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14120118CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10931 N DE ANZA BLVD CONTRACTOR: AIRTEKS.COM INC PERMIT NO: 14120118 OWNER'S NAME: VIDOVICH JOHN T ET AL 2432 ARMSTRONG ST DATE ISSUED: 12/22/2014 OWNER'S PHONE: 5107190621 LIVERMORE, CA 94551 PHONE NO: (925) 292-0148 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ TO CLEAR CODE ENFORCEMENT CASE: REMOVE AND License Class G 2. Lic. # 5.r REPLACE 8.5 TON PACKAGE UNIT. Contractor�iY t�K_ • t _ Date 12-22-Z f I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $12500 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 32610061 00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Issued by: �j�%/�/� G� Date: granting of this permit. Additionally, the applicant understands and will comply L with all non-point source r ons per the Cupertino Municipal Code, Section 9 18. /Z —e e , � Signature e 6 RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑OWNER-BUILDER DECLARATION Signature of Applicant: Date: I here affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay . it Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupert' o Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Secjions 25 , 25533, a 534. Section 3700 of the Labor Code, for the performance of the work for which this 12—,??— Owner or authorized age t: tip- Date: permit is issued. 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 to the Worker's CON RUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address— I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9 18. Signature Date CUPERTINO 11_10d -011e GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 MISC (408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.org ICAL ❑ELECTRICAL ❑MISCELLANEOUS FLUMbINU CHAN PROJECT ADDRESS / / APN # OWNERNAME � , J� /I C PHONE j /c?- Q � E-MAIL CITY, yCTDATE�ZIPz G FAX STREET ADDRESS_'�^ `�� %N�OrfG3 G U J CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE fes. L—z BUS. LIC # 1 95 COMPANY NAME E-MAIL_ a1, v ¢ FAX S�ETADDRESS CITY, SSE, ZIP I P cl'_3Zr ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI-FAMH.Y PROJECT IN WB.DLAND ElYES 7PROJICT IN ❑ YES IS THE BLDG AN ❑YES BUILDING: MMERCIAL (:O URBAN INTERFACE AREA NO. LO OD ZONE NO EICHLER HOME? >LNO y DESCRIPTION OF WORK ^\ RECEIVED EY, TOTAL VALUATION: By my signature below, Ipertify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the in ation I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and stato4aws relating to buildin ction. a esentatives of Cupertino to enter the above -identified property for inspection purposes. Date: 2 -2 ` l Signature of Applicant/Agent: SUPP MENTAL INFORMATION REQUIRED OFFICE USE ONLY W OYER -THE -COUNTER i>F EXPRESS - STANDARD - U �1 LARGE i p MAJOR MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO WAW 'Ur IV V Q rTX4 A Tnu - III TILLING DIVISION 1' iJJJ ••wJ a FEE ID a .••» -• QTY/FEE ADDRESS: 10931 N De Anza Blvd UNITS DATE: 12/22/2014 REVIEWED BY: SEan Other Appliance/Equip FBP#-: VALUATION: $12,500 APN: # $72 �''�'�' 1:'i='" h? *PERMIT TYPE: Mechanical Permit 11"wirh, hksp, Fee PLAN CHECK TYPE: Alteration /Addition /Repair PRIMARY SFD or Duplex PENTAMATION 1 RMAP1 PERMIT TYPE: i USE: PME Unit Fee: $72.00 WORK To Clear Code Enforcement Case: Remove and replace 8.5 ton package unit. (,'o wr..,.wtion dLia: SCOPE Administrative Fee: IADMIN APPLIANCE / EQUIP TYPE FEE ID a .••» -• QTY/FEE QTY UNITS BP FEES I'hurth_ 1 Ic7:a Ciaecis Other Appliance/Equip 113APPLOT 1 # $72 �''�'�' 1:'i='" h? 11"wirh, hksp, Fee PME Unit Fee: $72.00 PME Permit Fee: $48.00 (,'o wr..,.wtion dLia: Administrative Fee: IADMIN $45.00 Work Without Permit? (E) Yes 0 No $120.00 TOTALS: Travel Documentation Fee: ITRAVDOC $72.00 StronV Motion Fee: IBSEISMICR NOTE: This estimate does not includejees due to other Departments (Le. rianmrcg, ruuuc rrEll na, A 11c, u.w��•y �•-�• - •�-•-- _._ _. _ ___ _„___:__ __.:�� r. ... ,:r r r� ..,,d gra nnhi an o.ctimatn_ Contact the Dept for addn 7 info. District, etc.. [hese fees are based on cne /GIN 111-1 FEE ITEMS (Tee Resolution 11-053 Eff. 7/1/13) b,[ v, noucw.c uvu..w FEE a .