <building@sanjuancapistrano.org>
Subject: B25-0443 SJC Souvenir Shop - Landlord Letter
[The e-mail below is from an external source. Please do not open attachments or click links from an
unknown or suspicious origin.]
Hi Oscar,
Attached is the Landlord Approval Letter and the Fire Sprinkler Approval Letter and installed Fire Alarm
photo requested by Ruben Gomez at OCFA.
I look forward to receiving your email Tomorrow regarding more CSG corrections.
Thank you for all your assistance in getting this shop open for business!
Tim Algier
TAD DESIGN
41911 Avenida Vista Ladera
Temecula, CA 92591
mobile: 951-972-9686
South Coast
Air Quality Management District 21865 Copley Drive, Diamond Bar, CA 91765-4182
Small Busfnen Ani,tance omc«
-800-388--2121smallblLassislance@aqmd gov www.aqmd gov
Air Quality Permit Checklist ¥;�0 tf'��
South Coast Air Quality Management District developed this Air Quality Permit Checklist (checklist) as a
screening evaluation tool in the process required by California Government Code Section 65850.2.Please submit this checklist to the Small Business Assistance Office by email, mail, or in person for review.
If you have any questions or need assistance completing this checklist, contact the Small Business Assistance
Office. Provide a response to all stctions of this checklist as South Coast AQMD may decline to approve this
checklist due to lack of information from the applicant.
NOTE: This checklist is not intended for the approval of demolition or renovation activities. If there are any demolltion or renovation activities that may disturb building materials, please contact the
Asbestos Hotline at 909-396-2336.Section A-Operator and Business Information
l.Business Name: CAV\�P-ANO �OJ�&4(\2.. S'++o?
2.Address:?l1SI CA>'\ ( NO Cltf\ S1¥MJ a Sorte-201 A �JC· 92�7� CA Street City Zip
3.Contact Name:Mf\tJ�\ciO Le-MuS I Phone:( q � ) ¼ . BBL4.---
Title: uw� Email: Cap(S1YQV70SOlA-\SeJ1(V rk>f e 6�; J.
Section B -Business and Equipment Description Please provide a detailed description of the ongoing business operations perfonned and equipment used at this location, including both new and existing equipment. Provide the existing South Coast AQMD facility ID and/or permit numbers, if any.
$\W..'1 t'N.J <;�.
-�I. (;�t·S�v
Page 1 of 2
Rrv. lune 2019 AQPCI
�
•#2025-0799
Section C -Equipment List
Select from the ltst below equipment currently in operation or to be installed.
(Select all that apply and provide the specifications) ' Abrasive Blasting Cabinet/Room ' Air Conditioning Systems(> 50 lbs of refrigerant) ' Application of Paints/ Adhesives/Resins ' Baghouse/Dust Collector ' Bakery Oven (gas-fired, excluding eating establishments) ' Boiler/Water Heater
(max. heat input= or> I million BTU/hr)
Charbroiler ' Coffee Roaster (excluding eating establishments) ' Deep Fryer (excluding eating establishments) ' Dry Cleaning ' Electrostatic Precipitator ' Etching/Plating/Casting/Melting/Forging/Grinding/Cutting ' Fennentation ' Gasoline Storage & Dispensing
Internal Combustion Engine
(rated> 50 bhp; e.g. back-up generator, fire pump) ' Mixing/Bleding of Liquids and/or Powders ' Molding/Extruding/Curing of Plastics ' Phannaceutical/Nutraceutical ' Plasma/Laser Cutter ' Printing/Coating/Drying ' Refrigeration Systems (containing >50 lbs of refrigerant)
Contact the CA Air Resources Board to register the systems.
