15040143STATE OF CALIFORNIA F) I L L
LIGHTING CONTROL ACCEPTANCE DOCUMENT Q� gI4� •;
CEC -LTG -2A (Revised 08/09) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF ACCEPTANCE LTG-2A
Lighting Control Acceptance Document (Page I of 4
P ject Name /Address:
S
V stem Name or Identification/T.B.
System Location or Area erved:
Enforcement ency:
Permit Number:
1 v\r) ?—,ull D-Dt—
14-
--
Note: Submit one Certificate cVAcceptancefor e c system that
Enforcement Agency Use' Checked by /Date
must demonstrate compliance.
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FIELD TECHNICIAN'S DECLARATION STATEMENT
• I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.
• I am the person who performed the acceptance requirements verification reported on this Certificate of Acceptance (Field Technician).
• I certify that the construction/installation identified on this form 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 Installation Certificate(s) for the construction/installation identified on this form has been completed and is
posted or made available with the building permit(s) issued for the building.
RESPONSIBLE PERSON'S DECLARATION STATEMENT
• I certify under penalty of perjury, under the laws of the State of California, that 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 form.
• I am a licensed contractor, architect, or engineer, who is eligible under Division 3 of the Business and Professions Code, in the applicable
classification, to take responsibility for the scope of work specified on this document and attest to the declarations in this statement
(responsible person).
• I certify that the information provided on this form substantiates that the construction/installation identified on this form 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 Installation Certificate(s) for the construction/installation identified on this form 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.
Company Name: �
Phone:
Responsible Person's Name:
Re le Person's Signa
Instrumentation to perform test includes, but not limited to:
a. I Hand -held am era a and voltage meter
ce
Dat Signed:
Position With Company (Title): ` A
Occupant Sensor, Manual Da li ghting Control, and Automatic Time Switch Control
Intent: I Lights are turned off when not needed per Section 119(d) & 131(d ).
Construction Inspection
1
Instrumentation to perform test includes, but not limited to:
a. I Hand -held am era a and voltage meter
2008 Nonresidential Acceptance Forms August 2009
STATE OF CALIFORNIA
LIGHTING CONTROL ACCEPTANCE DOCUMENT
CEC -LTG -2A (Revised 08/09)
CALIFORNIA ENERGY COMMISSION `
CERTIFICATE OF ACCEPTANCE LTG -2A
Lighting Control Acceptance Document (Page 2 of 4
Pro' Name /Address:
r
Ftem Name or Identification/Tag: A
s —eo-
System Location or Area Served:
b. Power meter
continued on next page
2
Oppupancy Sensor Construction Inspection
Occupancy sensor has been located to minimize false signals
Light meter
Ultrasonic occupancy sensors do not emit audible sound (119a) 5 feet from source
3
Manual Daylighting Controls Construction Inspection
If dimming ballasts are specified for light fixtures within the daylit area, make sure they meet all the Standards
requirements, including "reduced flicker operation" for manual dimming controls stems
4
Automatic Time Switch Controls Construction Inspection
a.
Automatic time switch control is programmed for (check all):
Weekdays
Weekend
Holidays
b.
Document for the owner automatic time switch programming (check all):
Weekdays settings
Weekend settings
Holidays settings
Set -up settings
Preference program setting
Verify the correct time and date is properly set in the time switch
Verify the battery is installed and energized
Override time limit is no more than 2 hours
Occupant Sensors and Automatic Time Switch Controls have been certified to the Energy Commission in
accordance with the applicable provision in Section 119 of the Standards, and model numbers for all such controls
are listed on the Commission database as Certified Appliance and Control Devices
A.
Select Acceptance Test (Indicate lighting control systems Names/Designations by the applicable tests below)
1
Occupancy Sensor
Manual Daylighting Controls
3
Automatic Time Switch Controls
B. Equipment Testing Requirements
Check and verify those items applicable to selected system:
Applicable Lighting
Control Systems
Occupancy Sensor - Step 1: Simulate an unoccupied condition
2
3
a'
Lights controlled by occupancy sensors turn off within a maximum of 30 minutes from
start of an unoccupied condition per Standard Section 119 d
N
KJ
Y / N
Y / N
b.
The
The occupant sensor does not trigger a false "on" from movement in an area adjacent
the controlled space or from HVAC operation
/ N
Y / N
Y / N
C.
Signal sensitivity is adequate to achieve desired control
/ N
Y / N
Y / N
Occupant Sensor - Step 2: Simulate an occupied condition
2008 Nonresidential Acceptance Forms August 2009
STATE OF CALIFORNIA
LIGHTING CONTROL ACCEPTANCE DOCUMENT
CEC -LTG -2A (Revised 08109) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF ACCEPTANCE LTG-2A
Lighting Control Acceptance Document (Page 3 of 4
13r 4'T e /Addre n ^—
1 `C > a
S Y qeN Wme or Ide tification/Tag;
Systein Location or Area Served:
a.
Status indicator or annunciator operates correctly
/ N
Y / N
Y / N
b
Lights controlled by occupancy sensors turn on when Immediately upon an occupied
condition OR this requirement is mutually exclusive with Step 2.c.
N
I Y / N
Y / N
C.
Sensor indicates space is "occupied" and lights turn on manually
/ N
Y / N
Y / N
con 'nued on next page
Occupant Sensor - Step 3: System returned to initial operating conditions
&/N
/ N
Y / N
Occupant Sensor - Step 4 - Sensor is also a multi -Level Occupant Sensor used to qualify
for a Power Adjustment Factor in Section 146(a)2D of the Standards. If yes, then `a,' `b,'
and `c' must also be yes.
,9/ N
Y / N
Y / N
a
The first stage activates between 30 to 70% of the lighting either manually or
automatically.
/ N
Y / N
Y / N
b.
A reasonably uniform level of illuminance is achieved by dimming of all lamps or
luminaires; or by switching alternate lamps in luminaires, alternate luminaires, or
alternate rows of luminaires.
/ N
Y / N
Y / N
C.
After the first stage occurs, manual switches have been provided to activate the
alternate set of lights, activate 100% of the lighting power, and manually deactivate all
of the lights.
/ N
Y / N
Y / N
Manual Daylighting Controls –Step 1: Manual switching control
a.
At least 50% of lighting power in daylit areas is separately controlled from other lights
Y / N
/
Y / N
b.
The amount of light delivered to the space is uniformly reduced
Y / N
/N
Y / N
Manual Daylighting Controls - Step 2: System returned to initial operating conditions
Y / N
/ N
Y / N
Automatic Time Switch Controls - Step 1: Simulate occupied condition
a.
All lights can be turned on and off by their respective area control switch
Y / N
/ N
Y / N
b
Verify the switch only operates lighting in the ceiling- height partitioned area in which
the switch is located
Y / N
N
I &
Y / N
Automatic Time Switch Controls - Step 2: Simulate unoccupied condition
a.
All non - exempt lighting turn off per Section 131(d)l
Y / N
f1l N
Y / N
b.
Manual override switch allows only the lights in the selected ceiling height partitioned
space where the override switch is located, to turn on or remain on until the next
scheduled shut off occurs
Y / N
Q�
Jam/ N
Y / N
c.
All non - exempt lighting turns off
Y / N
N
Y / N
Automatic Time Switch Controls - Step 3: System returned to initial operating conditions
Y / N
Y / N
Note: Shaded areas do not apply forpardcular testprocedure
_&N
C.
PASS / FAIL Evaluation (check one):
PASS: All applicable Construction Inspection responses are complete and all applicable Equipment Testing
Requirements responses are positive - es
❑
FAIL: Any applicable Construction Inspection responses are incomplete OR there is one or more negative (N - no)
responses in any applicable Equipment Testing Requirements section. Provide explanation below. Use and attach
additional pages if necessary.
2008 Nonresidential Acceptance Forms _ August 2009
STATE OF CALIFORNIA
LIGHTING CONTROL ACCEPTANCE DOCUMENT
CEC -LTG -2A (Revised 08109)
CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF ACCEPTANCE LTG -2A
Lighting Control Acceptance Document (Page 4 of 4
Project Name /Address:
System Name or Identification/Tag:
System Location or Area Served:
2008 Nonresidential Acceptance Forms August 2009