••» -• QTY/FEE ___________ MISC ITEMS .0 $0.00 Mech. Plan Check 0hrs I'hurth_ 1 Ic7:a Ciaecis S":tf y)l Mech. Permit Fee: IMPERMIT Fter Mech. Insp. 0.0 hrs $48.00 01h,". -r 111vMb Irrs � �''�'�' 1:'i='" h? 11"wirh, hksp, Fee NOTE: This estimate does not includejees due to other Departments (Le. rianmrcg, ruuuc rrEll na, A 11c, u.w��•y �•-�• - •�-•-- _._ _. _ ___ _„___:__ __.:�� r. ... ,:r r r� ..,,d gra nnhi an o.ctimatn_ Contact the Dept for addn 7 info. District, etc.. [hese fees are based on cne /GIN 111-1 FEE ITEMS (Tee Resolution 11-053 Eff. 7/1/13) b,[ v, noucw.c uvu..w FEE a .••» -• QTY/FEE ___________ MISC ITEMS S":tf y)l PME Plan Check: $0.00 PME Unit Fee: $72.00 PME Permit Fee: $48.00 (,'o wr..,.wtion dLia: Administrative Fee: IADMIN $45.00 Work Without Permit? (E) Yes 0 No $120.00 Travel Documentation Fee: ITRAVDOC $48.00 StronV Motion Fee: IBSEISMICR $1.63 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 `� $335.63 TOTAL FEE.• $0.00$335.63 Revised: 10/0V2014 r Installation Table 1. Maximum unit & comer weights (lbs) and center of gravity dimensions (in.) - cooling models Maximum Model Center of Gravity Unit Weights(a) Corner Weights(b) (in.) Ton Model No. Shipping Net A S C D Length Width 3 TSC036E/THCO36E 555 481 157 122 95 107 31 19 4 TSC048E 586 511 167 129 101 114 31 19 5 TSCO60E 636 561 183 142 111 125 31 19 6 TSC072F 762 667 218 186 131 132 44 21 71/2 TSCO90F 781 686 222 195 136 134 44 21 71/2 TSC092F 940 797 249 235 163 149 46 21 81/2 TSC102F 999 856 264 239 177 175 45 22 10 TSC120F 1058 960 320 218 233 189 40 24 3 THC037E 614 544 163 144 111 125 33 19 4 THC048E/THCO47E 787 692 220 178 132 163 40 23 4 THC048F 737 642 208 177 128 130 44 22 5 THC060E/THC067E 841 746 241 193 139 173 39 22 5 THC060F 774 679 219 189 135 137 43 21 6 THC072F 883 740 228 219 155 138 47 21 71/2 THC092E 1445 1228 347 330 269 283 49 28 71/2 THC092F 1026 928 315 209 224 180 40 24 81/2 THC102E 1472 1_12.55 359 335 271 290 48 28 10 THC120E 1462 1245 353 332 271 288 48 28 (a) Weights are approximate. (b) Corner weights are given for information only. Figure 15. Rigging and center of gravity �CLEVIS Table 2. Factory installed options (fiops)/accessory net weights (Ibs)(a),(b) TSC036E-060E THC047E-067E THC036E/ THC048E/F- TSC072F-102F THC092F, THCO92E- THC037E 060E/F THC072F TSC120F 120E Net Weight Net Weight Net Weight Net Weight Net Weight Accessory 3-5 Ton 4-5 Ton 6-81/2 Ton 71/2.-10 Ton 71/2-10 Ton Barometric Relief 7 10 10 10 10 Belt Drive Option (3 phase only) 31 31 — — — Coil Guards 12 20 20 20 30 continued on next page 20 RT-SVX22J-EN .Inhncnn r.nntrols Unitary Products 5186;64Nf-E-1210 Table 9: ZS -06 thru -12 Physical Data Models Component ZS -06 ZS -07 ZS -08 ZS -10 ZS -12 Nominal Tonnage 6.51 7.5 8.5 10 12.5 ARI COOLING PERFORMANCE Gross Capacity @ ARI A point (Mbh) 81000 90000 104000 126000 156000 ARI net capacity (Mbh) 78000 88000 101000 120000 150000 EER 11.2 11.2 11.2 11.2 11.2 IEER 13 12.1 12.5 12.5 12.7 IPLV 12.9 12.1 12.5 12.6 13.06 Nominal CFM 2600 2500 3000 4000 4100 System power (KW) 6.95 7.87 8.60 10.70 13.40 Refrigerant type R -410A R-41 OA R-41 OA R-41 OA R-41 OA Refrigerant charge (Ib -oz) System 1 4-12 4-12 4-14 6-8 7-8 System 2 4-10 4-10 5-0 6-8 7-8 ARI HEATING PERFORMANCE Heating model 12 18 12 18 12 18 18 24 18 24 Heat input (K Btu) 120 180 120 180 120 180 180 240 180 240 Heat output (K Btu) 96 144 96 144 96 144 144 192 144 192 - - - - - - AFUE % - - Steady state efficiency (%) 80 80 80 80 80 80 80 80 80 80 No. burners 4 6 21 21 4 6 21 21 4 6 21 21 6 8 21 21 6 8 21 21 No. stages Temperature Rise Range (°F) 20-50 35-65 15-45 1 30-60 10-40 25-55 20-50 35-65 10-40 25-55 Gas Limit Setting (°F) 165 165 165 165 215 195 195 160 195 160 Gas piping connection (in.) 3/4 3/4 3/4 1 3/4 3/4 3/4 3/4 3/4 3/4 3/4 DIMENSIONS (inches) 89 89 89 89 119-1/2 Length 59 59 59 59 59 Width 42 42 50-3/4 50-3/4 50-3/4 Height OPERATING WT. (lbs.) 860 880 1020 1060 1253 COMPRESSORS Type Recip Recip Recip Recip Scroll 2. 