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HomeMy WebLinkAbout2753 JEFFERSON ST; ; PC2017-0042; Permit., • City of Carlsbad Print Date: 04/02/2018 . Permit No: PC2017-0042 Job Address: 2753 Jefferson St Permit Type: BLDG-Plan Check Work Class: . Commercial Status: Closed - Finaled Parcel No: 2031101400 Lot #: Applied: 11/09/2017 Valuation: $0.00 Reference #: . Issued: 12/07/2017 Occupancy Group: Construction Type Permit 04/02/2018 Finaled: U Dwelling Units: Bathrooms: Inspector: Bedrooms: Orig. Plan Check U: - Final Plan Check U: . Inspection: Project Title: . . Description: TUSCAN OFFICES: SHELL TO OFFICE -TOTAL 3,079 SF (SUITES: 200, 202, 204 & 206) Owner: Contractor: TRUST RUSH CIELO TRUST STANDARD WEST BUILDERS INC Po Box 1827 . S CARLSBAD, CA 92018-1827 1625 Alvarado St Oceanside, CA 92054-5903 760-586-1465 FEE S S AMOUNT MANUAL BUILDING PLAN CHECK FEE . $540.09 Total Fees: $ 540.09 Total Payments To Date: $ 540.09 Balance Due: $0.00 5, 4- 1635 Faraday Avenue, Carlsbad CA 92008-7314 1 760-602-2700 1 760-602-8560 f I www.carlsbadca.gov (4) Rt.2611 tciO )c\1Ot CPMc1 - 00 9-2., Cric-A 1-6 ti- O(rJ ITHE FOLLOWINGAPPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: ' 'PLANNING (NGINEERING 'BUILDING I VFIRE EJHEALTH DHAZMATIAPCDI Permit Application Plan Check No.fk2011-5O'-/2-..y Est. Value Na q5j, dO crr~-Cit Building of 1635 Faraday Ave., Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 Cd1sbad Plan Ck. Deposit email: building@carlsbadca.gov Date I /qr /17 www.carisbadca.gov JOB ADDRESS 'Z7 ; Jër SUITE#/SPACE#/UNIT# A F3 -LLo - Vt- - C)O CT/PROJECT # LOT# PHASE # # OF UNITS #BEDROOMS #BATHROOMS TENANTBUSINESS NAME CONSTR. TYPE OCC. GROUP DESCRIPTION OF WORK: Include Square Feet of Affected Area(s) oEhc— T%'t. 4 cut-rz&o— 4,31- 542t Pr, øz- 711 9QLFTZO1 C Q1Ff - e I e7 6Q I fj côi-s i'ir oF P -mcL L. &T t ro t!Tt.15j PVCM415 1b ef9 - P ./ . EXISTING USE - PROPOSED USE ' GARAGE (SF) PATIOS (SF) DECKS (SF) FIREPLACE AIR CONDITIONING FIRE SPRINKLERS - YESD# - NO YES EINO YES NO[_] APPLICANT NAME Primary Contact PROPERTY OWNER NAME FM ADDRESS ADDRESS E5 A-PI Z47 - 9 D fri7 CITY STATE ZIP CITY STATE ZIP FAX ~FAXPHONE - PHONE EMAIL EMAIL - DESIGN PROFESSIONAL CONTRACTOR BUS. NAME ADDRESS ADDRESS t t&4 CITY STATE ZIP CITY ' STATE ZIP :. - rt' P111 , FAX PHONE FAX EMAIL a-oo STATE LIC. # STATE LIC.# CLASS CIBUS. LIC.# q k3 (Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law fChapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)). , , --:' •: Workers' Compensation Declaration:/ hereby affirm under penally of perjury one of the following declarations: I 'i have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 370001 the Labor Code, for the performance of the work for which this permit is issued. I ihave and will maintain workers' Compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number am: Insurance Go. _tlJ Lo (LM,) Policy No. Cl 4 \ C) Expiration Date 7.) l This section need not be completed if the permit is for one hundred dollars ($100) or less. Certificate of Exemption: 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 10 the Workers' Compensation Laws of California. WARNING: Failure t e workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (&100,000), in addition to the cost o sation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees. DAGENT DATE - I hereby affirm that lam exempt from Contractor's License Law for the following mason: [11 I, 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 and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he did 001 build or improve for the purpose of sale). [] I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of properly who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law). I am exempt under Section .- -- Business and Professions Code for this reason: / I personally plan to provide the major labor and materials for construction of the proposed property improvement [—]Yes I1No I (have / have not) signed an application for a building permit for the proposed work. I have contracted with the following person (firm) to provide the proposed construction (include name address / phone / contractors' license number): - I plan to provide portions of the work, butt have hired the following person to coordinate, supervise and provide the major work (include name / address! phone /contractors' license number): I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone! type of work): ,PROPERTY OWNER SIGNATURE []AGENT DATE -- - Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? Yes No - Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? ' rYes No Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? ; Yes No IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. COINISTRU.CTA ON I hereby affirm that there is a construction lending agency for the performance of the work this permit is issued (Sec. 3097 (i) Civil Code). Lender's Name . ' Lender's Address iITTirvr. N TIIJJf .3F - I certify that l have read the application and state that the above information is correct and that the information on the plans is accurate. I agree to cemplywtth all Cityordinances and State laws relattngto buitdingcenstniction. I hereby authorize representative of the City of Carlsbad to enter upon th bove mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, CQSK au ENSES llCH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA M OSHA permit is required for excav4on ep and nolit or construction of structures over 3 stones in height. EXPIRATION: Every permit issued by the Building rthe D °ns is Code shall expire by limitation and become null and vo tithe bufiding orworic authorized bysuth permit iv not commenced within l8Odays from the date of suth permnitor if the uit uthor su permit is suspended or abandoned at any time after the work is commenced fora period of 180 days (Section 106.4.4 Uniform Building Code). A5APPLICANT'S SIGNATURE DATE 'A 1 STOP: THIS SECTION NOT REQUIRED FOR BUILDING PERMIT ISSUANCE. Complete the following ONLY if a Certificate of Occupancy will be requested at final inspection. CERTI FICATE O C C UP A NCY (ComI Na Nn -Pro je cts •1tJ Fax (760) 602-8560, Email buiIdinp(CarIsbadca.qOV or Mail the completed form to City of Carlsbad, Building Division 1635 Faraday Avenue, Carlsbad, California 92008. CO#: (Office Use Only) CONTACT NAME ::... ,. . ,.. .. . . . OCCUPANT NAME .'' '. . ... ADDRESS BUILDING ADDRESS CITY STATE ZIP CITY STATE ZIP .................................: .' - . ... - . . Carlsbad CA .i .• PHONE .. ...............• ........................ FAX . . .. - . EMAIL . . .. ,. . . OCCUPANT'S BUS. LIC. No. ' . .,: ......... DELIVERY OPTIONS PICK UP: CONTACT (Listed above) OCCUPANT (Listed above) CONTRACTOR (On P. 1.) ASSOCIATED CB# ., . MAIL TO: CONTACT (Listed above) OCCUPANT (Listed above) CONTRACTOR (On Pg. i.) . NO CHANGE IN USE/ NO CONSTRUCTION MAIL! FAX TOOTHER: ,. . .......... I . ......... . . . . CHANGE OF USE NO CONSTRUCTION - DATE ..APPLICANT'S SIGNATURE -: . .. . . .. .. .. . ., V •$ 4 -, •V - -. ..- • - - : . 4% - - 4 *44% EsGul A SAFEbuitf Company DATE 12/4/2017 - PPLICANT - •. --•:-- ,$JURIS.. JURISDICTION: Carlsbad ==! PLAN CHECK #: PC2017-0042 V SET: II - - PROJECT ADDRESS 2753 Jefferson St PROJECT NAME Tuscan Office Tenant Improvement The'plarstransmitted herewith have been corrected where necessary and substantially comply V with the jurisdiction's building codes. V _. V .. •VV - V V V V - The plans tan'smitted herewith will substantially comply with the jurisdiction's codes when minor deficiencies identified below are resolved and checked by building V department staff. The plans transmitted _ herewith have significant deficiencies identified on4 the enclosed check list' and should be corrected and resubmitted for a complete recheck. V V V VV The checklist transmitted herewith is for your inforiiation. The plans;are being held at EsGil - V until corrected plans,are submitted for recheck. 1 VV . •. Théàpplicat's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. - * V V V V •V V The applicant's copy of the check list has been sent to EsGil staff did not advise the applican't'-that the plan check has been completed.. .. LI EsGil staff did advise the applicant that the plan check has been completed. V V V Person contacted;,- telephone _ V V V Date contacted: V Email: VV V V V V •V V V Mail Telephone Fax 6n son .- .. LI REMARKS- By. Jason Pasiut Enclosures EsGil 11/30/2017 9320 Chesapeake Drive Suite 208 • San Diego California 92123 • (858) 560-W8 • Fax (858) 560-1576 a . - V V V 4 . V V V a V V V V V V V 44 -* V - V - V - -:: . V - - • V V a V V4V . *VV VVV•V - A EMSG11 A SAFEbuiLtCornpany .fl A DATE: 11/21/2017 •' APPLICANT 'y - 441 JURIS. , JURISDICTION: Carlsbad PLAN CHECK # PC2017-0042 SET I PROJECT ADDRESS 2753 Jefferson St - PROJECTINAME Tuscan Office Tenant Improvement The '-'plans transmitted herewith have been corrected where necëssànd substantially comply with the jurisdiction's codes. .•. ,• The trnsmitted herewith will substantially comply with he4juridictiôn's . codes when minor deficiencies identified below are resolved.andcheckéd by building department staff. The plans transmitted herewith have significnt deficiencies identified. -on the enclosed check list and should be corrected and resubmitted fora complete recheck. The check list transmitted herewith is for your information. The plans are being held atEsGil until corrected plans.are submitted for recheck. The applicant's copyof the check list is enclosed for the jurisdiction to forward to the applicant * contact person. The applicant's copy of the check list has been sent to: - •. - Wade Weber - - LII EsGil staff did not advise the applicant that the plan check has been completed EsGil staff did advise the applicant that the plan check has been completed. . Person contacted: Wade Weber Telephone #: 760-208-7687 - Date contacted )t/21117 (by—p?) Email weber _associates@cox net loft i ITeIephone Fax in Person • - - F-1 RE By: Jason Pasiut Enclosures: - 11 • .• EsGiI • - . 11/14/2017 _ • :. :.--- -- - I ..- I - • , .•- - -. - -.-. - 9320 Chesapeake Drive, Suite 208 • San Diego, California 92123 • (858) 560-1468 • Fax (858) 560-1576 4 1 - .. 44 4 1 I- Carlsbad PC2017-0042 11/21/2017 PLAN REVIEW CORRECTION LIST A • : TENANTIMPROVEMENTS PLAN CHECK #.: PC2017-0042 * JURISDICTION: Carlsbad OCCUPANCY :B USE Officew TYPE OF CONSTRUCTION: V-B ACTUAL AREA: 3,079 s.f. *4. _ • ALLOWABLE FLOOR AREA within STORIES 2 HEIGHT unchanged SPRINKLERS? YES OCCUPANT LOAD 33 REMARKS DATE PLANS RECEIVED BY .. DATE PLANS RECEIVED BY JURISDICTION: 11/9/2017 ESGIL CORPORATION" 11/14/2017 DATE INITIAL PLAN REVIEW . PLAN REVIEWER: Jason Pasiut COMPLETED: 11/21/2017 FOREWORD (PLEASE READ) Thisplan review is limited to the technical requirements contained in the California version of the International Building Code, Uniform Plumbing Code, Uniform Mechanical Code, National Electrical Code and state laws regulating energy conservation, noise attenuation and access for the disabled. This plan review is based on regulations enforced by the Building Department. You may have other corrections based on laws and ordinances enforced by the Planning Department, Engineering Department, Fire Department or other departments. Clearance from those departments may be required prior to the issuanceof a building permit. Code sections cited are based on the 2016 CBC, which adopts the 2015 IBC The following items listed need clarification, modification or change. All items must be satisfied before the plans will be in conformance with the cited codes and regulations. Per Sec. 105.4 of the 2015 International Building Code, the approval of the plans does not permit the violation of any state, county or city law. To speed up the recheck process, please note on this list (or a copy) where each correction item has been addressed, i.e., plan sheet number, specification section, etc. Be sure to enclose the marked up list whefl you submit the revised plans. .- . •t 4- , I. , . * - :. . •.4 - - . - •- .: - • _ •.4 -. • . - - . .- . . .4 -4 Carlsbad PC2017-0042 11/21/2017 -' : [DO NOT PAY- THIS IS NOT ANINVOICE] V VALUATION AND PLAN CHECK FEE JURISDICTION Carlsbad PLAN CHECK # PC2017-0042 PREPARED BY Jason Pasiut DATE 11/21/2017 BUILDING ADDRESS 2753 Jefferson St BUILDING OCCUPANCY B BUILDING PORTION AREA (Sq. Ft.) Valuation Multiplier Reg. Mod. VALUE. ($). City Estimate . . 