916-324-2517 or rmp@arb.ca.gov
Section D -Business Self Certification
7.Owner or Aund R epresen .ii tive •: MAv \2-\UO U5MUJ
' ' ' ' ' '
Soldering Oven
Spray Booth
Storage Tanks
Storage Silos
Fuel-burning equipment
OTHER equipment which may have the
potential to emit or control air
contaminants: \ 1'(2..lf; -C\IM • l � -Hu
M€�Qi}6� �\OW 2.'t-.9N w, l'.2 Gf <o'+-tt·
Title: tflUY\H
Signature: \. v... ---.Y l 0a;:1ulir Phone:qlt4 ) ?ob .�'b,," � i--
/ hereby certify by my sign riture above that, I am a duly authorized representative of the above-named business, and
that all information contained herein is true and correct.
Lq111pmcnt ,\rpro \t:d £3:,.:
0 D \rplicam IJJs permit/,) or ,cg, 1r Jl1on1 ,J O'>-<� D •\pplic:1111 h.1, filcJ for prnnH(, 1 r rc g1,1r Jliufl( ) io 8� -s ::> D \1,p iii:Jnt ,., ..:xe111p1 fr11m pL·rn111 ri:qu1rcmc11h
D Ba,cd on th.: 1nf•>rn1J1 ivn pnw1dcd, no t·qwpmcn1 rrn\·c-�.;
r.:4ui1111g <1 pt:rm1L 11r r.:!,!,htr:.111on.
• An Authorized Representative is an employee of the business described in Section A, who is authorized to sign on behalf of the
owner.
Page 2 of 2
Rev. June 2019 AQPC# #2025-0799
None
x
Rhea Lam
Santa Margarita Water District 26111 Antonio Parkway, Rancho Santa Margarita, CA 92688
www.SMWD.com (949) 459-6420
BOARD OF DIRECTORS
BETTY H. OLSON PH. D
LAURA FREESE
FRANK URY
SAUNDRA F. JACOBS
MARGARET NOVAK
ROBERT GRANTHAM
GENERAL MANAGER
July 30, 2025
Building Department
City of San Juan Capistrano
32400 Paseo Adelanto
San Juna Capistrano CA 92675
Attention: Building Department
Subject: Final Water and Sewer Will Serve Letter for Capistrano Souvenir Shop LLC at 31781
Camino Capistrano, Suite 201A, San Juan Capistrano, TR 103 in Improvement District
No. 9
Dear Building Department:
Subject to the developer’s successful completion of the on-site water and sewer facilities, and subject to the
availability of water from the Metropolitan Water District of Southern California, the District can and will
provide water and sewer service to the subject project. This approval is only for the issuance of building
permits and is only good for two years from the date of this letter. At this time, no further inspection of the
on-site water and sewer facilities is needed by SMWD to enable the City to release the certificate of
occupancy. However, The District still reserves the right to inspect the on-site plumbing and backflow
prevention when necessary. The use of water softeners is prohibited, except for those recharged at central plants
or specifically approved for commercial applications. For commercial purposes, the District allows the installation
of regenerative water softeners only after approving on-site holding facilities that enable brine to be collected,
pumped, and transported outside the District’s service area. For more detailed information, please refer to the
District’s Rules and Regulations for Water, Recycled Water, and Wastewater Service (No 2015-10-05).
The following fixtures will discharge to the Sanitary Sewer:
• 1 Hand Sink
• 1 Toilet
Should you have any questions or desire additional information, please call the Engineering Counter at (949)
459-6503.
Sincerely,
SANTA MARGARITA WATER DISTRICT
Pablo Marti
Senior Project Engineer
Generated Date/Time:Documentation Software: Energy Code Ace
CA Building Energy Efficiency Standards - 2022 Nonresidential Compliance Report Version: 2022.0.000
Schema Version: rev 20220101
Compliance ID: 313683-0725-0002
Report Generated: 2025-07-23 13:50:15
STATE OF CALIFORNIA
Indoor Lighting CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-LTI-E
This document is used to demonstrate compliance with requirements in 110.9, 110.12(c), 130.0, 130.1, 140.6 and 141.0(b)2 for indoor lighting scopes using the prescriptive path for
nonresidential and hotel/motel occupancies. It is also used to document compliance with requirements in 160.5, 170.2(e) and 180.2(b)4 for indoor lighting scopes using the prescriptive
path for multifamily occupancies. Multifamily includes dormitory and senior living facilities.