2 2 2 2 Quantity Unit Capacity -Steps(./.) 50/100 50/100 50/100 50/100 50/100 CONDENSER COIL DATA Face area (Sq. Ft.) 18.5 18.5 18.5 29.0 29.0 Rows 1 1 1 1 1 23 23 23 23 23 Fins per inch .71/18 .71/18 1/25 Tube diameter (in.)/mm .71/18 .71/18 2 -pass 2 -pass 2 -pass 2 -pass 2 -pass Circuitry Type Microchannel Microchannel Microchannel Microchannel Microchannel EVAPORATOR COIL DATA Face area (Sq. Ft.) 10.6 10.6 13.2 13.2 13.2 3 3 3 4 3 Rows 15 15 15 15 15 Fins per inch 0.375 0.375 0.375 0.375 0.375 Tube diameter Intertwined Intertwined Intertwined Intertwined Intertwined Circuitry Type TXV TXV TXV TXV TXV Refriaerant control .Inhncnn r.nntrols Unitary Products Plot Plan with unit locations Front Goodyear 8773 10931 North De Anza Raod Cupertino, CA Back RECEIVED NOV 2 2 2014 BY COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION - CUPERTINO APPROVED This set of plans and specifications N1UST be kept at the job site during construction. It is unlawful to make any changes or alterations on same, or to deviate therefrom, without approval from the Building Official. The Stamping of this plan and specifications SHALL NOT be held to permit or to be an approval of the violation Bany provisions of any Cit Ordinance or State Law. DAT—E�- �T� PERMIT # P �� PANS flA air DAVEs�G SEPT. Change existing 8.5 -Tan package unit: with new 8.5 -ton unit (like for like) Note: (1) Hook up existing high voltage electrical (2) Hook up existing gas (3) Hook up existing low voltage wiring (4) Reconnect existing duct smoke detector. i (5) Hook up existing condensate piping New Coleman ZS-8N12ATAAA6A (6) 4750 CFM 208/230/60/3 Gas Package unit. i (7) 2100 square feet N Weight 1020 pounds '0 (8) Factory Economizer m ,ham H Goodyear 8773 10931 North De Anza Raod Cupertino, CA o f h i a ur �HuruKNIH REQUIRED ACCEPTANCE TESTS MECHANICAL COMPLIANCE FORMS & WORKSHEETS (indicate if worksheet is included) For detailed instructions on the use of this and all Energy Efficiency Standards compliance forms, refer to the 2013 Nonresidential Manual Note: The Enforcement Agency may require all forms to be incorporated onto the building plans. Forms NRCC-MCH-04-E and NRCC-MECH-05-E are alternative forms to NRCC-MCH-01-E, NRCC-MCH-02-E and NRCC- MCH-03-E for projects using only single zone packaged HVAC systems. YES NO Form X NRCC-MCH-04-E (1 of 2) X NRCC-MCH-04-E (2 of 2) X NRCC-MCH-05-E (1 of 2) X NRCC-MCH-05-E (2 of 2) Title Certificate of Compliance. Required on plans when used. Mechanical Acceptance Tests. Required on plans when used. HVAC Prescriptive Requirements. It is required on plans when used. Mechanical SWH Equipment Summary is required for all submittals with service water heating, pools or spas. It is required on plans where applicable. CA Building Energy Efficiency Standards - 2Q13 Nonresidential Compliance June 2014 STATE OF CALIFORNIA REQUIRED ACCEPTANCE TESTS CEC-NRCC-MCH-04-E Revised 06/14 CERTIFICATE OF COMPLIANCE Required Acceptance Tests Project Name: Q—J ve.A b r ? -j j C2 i Date Preparedi CALIFORNIA ENERGY COMMISSION N RCC -MCH -04-E (Page 2 of 3) Designer: This form is to be used by the designer and attached to the plans. Listed below are all the acceptance tests for mechanical systems. The designer is required to check the applicable boxes by all acceptance tests that apply and list all