140,957 Air Conditioning Fire Sprinklers TOTAL VALUE - V V 140,957 Jurisdiction Code 1cb ' [By Ordinance V V V V V V $771.61 I Bldg. Permit Fee by Ordinance V V V I $501 Plan Check Fee by Ordinance Type of Review Ei Complete Review Structural Only Repetitive Fee El Other Repeats Hourly _____________ Hr. @ * V V EsGil Fee $439.821 V Comments Sheet 1 of 1 4., . , . - •- Carlsbad PC2017-0042 11/21/2017 •: • • Please make all corrections, as requested in the correction list. Submit FOUR new • complete sets of plans for commercial/industrial projects (THREE'sets of plans for residential projects). For expeditious processing, corrected sets can be submitted irf one of two ways: Deliver all corrected sets of plans and calculations/reports directly to the City of Carlsbad Building Department, 1635 Faraday Ave., Carlsbad, CA 92008, (760) 602- 2700. The City will route the plans to EsGil Corporation and the Carlsbad Planning, Engineering and Fire Departments. . • Bring TWO corrected set of plans and calculations/reports to EsGil Corporation, 9320 Chesapeake Drive, Suite 208, San Diego, CA 92123, (858) 5601468. Deliver all remaining sets of plans and calculations/reports directly to the City of Carlsbad Building Department for routing to their Planning, Engineering and Fire Departments: NOTE: Flans that are submitted directly to EsGil Corporation dnly will hót be reviewed by the City Planning, Engineering and Fire Departments until reviewby EsGil Corporation is 'complete: •: . PLANS •-- • ''-' 1. Provide a statement on the Title Sheet of the plans, stating that this project shall comply with the 2016 California Building Code, which adopts the 2015 IBC, 2015 UMC, 2015 UPC and the 2014 NEC. ', 2. Please provide a statement Of special inspection section on the plàhs and' designate any special inspection requirements. (welding, epoxy...) CBC 1705.12.3. ' . " • • 3 Please update the following sheets/notes a) , Sheet A7:0 electrical note I to state 15" measured fron bottom of * : receptacle and 48" measured from the top of the switch. 11 B-308. . ' EXITS .• - 1' ', - • - 4. The plans shall designate the number of occupants to be accommodated on every floor, and in all rooms and spaces. Our occupancy review shows office - area occupancy equal to 25 and foyer/reception area equal to 46. Per the plumbing code Table A and Table 422.1, the expansion of the space will require - a urinal for males and I service sink within the space. Please show these. ' Section 107.2.3. - - ,• - 5. ' Egress doors shall be of the pivoted or side-hinged swinging type. Please revise the egress doors that are sliding/pocket style for office egress-path. (3 locations) 1010.1.2. , .-. - - . , . •, 6. • Provide a note stating, "Door handles, pulls, latches, locks and other operating devices on doors required to be accessible by Chapter 1 1 or I 1 shall not -. . require tight grasping, tight pinching or twisting of the wrist to operate". CBC - -•-'•• 1010.1.9.1. . - • 1* .•, - -• • *c - ,•• --.•,- ••_,,, - - .*• -.--. - '- ' - , • : • '. •.- - * .- • t•* Carlsbad PC2017-0042 11/21/2017 Show on the plans the required means of egress illumination levels shall not be less than 1 foot-candle at the walking surface CBC 1008.2.1'. Show on the plans the location of the means of egress illumination that will be, maintained in the event of an emergency. CBC 1008.3 Show on the plans the required tactile and illuminated exit signs at all required exits. CBC 1013.3, 1013.4. -' Show egress door hardware height to be within.34" to 48" inches. Please update entrance note 4on sheet A7.0. CBC 1010.1.9.2. a) Egress doors that are part of an accessible route shall be 34" minimum to 44" maximum above the finish floor. 11 B-404.2.7. f . -END OF REVIEW To speed up the review process, please note on this list (or a copy) where 'each correction item has been addressed, i.e., plan sheet, note or detail number, calculation page, etc. Please indicate here if any changes have been made to the plans that ae not a result of corrections from this list. If there are other changes, please briefly describe them• and where they are located in the plans. ' Have changes been made to the plans not resulting from this correction list? Please indicate: Q Yes D No The jurisdiction has contracted with Esgil Corporation located at 9320 Chesapeake - Drive, Suite 208, San Diego, California 92123; telephone number of 858/560-1468, to perform the plan review foryour project. If you have any questions regarding these plan review items, please contact Jason Pasiut at Esgil Corporation. Thank you. - -- •. -- IN 4 • ' ' • -• - - - V,9 •1 .4 •4 ,-. *'., n • - 4 4 I' • • - - - . 4 4 . • - • _•,• - I- .. • • .• ,- - --4 - .- - • F , • • 4 .• -. 4 4 • 4 -, • , -'.4 - . - ICERTfl?ICATE OF ACCEPTANCE RCA.LTI-02-A liCone. . . I [Poct Name 2753 JEFFERSON ST. IEnfoitement Agei CITY OF CARLSBAD - P&ntNumber CBCA2017-0020 - I IPect Mdiess: 2753 jeffson st. ItyC.&hd ------- ]VipCo& 92M I LIGHTING CONTROL ACCEPTANCE. DOCUMENT. 2, Automatic Shut-off Controls: Automatic Time SwikhControl and Occupant Sensor Intent: Lights are turned off or set to a lower level when not needed per Section110.9(a) & 130.1(c). A Construction Inspection Fill out Section A to cover spaces 'l through 3 that are functionally testedundér Section B. Instruments neded to perform tests include, but are not limited to: handheIdnperage meter, power meter, or light meter 1 Automatic Time Switch Controls Construction Inspection—confirm for all hsted in Section B All automatictime switch controls are programmed for (check all): P Weekdays P Weekend P Holidays xv- Document for the owner automatic time switch prod rarnriirig(check P Weekday settings P Weekend settings P HólidaYS settings P Set-up settings ........................................ P Preference program setting P Verify the cbrettiine. cd-date-is properly set in the time switch P Verify the battery is installed and eriergizçP,Override time limit is no more than 2 hours f4 P Occupant Sensors and Automatic Time Switch Controls have been certified to the Energy Commission in accordance with the applicable provision in Section 110 9 of the Standards and model numbers for all such controls are listed on the Commission database as Certified Appliance and Control-,Devices 2 Occupancy Sensor Construction Inspection—confirm for all listed in Section B P Occupancy sensors are not located within four feet of anyNVAC diffuser 7. . . P Ultrasonic occupancy sensorsdo not emit audible sound 5 feet from source This is page 1 of 4. IFICATE OF ACCEPTANCE I JNRCA-Lfl-02 A Cbnhd Nani 2753 JEFFERSON ST. llEnfoitncnt Agcy CITY OF CARLSBAD Omnit Number. CBCA20I7- Athess: 2753 jeffsoa St Pit' Cmt4ad Codg 920 B Functional Testing of Lighting Controls For every space in the building, conduct functional tests 1 thrbugh 5 below if applicable. If there are several geometrically similar spaces that uáe the same lighting controls, test only one space and list in the cells below which "untested spaces" are represented by that tested space EXCEPTION For buildings with up to seven (7) occupancy sensors all occupancy sensors shall be tested (NA7 6 2 3) D Evaluation: PASS: All applicable Construction Inspection responses are complete and all applicable Equipment Testing Requirements responses are positive (Y - yes) Ibis is page 2of4 Zip Coda 91911 CEA/ATT Certification Identific applicat Date of Signature: 02/25/2018 Phone (619)841-5928 Author Signature Name 2753 JEFFERSON ST. Address: 2753 jeffson at DOCUMENTATION AUTHOR'S DECLARATION STATEMENT I certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Company Name Name Hugo iaquez Address City 601c e. Palomar St. IP-1fl-02-A Nutuber CS Iip Code 920 )6kez Electric Chula vista FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: The information provided on this Certificate of Acceptance is true and correct. I am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 1 have confirmed that the Certificate(s) of installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name . Company Name Hugo ]aquez )akez Electric City Chula vista Address: 601c e. Palomar St. Phone • (619)841-5928 Zip Code 91911 All Certification Position with Company Identification Tc-a813295 (Title) Owner Field Technician Signature Date of Signature: 02/25/2018 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California I am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. . 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 Acceptance and attest to the declarations in. this statement (responsible acceptance person). The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. I will ensure that a completed, signed copy of this Certificate of Acceptance 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 signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to-the building owner at occupancy. Responsible Acceptance - Company Name Person Name Hugo )aquez Jakez Electric - Address: City 601c e. Palomar at. Chula vista Zip Code . Phone 91911 . (619)841-5928 CSLB License ' - Position with Company 905761 Owner Responsible Acceptance Person Signature - , Date of Signature: 02/2512018 - CafltorAned LightingNF~TP - - Controls Training Program This is page 3 of 4 1FICATE OFACCEPrANCE -A I - C8CA2O17-O2O I t. • • a - 1, - This ispage4of4 AUTOMATIC DAYLIGHTING CONTROL ACCEPTANCE DOCUMENT check boxes for all pages of this NRCA tTl-03-A completed and included in this submittal NRCA-LTt.03-A Page 1&2. construction Inspection. This page required for all submittals, NRCA-LTI-03-A Page 3&4 continuous dimming control functional performance test - watt-meter or amp-meter measurement 13 NRCA-LTI-03-A Page stepped Switching! Stepped Dimming functional performance test - watt-meter or amp-meter measurement 5&6 0 NRCA-L11-03-A Page Continuous dimming control functional performance test - light meter power measurement, and default look-up 7&8 table of fraction of rated power versus fraction of rated light output. 0 NRCA-LTI-03-A Page Stepped Switching/ Stepped Dimming functional performance test -based on light output 10 & 11 1. NA7.6.1.1 Construction Inspection: Drawing of Daylit Zone(s) must be shown on plans or attached to this form. By checking this box, technician certifies that plans have been attached to this webform ri Document Name and Page #s El Add Control Systems below if sampling ,method is used in accordance with NA7.6.1.2. If adding, attach a page with names of other controls in sample (only for buildings with > 5 daylight control systems, sample group glazing same orientation) Suites Suites System information Zone Type: Skylit (Sky), Primary Sidelit (PS), or Secondary Sidelit (SS) . I - PS Control Type: Continuous Dimming with more than 10 light levels (C), Stepped Dimming (SD), Switching (SW) I SW Design Footcandles: (enter number or leave blank): I I Sensors and Controls Control Loop Type: Open Loop (OL), Closed Loop (CL) CL Sensor Location: Outside (0), Inside Skylight (IS), Near Windows facing out (NW), In Controlled Zone (CZ) CZ Sensor Location is Appropriate to Control Loop Type: (Y/N) If control loop type is Open Loop (OL): Enter yes (Y) if location = [_Yes Outside (0), Inside Skylight (IS), or Near Windows facing out (NW); otherwise, enter no (N). If Control loop type is Closed Loop (CL): Enter yes (Y) if location = In Controlled Zone (CZ); otherwise, enter no (N). Control Adjustments are in Appropriate Location (YIN): Yes, If Readily Accessible or Yes if in Ceiling less than or equal to lift, No Yes for all other. . as aocumetnation oeen proviaea Dy ttie tnstaiier: Installation Manuals and Calibration Instructions Provided to Building Owner: (Y/N) I Yes Location of Light Sensor on Plans: (Y/N) Yes Location of Light Sensor on Plans: (Page Number) El LOTr _) California Advanced Ughling : This is page 1 of 5 CERTIFICATE OF ACCEPTANCE - - - - Automatic D4ighling Control 4 .. .. I. Proed Name: 2753 JEFFERSON ST. 'Y OF CARLSBAD ilNumbec CBCA2017-)O2O -. Project Mdrms: 2753 jeffomon et ip Code, ocS I Separate Controls of Luminaires in Daylit Zones: - Are luminaires controlled by automatic daylighting controls only in daylit zones: (V/N) - Yes Separately circuited for. daylit zones by 'vindos and daylit zones under skylights: (YIN) Yes Daylighting control device certification . Daylighting control has been certified inaccordarce with 110.9: (Y/N) - Yes Construction Inspection PASS/FAIL. If all responses on, Construction Inspection pages 1 & 2are complete and all Yes/No questions Pass ] have a Yes (Y) response, the tests PASS; If any responses on this page are incomplete OR there are any no (N) responses, the tests FAIL 1. PASS/FAIL Evaluation (chéckoné):: . PASS: if all responses on Construction inspection pages 1 & 2 are complete and all Yes/No questions have a Yes (Y) response, the tests PASS rO FAIL: Any applicable Construction Inspection responses are incomplete OR there is one or more negative (N no)responses in any applicable Functional Performance Testing Requirements section. System does not pass and is NOT eligible for Certificate of Occupancy according to Section 10103(a)35. Fix problem(s) and retest until the system(s) passes all portions of this test before retesting and resubmitting NRCA-LTI-03-A with PASSED test to the enforcement agency. Describe below the failure mode and corrective action needed. 4 , * This is page 2 of 5 1FICATE oFACCEp'rANCE. 