HomeMy WebLinkAboutXC2022-1930 - MiscSTATE OF CALIFORNIA
MECHANICAL
CEGNRCI-MCH-01-E lRevised 01/20
CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF INSTALLATION
NRCI-MCH-01-E
Mechanical
(Page 1 of 2)
P"I"`"dTef
Newme er8rDillion
Eno ementPgenq: ary Heating & Air�ber.
P e
Pro'ed Addm.: 895 Dove St. 2nd Floor
" Newport Beach
LP Code. 926A
A. GENERAL INFORMATION
DATE OF BUILDING PERMIT:
BUILDING TYPE
I VINonresidential ❑ High -Rise Residential ❑ Hotel/Motel
PHASE OF
❑New Construction ❑Addition IfAlteration
CONSTRUCTION
If more than one person has responsibility for building construction, each person shall prepare and sign an Installation
Certificate document applicable to the portion of construction for which they are responsible; alternatively, the person
with chief responsibility for construction shall prepare and sign the Installation Certificate document(s) for the entire
construction.
B. SCOPE OF RESPONSIBILITY
Date of approval by the enforcement agency of the Certificate of Compliance that provides the
specifications for this Installation Certificate.
Date:
12/30/22
In the table below identify all applicable construction documents that specify the features, materials, components,
manufactured devices, or system performance diagnostic results required for the scope of responsibility for this Installation
Date Approved By
Document Title or Description Applicable Sheets or Pages, Tables, Schedules, etc. I the Enforcement
CA Building Energy Efficiency Standards -2019 Nonresidential Compliance January 2020
STATE OF CALIFORNIA
MECHANICAL
CEC-NRCI-MCH-01-E (Revised 011201 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF INSTALLATION NRCI-MCH-01-E
Mechanical (Page 2 of 2)
Pmle& Neme:Newme er&billion
fnroaemem Agenry:
Nuumber.
Pmject Address:0 5 Dove St., 2nd Floor
Car: Ne ort Beach
Zip rude:
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certificate of Installation documentation is accurate and complete.
Documentation Amhor Name:
D entart A or ignature:
Co Peterson
Documentation Author Company Name:
Date Sig
Contemporary Heating & Air Conditioning Inc.
12 22
Address:
CEA/ HERS Certification Identification (If applicable):
1750 E. Miraloma Ave.
NA
Cdy/Stme/Zip:
Phone:
Placentia CA 92870
714 572-8914
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 Installation Is true and correct.
2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the
system design, construction, or installation of features, materials, components, or manufactured devices for the scope of work
identified on this Certificate of Installation and attest to the declarations in this statement (responsible builder/installer),
otherwise I am an authorized representative of the responsible builder/installer.
3. The constructed or installed features, materials, components or manufactured devices (the installation) identified on this
Certificate of Installation conforms to all applicable codes and regulations, and the installation conforms to the requirements
given on the plans and specifications approved by the enforcement agency.
4. 1 reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the speck requirements
for the scope of construction or installation identified on this Certificate of Installation, and I have ensured thatthe requirements
that apply to the construction or installation have been met.
5. 1 will ensure that a completed signed copy of this Certificate of Installation shall be posted, or 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 Installation is required to be included with the documentation the builder provides to
the building owner at occupancy.
Responsible Builder/Installer Name:
Re sable Build nstaller Signature:
Co Peterson
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
Position Company(Trtle):
Contem ora Heating& Air Conditioning Inc.
P
Address:
CAR license:
1750 E. Miraloma Ave.
582-686
City/stmeRp:
Placentia. C
Phone:
714 572-8914
Date Signed: 12�30/22
CA Building Energy Efficiency Standards- 2019 Nonresidential Compliance January202O
CERTIFICATE OF INSTALLATION —USER INSTRUCTIONS NRCI-MCH-01-E
Mechanical (Page 1 of 1)
NRCI-MCH-01 User Instructions
Section A. General Information
02. Enter the date on the building permit.
02. Indicate the appropriate building type.
03. Indicate the appropriate phase of construction.
Section B. Scope of Responsibility
01. Enter the date the enforcement agency approved the Certificate of Compliance (NRCC-MCH-XX) that is used as
the basis of the specifications used to demonstrate compliance.
02. Enter the construction document that specifies the installed feature, material, component, manufactured device
or system performance diagnostic results required for compliance as specified on the certificate of compliance.
03. As needed, this row shall be filled according to the instructions for row B.02
04. As needed, this row shall be filled according to the instructions for row 8.02
05. As needed, this row shall be filled according to the instructions for row B.02
CA Building Energy Efficiency Standards - 2019 Nonresidential Compliance January 2020