equipment that requires an acceptance test. If all equipment of a certain type requires a test, list the equipment description and the number of systems. The NA number designates the Section in the Appendix of the Nonresidential Reference Appendices Manual that describes the test. Since this form will be part of the plans, completion of this section will allow the responsible party to budget for the scope of work appropriately. Enforcement Agency: Systems Acceptance. Before occupancy permit is granted for a newly constructed building or space, or a new space -conditioning system serving a building or space is operated for normal use, all control devices serving the building or space shall be certified as meeting the Acceptance Requirements for Code Compliance. Systems Acceptance. Before occupancy permit is granted. All newly installed HVAC equipment must be tested using the Acceptance Requirements.. The NRCC-MCH-04-E form is not considered a completed form and is not to be accepted by the building department unless the correct boxes are checked. The equipment requiring testing, person performing the test (Example: HVAC installer, TAB contractor, controls contractor, PE in charge of project) and what Acceptance test must be conducted. The following checked -off forms are required for ALL newly installed and replaced equipment. In addition a Certificate of Acceptance forms shall be submitted to the building department that certifies plans, specifications, installation certificates, and operating and maintenance information meet the requirements of Section 10-103(b) and Title 24 Part 6. The building inspector must receive the properly filled out and signed forms before the building can receive final occupancy. Test Description Equipment Requiring Testing or Verification # of units MCH -02-A Outdoor Air MCH -03-A Single Zone Unitary MCH -04-A Air Distribution Ducts MCH -05-A Economizer Controls MCH -06-A Demand Control Ventilation (DCV) MCH -07-A Supply Fan VAV MCH -11-A Automatic Demand Shed Control MCH -12-A FDD for Packaged DX Units MCH -14-A Distribute d Energy Storage DX AC MCH -18-A Energy Managem ent Control Test Performed By: Systems System ZS -8N12 1 X X X CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 REQUIRED ACCEPTANCE TESTS CEC-NRCC-MCH-04-E Revised 46/14 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-MCH-04-E Required Acceptance Tests (Page 3 of 3} Project Name: Goodyear 877310931 NORTH DE ANZA BLVD Cupertino, CA Date Prepared: 11/15/2014 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Jerry Bohland Documentation Author Signature: f / Company: Airteks.com, Inc. Signature Date: f 11/17/2024 Address: 2432 Arnstrong Street CEA/ HERS Certification Identifi tion (if applicable): City/state/Zip: Livermore, CA 94551 Phone: 925-292-0148 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Compliance is true and correct. 2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer). 3. The energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations. 4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. 5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a completed signed copy of this Certificate of Compliance is required to be included with the ocu the builder provides to the building owner at occupancy. Responsible Designer Name: ,ferry Bohland Responsible Designer Signature: Company : Airteks.com, Inc. Address: 2432 Arnstrong Street Livermore, CA 94551 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance Date Signed: 11/17/2014 License: 930172 Phone: 925-292-0148 .lune 2014 STATE OF CALIFORNIA REQUIREMENTS FOR PACKAGED SINGLE ZONE UNiTS CEC-NRCC-MCH-05-E (Revised 06/14) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-MCH-05-E Requirements for Packaged Single -Zone Units (Page 1 of 2) Project Name: Goodyear 8773 10931 