11-03-A tic D04htin Control Name 2753 JEFFERSON ST. IEnfomement Agency C Address: 2753 jeffson at 2. NA7.6.1.2.1. Functional Performance Testing Continuous Dimming Systems: Power estimation using light meter measurement Complete all tests on page 3 & 4 (No Daylight Test, Full Daylight Test, and Partial Daylight Test) and fill out Pass/Fail section on Page 4. Suites Svtøni Trtfnrmtinn e. Control Loop Type: Open Loop or Closed Loop? (0 or C) C Indicate if Mandatory control - M (required for skylit zone or primary sidelit zone with installed general lighting power > 120 W); N for Control Credit - CC; or Voluntary not for credit -V (N, CC, V) - If automatic daylighting controls are mandatory, are all general lighting luminaires in daylit zones controlled by automatic Yes daylight controls? (Y/N) Documented general lighting design footcandles. If design footcandles not documented leave blank (enter fc) I Power estimation method. (see line o) Default ratio of power to light (Dfc), cut-sheet ratio of power to light (CSfc) If CSFc - Dfc attach cut-sheet. Enter Dfc or CSfc Step 1: Identify Reference Location (location where minimum daylight illuminance is measured in zone served by the controlled lighting.) FMethod Used: Illuminance or Distance? (I or 0) .1_1 Override daylight control system and drive electric lights to highest light level for the following: Highest light level fc - enter measured controlled electric lighting footcandles (fc) I Indicate whether this is Full Output (FO), or Task Tuned (Lumen Maintenance) (U) . FO Sten 2 No Davliaht Test controls enabled & davlioht less than 1 fc at reference location Method Used: Night time manual measurement (Night), Night Time Illurninãnce Logging (Log), Cover Fenestration (CF), Cover Night Open Loop Photosensor (COLP) . Reference Illuminance (footcandles) as measured at Reference Location (see Step 1). Enter footcandles 10.2 Enter Y if either of the following statements are true: If line h = FO; [Reference Illuminance (line j)] / [Full Output fc (line g)] > j Yes 70%? or [Reference Illuminance (line j)] / [design footcandles (line d)] > 80%? (Y/ N) Stan 3! Full Davliaht Test conducted when davlioht> reference illuminance (line fl I. Daylight illuminance (light level with electric lighting turned off) measured at Reference Location (fc) 11.59 Daylight illuminance (line I) greater than Reference Illuminance (line j)? (YIN) Yes - Fraction controlled wattage turned off. Enter %. 100 Fraction of controlled wattage dimmed (1 - (line n)] Enter %. I 0 Fill out lines p through s only if fraction of controlled wattage turned off (line n) < 100%. Total (daylight + electric light) illuminance measured at the Reference Location (fc) 12.4 Electric lighting illuminance at the Reference Location (fc) [(line p) - (line I)] 0.8100000000000105 Electric lighting illuminance (line q) divided by Highest Light Level fc (line g). Enter % 6.5164923572O037 Dimmed luminaire fraction of rated power. Attach manufacturer's cut-sheet or use default graph of rated power to light output. Label applicable control system (column A, B or C) on cut-sheet or graph. Enter fraction of rated power in %. I System Power Reduction = [1 - (line o) * (line s)] . 100 . Is System Power Reduction (line t) > 65% when line h = FO, or > 56% when line h = U (Y/N) Yes Yt CalllomiaAdvancedughting ,.'. I Controls Training Program 4 This is page 3 of 5 FICATE OF ACCEPTANCE .' . RCA-LTI-03-A o t4ightiig Control - ame 2753 JEFFERSON ST. IEnforoement Agoncy CITY OF CARLSBAD jPonit Nmnber CBCA20I7-0020 Mess: 2753jeffes0nst. - . ity. Cai1sted lop Coda 92008 - With uncontrolled lights also on, no lamps dimmed outside of daylit zone by control (YIN) Yes Dimmed lamps have stable output, no perceptible flicker (YIN) Ye Sten 4 Partial Davlinht Test conducted when davlinht between 600/b and g% of (line 11 Daylight illuminance (light level without electric light) measured at Reference Location (fc) 7.68 . Daylight illuminance divided by the Reference Illuminance = (line x )/ (line j). Enter %. I' 75.29411764705843 is Ratio of Daylight illuminance to Ref. illuminance (line y) between 60% and 95%? (Y/N) Yes as. Total (daylight + electric light) illuminance measured at the Reference Location (fc) 12.4 bb. Total illuminance divided by the Reference Illuminance = (line aa )/ (line j), Enter %.. I 121.5686274509844 cc. Is Total illuminance divided by the Reference illuminance (line bb) between 100% and 150%? (Y/N) - Yes 3. PASS/PAIL Evaluation (check one): . V PASS: All applicable Construction Inspection responses are complete and all applicable Functional Performance Testing Requirements responses are positive (Y - yes) . FAIL: Any applicable Construction Inspection responses are incomplete OR there is one or 'more negative (N no)responses in any applicable Functional Performance Testing Requirements section. System does not pass and is NOT eligible for-Certificate of Occupancy according to Section 10103(a)35. Fix problem(s) and retest until the system(s) passes all portions of this test before retesting and resubmitting NRCA-LTI-03-A with PASSED test to the enforcement agency. Describe below the failure mode and corrective action needed. 1 - -'-• - . il flCalifomla Advanced Uqh1ing; ¼.L..\#1Ir aControis TrainIng Program . . . - t -..........- -V - This is page 4 of 5 I1CATEOFACCEPTANCE . .Jfl3A :DwytgbhMCm%tro1 - mm 2753 JEFFERSON ST. Iorcmuent Agmlc)c CITY OF CARLSBAD pen3it Number. CBCA20I7-0020 tcoss: 2753jeffetu00nt - - IPtY Coñsbad . VIPCOdrc 92008 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT I certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author flume - Company Name Hugo )aquez - iakez Electric Address City 601c e. Palomar st. #316 Chula vista Zip Code Phone 91911 (619)841-5928 CEA/Arrcertlncatioo Identification Of Author Signature applicable) Tc-a813295 - Date of Signature: - 02/25/2018 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: The Information provided on this Certificate of Acceptance Is true and correct. I am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). The construction or Installation Identified on this Certificate of Acceptance compiles with the applicable acceptance requirements Indicated In the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified is Reference Nonresidential Appendix NA7. those confirmed that the Certificate(s) of Installation for the construction or Installation Identified on this Certificate of Acceptance has been completed and signed by the responsible builder/Installer and has been posted or made available with the building permit(s) Issued for the building. - Field Technician Name Company flume Hugo Jaquez -- 30ke# Electric Address: City 601c e. Palomar St. #316 . Chula vista Zip Code - - phone 91911 (619)841-5928 All Certification Identification Position With Company (Title) Tc-a813295 e . Owner Field Technician Slghature Date of Signature: 02/25/2018 - RESPONSIBLE PERSON'S DECLARATION STATEMENT . I certify the following under penalty of perjury, under the laws of the State of California: - tom the Field Technician, or the Field Technician Is acting on my behalf as my employee or my agent and t have reviewed the information provided on this Certificate of Acceptance. tam 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 Acceptance and attest to the declarations in this statement (responsible acceptance person). The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements Indicated In the plans and specifications approvedby the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) Issued for the building. twill ensure that a completed, signed copy of this Certificate of Acceptance 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. t understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name Company Name llugoiaqoez IakeZ Electric Address: . City 601c c. Palomar st 0316 . Chub vista Zip Code Phone - 91911 . (619)841-5928 CSLB License Position with Company (Tttte) 905761 Owner Responsible Acceptance Person Signature __ r Dote of Signature: - - 02/25/2018 'v a I U Controls Trainiri Program '° ' This is page 5 of 5 STATE OF CALIFORNIA OUTDOOR AIR ACCEPTANCES CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION 0. CERTIFICATE OF ACCEPTANCE S NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 o 3) Project Na : - S Enfo mentAgen : CATI' Permit Number Pr,q,lect Address: City: System Name or IdentifIcation/Tag: S •S System Location or Area Ser1d: S Note: Submit one certificate of Acceptance for each system that must demonstrate compliance '4 Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC Intent: I units. Reference MCH-03 (Column 14) .or Mechanical Equipment Schedules. A. ConstrUction Inspection S Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. Supporting documentation needed to perform test includes: S a As-built and/or design documents (for example, Mechanical Equipment Schedules, Equipment Start-Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA 7.5.1.1 Ventilation Systems: Variable Air Systems At-A-Glance and NA 7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At-A-Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: Watch Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). S L Method and equipment used: //OT J.) iaO 4Sywjx)13 7c-(L ii. Equipment calibration date (must be within one year):9''l. 3. System type (check either VAV or CAV): 0 VAV i: CAV S a. Check if Variable Air Volume (VAV) and complete the following: I . Outside airflow is either factory calibrated or field calibrated. El Check if factory calibrated and attach calibration certification. E] Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) O Outdoor Air CFM Compensation Energy Balance Method 0 Demand Control Ventilation O Return Fan Tracking S O Injection Fan Method '0 Dedicated Minimum Ventilation Damper with Pressure Control 0- Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: E System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of dIivering outside air to the unit (check one of the following):. Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): 5ft.ofthe unit. S S 15 ft. of the unit, with the air directed substantially toward the unit. - 0 Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is - provided independent of the unit, or economizer) - 5. Ore-occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. 0 Complete air chanes to the zone served by the air handler. I CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 - STATE OF CALIFORNIA OUTDOOR AIR ACCEPTANCE F CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA EIJEROV COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Na : tmLALuL,rt En mentAgency: 51%4.0 cct'? PeenItNumr. Project Address, C CO-ity: System Name or iderrti&ation/rag System Location or Area B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing cv VAV Step 1: Disable demand control ventilation (If applicable) 0 0 Step 2: Verify unit is not in economizer mode during test (economizer disabled) - 0 Note Shaded boxes do not appiy for CAy systems Step 3: CAV and VAV testing atfull supply airflow Adjust supply air to achieve design airflow or maximum airflow atfull cooling. Record VFD speed (Hz). i . Hz Measured outdoor airflow reading (cfm)1L.0 cfm cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). K) cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): . ;. ..-. . mm Step 4: VAV testing at reduced supply airflow CAV VAV a Adjust supply airflow to either the sum of the minimum zone airflows full heating or 30% of the total design airf low. Record VFD speed (Hz). ,' Hz b. Measured outdoor airflow reading (cfm). ' cirm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules).../ . cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): ' ' '. ' mm Step 5: Return to Initial conditions (check) 0 C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) J01 °'° Yes a No 0 %OAFA is within 10% of design Outside Air. (90%:5 %OAFA :5 110%) - Yes 0 No 0 C. Outside air damper position stabilizes within 5 minutes. (Step 3d <5 minutes) . - Yes 0 No C) Determine Percent Outside Air at reduced supply airflow (%OA) for Step 4. (VAV only) %0 RA =Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) V, . . % %OARA is within 10% of design Outside Air. (90%!5 %OA 15 110%) ;- Yes 0 No 0 C Outside air damper position stabilizes within 5 minutes (Step 4d < 5 minutes) .' Yes 0 No 0 Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. V D. Evaluation V ( PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 STATE OF CALIFORNIA - OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07I16) (AI IFCRNIA FWFR(Y COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: , Enforcement A6cy Permit Number Project Address city. System Name or Identification/Tag: j System Location or Area Served: DOCUMENTATION AUTHOR'S DECLARATION STATEMENT r 1. I certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: '. Documentation Author - Documentation Authopmanv Name: 5 Date Signed: Address: 1A-iiii ,toS Alt Certifiatlon Identification (If applicable): - Clty/State/Zi •Cz4: Phone: tsl 5%c'4' FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: The information provided on this Certificate of Acceptance is true and correct. I am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. - I have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been' posted