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STATE OF CALIFORNIA <br />INDOOR LIGHTING <br />CEC.NRCILI.Ol.E 06/1 FORNIA <br />Document Title or Description Applicable Sheets or Paget Tables, Schedules, etc <br />Date Approved By <br />the Enforcement <br />Agency <br />OOCUMTNTATION AUTHOR'S DECI.ARATION STATEMENT <br />1. I certifythat this Certificate of installation documentation is accurate and compl€te <br />Oo(umentation Author Name:€elE zL,b L€t e*f,erta|],on <br />^u/.not <br />wvf /f \ <br />Do.um6tetion Autho. Com p.ry N.me:€ztz d. a <.€6 61g11ai(-/t/ ot /ts <br />z7 f6y4 a rtou{ 3r-C€Al HEn5 Cenifi@tio; Bentifi6tion (lf .pplicable) <br />cnvtst"t"t4fzA t< t,(_o C.tgl,,VaN ( A qk11 <br />REsPONSIBLE PERSON'S DECLARATION STATEMENT <br />I c€rtify the following under penalty of perjury, under the laws ofthe State of California: <br />1. The information provided on this Certifiarte of lnstallation is true and correct. <br />2. I am eliSible under Division 3 ofthe Eusiness and Professions Code in the app,lcable classification to accept responsibility for the <br />system design, construction, or installation offeatures, materials, components. or manufactured devices forthe scope ofwork <br />identified on this Certificate of lnstallation and attest to th€ declarations in this statement (responsible builder/installer), <br />otherwise I am an authorized representative ofthe responsible builder/installer. <br />3. The constructed or installed IeatLrres, materials, componehts or manufadured devices (the installation) identified on this <br />Certificate of lnstallation conforms to allapplicable codes and regulations, and the installation confomsto the requirements <br />given on the plans and specifications approved by the enforcement agency. <br />4. I reviewed a copy ofthe Certificate of Cohpliance approv€d bythe enforcement agencl that identifiesthe specific requirements <br />for the scope ofconstruction or installation identified on this Certificate of lnstallation, and lhave ensured that the requirements <br />that apply tothe construction or installation have been met. <br />5. lwillensure that a completed signed copy ofthis Certificate of lnstallation shallbe posted, or made avallable with the building <br />permit{s}issued {or the buildin& and made available to the enforcehent a8ency for allapplicable inspections. I understand that a <br />completed signed copy afthis Ceitificate of lnstallation is required to be lncluded with the documgntation the builder provides to <br />the buildln8 owner at occupancy. - ,/ <br />Responsible Suilder/|tutaller Narne:€.2(C 4,,oLFC Retponrible Builder/hstalle, sisns <br />Company Name: {l6t lllngSukontEcroror Gene6l Co.tracro. or <br />Bui e,/odnB) €Ete A- o <.€€ 6T-car'z t a Position With Company trnbl /,.,t t/2...,/r€ft- <br />2-l fot?A NAorL gf,e41za3'"'''?rihtst., 1,oLYa'}.r, lA lzitc "n <br />*qe.q LlzZ- ig4 g *ns"*,/,r/or/(g <br />N <br />CERTIFICATE OF INSTALLATION NRCI-LTI-01-E <br />lndoor Li8htinB (Paee 2 of 2) <br />e'*ax'*' 4"RP/7-Ac ltat / 2-o LEruAv=;E o@iat^$r.1sn|r-A &^ /l zvFyesbs <br />*"i'a tudff 5 I at. ToSTl tt AL€SanrA AlvA <br />CA BuildinS EneBy Ef{iciency Standards - 2013 Nonresidential Compliance l0ne 2013 <br />** qr/q-.1/ZL- (8q 8