Project Name: SJC Souvenir Shop. Suite 201A Report Page: (Page 1 of 9)
Project Address: Date Prepared: 2025-07-23T16:50:12-04:00
A. GENERAL INFORMATION
01 Project Location (city)San Juan Capistrano 04 Total Conditioned Floor Area (ft2)1,111
02 Climate Zone 6 05 Total Unconditioned Floor Area (ft2)0
03 Occupancy Types Within Project (select all that apply):06 # of Stories (Habitable Above Grade)1
● Retail
B. PROJECT SCOPE
This table includes any lighting systems that are within the scope of the permit application and are demonstrating compliance using the prescriptive path outlined in 140.6 / 170.2(e) or
141.0(b)2 / 180.2(b)4 for alterations.
Scope of Work Conditioned Spaces Unconditioned Spaces
01 02 03 04 05
My Project Consists of (check all that apply):Calculation Method Area (ft2)Calculation Method Area (ft2)
New Lighting System Area Category Method 1111 N/A 0
New Lighting System - Parking Garage N/A 0 N/A 0
Total Area of Work (ft2)1111
STATE OF CALIFORNIA
Indoor Lighting CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-LTI-E
Project Name: SJC Souvenir Shop. Suite 201A Report Page: (Page 2 of 9)
Date Prepared: 2025-07-23T16:50:12-04:00
Generated Date/Time:Documentation Software: Energy Code Ace
CA Building Energy Efficiency Standards - 2022 Nonresidential Compliance Report Version: 2022.0.000
Schema Version: rev 20220101
Compliance ID: 313683-0725-0002
Report Generated: 2025-07-23 13:50:15
C. COMPLIANCE RESULTS
If any cell on this table says "DOES NOT COMPLY" or "COMPLIES with Exceptional Conditions" refer to Table D. for guidance.
Lighting in
conditioned and
unconditioned
spaces must not be
combined for
compliance per
140.6(b)1 / 170.2(e)
Allowed Lighting Power per 140.6(b) / 170.2(e) (Watts)
≥
Adjusted Lighting Power per 140.6(a) / 170.2(e)
(Watts)Compliance Results
01 02 03 04
=
05 06 07
=
08 09
Complete
Building
140.6(c)1
Area
Category
140.6(c)2 /
170.2(e)4
Area
Category
Additional
140.6(c)2G /
170.2(e)4Av
( +)
Tailored
140.6(c)3 /
170.2(e)4B
( +)
Total
Allowed
(Watts)
Total
Designed
(Watts)
Adjustments
Total Adjusted
(Watts)
*Includes
Adjustments
05 must be >= 08
140.6 / 170.2(e)
PAF Lighting
Control Credits
140.6(a)2 /
170.2(e)1B
(-)
(See Table I)(See Table I)(See Table J)(See Table K)(See Table F)(See Table P)
Conditioned 947.1 =947.1 ≥917 =917 COMPLIES
Unconditioned =≥=
Controls Compliance (See Table H for Details)COMPLIES
Rated Power Reduction Compliance (See Table Q for Details)
D. EXCEPTIONAL CONDITIONS
This table is auto-filled with uneditable comments because of selections made or data entered in tables throughout the form.
Track Lighting has been included in this project, details are provided in Table G.
E. ADDITIONAL REMARKS
This table includes remarks made by the permit applicant to the Authority Having Jurisdiction.