NORTH DE ANZA BLVD Cupertino, CA Date Prepared: 11/15/2014 Equipment Tag(s)l MANDATORY MEASURES Heating Equipment Efficiency4 Cooling Equipment Efficiency4 Thermostats5 Furnace Standby Loss Contro16 Law Leakage AHU Ventilation? Demand Control Ventilation$ Occupant Sensor Ventilation Control$ Shutoff and Reset Controls9 Outdoor Air and Exhaust Damper Control Automatic Demand Shed Controls Economizer FDD Duct Insulation PRESCRIPTIVE MEASURES Equipment is sized in conformance with 140.4(a&b) Economizer Electric Resistance Heatingi0 Duct Leakage Sealing and Testing." T-24 Sections Requirement3 As Scheduled3 Requirement3 As Scheduled3 Requirement3 As Scheduled3 110.1 or 110.2(a) 80% 80% 110.1 or 110.2(a) 11.2 EER 11.2 EER 110.2(b), 110.2(c) Setback setback 110.2(d) N/A N/A 110.2(f) N/A N/A 120.1(b) N/A N/A 120.1(c)4 N/A N/A 120.1(c)5, 120.2(e)3 N/A N/A 120.2(e) N/A N/A 120.2(f) N/A N/A 120.2(h) N/A N/A 120.2(i) Yes Yes 120.4 N/A N/A 140.4(a & b) 140.4(e) 140.4(8) 140.401 Notes: 1. Provide equipment tags (e.g. ACI orAC1 to 101. Multiple units of the same make and model with the same application and accessories can be grouped together. 2. Enter the following information as appropriate: Unit Manufacturer; Unit Model Number (including all accessories); Description of the unit (e.g. gas -pack or heat pump; rated heating capacity (enter "N/A" if no heating); and, rated cooling capacity (enter "N/A° if no cooling). For unit capacities include the units (e.g. kBtuh or tons). 8. For each requirement, enter the minimum requirement from the Standard In the left column (under "Standard Requirement"). In the right column (under "As Scheduled") enter the value for the units as specified. 4. Where there is more than one requirement (e.g. full and part load efficiency) enter both with the appropriate labels (e.g. COP and /EER). 5. In the left column identify the thermostatic requirements from the standard (e.g. programmable setback thermostat or heatpump with electric heat), . In the right column indicate the capabilities of the thermostat as scheduled. 6. If the unit has a furnace which is rated at >=225,000 Btuh of capacity, indicate the rated standby loss and ignition source (e.g. IID). If there is no furnace or the unit is rated for <225,000 Btuh indicate "N/A". Z In the left column, enter both the required ventilation value from Table 120.1A and for the number of occupants times 15 cfm/person. In the right column enter the actual minimum ventilation as scheduled. If the space is naturally ventilated enter "N/A" in the left column and "the space is naturally ventilated" in the right column. 8. If the space is required to have either DCV or Occupant Sensor Ventilation Control indicate "required" in the left column (otherwise indicate "N/A" in the left column). If either DCV or Occupant Sensor Ventilation Control is provided indicate "provided" in the right column (otherwise indicate "N/A" in the right column) 9. In the left column indicate the required time controls from the standard. In the right column identify the device that provides this functionality (e.g. EMCS or programmable timeclock). 10. Enter N/A if there is no electric heating. If the system has electric heating indicate which exception to 140.4(8) applies. 11. If duct leakage sealing and testing is required, a MCH -04-A form must be submitted. CA Building Energy Efficiency Standards - 2013 Nonresidential Comptiance June 2014 QI^I=vrruirvrttvih p q REQUIREMENTS FOR PACKAGE® SINGLE ZONE UNITS U=U-NKX-1V1GH-05-E Revised 06/14 CALIFORNIA ENERGY COMMISSION ' .W' CERTIFICATE OF COMPLIANCE NRCC-MCH-05-E Requirements for Packaged Single -Zone Units (Page 2 of 2) Project Name: Goodyear 877310931 NORTH DE ANZA BLVD Cupertino, CA Date Prepared: 11/15/2014 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Jerry Bohland Documentation Author Signature Company: Airteks.com, Inc. Signature Date: 11/17/2014 Address: 2432 Armstrong Street CEA/ HERS Certification Iden ifcation (if applicable): City/state/Zip: Livermore, CA 94551 Phone: 925-292-0148 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Compliance is true and correct. 