The 01 E Env form, officially known as the California Energy Commission Certificate of Installation NRCI-ENV-01-E, is a crucial document for a wide range of construction projects within California. Revised in January 2016, this two-page form plays a pivotal role in ensuring that buildings comply with the state's energy efficiency standards. It is required for nonresidential buildings, high-rise residential structures, and hotel/motel guest rooms, whether the project involves new construction, addition, alteration, or unconditioned spaces. For projects with multiple stakeholders, each individual responsible for a portion of the construction must either prepare and sign their own Installation Certificate or delegate this task to a primary individual who then becomes responsible for the entire project's certification. The form requires detailed information about the project, including the project name, enforcement agency, permit number, and project address. It also calls for an acknowledgment of responsibility from both the documentation author and the responsible builder or installer, who must certify under penalty of perjury that all installations conform to the specified requirements and applicable codes and regulations. Additionally, this document emphasizes the necessity of making a completed signed copy available both at the construction site for inspections and with the building permits, as well as including it in the documentation provided to the building owner upon occupancy. This ensures transparency and adherence to the California Building Energy Efficiency Standards, solidifying the state's commitment to sustainable construction practices.
| Question | Answer |
|---|---|
| Form Name | 01 E Env Form |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | cec nrci env, 2016 env 01, cec env e 01, env e envelope |
STATE OF CALIFORNIA
ENVELOPE
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CALIFORNIA ENERGY COMMISSION |
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CERTIFICATE OF INSTALLATION |
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Envelope |
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(Page 1 of 2) |
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Project Name: |
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Enforcement Agency: |
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Permit Number: |
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Project Address: |
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GENERAL INFORMATION |
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DATE OF BUILDING PERMIT: |
PERMIT # |
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BUILDING TYPE |
Nonresidential |
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Hotel/Motel Guest Room |
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PHASE OF |
New Construction |
Addition |
Alteration |
Unconditioned |
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CONSTRUCTION |
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If more than one person has responsibility for building construction, each person shall prepare and sign 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 Installation Certificate document(s) for the entire construction.
SCOPE OF RESPONSIBILITY
Enter the date of approval by enforcement agency of the Certificate of Compliance that provides the specifications for the energy efficiency measures for the scope of responsibility for this Installation Certificate.
Date:
In the table below identify all applicable construction documents that specify the requirements for the scope of responsibility for this Installation Certificate.
Document Title or Description
Applicable Sheets or Pages, Tables, Schedules, etc.
Date Approved By
the Enforcement
Agency
CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance |
January 2016 |
STATE OF CALIFORNIA
ENVELOPE
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CALIFORNIA ENERGY COMMISSION |
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CERTIFICATE OF INSTALLATION |
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Envelope |
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(Page 2 of 2) |
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Project Name: |
Enforcement Agency: |
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Permit Number: |
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Project Address: |
City: |
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Zip Code: |
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DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1.I certify that this Certificate of Installation documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Documentation Author Company Name:
Date Signed:
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 Installation is true and correct.
2.I 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.I reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the specific requirements for the scope of construction or installation identified on this Certificate of Installation, and I have ensured that the requirements that apply to the construction or installation have been met.
5.I 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:
Responsible Builder/Installer Signature:
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
Position With Company (Title):
Address:
CSLB License:
City/State/Zip:
Phone
Date Signed:
CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance |
January 2016 |