or made available with the building permit(s) issued for the building. Field Technician Name: Field Technician Signature: Field Technician Company Name: . Position with Company (Title): Address: ' - ' - Alt Certification Identification (if applicable): City/State/Zip: . Phone: Date Signed: RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State ofCalifornia: I am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 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 Acceptance and attest to the declarations in this statement (responsible acceptance person). The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency; and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7: •I have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. I will ensure that a completed, sig copy of this Certificate of Acceptance shall be posted, or made available with the biiIding permit(s) issued for the building d made available to the Cément agency for all applicable inspections. I understand that a signed copy of this Certificate ceptance is requ' o be included with the documentation the builder provides to the building owner at occupancy. - Responsible Acceptance Person Name , / - Responsible Acceptance Person Signature: Responsible Acceptance Person Com y Name: Position with Company (Title): Address: - CSI-8 License: City/State/Zip: - ' • Phone: Date Signed: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 \ STATE OF CALIFORNIA - ' CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) J' 'AIR CONDITIONER AND HEAT PUMP SYSTEMS . rr_hlprAkA,-J-Ln'4A Posices1 11I11 - (AI trripma mvii:Pny (MIQWM CERTIFICATE OF ACCEPTANCE NRCA MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems (Page 1 of 3) Project Name: - Enforcement Agency. Permit Numbec Project Address: • C5r. o Zip code: 5 System Name or Idemificat1onfra5 System Lccatimr or Area Servoth Note: Submit one Certificate of Acceptance for each system that must Enforcement Agency Use: Checked by/Date demonstrate compliance. A. Construction Inspection 1. Supporting documentation needed to perform test includes, but not limited to: 2013 Buildini Energy Efficiency Standards Nonresidential Compliance Manual (NA 7.5.2 Constant Vokime, Single-zone, i Unitary Air Conditioner and I-feat Pumps Systems Acceptance At-A-Glance). 2013 Building Energy Efficiency Standards Manual. 2. Instrumentation to perform test includes, but not limited to: a Temperature Meter b Amp Meter 3. Installation (check if applies): . Thermostat is located within the space-conditioning zone that is served by the HVAC syste m 4. Programming (check all those that apply): . Thermostat meets the temperature adjustment and dead band requirements of 2013 Building E n e r g y E f f i c i e n c y S t a n d a r d s Manual section 120.2(b). Minimum heatirigsetpoint: °F. Maximum cooling setpoint '12, OF. Deadband: --- OF. . Occupied, unoccupied, and holiday schedules have been programmed perthe facility 's schedule. Pre-occupancy purge has been programmed to meet the requirements of 2013 Building Ener g y E f f i c i e n c y S t a n d a r d s M a n u a l section 120.1(c)2. - 1. Check method used to determine pre-occupancy purge: Lesser of: conditioned floor area times ventilation rate from 2013 Building Energy Efficiency Standards T A B L E 12O:1A or 15dm per person times the expected number of occupants. 0 3complete air changes. Notes: . . - - . - CA Building Energy Efficiery Standards 201.3 Nonresidential Compliance December 2015 STATE OF CALIFORNIA \ CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP. SYSTEMS ,,'r.-n5 a 4')I45 - r'AI rsOMIA fihA1QQ1nK1 CERTIFICATE OF ACCEPTANCE . NRcA.MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems (Page 2 of 3) I nmemA7 Permit Number Project Address, CitW C5i3. J VPCzç,,. System Name or identiflätion/Tag: . - System Location or Area ersed B. Functional Testing Requirements Operating Modes Step 1: Disable economizer control and demand-controlled ventilation (if applicable) to p r e v e n t u n e x p e c t e d i n t e r a c t i o n s . Occupied Mode - Step 2: Heating load during occupied condition Step 3: No-load during occupied condition Step 4: Cooling load during occupied condition Unoccupied Mode Step 5: No-load during unoccupied condition Step 6: Heating load during unoccupied condition Step 7: Cooling load during unoccupied condition - Step8: Manual override 8 7 6 5 4 3 -2 Step 2-8 Check and verify the following for each simulation mode required . a r,. ... a Supply fan operates continually b Supply fan turns off C Supply fan cycles on and off d System reverts to occupied mode to satisfy any condition iW 10 e System turns off when manual override time period expires W. ic f Gas fired furnace heat pump or electric heater stages on - g No heating is provided by the unit K h No cooling is provided by the unit Compressor stages on Npia ®R Outside air damper is open to minimum position. ) Outside air damper closes completely Step 9: System returned to initial operating conditions after all tests have been completed: Yes ( — N: 0 — EC. Testing Results 8 7dicate if Passed (P), Failed (F), or N/A (X), fill in appropriate letter -. - ( ? 1.(f... f_Ej D. Evaluation .. (!J I PASS: All Construction Inspection responses are complete and all applicable Testing R e s u l t s r e s p o n s e s a r e " P a s s " ( P ) CA Building Energy Efficiency Standards -2013 Nonresidential Compliance . December 2015 STATE OF CALIFORNIA CONSTANT VOLUME, SINGLE ZON E , U N I T A R Y ( P A C K A G E D A N D S P L I T ) "AIR CONDITIONER AND HEAT PUMP S Y S T E M S , CALIFORNIA ENEI CEC-NRCA-MCH-03-A (Revised 12115) CERTIFICATE OF ACCEPTANCE Constant Volume, Single Zone, Unitary ( P a c k a g e d a n d S p l i t ) A i r C o n d i t i o n e r a n d H e a t P u m p S y s t e m s Pmlest Name: Enfererneflt Permit Number 1tA2)4fl 1-'$ ()r'? Project Address: City. ZIpC 0 System Name ortdentlficetmfl/tB& System Lecatwfl or Area Served: DMMISSION NRCA-MCH-03-A (Page 30f 3) is DECLARATION STATEMENT 1. I certify that this Certificate of Acceptance documentation is accur a t e a n d c o m p l e t e . Documentation Author Name: ' - Documentation Documentation Author Company Name _---s Date Signed: Address: , r )j1 S All Certification Identification (If applicable): Citf/State/Zi) Phone: , ' FIELD TECHNICIANS DELARA11ON STATEMENT I certify the following under penalty of perjury, u n d e r t h e l a w s o f t h e S t a t e o f C a l i f o r n i a : The infàrmation provided on this Certificate of A c c e p t a n c e i s t r u e a n d c o r r e c t . I am the person who performed the acceptanc e v e r i f i c a t i o n r e p o r t e d o n t h i s C e r t i f i c a t e o f A c c e p t a n c e ( F i e l d T e c h n i c i a n ) . The construction or installation identified on t h i s C e r t i f i c a t e o f A c c e p t a n c e c o m p l i e s w i t h t h e a p p l i c a b l e a c c e p t a n c e r e q u i r e m e n t s indicated in the plans and specifications ap p r o v e d b y t h e e n f o r c e m e n t a g e n c y , a n d c o n f o r m s t o t h e a p p l i c a b l e a c c e p t a n c e requirements and procedures specified in R e f e r e n c e N o n r e s i d e n t i a l A p p e n d i x N A 7 . I have confirmed that the Certificate(s) of Inst a l l a t i o n f o r t h e c o n s t r u c t i o n o r i n s t a l l a t i o n i d e n t i f i e d o n t h i s C e r t i f i c a t e o f A c c e p t a n c e h a s been completed and signed by the responsi b l e b u i l d e r / i n s t a l l e r a n d h a s b e e n p o s t e d o r m a d e a v a i l a b l e w i t h t h e b u i l d i n g p e r m i t ( s ) issued for the building. Field Technician Name: - Field Technician Signature: Field Technician Company Name: . Position with Company (Title): Address: . . . AlT Certification Identification (if applicable): City/State/Zip: Phone: -. Date Signed: RESPONSIBLE PERSON'S DECLARATION STATEMENT l certify the following under penalty of perjury, u n d e r t h e l a w s o f t h e S t a t e o f C a l i f o r n i a : I am the Field Technician, or the Field Technici a n i s a c t i n g o n m y b e h a i f a s m y e m p l o y e e o r m y a g e n t a n d I h a v e r e v i e w e d t h e information provided on this Certificate of Ac c e p t a n c e . I am eligible under Division 3 of the Business an d P r o f e s s i o n s C o d e i n t h e a p p l i c a b l e c l a s s i f i c a t i o n t o a c c e p t r e s p o n s i b i l i t y f o r t h e system design, construction or installation of fea t u r e s , m a t e r i a l s , c o m p o n e n t s , o r m a n u f a c t u r e d d e v i c e s f o r t h e s c o p e o f w o r k identified on this Certificate of Acceptance a n d a t t e s t t o t h e d e c l a r a t i o n s i n t h i s s t a t e m e n t ( r e s p o n s i b l e a c c e p t a n c e p e r s o n ) . The information provided on this Certificat e o f A c c e p t a n c e s u b s t a n t i a t e s t h a t t h e c o n s t r u c t i o n o r i n s t a l l a t i o n i d e n t i f i e d o n t h i s Certificate of Acceptance complies with the ac c e p t a n c e r e q u i r e m e n t s i n d i c a t e d i n t h e p l a n s a n d s p e c i f i c a t i o n s a p p r o v e d b y t h e enforcement agency, and conforms to the appli c a b l e a c c e p t a n c e r e q u i r e m e n t s a n d p r o c e d u r e s s p e c i f i e d i n R e f e r e n c e N o n r e s i d e n t i a l Appendix NA7. I have confirmed that the Certificate(s) of Install a t i o n f o r t h e c o n s t r u c t i o n o r i n s t a l l a t i o n i d e n t i f i e d o n t h i s C e r t i f i c a t e o f A c c e p t a n c e h a s been completed and is posted or made avail a b l e w i t h t h e b u i l d i n g p e r m i t ( s ) i s s u e d f o r t h e b u i l d i n g . 5.. I will ensure that a completed, signed copy o f t h i s C e r t i f i c a t e o f A c c e p t a n c e s h a l l b e p o s t e d , o r m a d e a v a i l a b l e w i t h t h e b u i l d i n g permit(s) issued for the building, and made a v a i l a b l e t o t h e e n f o r c e m e n t a g e n c y f o r a l l a p p l i c a b l e i n s p e c t i o n s . I u n d e r s t a n d t h a t a signed c0p , f this Certifica e..ef cEptance is required to be included with the d o c u m e n t a t i o n t h e b u i l d e r p r o v i d e s t 6 t h e b u i l d i n g owner atcupan Responsible nce P n Name: Fiesponsible Acceptance Person Signature: - Responsibleteptanca Person Company Name: Position with Company (Tide): Address: J CSLttucense: City/State/Zip: I Phone: Date Signed: CA Building Energy Efficiency Standards -2013 N o n r e s i d e n t i a l C o m p l i a n c e December 2015 STATE OF CALIFORNIA OUTDOOR AIR ACCEPTANCE CCNRCA-MCl-1-09-A (Revised (1711 61 r'AI Ir1PMIa I'JP(V (YRauisIrmi CERTIFICATE OF ACCEPTANCE - NRA-MCH-02-A Outdoor Air Acceptance - - (Page 1 of 3) Project Na Enfo mentAgen -PermitNumbec Pro act Mdress: 63 - •- 0ty. - System Name Name or Identification/Tag; System Location or Area Served: L 3-17 Note: Submit one Certificate of Acceptance for each system nforcement Agency Use: Checked by/Date that must demonstrate compliance. .... Intent: Verify measured outside airflow reading is within 10% of the total required ou t s i d e a i r f l o w . R e q u i r e d f o r a l l n e w l y i n s t a l l e d H V A C units. Reference MCI-I-03 (Column 14) or Mechanical Equipment Sche d u l e s . A. Construction inspection Note: MCH-02-A can be performed in conjunction with MCJ-I-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap 1. Supporting documentation needed to perform test includes: a As-built and/or design documents (for example, Mechanical Equipment Schedules , E q u i p m e n t Start-Up Sheets or Balancing Reports). V . b 2016 Building Energy Efficiency Standards Nonresidential Compliance Ma n u a l (NA7 51 1 Ventilation Systems Variable Air Systems At-A-Glance and NA7.5.1.2 Constant Volume Systems Outdoor AJrAcceptance A t A-Glance). C. 2016 Building Energy Efficiency Standards. V V 2. Instrumentation needed to perform test includes:' a. Watch V V V b. V Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pr e s s u r e p r o b e , e t c . ) . L Method and equipment used: Ho j.) ijr2/J V d-_5i4.?"d 7c(Z. ii. Equipment calibration date (must be within one year): 9-4f- 3. System type (check either VAV orCAV): V 0 VAV . CAV -. a. Check if Variable Air Volume (VAV) and complete the following: i. Outside airflow is either factory calibrated or field calibrated. V 0 Check if factory calibrated and attach calibration certification. Check if field calibrated and attach calibration results. Damper Control (must be checked): V E] Dynamic damper control is being used to control outside air. (This is NOT a f i x e d m i n i m u m p o s i t i o n ) . One of the following dynamic controls is being utilized to control outside ai r ( c h e c k m e t h o d u s e d ) Outdoor Air CFM Compensation V O V Energy Balance Method V . Demand Control Ventilation 0, ReturnFanTracking V V 0 Injection Fan Method Dedicated Minimum Ventilation Damper with Pressure Control V 0 Other Active Control, Describe: b. Check if Constant Air Volume (CAy-) and verify the following: V V [ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of thefollowing): V V Outside air is ducted to the return air plenum. Confirm that outside air is ducted t o w i t h i n ( c h e c k o n e o f t h e f o l l o w i n g ) : V sft.ofthe unit. V 0 15 ft. of the unit, with the air directed sutstantialty toward the unit. 0 Return air plenum is NOT used to distribute outside air to the unii. (i. e . o u t s i d e a i r i s d u c t e d directly to the unit, outside air is provided independent of the unit, or economizer) 5. Pre-occupancy purge has been programmed for the 1-hour period imm e d i a t e l y b e f o r e t h e b u i l d i n g i s n o r m a l l y o c c u p i e d t o p r o v i d e ( o n e V of the following methods must be verified and checked): The conditioned floor area times the ventilation rate from the 2016 Building E n e r g y E f f i c i e n c y S t a n d a r d s T A B L E 1 2 0 . 