2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer). 3. The energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations. 4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information other documents, provided on applicable compliance worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. 5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a completed signed copy of this Certificate of Compliance is required to be incl ed wit the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: Jerry Bohland Responsible Designer Signature: Company: Airteks.com, Inc. Date Signed: 11/17/2014 Address: 2432 Armstrong Street License: 930172 City/State/Zip: Livermore, CA 94551 Phone: 92S-292-0148 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 41 STATE OF CALIFORNIA REQUIR8D ACC STS CEC-NRCC-MQH-04-E (ReVis r� ma" CALIFORNIA ENERGY COMMISSION CERTIFICATE OFC PLIANCE Required Accepta ce Tests NRCC-MCH-04-E (Page 1 of 3) Project Name: G odyear 877310931 NORTH DE ANZA BLVD upertino, CA Date Prepared: 11/15/2014 MECHANICAL CE FORMS & (indicate if worksheet Is included) For detailed instructio on the use o Isand all Energy Efficiency Standards compliance forms, refer to the 2013 Nonresidential Manual Note: The Enforcement Agency may require- all forms to be incor ed onto the building plans. Forms NRCC-MCH-04-E and NRCC-MECH-05-E are alternative forms to NRCC-MCH-01-E, NRCC-MCH-02-E and NRCC- MCH-03-E for projects using only single zone packaged HVAC systems. YES NO Form X NRCC-MCH-04-E (1 of 2) X NRCC-MCH-04-E (2 of 2) X NRCC-MCH-05-E (1 of 2) X NRCC-MCH-05-E (2 of 2) Title Certificate of Compliance.'Required on plans when used. Mechanical Acceptance Tests. Required on plans when used. HVAC Prescriptive Requirements. It is required on plans when used. Mechanical SWH Equipment Summary is required for all submittals with service water heating, pools or spas. It is required on plans where applicable. CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 STATE OF CALIFORNIA REQUIRED ACCEPTANCE TESTS CEC-NRCC-M6,H-04-E Revised 06/14 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-MCH-04-E Required Acceptance Tests (Page 2 of 3) Project Name: r�^4 v V C�� 6 % I `�, 1 i �.� �•� �.�J �r� Date Prepared: Designer: This form is to be used by the designer and attached to the plans. Listed below are all the acceptance te'ts for mechanical systems. The designer is required to check the applicable boxes by all acceptance tests that apply and list all equipment that requires an acceptance test. If all equipment of a certain type requires a test, list the equipment description and the number of systems. The NA number designates the Section in the Appendix of the Nonresidential Reference Appendices Manual that describes the test. Since this form will be part of the plans, completion of this section will allow the responsible party to budget for the scope of work appropriately. Enforcement Agency: Systems Acceptance. Before occupancy permit is granted for a newly constructed building or space, or a new space -conditioning system serving a building or space is operated for normal use, all control devices serving the building or space shall be certified as meeting the Acceptance Requirements for Code Compliance. Systems Acceptance. Before occupancy permit is granted. All newly installed HVAC equipment must be tested using the Acceptance Requirements.. The NRCC-MCH-04-E form is not considered a completed form and is not to be accepted by the building department