STATE OF CALIFORNIA
Indoor Lighting CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-LTI-E
Project Name: SJC Souvenir Shop. Suite 201A Report Page: (Page 3 of 9)
Date Prepared: 2025-07-23T16:50:12-04:00
Generated Date/Time:Documentation Software: Energy Code Ace
CA Building Energy Efficiency Standards - 2022 Nonresidential Compliance Report Version: 2022.0.000
Schema Version: rev 20220101
Compliance ID: 313683-0725-0002
Report Generated: 2025-07-23 13:50:15
F. INDOOR LIGHTING FIXTURE SCHEDULE
This table includes all planned permanent and portable lighting other than dwelling unit/ hotel/ motel room lighting. Multifamily dwelling unit and hotel/motel room lighting is
documented in Table T. If using Table T to document lighting in multifamily common use areas providing shared provisions for living, eating, cooking or sanitation, those luminaires are
not included here.
Designed Wattage: Conditioned Spaces
01 02 03 04 05 06 07 08 09 10
Name or Item
Tag
Complete Luminaire
Description
Modular
(Track) Fixture
Small
Aperture &
Color Change1
Watts per
luminaire2
How is Wattage
determined
Total Number
of Luminaires
Excluded per
140.6(a)3 /
170.2(e)2C
Design Watts
Field Inspector
Pass Fail
A RECESSED 1'X4' FLAT PANEL
LED No NA 45 Mfr. Spec 3 No 135
B RECESSED 6" LED
DOWNLIGHT No NA 10 Mfr. Spec 20 No 200
C RECESSED 14" LED
DOWNLIGHT No NA 24 Mfr. Spec 3 No 72
D TRACK LIGHTING Yes NA 480 See Other
Section 1 No 480
E PENDANT LED No NA 10 Mfr. Spec 3 No 30
Total Designed Watts: CONDITIONED SPACES 917
1FOOTNOTE: Design Watts for small aperture and color changing luminaires which qualify per 140.6(a)4B / 170.2(e)2D is adjusted to be 75% /80% of their rated wattage. Table F
automatically makes this adjustment, the permit applicant should enter full rated wattage in column 05.
2Authority Having Jurisdiction may ask for Luminaire cut sheets to confirm wattage used for compliance per 130.0(c) / 160.5(b). Wattage used must be the maximum rated for the
luminaire, not the lamp.
STATE OF CALIFORNIA
Indoor Lighting CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-LTI-E
Project Name: SJC Souvenir Shop. Suite 201A Report Page: (Page 4 of 9)
Date Prepared: 2025-07-23T16:50:12-04:00
Generated Date/Time:Documentation Software: Energy Code Ace
CA Building Energy Efficiency Standards - 2022 Nonresidential Compliance Report Version: 2022.0.000
Schema Version: rev 20220101
Compliance ID: 313683-0725-0002
Report Generated: 2025-07-23 13:50:15
G. MODULAR LIGHTING SYSTEMS
This table calculates wattage for modular lighting systems/ track lighting fixtures indicated on Table F and transfers wattage to Table F.
01 02 03 04
Name or
Item Tag Complete Track Description Calculation Method per 130.0(c)6 Track
Wattage
D TRACK LIGHTING i Installed Luminaires
vs Default 30 W/ft ii Current Limiter iii Overcurrent Protection
Panel
iv Power supplied by
driver, power supply or
transformer1
Voltage of branch circuit x Sum of Ampere ratings for all devices on panel 4801204
1FOOTNOTE: For power-over-Ethernet lighting systems, power provided to installed non-lighting devices may be subtracted from the total power rating of the power-over-Ethernet
system.
H. INDOOR LIGHTING CONTROLS (Not including PAFs)
This table includes lighting controls for conditioned and unconditioned spaces.