1 - A , o r 1 5 cfm per person times the expected number of occupants, whichever is greater. V •O Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards 2016 Nonresidential Compliance July 2016 - • V V - - - - VV• - --.- ' STATE OF CALIFORNIA ' OUTDOOR AIR ACCEPTANCE CC.NRCA-McI-i-02.A (Revised 07/161 CAI lirtpMIA CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Na mIAivt,Lfl . SO entAg000ys S (—¼T'' PermitNum r. Project Addron,r zZ yic>.) ZIP Code. System Name or identification/Tag: System Locat on or Area Served'.. B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing cAy VAV Step 1: Disable demand control ventilation (if applicable) 0 0 Step 2: Verify unit is not in economizer mode during test (economizer disabled) - 0 Note Shaded boxes do not apply for CAV systems Step 3 CAy and VAV testing at full supply airflow -irj L4t a Adjust supply air to achieve design airflow or maximum airflow at full cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) B cfm cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). C10 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achi e v e d (minutes): mm Step 4: VAV testing at reduced supply airflow CAV VAV a Adjust supply airflow to either the sum of the minimum zone airflows full h e a t i n g , o r 3 0 % o f t h e total design airflow. Record VFD speed (Hz). . Hz b Measured outdoor airflow reading (cfm) cfm C. Required outdoor airflow (cfm) (from MCH-03 Column 14 or Mechanical Equipment Schedules) cfm d Time for outside air damper to stabilize after reduced supply airflow is ac h i e v e d ( m i n u t e s ) mm Step 5: Return to initial conditions (check) . 0 C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/S t e p 3 c ) ) t % . %OAFA is within 10% of design Outside Air. (90%:5 %OAFA :5 110%) . Yes ( No 0 Yes 0 No 0 C. Outside air damper position stabilizes within 5 minutes (Step 3d <5 mi n u t e s ) f Yes 0 No © Determine Percent Outside Air at reduced supply airflow, (%OA) for Step 4. (VAV only) a. %OAM = Measured outdoor airflow reading /Required outdoor airflow readin g . ( S t e p 4 b / S t e p 4 c ) % b %OApA is within 10% of design Outside Air. (90% 5 %OA ~ 110%) Yes 0 No 0 C. Outside air damper position stabilizes within 5 minutes (Step 4d <5 minutes) Yes 0 No 0 Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. - D. Evaluation . j PASS: All Construction Inspection responses are complete and Testing Calculatio n s & R e s u l t s r e s p o n s e s a r e p o s i t i v e . CA Building Energy Efficiency Standards -2016 Nonresidential Com p l i a n c e July 2016 STATE OF CAUFORNIA OUTDOOR AIR ACCEPTANCE CECRCA-MCH-02-A (Revised 07/161 (Al IPNIA PPJFR(Y ()MMISlClN 6 CERTIFICATE OF ACCEPTANCE' - NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name; L) C Enforcement cy w;:> -T? Permit Numbec ProJect System Name or IdentIficatlonITag System Location or Area Served: DOCUMENTATION AUTHOR'S DECLARATION STATEMENT I - 1. I certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name:3 . Documentation Author ___________ Documentation Autttompany Name: Date Signed: 2 Address: ATI Certification Identification (If applicable): C A4 Phone:V/529 FIELD TECHNICIANS DECLARATION STATEMENT I certify théfollowing under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2.' I am the person who performed the acceptance verification reported on this Certificate o f A c c e p t a n c e ( F i e l d T e c h n i c i a n ) . The construction or installation identified on this Certificate of Acceptance complies w i t h t h e a p p l i c a b l e a c c e p t a n c e r e q u i r e m e n t s indicated in the plans and specifications approved by the enforcement agency, and c o n f o r m s t o t h e a p p l i c a b l e a c c e p t a n c e requirements and procedures specified in Reference Nonresidential Appendix NA7. I have confirmed that the Certificate(s) of Installation for the construction or installation i d e n t i f i e d o n t h i s C e r t i f i c a t e o f A c c e p t a n c e h a s been completed and signed by the responsible builder/installer and has been p o s t e d o r m a d e a v a i l a b l e w i t h t h e b u i l d i n g p e r m i t ( s ) issued for thq b g. Field Technician Name: . Field TechnicianSignature: Field Technician Co a ame: Position with Company (Title): Address: - All Certification Identification (if applicable): City/State/Zip: Phone: Date Signed: RESPONSIBLE PERSONS DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of.Calif o r n i a : 1. I am the Field Technician, or the Field Technician is acting on my behalf as my em p l o y e e o r m y a g e n t a n d I h a v e r e v i e w e d t h e information provided on this Certificate of Acceptance. 2 I am eligible under Division 3 of the Business and Professions Code in the applicable cl a s s i f i c a t i o n t o a c c e p t r e s p o n s i b i l i t y f o r t h e system design, construction or installation of features, materials, components, o r m a n u f a c t u r e d d e v i c e s f o r t h e s c o p e o f w o r k identified on this Certificate of Acceptance and attest to the declarations in this stat e m e n t ( r e s p o n s i b l e a c c e p t a n c e p e r s o n ) . The information provided on this Certificate of Acceptance substantiates that the co n s t r u c t i o n o r i n s t a l l a t i o n i d e n t i f i e d o n t h i s Certificate of Acceptance complies with the acceptance requirements indicated in the pl a n s a n d s p e c i f i c a t i o n s a p p r o v e d b y t h e enforcement agency, and conforms to the applicable acceptance requirements and pro c e d u r e s s p e c i f i e d i n R e f e r e n c e N o n r e s i d e n t i a l Appendix NA7. I have confirmed that the Certificate(s) of Installation for the construction or installation id e n t i f i e d o n t h i s C e r t i f i c a t e o f A c c e p t a n c e h a s been completed and is posted or made available with the building permit(s) iss u e d f o r t h e b u i l d i n g . I will ensure that a completed, signed copy of this Certificate of Acceptance sh a l l b e p o s t e d , o r m a d e a v a i l a b l e w i t h t h e b u i l d i n g permit(s) issued for the building, and made available to the enforcement agency for a l l a p p l i c a b l e i n s p e c t i o n s . I u n d e r s t a n d t h a t a signed copy of his Certific Aèceptance is required to be included with the documentation the builder provides to the building owner at occ ancy. . - Responsible Accepts erso ame: . Responsible Acceptance Person Signature: Responsible Accep,th&e bison Company Name: - Position with Company (Title): Address: - C518 License: City/State/Zip: , Phone: Date Signed: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 STATE OF CALIFORNIA'. - CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT)' AIR CONDITIONER AND HEAT PUMP SYSTEMS , CEC-NRCA-MCH-03-A (Revised 12/15) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems . (Pagel of 3) Project Name - -. EnfocernentAaencr. Project Address: ode z -s> :::J a , J PPc Num1er System Name or tdentlficatton/rag7_ System Location or Area Served , ,, 2... te: Submit one Certificate ófAcceptance for each system that must Enforcement Agency Use: Checked by/Date 770nstrate compliance. > . A. Construction Inspection . . . - 1. Supporting documentation needed to perform test includes, but not limited to: 2013 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA 7.5.2 Constant Volume, Single-zone, Unitary Air Conditioner and Heat Pumps Systems Acceptance At-A-Glance). 2013 Building Energy Efficiency Standards Manual. 2. Instrumentation to perform test includes, but not limited to: Temperature Meter Amp Meter 3. lnstllation (check if applies): Thermostat is located within the space-conditioning zone that is served by the HV A C s y s t e m . . 4. Programming (check all those that apply):r . . . . Thermostat meets the temperature adjustment and dead band requirments of 2013 Building Energy Efficiency Stand a r d s Manual section 120.2(b). . . . . Minimum héatingsetpoint: °F. Maximum cooling setpoint °F. Deadband: Occupied, unoccupied, and holiday schedules have been programmed per the facility's sc h e d u l e . Pre-occupancy purge has been programmed to meet the requirements of 2013 B u i l d i n g E n e r g y E f f i c i e n c y S t a n d a r d s M a n i a l $ section 120.1(c)2.' 1. Check method used to determine pre-occupancy purge: - L. [ Lesser of conditioned floor area times ventilation rate from 2013 Building Energy Efficienc y S t a n d a r d s T A B L E 120.1-A or15cfm per person times the expected numb& of occupants. 0 3 complete air changes. .. - Notes: - . . -• . . •- . V - -V - CA Building Energy Efficiency Standards :2013 Nonresidential Compliance ---. - -- STATE OF CALIFORNIA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) - AIR CONDITIONER AND HEAT PUMP SYSTEMS fl'A .er,nO A l')I15 - ('AI Wr',PMl IprvMIitIrsP,I CERTIFICATE OF ACCEPTANCE - - NRCA-MCI1-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems (Page 2 of 3) P.ojaa Name: • tefoltem Agency: f Permit Number, Project Address, city:Zip cod'iZ Cr—) System Name or IdentificatiorTag: System location or Area Served- B. Functional Testing Requirements , [ opératrng Modes Step 1: Disable economizer control and demand-controlled ventilation (if applica b l e ) t o p r e v e n t u n e x p e c t e d i n t e r a c t i o n s . - Occupied Mode - Step 2: Heating load during occupied condition - Step 3: No-load during occupied condition Step 4: Cooling load during occupied condition Unoccupied M6de - Step 5: No-load during unoccupied condition - - Step 6: Heating load during unoccupied condition S - Step 7: Cooling load during unoccupied condition Step 8: Manual override - 8 7 6 5 4 3 2 Step 2-8: Check and verify the following for each Simulation mode required :. 4 a Supply fan operates continually . b. Supply fan turns off - - (\ C. Supply fan cycles on and off ? , System reverts to "occupied" mode to satisfy any condition System turns off when manual override time period expires r f Gas fired furnace heat pump or electric heater stages on c No heating is provided by the unit No cooling is provided by the unit - I Compressor stages on a Outside air damper is open to minimum position Outside air damper closes completely Step 9: System returned to initial operating conditions after all tests have been completed: Yes 0 No 0 C. Testing Results - 81 7 1 6 4 3 2 Indicate if Passed (P), Failed (F), or N/A (X),fill in appropriate letter D. Evaluation - ] PASS: All Construction Inspection responses are complete and all applicable Testing Results r e s p o n s e s a r e " P a s s ' ( P ) CA Building Energy Efficiency Standards -2013 Nonresidential Compliance December 2015 STATE OF CALIFORNIA CONSTANT VOLUME, SINGLE ZONE, UN I T A R Y ( P A C K A G E D A N D S P L I T ) fa%MlIVI1k10 AMfl L1AT PUMP VSTFMS Iffla-', CEC-NRCA-MCH-03-A (Revised 12115) - CALIFORNIA EN1ZF(t3Y WMILJrI CERTIFICATE OF ACCEPTANCE . NRCA-MCH-03-A Constant Volume, Single Zone, Unitary ( P a c k a g e d a n d S p l i t ) A i r C o n d i t i o n e r a n d H e a t P u m p S y s t e m s (Page 3 of 3) Project Name: ' I Age. T1i (r( I Project Address' zlPc I 2- S ca-Ez. 0 System Name or Went' ftmtlQnJTa8 System Lecatien or Area Served: - DOCUMENTATION AUThoR'S DECLARATION ST A T E M E N T 1. I certify that this Certificate of Acceptance documentati o n i s a c c u r a t e a n d c o m p l e t e . . , Documentation Author Name Documentation Documentation Author Company Name _.T ._ Date Signed: Address: AlTCertiflcation Identification (If applicable): City/Sr2te/Zij Phone : r)) 1 4L1 4 FIELD TECHNICIAN'S DEIARA11ON STATEMENT I certify the following under penalty of perjury, under th e l a w s o f t h e S t a t e o f C a l i f o r n i a : The information provided on this Certificat e o f A c c e p t a n c e i s t r u e a n d c o r r e c t . I am the person who performed the acceptance v e r i f i c a t i o n r e p o r t e d o n t h i s C e r t i f i c a t e o f A c c e p t a