unless the correct boxes are checked. The equipment requiring testing, person performing the test (Example: HVAC installer, TAB contractor, controls contractor, PE in charge of project) and what Acceptance test must be conducted. The following checked -off forms are required for ALL newly installed and replaced equipment. In addition a Certificate of Acceptance forms shall be submitted to the building department that certifies plans, specifications, installation certificates, and operating and maintenance information meet the requirements of Section 10-103(b) and Title 24 Part 6. The building inspector must receive the properly filled out and signed forms before the building can receive final occupancy. Test Description MCH -02-A MCH -03-A MCH -04-A MCH -05-A MCH -06-A MCH -07-A MCH -11-A MCH -12-A MCH -14-A MCH -18-A Test Performed By: Equipment # of Outdoor Single Zone Air Economizer Demand Supply Automatic FDD for Distribute Energy Requiring units Air Unitary Distribution Controls Control Fan VAV Demand Packaged d Energy Managem Testing or Ducts Ventilation Shed ADX Units Storage ent Verification (DCV) Control DX AC Control Systems System ZS -8N 12 1 X X X CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 REQUIRED ACCEPTANCE TESTS Ute-NKUL;-Mu1i-04-t Kevised 05114 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-MCH-04-E Required Acceptance Tests (Page 3 of 3) Project Name: Goodyear 877310931 NORTH DE ANZA BLVD Cupertino, CA Date Prepared:. 11/15/2014 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Jerry Bohland Documentation Author Signature: Company: Airteks.com, Inc. ' Signature Date: 11/17/201 Address: 2432 Arnstrong Street CEA/ HERS Certification Identifi tion (if applicable): City/state/zip: Livermore, CA 94551 Phone: 925-292-0148 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Compliance is true and correct. 2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer). 3. The energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations. 4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. 5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a completed signed copy of this Certificate of Compliance is required to be included with the docu the builder provides to the building owner at occupancy. Responsible Designer Name: Jerry Bohland Responsible Designer Signature: company: Airteks.com, Inc. Date Signed: 11/17/2014 Address: 2432 Arnstrong Street License: 930172 Phone: 925-292-0148 City/state/zip: Livermore, CA 94551 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 0 STATE OF CALIFORNIA REQUIREMENTS FOR PACKAGED SINGLE ZONE UNITS 1+ , GLG-NKGG-MGhi-Ub-t Kevisea Ub/74 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-MCH-05-E . Requirements for Packaged Single -Zone Units (Page 1 of 2) Project Name: Goodyear 8773 10931 NORTH DE ANZA BLVD Cupertino, CA Date Prepared: 11/15/2014 Equipment Tag(s)' MANDATORY MEASURES T-24 Sections Requirement3 As Scheduled3 Requirement3 As ScheduledRequirement3 As ScheduledHeating Equipment Efficiency4 110.1 or 110.2(a) 80 80% Cooling Equipment Efficiency4 110.1 or 110.2(a) 11.2 EER 11.2 EER ThermostatS5 110.2(b), 110.2(c) Setback Setback Furnace Standby Loss Contro16 110.2(d) N/A N/A Low Leakage AHU 110.2(f) N/A N/A Ventilation? 120.1(b) N/A N/A Demand Control Ventilation$ 120.1(c)4 N/A N/A Occupant Sensor Ventilation Controls 120.1(c)5, 120.2(e)3 N/A N/A Shutoff and ,Reset Controls 120.2(e) N/A N/A Outdoor Air and Exhaust Damper Control 120.2(f) N/A N/A Automatic Demand Shed Controls 120.2(h) N/A N/A Economizer FDD 120.2(i) Yes Yes Duct Insulation 120.4 N/A N/A PRESCRIPTIVE MEASURES Equipment is sized in conformance with 140.4(a & b) 140.4(a&b) Economizer 140.4(e) Electric Resistance Heating10 140.4(8) Duct Leakage Sealing and Testing." 