Building Level Controls
01 02 03
Mandatory Demand Response 110.12(c)Shut-off controls 130.1(c) / 160.5(b)4C Field Inspector
Pass Fail
NA < 4,000W subject to multilevel See Area/Space Level Controls
STATE OF CALIFORNIA
Indoor Lighting CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-LTI-E
Project Name: SJC Souvenir Shop. Suite 201A Report Page: (Page 5 of 9)
Date Prepared: 2025-07-23T16:50:12-04:00
Generated Date/Time:Documentation Software: Energy Code Ace
CA Building Energy Efficiency Standards - 2022 Nonresidential Compliance Report Version: 2022.0.000
Schema Version: rev 20220101
Compliance ID: 313683-0725-0002
Report Generated: 2025-07-23 13:50:15
H. INDOOR LIGHTING CONTROLS (Not including PAFs)
Area Level Controls
04 05 06 07 08 09 10 11 12
Area Description
Complete Building or Area
Category Primary Function
Area
Manual Area
Controls
130.1(a) /
160.5(b)4A
Multi-Level
Controls
130.1(b) /
160.5(b)4B
Shut-Off Controls
130.1(c) //
160.5(b)4C
Primary/Sky
lit
Daylighting
130.1(d) /
160.5(b)4D
Secondary
Daylighting
130.1(d) /
160.5(b)4D
Interlocked
Systems
140.6(a)1/
170.2(e)2A
Field Inspector
Pass Fail
RETAILS Retail Merchandise Sales
Wholesale Showroom
Readily
Accessible Dimmer Occupancy Sensor NA: General
Ltg < 120W
NA: General
Ltg < 120W No
OFFICE Office ( <=250 square feet)Readily
Accessible Dimmer Occupancy Sensor NA: Not
daylit zone
NA: Not
daylit zone No
STORAGE Storage - MF common areas Readily
Accessible Dimmer Occupancy Sensor NA: Not
daylit zone
NA: Not
daylit zone No
CORRIDOR Corridor Readily
Accessible
NA: Enclosed
area <100SF Occupancy Sensor NA: Not
daylit zone
NA: Not
daylit zone No
RESTROOM Restroom Readily
Accessible
NA: Enclosed
area <100SF Occupancy Sensor NA: Not
daylit zone
NA: Not
daylit zone No
13
Plan Sheet Showing Daylit Zones:
I. LIGHTING POWER ALLOWANCE: COMPLETE BUILDING OR AREA CATEGORY METHODS
Each area complying using the Complete Building or Area Category Methods per 140.6(b) are included in this table. Column 06 indicates if additional lighting power allowances per
140.6(c) or adjustments per 140.6(a) are being used .
Conditioned Spaces
01 02 03 04 05 06
Area Description Complete Building or Area Category Primary
Function Area
Allowed Density
(W/ft2)Area (ft2)Allowed Wattage
(Watts)
Additional Allowance / Adjustment
Area Category PAF
RETAILS Retail Merchandise Sales Wholesale Showroom 0.95 834 792.3 No No
STATE OF CALIFORNIA
Indoor Lighting CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-LTI-E
Project Name: SJC Souvenir Shop. Suite 201A Report Page: (Page 6 of 9)
Date Prepared: 2025-07-23T16:50:12-04:00
Generated Date/Time:Documentation Software: Energy Code Ace
CA Building Energy Efficiency Standards - 2022 Nonresidential Compliance Report Version: 2022.0.000
Schema Version: rev 20220101
Compliance ID: 313683-0725-0002
Report Generated: 2025-07-23 13:50:15
I. LIGHTING POWER ALLOWANCE: COMPLETE BUILDING OR AREA CATEGORY METHODS
OFFICE Office ( <=250 square feet)0.65 46 29.9 No No
STORAGE Storage - MF common areas 0.45 167 75.15 No No
CORRIDOR Corridor 0.4 35 14 No No
RESTROOM Restroom 0.65 55 35.75 No No
TOTALS:1,137 947.1 See Tables J, or P for detail
J. ADDITIONAL ALLOWANCE: AREA CATEGORY METHOD QUALIFYING LIGHTING SYSTEM
This section does not apply to this project.
K. TAILORED METHOD GENERAL LIGHTING POWER ALLOWANCE
This section does not apply to this project.
L. ADDITIONAL LIGHTING ALLOWANCE: TAILORED WALL DISPLAY
This section does not apply to this project.
M. ADDITIONAL LIGHTING ALLOWANCE: TAILORED FLOOR AND TASK LIGHTING
This section does not apply to this project.