n c e ( F i e l d T e c h n i c i a n ) . The construction or installation identified on thi s C e r t i f i c a t e o f A c c e p t a n c e c o m p l i e s w i t h t h e a p p l i c a b l e a c c e p t a n c e r e q u i r e m e n t s indicated in the plans and specifications ap p r o v e d b y t h e e n f o r c e m e n t a g e n c y , a n d c o n f o r m s t o t h e a p p l i c a b l e a c c e p t a n c e requirements and procedures specified in Re f e r e n c e N o n r e s i d e n t i a l A p p e n d i x N A 7 . ( I have confirmed that the Certificate(s) of Inst a l l a t i o n f o r t h e c o n s t r u c t i o n o r i n s t a l l a t i o n i d e n t i f i e d o n t h i s C e r t i f i c a t e o f A c c e p t a n c e h a s been completed and signed by the responsibl e b u i l d e r / i n s t a l l e r a n d h s b e e n p o s t e d o r m a d e a v a i l a b l e w i t h t h e b u i l d i n g p e r m i t ( s ) issued for the building. Field Technician Name: Field Technician Signature: Field Technician Company Name: V Position with Company (Title): Address V AFT Certification Identification (if applicable): City/State/Zip: Phone: Date Signed: - RESPONSIBLE PERSON'S DECLARATION STATEMENT V I certify the following under penalty of perjury, under the laws of the State of California:. I am the Field Technician, or the Field Technician i s a c t i n g o n m y b e h a l f a s m y e m p l o y e e o r m y a g e n t a n d I h a v e r e v i e w e d t h e information provided on this Certificate of Acc e p t a n c e . V lam eligible under Division 3 of the Business a n d P r o f e s s i o n s C o d e i n t h e a p p l i c a b l e c l a s s i f i c a t i o n t o a c c e p t r e s p o n s i b i l i t y f o r t h e system design, construction or installation of f e a t u r e s , m a t e r i a l s , c o m p o n e n t s , o r m a n u f a c t u r e d d e v i c e s f o r t h e s c o p e o f w o r k V identified on this Certificate of Acceptance and a t t e s t t o t h e d e c l a r a t i o n s i n t h i s s t a t e m e n t ( r e s p o n s i b l e a c c e p t a n c e p e r s o n ) . The information provided on this Certificate o f A c c e p t a n c e s u b s t a n t i a t e s t h a t t h e c o n s t r u c t i o n o r i n s t a l l a t i o n i d e n t i f i e d o n t h i s Certificate of Acceptance complies with the acc e p t a n c e r e q u i r e m e n t s i n d i c a t e d i n t h e p l a n s a n d s p e c i f i c a t i o n s a p p r o v e d b y t h e enforcement agency, and conforms to the a p p l i c a b l e a c c e p t a n c e r e q u i r e m e n t s a n d p r o c e d u r e s s p e c i f i e d i n R e f e r e n c e N o n r e s i d e n t i a l Appendix NA7. V V I have confirmed that the Certificate(s) of Installation for the construction or installation i d e n t i f i e d o n t h i s C e r t i f i c a t e o f A c c e p t a n c e h a s been completed and, is posted or made avail a b l e w i t h t h e b u i l d i n g p e r m i t ( s ) i s s u e d f o r t h e b u i l d i n g . S. I will ensure that a completed, signed copy of thi s C e r t i f i c a t e o f A c c e p t a n c e s h a l l b e p o s t e d , o r m a d e a v a i l a b l e w i t h t h e b u i l d i n g permit(s) issued for the building, and made available to th e e n f o r c e m e n t a g e n c y f o r a l l a p p l i c a b l e i n s e t i o n s . I u n d e r s t a n d t h a t a V signed copy of this .lc:f Acceptance is required to be include d w i t h t h e d o c u m e n t a t i o n t h e b u i l d e r p r o v i d e s t o t h e b u i l d i n g owner at occupan Responsible Acceptance Per n e: ' I Responsible Acceptance Person Signature: Responsible Acceptance Pa Name: - I Position with Company (Title): Address: V I CSLBLlcense: ' V City/State/Zip: . j Phone: -. J Date Signed: CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance December 2015 STATE OF CALIFORNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) I It CA1 lPrsilA PNR(Y (OMMlSlN CERTIFICATE OF ACCEPTANCE NRCA-MCFI-02-A Outdoor Air Acceptance (Page 1 of 3) PsoJect Na . EnfoimentAgen 3 : Permit Number - JlibO System Name or Identification/rag: System Location Of Area Served:. Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date - that must demonstrate compliance. - - :- Intent Verify measured outside airflow reading is within 10% of the total requir e d o u t s i d e a i r f l o w . R e q u i r e d f o r a l l n e w l y i n s t a l l e d H V A C units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A; Construction Inspection - •. Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fcrn VFD A c c e p t a n c e ( i f a p p l i c a b l e ) s i n c e t e s t i n g a c t i v i t i e s o v e r l a p . 1. Supporting documentation needed to perform test includes:- - a As-built and/or design documents (for example, Mechanical Equipment Sch e d u l e s , E q u i p m e n t Start-Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (P147.5.1.1 Ventilation Systems: Variable Air Systems At-A-Glance and NA 7.5.1.2 Constant Volume Systems Outdoor AirAcceptance At-A- G l a n c e ) . C. 2016 Building Energy Efficiency Standards. 2: Instrumentation needed to perform test includes: Watch 1 Calibrated means to measure airflow (i.e. hot-wire anemometer, veloci t y p r e s s u r e p r o b e , e t c . ) . I. Method and equipment used: &07- (_A) ,,ZG 4U3aiiaid 74,Nt ii. Equipment calibration date (must be within one year): 244f9L 3. System type (check either VAV or CAV): VAV, CAV - a. Check if Variable Air Volume (VAV) and complete the following: i. Outside airflow is either factory calibrated or field calibrated. Check if factory calibrated and attach calibration certification. Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): 0 Dynamic damper control is being used to control outside air. (This is NO T a f i x e d m i n i m u m p o s i t i o n ) . iii. One of the following dynamic controls is being utilized to control outside air (check m e t h o d u s e d ) E] Outdoor Air CFM Compensation Energy Balance Method Demand Control Ventilation 0 Return Fan Tracking' F1 Injection Fan Method E] Dedicated Minimum Ventilation Damper with Pressure Control 0 Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: a System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): Outside air is ducted to the return air plenum. Confirm that outside air is d u c t e d t o w i t h i n ( c h e c k o n e o f t h e f o l l o w i n g ) : 5ft.oftheunit. O 15 ft. of the unit, with the air directed substantially toward the unit. D Return air plenum is NOT used to distribute outside air to the unit. (i.e. outsi d e a i r i s d u c t e d d i r e c t l y t o t h e -unit, outside air is provided independent of the unit, or economizer) S. Pre-occupancy purge has been programmed for the 1-hour period immediatel y b e f o r e t h e b u i l d i n g i s n o r m a l l y o c c u p i e d t o p r o v i d e ( o n e of the following methods must be verified and checked): The conditioned floor area times the ventilation rate from the 2016 Building En e r g y E f f i c i e n c y S t a n d a r d s T A B L E 1 2 0 . 1 - A , o r 1 5 c f m per person times the expected number of occupants, whichever is greater. Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards -2016 Nonresidential Compliance July 2016 STATE OF CALIFORNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION ' -0 CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Na 1Ak,L,Lr Enfpçeement Agency Permit Number Project Address' 2t S3 t>a) C5y Zip code. System Name or identlfication/rag - - System Loeatsoe or Area Served: B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) 0 0 Step 2: Verify unit is not in economizer mode during test (economizer disabled) 0 Note Shaded boxes do not applyfor CAVsystems Step 3 CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full cooling. Record VFD speed (Hz). Hz Measured outdoor airflow reading (cfm) CID cfm cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm cfm d Time for outside air damper to stabilize after full supply airflow is achiev e d (minutes): ei-- mm Step 4: VAV testing at reduced supply airflow . CAV VAV a Adjust supply airflow to either the sum of the minimum zone airflows full h e a t i n g , o r 3 0 % o f t h e total design airflow. Record VFD speed (Hz) Hz b Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCJ-!-03 Column 14 or Mechanical Equipment Schedules) cfm d Time for outside air damper to stabilize after reduced supply airflow is achi e v e d ( m i n u t e s ) mm Step 5: Return to initial conditions (check) . 0 C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. %OAFA = Measured outdoor airflow, reading /Required outdoor airflow. (Step3b/Step3c) P OC) % % %OAFA is within 10% of design Outside Air. (90%:5 %OAFA :5 110%) Yes @ No 0 Yes 0. No 0 C. Outside air damper position stabilizes within 5 minutes (Step 3d <5 minute s ) Yes 0 No 0 Determine Percent Outside Air at reduced supply airflow (%OA) for Step 4 . ( V A V o n l y ) - a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading ( S t e p 4 b / S t e p 4 c ) b %OAiswithin 10% of design Outside Air.%OARA 110%) Yes 0 No C. Outside air damper position stabilizes within 5 minutes (Step 4d <5 minutes ) Yes 0 No 0 Note: The intent of this test is to ensure that 1) all air handlers provide the mi n i m u m a m o u n t o f O S A a n d 2 ) V A V a i r h a n d l e r s u s e d y n a m i c controls to avoid over ventilation. - D. Evaluation PASS: All Construction Inspection responses are complete and Testing C a l c u l a t i o n s & R e s u l t s r e s p o n s e s a r e p o s i t i v e . CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 STATE OF CALIFORNIA OUTDOOR AIR ACCEPTAN C E CEC-NRCA-MCH-02-A (Revised 07/16) CAi IPMIA JP(V (MML.qlrw CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance . (Page 3 of 3) Project Name: Lit Enforcement jfs5ç; Permit Number P-1 A city: NpAs System Name or IdesstIflcation/Tagr System Ltlorr or Area Served: DOCUMENTATION AUTHORS DECLARATION STATEMENT 1. I certify that this Certificate of Acceptance documentation is accurate a n d c o m p l e t e . Documentation Author Name: t Documentation Author Documentation Autho mpanyName: to-- r Tt Date Signed: 2 ZZc' Zo /5 Address: Arr Certification Identification (If applicable): Phone:. FIELD TECHNICIANS DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of C a l i f o r n i a : The information provided on this Certificate of Acceptance is true and correct. lam the person who performed the acceptance verification reported on t h i s C e r t i f i c a t e o f A c c e p t a n c e ( F i e l d T e c h n i c i a n ) . The construction or installation identified on this Certificate of Accepta n c e c o m p l i e s w i t h t h e a p p l i c a b l e a c c e p t a n c e r e q u i r e m e n t s indicated in the plans and specifications approved by the enforcement agency, a n d c o n f o r i i s t o t h e a p p l i c a b l e a c c e p t a n c e requirements and procedures specified in Reference Nonresidential A p p e n d i x N A 7 . I have confirmed that the Certificate(s) of Installation for the constructio n o r i n s t a l l a t i o n i d e n t i f i e d o n t h i s C e r t i f i c a t e o f A c c e p t a n c e h a s been completed and signed by the responsible builder/installer and h a s b e e n p o s t e d o r m a d e a v a i l a b l e w i t h t h e b u i l d i n g p e r m i t ( s ) issued for the building. Reid Technician Name: - Field Technician Signature: . Field Technician Company Name: V Position with Company (Title): Address: ATT Certification Identification (if applicable): City/Ste/Zlp: V V Phone: Date Signed: V RESPONSIBLE PERSON'S DECLARATION STATEMENT . V I certify the following under penalty of perjury, under the laws of the State of. C a l i f o r n i a : I am the Field Technician, or the Field Technician is acting on my behal f a s m y e m p l o y e e o r m y a g e n t a n d I h a v e reviewed the information provided on this Certificate of Acceptance. I am eligible under Division 3 of the Business and Professions Code in the ap p l i c a b l e c l a s s i f i c a t i o n t o a c c e p t r e s p o n s i b i l i t y f o r t h e system design, construction or installation of features, materials, comp o n e n t s , o r m a n u f a c t u r e d d e v i c e s f o r t h e s c o p e o f w o r k identified on this Certificate of Acceptance and attest to the declarations i n t h i s s t a t e m e n t ( r e s p o n s i b l e a c c e p t a n c e p e r s o n ) . The information provided on this Certificate of Acceptance substantiates t h a t t h e c o n s t r u c t i o n o r i n s t a l l a t i o h i d e n t i f i e d o n t h i s Certificate of Acceptance complies with the acceptance requirements indic a t e d i n t h e p l a n s a n d s p e c i f i c a t i o n s a p p r o v e d b y t h e enforcement agency, and conforms to the applicable acceptance requirement s a n d p r o c e d u r e s s p e c i f i e d i n R e f e r e n c e N o n r e s i d e n t i a l V V Appendix NA7. S I have confirmed that the Certificate(s) of Installation for the construction or i n s t a l l a t i o n i d e n t i f i e d o n t h i s C e r t i f i c a t e o f A c c e p t a n c e h a s been completed and is posted or made available with the building per m i t ( s ) i s s u e d f o r t h e b u i l d i n g . I Will ensure that a completed, signed copy of this Certificate of Acceptance shall b e p o s t e d , o r m a d e a v a i l a b l e w i t h t h e b u i l d i n g V pemit(s) issued for the building, thnade available to the enforcement agency for all applicable inspectio n s . I u n d e r s t a n d t h a t a signed copy of th Ce 11 rtificat Acceptance is required to be included with the documentation the build e r p r o v i d e s t o t h e b u i l d i n g owneratoccup cy. •V - - Responsible Accepta n Na : V V Responsible Acceptance Person Signature: Responsible Accep Pe Company Name: V Position with Company (Title): Address: CSLB License: City/StatefZlp: V - V Phone: Date Signed: CA Building Energy Efficiency Standards -2016 Nonresidential Compliance V - July 2016 STATE OF CALIFORNIA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS - CERTIFICATE OF ACCEPTANCE -. NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems i (Page 1 of 3) Project Name: Enforcement Agency: - Permit Number. Project Address: - City: ZipCode: ystem Name or Identification/rag: • F System Location or Area Served Note: Submit one Certificate of Acceptance for each system that must Eñfórcèment Agency Use: Chéckèd /Dater demonstrate compliance A. Construction Inspection 1; Supporting documentation needed to perfothi test includes, but not limited to: 2013 Building Energy Efficiency Standards Nonrsident!ai Compliance Manual (NA 7.5.2 Constant Volume, Single-zone, Unitary Air Conditioner and Heat Pumps System's Acceptdnce At-A-Glance). - 2013 Building Energy Efficiency Standards Manual. 2. Instrumentation to perform test includes: but not limited to: Temperature Meter Amp Meter 3. Installation (check if applies): Thermostat is located within the space-conditioninjzone that is served by the HVAC system. 4. Programming (check all those that apply): Thermostat meets the temperature adjustment ana dead band requirements 'of 2013 Building Energy Efficiency Standards Manual section 120.2(b). * Minimum heating setpoint: °F.-Maximurn coolinsetpoint 1? 2 °F. Deadband: I - °F. • Occupied, unoccupied, and holiday schedules have been programmed per the facility's schedule. Pre-occupancy purge has been programmed to meet the requirements of 2013 Building Energy Efficiency Standards Manual section 120.1(c)2. - 1. Check method used to determine pre-occupañcy purge: - - 91 Lesser of: conditioned floor area times ventilation rate from 2013 Building Energy Efficieny Standards TABLE 120.1-A or 15cfm per person times the expected number of occupants. . 0 3 complete air changes.- Notes: CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance December 2015 r -- STATE OF CALIFORNIA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-NRCA-MCH4)3-A (Revised 12J15) ('M IPtP111I1s IMIP(V (EAEAIststItI/ CERTIFICATE OF ACCEPTANCE NRA-MCH-O3-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems (Page 2 of 3) Project Name: • t Cs Enforce Agency: m c-cs 'i Permit Number - Project Address.- City: System Name or IdentIficatIon/rag: System Location or Area Served: B. Functional Testing Requirements - . Operating Modes Step 1: Disable economizer control and demand-controlled ventilation (if applicable) to prevent unexpected interactions. Occupied Mode Step 2: Heating load during occupied condition Step 3: No-load during occupied condition Step 4: Cooling load during occupied condition .. - Unoccupied Mode Step 5: No-load during unoccupied condition Step 6: Heating load during unoccupied condition - Step 7: Cooling load during unoccupied condition - Step 8: Manual override 8 7 6 5 4 31 2 Step 2-8 Check and verify the following for each simulation mode required a Supply fan operates continually b. Supply fan turns off C Supply fan cycles on and off - d System reverts to occupied mode to satisfy any condition - e. System turns off when manual override time period expires f Gas fired furnace heat pump or electric heater stages on - - No heating is provided by the unit . No cooling is provided by the unit .. . Compressor stages on .. 'p ) " Outside air damper is open to minimum position - k Outside air damper closes completely Step 9: System returned to initial operating conditions after all tests have been completed: Yes ( No C) — C. Testing Results . - 8 1 7 1 6 1 s 1 4 3 [Indicate if Passed (P), Failed (F), or N/A (X), fill in appropriate letter - ? I I '? IT 'i.. i1 D. Evaluation - PASS: All Construction Inspection responses are complete and all applicable Testing Results responses are "Pass" (P) CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance December 2015 STATE OF CALIFORNIA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS ___ CC-NRCA-MCI-1-03-A (Revised 19/151 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE - NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems (Page 3 of 3) Project Name: Enforcement AflCY Permit Numben - Project Address 2-VS -, car ° ZipC: 7C) System Name or . dentfficatntrag: . System Location or Area Served: - DOCUMENTATION AUTHOR'S DECLARATION STATEMENT • 1. I certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Documentation Author Names 'r1P- 4 - Documentation Author Company Name LS Date Signed: Z-2-2- € Address: , Air Certification Identification (If applicable): City/State/Z 7-4D cWt Phone: 49 l(c) 2 (3 FIELD TECHNICIANS DE&ARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: The information provided on this Certificate of Acceptance is true and correct. I am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. I have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Field Technician Signature: Field Technician Company Name: . Position with Company (Title): Address: Air Certification Identification (if applicable): City/state/zip: . Phone: Date Signed: RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: lam the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. lam 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 Acceptance and attest to the declarations in this statement (responsible acceptance person). The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. I have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. I will ensure that a completed, signed copy of this Certificate of Acceptance 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 undestand that a signed copy, this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at Wupancy. -. 2 Responsible AcceJD6nce Person Name: Responsible Acceptance Person Signature: Responsible p Per panyName:. - •.;': -, . 'Posltionwith Company (Tltle): Address: -. CSLB license: - City/State/Zip: Phone: Date Signed: CA Building Energy Efficiency Standards -2013 Nonresidential Compliance December 2015 .1 STATE OF:CALIFORNIA - - CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-NRCA-MCH-03-A (Revised 12/15) - - - - - - CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-03 A Constant VolUme, Single Zone, Unitary (Packaged and Split) Air conditioner and Heat Pump Systems -, (Pagel of 3) Project 144 Name -. - - , EnforcementAgenCy PenojtNwnber- Project Address: - CCar-) city ZipCode: 5 ZW svctemNamrorldenttffcatbn/re. '- : ~vswm Location or Area Serve Note: Submit one Certificate-of Acceptance for each system that must Enforcement Agency. Use: Checked by/Date demonstrate compliance. - A. Construction Inspection 1. Supporting documentation needed to perform test includes, but not limited to : a.-, 2013 Building Energy Efficiency Standards Nonresidential Compliance Maival (AL475.2 Constant Volume, Single-zone, Unitary Air Conditioner and Heat Pumps Systems Acceptance At-A-Glance). . b. 2013 Building Energy Efficiency Standards Manual. - 2. Instrumentation to perform test includes, but not limited to: Temperature Meter -- - Amp Meter • 3. Installation (check if applies): - - - -. . Thermostat is located within the space-conditioning zone that is served by the H V A C s y s t e m . - 4. Programming (check all those that apply): * - Thermostat meets the temperature adjustment and dead band requirements of 2 0 1 3 B u i l d i n g E n e r g y E f f i c i e ncy Standards - Manual section 120:2(b). Minimum heating setpoint: °F. Maxim*um coolirigsetpoint °F. Deadband: ______°F. 0ccupied, unoccupied, and holiday schedules have been programmed per the facility's sc h e d u l e . - - LX Pre-occupancy purge has been programmed to meet the requirements of 2013 Building E n e r g y E f f i c i e n c y S t a n d a r d s M a n u a l section 120.1(c)2. . . . . 1. Check method used to determine pre-occupany purge: - - Lesser of: conditioned floor area times ventilation rate from 2013 Bilding Energy Efficienc y S t a n d a r d s T A B L E - 120.1-A or 15dm per person times the expected ntmber of occupants. - - 0 3 complete air changes. . -. Notes: - - . - . • t a. 't • -. - I - 1 - C - . (A 5uikilng 1nergy Etticiency Standards = 2013 Nonresidential Compliance. December 2015 _-- STATE OF CALIFORNIA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS rei IrsPMIe MIV rrThAhAIIrteI CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems (Page 2 of 3) P Na Lu I E me Permit Number. Project Address: V-S jcc I System Name or IdentIficatbnfTag System Location or Area Served: B. Functional Testing Requirements Operating Modes Step 1: Disable economizer control and demand-controlled ventilation (if applicable) to prevent unexpe c t e d i n t e r a c t i o n s . Occupied Mode Step 2: Heating load during occupied condition Step 3: No-load during occupied condition Step 4: Cooling load during occupied condition Unoccupied Mode Step 5: No-load during unoccupied condition - Step 6: Heating load during unoccupied condition - Step 7: Cooling load during unoccupied condition Step 8: Manual override 8 7 6 5 4 3 V Step 2-8: Check and verify the following for each simulation mode required ; : . a Supply fan operates continually b. Supply fan turns off Z 5t, c ('¼ - C. Supply fan cycles on and off - if, d. System reverts to "occupied" mode to satisfi any condition V At £ e. System turns off when manual override time period expires - i. • ii'. f. Gas-fired furnace, heat pump, or electric heater stages on g. No heating is provided by the unit IS V h. No cooling is provided by the unit • . ( '; 1' L Compressor stages on Outside air damper is open to minimum position I, - Outside air damper closes completely - • Step 9: System returned to initial operating conditions after all tests have been completed: Yes ( No 0 - C. Testing Results 8 7 1 6 1 5 1 4 1 3_ Indicate if Passed (P), Failed (F), or N/A (X), fill in appropriate letter D. Evaluation S PASS: All Construction Inspection responses are complete and all applicable Testing Results responses are "Pass" (P) CA Building Energy Efficiency Standards -2013 Nonresidential Compliance December 2015 STATOF CALIFORNIA -. . CONSTANT VOLUME, SINGLE ZONE, UNI T A R Y ( P A C K A G E D A N D S P L I T ) AIR CONDITIONER AND HEAT PUMP SY S T E M S JIR(Y COMMISSION 0ECNRCA.McH4)3-A (Revised 12/15) -•--•-- - - NRCA-MCH-03- CERTIFICATE OF ACCEPTANCE Systems (Page 3 of 3) Constant Volume, Single Zone, Unitary (Pa c k a g e d a n d S p l i t ) A i r C o n d i t i o n e r a n d H e a t P u m p Project Name:- .. tnforcenroitAeeflcy PennitNumbec Project Address. Ctty VpC o System Cameo, ide,d,ftcatiofl/Iag SyStem Lecatron or Area Served DOCUMENTATION AUTHOR'S DECLARATIO N S T A T E M E N T 1. I certify that this Certificate of Acceptance d o c u m e n t a t i o n i s a c c u r a t e a n d c o m p l e t e . Documentation Author Names Documentation Author e* Documentation Author Company Name, tT Date Signed: Z-2-Z ZLi € - Address: - S AU certification Identification (If applicable): Cl/State/Zi ) c czLcLt Phone t. ( 4L4 Lf FIELD TECHNICIAN'S DELARATION STATEMENT I certify the following under penalty of perjury, u n d e r t h e l a w s o f t h e S t a t e o f C a l i f o r n i a : The information provided on this Certificate of A c c e p t a n c e i s t r u e a n d c o r r e c t . I am the person who performed the acceptance v e r i f i c a t i o n r e p o r t e d o n t h i s C e r t i f i c a t e o f A c c e p t a n c e ( F i e l d T e c h n i c i a n ) . The construction or installation identified on t h i s C e r t i f i c a t e o f A c c e p t a n c e c o m p l i e s w i t h t h e a p p l i c a b l e a c c e p t a n c e r e q u i r e m e n t s indicated in the plans and specifications ap p r o v e d b y t h e e n f o r c e m e n t a g e n c y , a n d c o n f o r m s t o t h e a p p l i c a b l e a c c e p t a n c e requirements and procedures specified in R e f e r e n c e N o n r e s i d e n t i a l A p p e n d i x N A 7 . I have confirmed that the Certificate(s) of Ins t a l l a t i o n f o r t h e c o n s t r u c t i o n o r i n s t a l l a t i o n i d e n t i f i e d o n t h i s C e r t i f i c a t e o f A c c e p t a n c e h a s been completed and signed by the responsi b l e b u i l d e r / i n s t a l l e r a n d h a s b e e n p o s t e d o r m a d e a v a i l a b l e w i t h t h e b u i l d i n g p e r m i t ( s ) issued for the building. Field Technician Name: - Field Technician Signature: Field Technician Company Name: , Position with Company (Title): Address: AU Certification Identification (if applicable): - City/State/Zip: . Phone: Date Signed: - RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, u n d e r t h e l a w s o f t h e S t a t e o f C a l i f o r n i a : I am the Field Technician, or the Field Tec h n i c i a n i s a c t i n g o n m y b e h a l f a s m y e m p l o y e e o r m y a g e n t a n d I h a v e r e v i e w e d t h e information provided on this Certificate of Ac c e p t a n c e . I am eligible under Division 3 of the Busines s a n d P r o f e s s i o n s C o d e i n t h e a p p l i c a b l e c l a s s i f i c a t i o n t o a c c e p t r e s p o n s i b i l i t y f o r t h e system design, construction or installation o f f e a t u r e s , m a t e r i a l s , c o m p o n e n t s , o r m a n u f a c t u r e d d e v i c e s f o r t h e s c o p e o f w o r k identified on this Certificate of Acceptance a n d a t t e s t t o t h e d e c l a r a t i o n s i n t h i s s t a t e m e n t ( r e s p o n s i b l e a c c e p t a n c e p e r s o n ) . The information provided on this Certificate o f A c c e p t a n c e s u b s t a n t i a t e s t h a t t h e c o n s t r u c t i o n o r i n s t a l l a t i o n i d e n t i f i e d o n t h i s Certificate of Acceptance complies with the ac c e p t a n c e r e q u i r e m e n t s i n d i c a t e d i n t h e p l a n s a n d s p e c i f i c a t i o n s a p p r o v e d b y t h e enforcement agency, and conforms to the a p p l i c a b l e a c c e p t a n c e r e q u i r e m e n t s a n d p r o c e d u r e s s p e c i f i e d i n R e f e r e n c e N o n r e s i d e n t i a l Appendix NA7. I have confirmed that the Certificate(s) of In s t a l l a t i o n f o r t h e c o n s t r u c t i o n o r i n s t a l l a t i o n i d e n t i f i e d o n t h i s C e r t i f i c a t e o f A c c e p t a n c e h a s been completed and is posted or made availa b l e w i t h t h e b u i l d i n g p e r m i t ( s ) i s s u e d f o r t h e b u i l d i n g . S. I will ensure that a completed, signed cop y o f t h i s C e r t i f i c a t e o f A c c e p t a n c e s h a l l b e p o s t e d , o r m a d e a v a i l a b l e w i t h t h e b u i l d i n g permit(s) issued for the building, and made a v a i l a b l e t o t h e e n f o r c e m e n t a g e n c y f o r a l l a p p l i c a b l e i n s p e c t i o n s . I u n d e r s t a n d t h a t a signed copy of this Certificate of Acceptance i s r e q u i r e d t o b e i n c l u d e d w i t h t h e d o c u m e n t a t i o n t h e b u i l d e r p r o v i d e s t o t h e b u i l d i n g owner at occupaq4. - Responsible Acceptance Responsthle Acceptance Person Signature Responsible Accepta n ny Name: - Position with Company (Title): Address: V CSLB License: cltyfSlate/Zlp: - - - Phone: Date Signed: - 7 CA Building Energy Efficiency Standards i Nonresidential Compliance December 2015 STATE OF CALIFORNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MH-02-A (Revised 07/16) r'i ppji cPV (MMIS.qiCTh CERTIFICATE OF ACCEPTANCES .- NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) - Project Narr Enfo mentAgen ?asO ccv¼? PerrnitNumber. PM . o-• System Name or ldentiNcation/Tag: System Location or Area Served: Note: Submit one Certificate of Acceptance for each system. Enforcement agency Use: Checked by/Date that must demonstrate compliance.. Intent Verijj, measured outside airflow reading is within 10% of the total required o u t s i d e a i r f l o w . R e q u i r e d f o r a l l n e w l y i n s t a l l e d H I / A C units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Ac c e p t a n c e ( i f a p p l i c a b l e ) s i n c e t e s t i n g o c t M t t h s o v e r l a p . 1. Supporting documentation needed to perform test includes: As-built and/or design documents (for example, Mechanical Equipment Schedules, Equip m e n t Start-Up Sheets or Balancing Reports). - 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At-A-Glance and NA 7.5.1.2 Constant Volume Systems Outdoor AirAcceptance At-A-G l a n c e ) . C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: Watch Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure p r o b e , e t c . ) . L Method and equipment used: P07 u- a- 7cQ ii. Equipment calib ration date (must be within one year): _'t 3. System type (check eit her VAV or CAV): VAV CAV a. Check if Variable Air Volume (VAV) and complete the following: I. Outside airflow is either factory calibrated or field calibrated. Check if factory calibrated and attach calibration certification. Check if field calibrated and attach calibration results. Damper Control (must be checked): E] Dynamic damper control is being used to control outside air. (This is NOT a fixed mini m u m p o s i t i o n ) . One of the following dynamic controls is being utilized to control outside air (check m e t h o d u s e d ) 0 Outdoor Air CFMCompensation . 0 Energy Balance Method 0 Demand Control Ventilation Return Fan Tracking E] Injection Fan Method - Dedicated Minimum Ventilation Damperwith Pressure COntrol 0 Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): Outside air is ducted to the return air plenum Confirm that outside air is ducte d t o w i t h i n ( c h e c k o n e o f t h e f o l l o w i n g ) Sft.oftheunit. O 15 ft. of the unit, with the air directed substantially toward the unit. 0 Return air plenum is NOT used to distribute outside ai to the Linft. (i.e. outside a i r i s d u c t e d d i r e c t l y t o t h e u n i t , o u t s i d e a i r i s provided independent of the unit, oreconomizer) 5. Pre-occupancy purg has been programmed for the 1-hour period immediately be f o r e t h e b u i l d i n g i s n o r m a l l y o c c u p i e d t o p r o v i d e ( o n e of thefollowing methods must be verified and checked): The conditioned floor area times the ventilation rate from the 2016 Buildig Energy Effi c i e n c y S t a n d a r d s T A B L E 1 2 0 . 1 - A , o r 1 5 c f m per person times the expected number of occupants, whichever is greater. Complete air changes to the zone served by the air handler CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 STATE OF CALIFORNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA FNFR(W COMMISSION CERTIFICATE OF ACCEPTANCE - NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Na tnfpcemeot Ageecv Permit Number. Pro net Address: S City: Zip Code: System Name or Identificatbn/Tag System Location or Area Served: - - B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) 0 0 Step 2: Verify unit is not in economizer mode during test (economizer disabled) 0 Note Shaded boxes do not apply for CAy systems Step 3 CAy and VAV testing at full supply airflow a Adjust supply air to achieve design airflow or maximum airflow at full cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) f62.. cfm cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or . C. Mechanical Equipment Schedules). CIO cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): mm Step 4: VAV testing at reduced supply airflow • CAy VAV a Adjust supply airflow to either the sum of the minimum zone airflows full heating, or 30% of the total design airflow. Record VFD speed (Hz). • Hz b Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03 Column 14 or Mechanical Equipment Schedules) d Time for outside air damper to stabilize after reduced supply airflow is achi e v e d ( m i n u t e s ) : mm Step 5: Return to initial conditions (check) 0 S 5' C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) )O %. %OAFA is within 10% of design Outside Air. (90% :5 %OAFA 15 110%) Yes No 0 Yes 0 No 0 C. Outside air damper position stabilizes within 5 minutes (Step 3d <5 minutes) Yes 0 No 0 Determine Percent Outside Air at reduced supply airflow (%OA) for Step 4. (VAV o n l y ) a %OAPA = Measured outdoor airflow reading /Required outdoor airflow reading (Step4b/St e p 4 c ) % b %OARA is within 10% of design Outside Air. (90%:s %OAU 110%) Yes 0 No 0 C Outside air damper position stabilizes within 5 minutes (Step 4d <5 minute s ) Yes 0 No 0 Note: The intent of this test is to ensure that 1) all air handlers provide the mi n i m u m a m o u n t o f O S A a n d 2 ) V A V a i r h a n d l e r s u s e d y n a m i c controls to avoid over ventilation. D. Evaluation PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 P C- STATE OF CALIFORNIA OUTDOOR AIR ACCEPTANCE • CEC-NRCA-MCH-02-A (Revised 07/16 C.AI tPIJlA FNIP(V CMMItSW)N CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Enforcement cy . 4T? Pennit Number Pre System Name or Identification/Tag: System Location or Area Served: DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. I certify that this Certificate of Acceptance documentation is accurate and co m p l e t e . Documentation Author Name; ' Documentation Author iT> Documentation AuthopmPanv Name: , Date Signed: 2 -.z -z Zo '5 - Addrest:ZS(, ATTCertiflcation Identification Of applicable)' Phone: FIELD TECHNICIAN'S DECLARATION STATEMENT I certify thefollowing under penalty of perjury, underthe laws of the Sta t e o f C a l i f o r n i a : 1. The information provided on this Certificate of Acceptance is true and corre c t . 2. I am the person who performed the acceptance verification reported on this C e r t i f i c a t e o f A c c e p t a n c e ( F i e l d T e c h n i c i a n ) . 3. The construction or installation identified on this Certificate of Acceptance co m p l i e s w i t h t h e a p p l i c a b l e a c c e p t a n c e r e q u i r e m e n t s indicated in the plans and specifications approved by theenforcement age n c y , a n d c o n f o r m s t o t h e a p p l i c a b l e a c c e p t a n c e requirements and procedures specified in Reference Nonresidential Appendi x N A 7 . 4. I have confirmed that the Certificate(s) of Installation for the construction or i n s t a l l a t i o n i d e n t i f i e d o n t h i s C e r t i f i c a t e o f A c c e p t a n c e h a s been completed and signed by the responsible builder/installer and has been po s t e d o r m a d e a v a i l a b l e w i t h t h e b u i l d i n g p e r m i t ( s ) issued for the building. Field Technician Name: Field Technician Signature: Field Technician Company Name: Position with company (Title): Address: . - - ATT Certification Identification (if applicable): City/State/Zip: Phone: Date Signed: RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the Stat e o f C a l i f o r n i a : I am the Field Technician, or the Field Technician is acting on my behalf as m y e m p l o y e e o r m y a g e n t a n d I h a v e r e v i e w e d t h e information provided on this Certificate of Acceptance. I am eligible under Division 3 of the Business and Professions Code in the applica b l e c l a s s i f i c a t i o n t o a c c e p t r e s p o n s i b i l i t y f o r t h e system design, construction or installation of features, materials, compone n t s , o r m a n u f a c t u r e d d e v i c e s f o r t h e s c o p e o f w o r k identified on this Certificate of Acceptance and attest to the declarations in th i s s t a t e m e n t ( r e s p o n s i b l e a c c e p t a n c e p e r s o n ) . The information provided on this Certificate of Acceptance substantiates tha t t h e c o n s t r u c t i o n o r i n s t a l l a t i o n i d e n t i f i e d o n t h i s Certificate of Acceptance complies with the acceptance requirements indicated in t h e p l a n s a n d s p e c i f i c a t i o n s a p p r o v e d b y t h e enforcement agency, and conforms to the applicable acceptance requirements an d p r o c e d u r e s s p e c i f i e d i n R e f e r e n c e N o n r e s i d e n t i a l Appendix NA7. 4.' I have confirmed that the Certificate(s) of Installation for the constructio n o r i n s t a l l a t i o n i d e n t i f i e d o n t h i s C e r t i f i c a t e o f A c c e p t a n c e h a s been completed and is posted or made available with the building permit( s ) i s s u e d f o r t h e b u i l d i n g . 5. I will ensure that a completed, signed copy of this Certificate of Acceptance s h a l l b e p o s t e d , o r m a d e a v a i l a b l e w i t h t h e b u i l d i n g permit(s) issued for the building, and made available to the enforcement agency f o r a l l a p p l i c a b l e i n s p e c t i o n s . I u n d e r s t a n d t h a t a signed copy of this Cefjifièate of Acceptance is required to be included with t h e d o c u m e n t a t i o n t h e b u i l d e r p r o v i d e s t o t h e b u i l d i n g owner atoccupay Responsible Acceptance Pe • ame: . Responsible Acceptance Person Signature: Responsible Acceptance e n mpany ' e: Position with Company (litle): Address:' CSLB License: City/State/Zip: Phone: Date Signed: CA Building Energy Efficiency Standards -2016 Nonresidential Compliance July 2016