140.4(1) Notes: 1. Provide equipment togs (e.g. AC1 orAC1 to 10). Multiple units of the same make and model with the same application and accessories can be grouped together. 2. Enter the following information as appropriate: Unit Manufacturer; Unit Model Number (including all accessories); Description of the unit (e.g. gas -pack or heat pump; rated heating capacity (enter "N/A" if no heating); and, rated cooling capacity (enter "N/A" if no cooling). For unit capacities include the units (e.g. kBtuh or tons). 3. For each requirement, enter the minimum requirement from the Standard In the left column (under "Standard Requirement"). In the right column (under "As Scheduled") enter the value for the units as specified. 4. Where there is more than one requirement (e.g. full and part load efficiency) enter both with the appropriate labels (e.g. COP and LEER). 5. In the left column identify the thermostatic requirements from the standard (e.g. programmable setback thermostat or heatpump with electric heat), . In the right column indicate the capabilities of the thermostat as scheduled. 6. if the unit has a furnace which is rated at>=225,000 Btuh of capacity, indicate the rated standby loss and ignition source (e.g. IID). If there is no furnace or the unit is rated for <225,000 Btuh indicate "N/A". 7. In the left column, enter both the required ventilation value from Table 120.1A and for the number of occupants times 15 cfm/person. In the right column enter the actual minimum ventilation as scheduled. If the space is naturally ventilated enter "N/A" in the left column and "the space is naturally ventilated" in the right column. 8. If the space is required to have either DCV or Occupant Sensor Ventilation Control indicate "required" in the left column (otherwise indicate "N/A" in the left column). If either DCV or Occupant Sensor Ventilation Control is provided indicate "provided" in the right column (otherwise indicate "N/A" in the right column) 9. In the left column indicate the required time controls from the standard. In the right column identify the device that provides this functionality (e.g. EMCS or programmable timeclock). 10. Enter N/A if there is no electric heating. If the system has electric heating indicate which exception to 140.4(g) applies. 11. If duct leakage sealing and testing is required, a MCH -04 -A form must be submitted. CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 o i m i r- yr �.nurvrtt%ire REQUIREMENTS FOR PACKAGED SINGLE ZONE UNITS GH -05-E CERTIFICATE OF COMPLIANCE NRCC-MCH-05-E Requirements for. Packaged Single -Zone Units (Page 2 of 2) Project Name: Goodyear 877310931 NORTH DE ANZA BLVD Cupertino, CA Date Prepared: 11/15/2014 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: ferry Bohland Documentation Author Signature: -/r Company: Airteks.com, Inc. Signature Date: f 11/17/2014 Address: 2432 Armstrong Street CEA/ HERS Certification Iden fication (if applicable): City/State/Zip: Livermore, CA 94551 Phone: 925-292-0148 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Compliance is true and correct. 2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer). 3. The energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations. 4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information on other compliance documents, provided applicable worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. S. i will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a completed signed copy of this Certificate of Compliance is required to be incl ed wit the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: Jerry Bohland Responsible Designer Signature:" Company: Airteks.com, Inc. Date Signed: 11/17/2014 Address: 2432 Armstrong Street License: 930172 City/State/Zip: Livermore, CA 94551 Phone: 925-292-0148 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014