N. ADDITIONAL LIGHTING ALLOWANCE: TAILORED DECORATIVE /SPECIAL EFFECTS
This section does not apply to this project.
O. ADDITIONAL LIGHTING ALLOWANCE: TAILORED VERY VALUABLE MERCHANDISE
This section does not apply to this project.
STATE OF CALIFORNIA
Indoor Lighting CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-LTI-E
Project Name: SJC Souvenir Shop. Suite 201A Report Page: (Page 7 of 9)
Date Prepared: 2025-07-23T16:50:12-04:00
Generated Date/Time:Documentation Software: Energy Code Ace
CA Building Energy Efficiency Standards - 2022 Nonresidential Compliance Report Version: 2022.0.000
Schema Version: rev 20220101
Compliance ID: 313683-0725-0002
Report Generated: 2025-07-23 13:50:15
P. POWER ADJUSTMENT: LIGHTING CONTROL CREDIT (POWER ADJUSTMENT FACTOR (PAF))
This section does not apply to this project.
Q. RATED POWER REDUCTION COMPLIANCE FOR ONE-FOR-ONE ALTERATIONS
This section does not apply to this project.
R. 80% LIGHTING POWER FOR ALL ALTERATIONS - CONTROLS EXCEPTIONS
This section does not apply to this project.
S. DAYLIGHT DESIGN POWER ADJUSTMENT FACTOR (PAF)
This section does not apply to this project.
T. DWELLING UNIT LIGHTING
This section does not apply to this project.
U. DECLARATION OF REQUIRED CERTIFICATES OF INSTALLATION
Selections have been made based on information provided in this document. If any selections have been changed by permit applicant, an explanation should be included in Table E.
Additional Remarks. These documents must be provided to the building inspector during construction and can be found online
Form/Title
NRCI-LTI-E - Must be submitted for all buildings
STATE OF CALIFORNIA
Indoor Lighting CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-LTI-E
Project Name: SJC Souvenir Shop. Suite 201A Report Page: (Page 8 of 9)
Date Prepared: 2025-07-23T16:50:12-04:00
Generated Date/Time:Documentation Software: Energy Code Ace
CA Building Energy Efficiency Standards - 2022 Nonresidential Compliance Report Version: 2022.0.000
Schema Version: rev 20220101
Compliance ID: 313683-0725-0002
Report Generated: 2025-07-23 13:50:15
V. DECLARATION OF REQUIRED CERTIFICATES OF ACCEPTANCE
Selections have been made based on information provided in this document. If any selections have been changed by the permit applicant, an explanation should be included in Table E.
Additional Remarks. These documents must be provided to the building inspector during construction and any with "-A" in the form name must be completed through an Acceptance
Test Technician Certification Provider (ATTCP). For more information visit: http://www.energy.ca.gov/title24/attcp/providers.html
Form/Title Systems/Spaces To Be Field
Verified
NRCA-LTI-02-A - Must be submitted for occupancy sensors and automatic time switch controls.RETAILS; OFFICE; STORAGE;
CORRIDOR; RESTROOM
STATE OF CALIFORNIA
Indoor Lighting CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-LTI-E
Project Name: SJC Souvenir Shop. Suite 201A Report Page: (Page 9 of 9)
Project Address: Date Prepared: 2025-07-23T16:50:12-04:00
Generated Date/Time:Documentation Software: Energy Code Ace
CA Building Energy Efficiency Standards - 2022 Nonresidential Compliance Report Version: 2022.0.000
Schema Version: rev 20220101
Compliance ID: 313683-0725-0002
Report Generated: 2025-07-23 13:50:15
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
I certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Lan Nguyen
Documentation Author Signature:
Company:Signature Date:
Address:CEA/ HERS Certification Identification (if applicable):
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.I 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.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:Responsible Designer Signature:
Company:Date Signed:
Address:License:
City/State/Zip:Phone: