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15110164CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10101 BUBB RD CONTRACTOR: SILICON VALLEY PERMIT NO: 1511#164 MECHANICAL OWNER'S NAME: CACITTI ROSALIE TRUSTEE & ET AL 2087 RINGWOOD AVE STE 50 DATE ISSUED: 11/23/2015 OWNER'S PHONE: 4089748221 SAN JOSE, CA 95131 PHONE NO: (408) 943-0380 iJ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL p �+ Z r APPLE - REPLACE HVAC EQUIPMENT, 4 UNITS (3 A/C & 1 License Class C-2-&2Lic. # ! 1 3 BOILER), LIKE FOR LIKE Contractor S U Ih, /— —Date/( 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: $100000 performance of the work for which this permit is issued. v and will maintain Worker's Compensation Insurance, as provided for by ection 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 35720003.00 Occupancy Type: 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 DA T 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 + O LED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of th granting of this permit. Additionally, the applicant understands and will comply Issued Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature Date IIA -3. —6 -6)S 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. 13OWNER-BUILDERDECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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) I, 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. 1 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 Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which thisi" permit is issued. Owner or authorized agent: Date: 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 Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY 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 Lender's Address APPLICANT CERTIFICATION 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 GENERAL PERNU T APPLICATIONE P` COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 • buildinO(a)cuoeriino.oro CUPERTINO /—r//0(16 - ❑ PLUMBING El ),MCKkXTTICA L, ❑ EL.ECTRICA? ❑ h4ISCELLA.*\TEO-S PRO2P.CT ADDP-ESS I A2\. /� C / �7 r1 — a� xoI.E _ n Fj Z Lo Q S ✓ L,� i S T / Pke Tie. , e , n'1 , �_� r•� STREET DRN lle— C S G% vS / -U 3 F. "��tt- COA'TACT NAME PHONE E-1,1AII. STREET ADDRESS_ 'I'-nr� I4 _ CITY, STATE, ZIP I PAX �,f 1! OFgt ❑ OR'ma-BunzER ❑ ow.1' AC -M T ❑ COMil4CTOR ❑ CO1,7RSCTOR AGM,:,T ❑ ARC?SECT ❑ -ENG-Da-ER ❑ D_VtLOPcq ❑ T�� T? CONTRACTOR M UCE LICENSE TYPE BUS. LIC r L. e --I v COIa.A, N N.A vM E -M 4II ( F.A.. STREET ADDRESS_CITY, STATE, ZIP _ PH0\7- A_RCETECTat ,GI\E RN.4T1E �a-1 ✓ 11 u�^°� LICENSE M fBER I BUS. LIC COMPA.YN6�ffi E-MAIL I FAX STREET.4DDRESS CITY, STATF, ZIP PHONE, USE OF [3SFD.=?LEX ❑ man-FAm Y . PROJECT LN R'IIMLA M ❑ YES PROTECT IN ❑ YFS IS THE BLDG AN ❑ .S BUM IG: COMrb�acim- URBAN A'TERFACE AREA NO FLOOD ZOMB ❑ 1\10 I EICIIS-IL HOME? ❑ NO I DESCP.IP7ION' OF WORT{ --4 1-•¢ G� - Z TOTAL VALUATI By ivy signature below, I certify to each of the following: I am the property owner or authorized agent to act o e properly owner -s behalf. I have read this application and the information 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 state laws relating to buil " g cons rite representztives of Cupertino to enter the above -i entifi�d ropeily for inspection purposes. Signaure offipplicamUA� Date: �Z3 �Z G SUPPLEhfENTAL INFORMATION REQUIRED r MR �. �a .;� -AWOR.- MEPAliSC-4RP_2011.doc revised 06/21/11 CUPERTINO STATEMENT OF SPECIAL INSPECTIONS, 2013 CBC COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building a(5.cupertino.orq SITE ADDRESS 10101 Bubb Road APN ✓ ZO _ 3 BP# / Owner.. !�J7/ )... :..................................... Contractor ... :5..V.A..... .+�..! A ...................................................................... / 3 � — Li2-4-p............................................. Address......................�4-................................... Address $- (N l►Wcrsl� .....�...........................�'�....................................... City/St.. ... 7 .�.............. Zip ....53..." ...... Phone ..................... City/St/ —..P.t.��..................... Zip�130... Phone.VCJ..1.s.... Applicant. :. Engineer/Architect Steve, Wade,.SE............................................. _ 3....P ..:................................................ Address.... 175.8.2.S.an.13.er)jto..W City/St..`!�'^'�jt ........... Zip...........................Phone.P.............. City/St... Monte Sereno/CA 4030 Phone 408:399-0623 . PROJECT DESCRIPTION: Apple Bubb 4 RTU Replacement This "STATEMENT OF SPECIAL INSPECTIONS" is submitted in fulfillment of the requirements oW Sections 1704 and 1705. This form is structured after and used by permission from the Structural Engineer Association of NArtbern California's (SEAONC) mode statement of Special Inspections. Also, included with this form is the following: ❑ "LIST OF SPECIAL INSPECTION AGENCIES (page 2). A list of testing agenIs other special inspectors that will be retained to conduct the tests and inspections for this project ❑ "SCHEDULE OF SPECIAL INSPECTION" (page 3 — 6). The Schedule of nspections summarizes the Special Inspections and tests required. Special Inspectors will refer to the appro d la s and specifications for detailed special inspection requirements. Any additional tests and inspections required pproved plans and specifications shall also be performed. Special Inspections and Testing will be performed in accordance with the app a fans and specifications, this statement and CBC Sections 1704, 1705, 1706, 1707, and 1708. Interim reports will be submitted t uilding Official and the Registered Design Professional in Responsible Charge in accordance with CBC Section 1704.1.2. A Final Report of Special Inspections documenting required Special Inspections, testing and correction of any discrepancies noted in the inspections shall be submitted prior to issuance of a Certificate of Use and Occupancy (Section 1704.1.2). The Final Report will document: • Required special inspections. • Correction of discrepancies noted in inspections. The Owner recognizes his or her obligation to ensure that the construction complies with the approved permit documents and to implement this program of special inspections. In partial fulfillment of these obligations, the Owner will retain and directly pay for the Special Inspections as required in CBC Section 1704.1. This plan has been developed with the understanding that the Building Official will: • Review and approve the qualifications of the Special Inspectors who will perform the inspections. • Monitor special inspection activities on the job site to assure that the Special Inspectors are qualified and are performing their duties as called for in this Statement of Special Inspection. • Review submitted inspection reports. • Perform inspections as required by the local building code. I have read and aqree to comply with the terms and conditions of this statement Prepared By: Project Engineer ❑ Architect — - 7 Exp. Registered Design Professional in Charge I t`�__� Signature .................................................................... Lic.# ... S421.2 Date: 6-30-16 .............. Owner Name: . jr (� Owner's Authorization Si nature .................................................................................................................. Date: t!t'. . .J..Ii. J. Inspection Agency / Inspector Name: Biggs Cardosa Associates, Inc 11/23/15 Signature...., ............................................ Date:.......................... Building Official or designee: Si nature ........... ... Date:... .Z...f! SpeciabnspectionForm_2012.doc revised 09/06/12 IUA CUPERTINO STATEMENT OF SPECIAL INSPECTIONS, 2013 CBC COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.org SITE ADDRESS 10101 Bubb Road APN BP# Owner...... ...( .%.......:-//4��r....e................................................................... Contractor.,5.{.M.....7F, 1.,C............................�............................................... Address./. ...'. 'SQrV `�?............................................... Address..�r�.�. .....!4r�..!�. i.. O.r�.......rl�Y�..1"...................................... ....4�.-Zip...........................Phone7.� .,.1. City/St...M.l.�.tO..i7A.S.................Zip..� 0,� ..PhonegP&...5 e.�/. Applicant...�i.�C F...!'............................................................... Engineer/ArchitectSteye,Wade,,SE Address..5.+',.,G.....tri...P! 2..v ................................................ Address... 17.5.a2.San.5Qnl1.Q..Way.................................................. City/St............................................. Zip ........................... Phone..................... I City/St...Monte Sereno/CA....... Zip 94030.... Phone 408.399.0623 PROJECT DESCRIPTION: Apple Bubb 4 RTU Replacement This "STATEMENT OF SPECIAL INSPECTIONS" is submitted in fulfillment of the requirements of CBC Sections 1704 and 1705. This form is structured after and used by permission from the Structural Engineer Association of Northern California's (SEAONC) mode statement of Special Inspections. Also, included with this form is the following: ❑ "LIST OF SPECIAL INSPECTION AGENCIES (page 2). A list of testing agencies and other special inspectors that will be retained to conduct the tests and inspections for this project ❑ "SCHEDULE OF SPECIAL INSPECTION" (page 3 — 6). The Schedule of Special Inspections summarizes the Special Inspections and tests required. Special Inspectors will refer to the approved plans and specifications for detailed special inspection requirements. Any additional tests and inspections required by the approved plans and specifications shall also be performed. Special Inspections and Testing will be performed in accordance with the approved plans and specifications, this statement and CBC Sections 1704, 1705, 1706, 1707, and 1708. Interim reports will be submitted to the Building Official and the Registered Design Professional in Responsible Charge in accordance with CBC Section 1704.1.2. A Final Report of Special Inspections documenting required Special Inspections, testing and correction of any discrepancies noted in the inspections shall be submitted prior to issuance of a Certificate of Use and Occupancy (Section 1704.1.2). The Final Report will document: • Required special inspections. • Correction of discrepancies noted in inspections. The Owner recognizes his or her obligation to ensure that the construction complies with the approved permit documents and to implement this program of special inspections. In partial fulfillment of these obligations, the Owner will retain and directly pay for the Special Inspections as required in CBC Section 1704.1. This plan has been developed with the understanding that the Building Official will: • Review and approve the qualifications of the Special Inspectors who will perform the inspections. • Monitor special inspection activities on the job site to assure that the Special Inspectors are qualified and are performing their duties as called for in this Statement of Special Inspection. • Review submitted inspection reports. • Perform inspections as required by the local building code. l have read and aqree to comply with the terms and conditions of this statement Prepared By: V Exp. Project Engineer Ll Architect � Registered Design Professional in Charge Signature .................................................................... Lic.# ... S421.2....................... Date: 6-30-16... Owner Name: Owner's Authorization Signature .................................................................................................................... Date:.......................... Inspection Agency / Inspector Name: Signature.......... .......................................................... Lic.#....................................... Date:.......................... Building Official or designee: Signature.................................................................................................................... Date:.......................... SpecialnspectionForm_2012.doc revised 09/06112 `U0� LIST OF SPECIAL INSPECTION AGENCIES APPROVAL OF SPECIAL INSPECTORS: Each special inspection agency, testing facility, and special inspector shall be recognized by the Building Official prior to performing any duties. Special Inspection agency's listed on this form must be pre -approved and listed on Cupertino's approved Special Inspector's list. Special inspectors shall carry approved identification when performing the functions of a special inspector. Identification cards shall follow the criteria set by the California Council of Testing and Inspection Agencies. No personnel changes shall be made without first obtaining the approval of the Building Official. Any unauthorized personnel changes may result in a "Stop Work Order" and possible permit revocation. To be pre- approved by the City of Cupertino, refer to the SPECIAL INSPECTION CRITERIA handout. Please allow two weeks to complete the application process. I he tollowmg are the testing and special inspection agencies that will ne retained to conduct tests and inspection on tnis project EXPERTISE FIRM / INSPECTOR INFORMATION * 1. Special Inspection (except for Firm........................CA'7V.P.7-0-1 ... ......... Addr ......................................................................................... geotechnical) City.......................................................................................................... State .......................Zip ...................... Telephone...................................... Fax ......................................... ... Email ......................................................... 2. Material Testing Firm.....................................................................Addr......................................................................................... City.......................................................................................................... State .......................Zip ...................... Telephone.......................................Fax............................................ Email......................................................... 3. Geotechnical Inspections Firm.....................................................................Addr......................................................................................... City.......................................................................................................... State .......................Zip ...................... Telephone...................................... Fax ............................................ Email......................................................... 4. Other: Firm.....................................................................Addr......................................................................................... City.......................................................................................................... State .......................Zip ...................... Telephone...................................... Fax ............................................ Email......................................................... *All agencies specified on this form must be pre -approved and listed on the City of Cupertino's Approved Special Inspector's List. SEISMIC REQUIREMENTS (Section 1705.3.6) Description of seismic -force -resisting system and designated seismic systems subject to special inspections as per Section 1705.3: - Seismic anchorage of roof mounted replacement mechanical equipment The extent of the seismic -force -resisting system is defined in more detail in the construction documents. WIND REQUIREMENTS Section 1705.4.1 Description of main wind -force -resisting system and designated wind resisting components subject to special inspections in accordance with Section 1705.4.2: The extent of the main wind -force -resisting system and wind resisting components is defined in more detail in the construction documents. SpecialnspectionFonn 2012. doe revised 09/06/12 SCHEDULE OF SPECIAL INSPECTION SITE( nn APN BP# Sa 0 /! 1, W / (( � ADDRESS I G PROJECT DESCRIPTION: _ Notation Used in Table Column headers: C Indicates continuous inspection is required. P Indicates periodic inspections are required. The notes and/or contract documents should clarify. Box entries: X Is placed in the appropriate column to denote either "C" continuous or "P" periodic inspections. --- Denotes an activity that is either a one-time activity or one whose frequency is defined in some other manner. 4dditional detail regarding inspections and tests are provided in the project specifications or notes on the drawings. VERIFICATION AND INSPECTIONC P REFERENCED IBC REFERENCE STANDARD INSPECTION OF FABRICATORS 1. id Inspect fabricator's fabrication and quality control 1704.3 procedures. INSPECTION OF STEEL 1. Material verification of high-strength bolts, nuts and washers. ❑ Identification marking to conform to ASTM stds AISC 360, specified in the approved construction documents. X Section A3.3 and applicable ASTM material standards ❑ Inspect fabricator's fabrication and quality control X procedures. 2. Inspection of high-strength bolting: ❑ Snug -tight joints. --- X ❑ Pretensioned and slip -critical joints using turn -of -nut with matchmarking, twist -off bolt or direct tension --- X AISC 360, indicator methods of installation. 1704.3.3 Section M2.5 ❑ Pretensioned and slip -critical joints using turn -of -nut without matchmarking or calibrated wrench methods X --- of installation. 3. Material verification of structural steel and cold -formed steel deck. For structural steel, identification markings to conform X AISC 360, to AISC 360. _ Section M2.5 ❑ For other steel, identification markings to conform to Applicable ASTM ASTM standards specified in the approved --- X material standards construction documents. ❑ Manufacturer's certified test reports. --- X SpecialnspectionForm_2012.doc revised 09/06112 VERIFICATION AND INSPECTIONC p REFERENCED STANDARD IBC REFERENCE 4. Material verification of weld filler materials: Identification marking to conform to AWS specification in the approved construction documents. _Y X AISC 360, Section A3.5 and applicable AWS A5 documents --- ❑ Manufacturer's certificate of compliance required. --- X --- --- 5. Inspection of welding: a. Structural steel and cold -formed steel deck: ❑ Complete and partial joint penetration groove welds. X --- AWS D1.1 1704.3.1 ❑ Multipass fillet welds. X --- ❑ Single -pass fillet welds > 5/16" X -- ❑ Plug and slot welds. X --- Single-pass inlet welds <= 5/16" --- X ❑ Floor and roof deck welds. --- X AWS D1.3 b. Reinforcing steel: ❑ Verification of weldability of reinforcing steel other than ASTM A 706. X AWS D1.4 ACI 318: Section 3.5.2 ❑ Reinforcing steel resisting flexural and axial forces in intermediate and special moment frames, and boundary elements of special structural walls of concrete and shear reinforcement. X --- ❑ Shear reinforcement. X --- ❑ Other reinforcing steel. --- X 6. Inspection of steel frame joints details for compliance: ❑ Details such as bracing and stiffening. --- X --- 1704.3.2 ❑ Member locations. --- X ❑ Application of joint details at each connection. --- X VERIFICATION AND INSPECTIONC p REFERENCED STANDARD IBC IREFERENCE INSPECTION OF WELDING 1. ❑ Welded studs when used for structural diaphragms. --- X --- 1704.3 2. ❑ Welding of cold -formed steel framing members. --- X 3. ❑ Welding of stairs and railing systems. --- X SpecialnspectionForm_2012.doc revised 09/06/12 VERIFICATION AND INSPECTION C P REFERENCED STANDARD IBC REFERENCE INSPECTION OF CONCRETE 1. ❑ Inspection of reinforcing steel, including prestressing --- X ACI 318: 3.5, 7.1-7.7 1913.4 tendons and placement. 2. ❑ Inspection of reinforcing steel welding in accordance AWS D1.4 ACI 318: with Table 1704.3 Item 5b. 3.5.2 3. ❑ Inspection of bolts to be installed in concrete prior to and during placement of concrete where allowable X ACI 318: 8.1.3, 1911.5, 1912.1 loads have been increased or where strength design 21.2.8 is used. 4. ❑ Inspection of anchors installed in hardened concrete. --- X ACI 318: 1912.1 5. ❑ Verifying use of required design mix. 1904.2.2,1913.2, --- X ACI 318: 1913.3 6. ❑ At time fresh concrete is sampled to fabricate ASTM C 172 specimens for strength tests, perform slump and air X --- ASTM C 31 1913.10 content tests and determine the temperature of the concrete. ACI 318: 5.6, 5.8 7. ❑ Inspection of concrete and shotcrete placement for X --- ACI 318: 5.9, 5.10 1913.6, 1913.7, proper application techniques. 1913.8 8. ❑ Inspection for maintenance of specified curing --- X ACI 318: 5.11-5.13 1913.9 temperature and techniques. 9. Inspection of prestressed concrete: ❑ Application of prestressing forces. X --- ACI 318:18.20 ❑ Grouting of bonded prestressing tendons in the X --- ACI 318: 18.18.4 seismic force -resisting system. 10. ❑ Erection of precast concrete members. --- X ACI 318: Ch. 16 --- 11. ❑ Verification of in-situ concrete strength, prior to stressing of tendons in posttensioned concrete and --- X ACI 318: 6.2 --- prior to removal of shores and forms from beams and structural slabs. 12. ❑ Inspect formwork for shape, location, and dimensions --- X ACI 318: 6.6.1 --- of the concrete member being formed. 13. ❑ Bolts Installed in Existing Masonry or Concrete ❑ Direct tension testing of existing anchors. --- X See ICC ES Reports form special inspection requirements for proprietary products ❑ Direct tension testing of new bolts. --- X ❑ Torque testing of new bolts. --- X ❑ Prequalification test for bolts and other types of X anchors. - 14. ❑ Other: SpecialnspectionForm_2012.doe revised 09/06/12 SpeciaZnspectionForm 2012.doc revised 09/06/12 REFERENCE FOR CRITERIA VERIFICATION AND INSPECTION C P IBC TMS 402/ACI TMS 402/ACI SECTION 530/ASCE 5 530/ASCE 6 INSPECTION OF LEVEL 1 MASONRY 1. ❑ Compliance with required inspection provisions of the construction documents and the approved --- X --- --- Art. 1.5 submittals shall be verified. 2. ❑ Verification of f , and f AAC prior to construction ___ X ___ ___ Art. 1.413 except where specifically exempted by this code. 3. ❑ Verification of slump flow and VSI as delivered to X --- --- --- Art. 1.513.1.b.3 the site for self consolidating grout. 4. As masonry construction begins, the following shall be verified to ensure compliance: ❑ Proportions of site -prepared mortar. --- X --- --- Art. 2.6A ❑ Construction of mortar joints. --- X --- --- Art.3.313 ❑ Location of reinforcement, connectors, --- X --- --- Art. 3.4, 3.6A prestressing tendons, and anchorages. ❑ Prestressing technique. --- X --- --- Art. 3.613 ❑ Grade and size of prestressing tendons and X --- ___ Art. 2.413, 2.4H anchorages. 5. During construction the inspection program shall verify: ❑ Size and location of structural elements. --- X --- --- Art. 3.3F ❑ Type, size, and location of anchors, including Sec. 1.2.2(e), other details of anchorage of masonry to __- X ___ 1.16.1 structural members, frames or other construction. ❑ Specified size, grade, and type of reinforcement, anchor bolts, prestressing tendons and --- X --- Sec. 1.15 Art. 2.4, 3.4 anchorages. ❑ Welding of reinforcing bars. X --- --- --- ❑ Preparation, construction and protection of masonry during cold weather (temperature below ___ X Sec. 2104.3, --- Art. 1.8C, 1.8D 40 degrees F) or hot weather (temperature above 2104.4 90 degrees F). ❑ Application and measurement of prestressing X -- --- --- Art. 3.613 force. 6. Prior to grouting the following shall be verified to ensure compliance: ❑ Grout space is clean. --- X --- --- Art. 3.2D ❑ Placement of reinforcement and connectors and ___ X --- Sec. 1.3 Art. 3.4 prestressing tendons and anchorages. ❑ Proportions of site -prepared grout and -_- X --_ __- Art. 2.613 prestressing grout for bonded tendons. ❑ Construction of mortar joints. --- X --- --- Art. 3.313 7. Grout placement: ❑ Grout placement shall be verified ensure X --- --- __- Art. 3.5 compliance. ❑ Observe grouting of prestressing bonded X --- ___ -__ Art 3.6C tendons. SpeciaZnspectionForm 2012.doc revised 09/06/12 SpeciabispectionForm_2012.doc revised 09/06/12 REFERENCE FOR CRITERIA VERIFICATION AND INSPECTION C P IBC TMS 402/ACI TMS 402/ACI SECTION 530/ASCE 5 530/ASCE 6 8. ❑ Preparation of any required grout specimens, Sec. mortar specimens, and/or prisms shall be -- X 2105.2.2, --- Art. 1.4 observed. 2105.3 INSPECTION OF LEVEL 2 MASONRY 1. ❑ Compliance with required inspection provisions of the construction documents and the approved --- X --- --- Art. 1.5 submittals. 2. ❑ Verification of fm and fAAC prior to construction and for every 5,000 square feet during --- X --- --- Art. 1.413 construction. 3. ❑ Verification of proportions of materials in premixed or preblended mortar and grout as --- X --- --- Art. 1.51B delivered to the site. 4. ❑ Verification of slump flow and VSI as delivered to X --- --- --- Art. 1.5B.1.b.3 the site for self consolidating rout. 5. The following shall be verified to ensure compliance: ❑ Proportions of site -prepared mortar, grout, and --- X --- --- Art. 2.6A prestressing grout for bonded tendons. ❑ Placement of masonry units and construction of --- X --- --- Art. 3.313 mortar joints. ❑ Placement of reinforcement, connectors and --- X --- Sec. 1.15 Art. 3.4, 3.6A prestressing tendons and anchorages. ❑ Grout space prior to grouting. X --- --- --- Art. 3.2D ❑ Placement of grout. X --- --- --- Art. 3.5 ❑ Placement of prestressing grout. X --- --- --- Art. 3.6C ❑ Size and location of structural elements. --- X --- --- Art. 3.317 ❑ Type, size, and location of anchors, including other details of anchorage of masonry to X --- --- Sec. 1.2.2(e) structural members, frames and other construction. ❑ Specified size, grade, and type of reinforcement, anchor bolts, prestressing tendons and --- X --- Sec. 1.15 Art. 2.4, 3.4 anchorages. ❑ Welding of reinforcing bars. X --- Sec. 2.1.9.7.2, --- 3.3.3.4 (b) ❑ Preparation, construction, and protection of masonry during cold weather (temperature below ___ X Sec. 2104.3, --- Art. 1.8C, 1.81D 40 degrees F) or hot weather (temperature above 2104.4 90 degrees F). ❑ Application and measurement of prestressing X --- --- --- Art. 3.66 force. 6. ❑ Preparation of any required grout specimens, Sec. mortar specimens, and/or prisms shall be X --- 2105.2.2, --- Art. 1.4 observed. 2105.3 SpeciabispectionForm_2012.doc revised 09/06/12 VERIFICATION AND INSPECTIONC p REFERENCED STANDARD IBC REFERENCE INSPECTION OF WOOD 1. ❑ Inspect prefabricated wood structural elements and assemblies in accordance with Section 1704.2. --- 1704.6 2. ❑ Inspect site built assemblies. --- --- 3. Inspect high -load diaphragms: ❑ Verify grade and thickness of sheathing. --- --- ❑ Verify nominal size of framing members at adjoining panel edges. --- 1704.6.1 ❑ Verify nail or staple diameter and length, --- --- ❑ Verify number of fastener lines, --- 0 Verify spacing between fasteners in each line and at edge margins. 4. ❑ Metal -plate -connected wood trusses spanning 60 feet or greater: Verify temporary installation restraint/bracing and the permanent individual truss --- X --- 1704.6.2 member bracing are installed in accordance with the approved truss submittal package. REQUIRED VERIFICATION AND INSPECTION OF SOIL 1. ❑ Verify materials below footings are adequate to X achieve the desired bearing capacity. _ 2. ❑ Verify excavations are extended to proper depth and X have reached proper material. 3. ❑ Perform classification and testing of compacted fill X materials. --- Table 1704.7 4. ❑ Verify use of proper materials, densities and lift thicknesses during placement and compaction of X --- compacted fill. 5. ❑ Prior to placement of compacted fill, observe subgrade X 7 and verify that site has been prepared properly. REQUIRED VERIFICATION AND INSPECTION OF DEEP DRIVEN FOUNDATION ELEMENTS 1. ❑ Verify element materials, sizes and lengths comply X with the requirements. 2. ❑ Determine capacities of test elements and conduct X additional load tests, as required. 3. ❑ Observe driving operations and maintain complete X and accurate records for each element. 4. ❑ Verify locations of piles and their plumbness, confirm type and size of hammer, record number of blows per --- Table 1704.8 foot of penetration, determine required penetrations to X --- achieve design capacity, record tip and butt elevations and document any damage to foundation element. 5. ❑ For steel elements, perform additional inspections in accordance with Section 1704.3. 6. ❑ For concrete elements and concrete filled elements, perform additional inspections in accordance with --- --- Section 1704.4. SpecialnspectionForin_2012.doc revised 09/06/12 VERIFICATION AND INSPECTION C P REFERENCED IBC STANDARD REFERENCE 7. ❑ For specialty piles, perform additional inspections as determined by the registered design professional in --- --- --- Table 1704.8 responsible charge. REQUIRED VERIFICATION AND INSPECTION OF CAST -IN-PLACE DEEP FOUNDATION ELEMENTS 1 ❑ Observe drilling operations and maintain complete and X -- accurate records for each element. 2. ❑ Verify placement locations and plumbness, confirm element diameters, bell diameters (if applicable), lengths, embedment into bedrock (if applicable), and X --- --- Table 1704.9 adequate end -bearing strata capacity. Record concrete or grout volumes. 3. ❑ For concrete elements, perform additional inspections in accordance with Section 1704.4. HELICAL PILE FOUNDATIONS 1. ❑ Record installation equipment used, pile dimensions, X --- --- 1704.10 tip elevations, final depth, final installation torque. SPRAYED FIRE-RESISTANT MATERIALS Physical and visual tests 1. Condition of substrates. ❑ Inspect surface for accordance with the approved fire - resistance design and the approved manufacturer's --- --- written instructions. ❑ Verify minimum ambient temperature before and after application. --- X --- 1704.12.1 ❑ Verify ventilation of area during and after application. --- X 2. ❑ Measure average thickness per ASTM E605 and --- --- Section 1704.12.4. 3. ❑ Verify density of material for conformance with the approved fire-resistant design and ASTM E605. (Ref. --- --- Section 1704.12.5) 4. ❑ Test cohesive/adhesive bond strength per S SpeciakispectionForm_2012.doe revised 09/06/12 SCHEDULE OF SPECIAL INSPECTION SITE APN BP# ADDRESS PROJECT DESCRIPTION: Notation Used in Table: Column headers C Indicates continuous inspection is required. P Indicates periodic inspections are required. The notes and/or contract documents should clarify. Box entries: X Is placed in the appropriate column to denote either "C" continuous or "P" periodic inspections. --- Denotes an activity that is either a one-time activity or one whose frequency is defined in some other manner. Additional detail regarding inspections and tests are provided in the project specifications or notes on the drawings. VERIFICATION AND INSPECTIONC P REFERENCED IBC REFERENCE STANDARD INSPECTION OF FABRICATORS 1. id Inspect fabricator's fabrication and quality control _ 1704.3 procedures. INSPECTION OF STEEL 1. Material verification of high-strength bolts, nuts and washers. ❑ Identification marking to conform to ASTM stds AISC 360, specified in the approved construction documents. X Section A3.3 and applicable ASTM material standards ❑ Inspect fabricator's fabrication and quality control _ X procedures. 2. Inspection of high-strength bolting: ❑ Snug -tight joints. --- X ❑ Pretensioned and slip -critical joints using turn -of -nut with matchmarking, twist -off bolt or direct tension --- X AISC 360, indicator methods of installation. Section M2.5 1704.3.3 ❑ Pretensioned and slip -critical joints using turn -of -nut without matchmarking or calibrated wrench methods X --- of installation. 3. Material verification of structural steel and cold -formed steel deck. For structural steel, identification markings to conform _ _ X AISC 360, to AISC 360. Section M2.5 ❑ For other steel, identification markings to conform to Applicable ASTM ASTM standards specified in the approved --- X material standards construction documents. ❑ Manufacturer's certified test reports. --- X SpecialnspectionForm_2012.doc revised 09/06/12 VERIFICATION AND INSPECTION C p REFERENCED STANDARD IBC REFERENCE 4. Material verification of weld filler materials: Identification marking to conform to AWS specification in the approved construction documents. -_ X AISC 360, Section A3.5 and applicable AWS A5 documents - ❑ Manufacturer's certificate of compliance required. --- X --- --- 5. Inspection of welding: a. Structural steel and cold -formed steel deck: ❑ Complete and partial joint penetration groove welds. X --- AWS D1.1 1704.3.1 ❑ Multipass fillet welds. X --- ❑ Single -pass fillet welds > 5/16" X --- ❑ Plug and slot welds. X --- Single-pass fillet welds <= 5/16" --- X ❑ Floor and roof deck welds. --- X AWS D1.3 b. Reinforcing steel: ❑ Verification of weldability of reinforcing steel other than ASTM A 706. -_ X AWS D1.4 ACI 318: Section 3.5.2 ❑ Reinforcing steel resisting flexural and axial forces in intermediate and special moment frames, and boundary elements of special structural walls of concrete and shear reinforcement. X --- ❑ Shear reinforcement. X --- ❑ Other reinforcing steel. --- X 6. Inspection of steel frame joints details for compliance: ❑ Details such as bracing and stiffening. --- X --- 1704.3.2 ❑ Member locations. --- X ❑ Application of joint details at each connection. --- X VERIFICATION AND INSPECTIONC p REFERENCED STANDARD IBC REFERENCE INSPECTION OF WELDING 1. ❑ Welded studs when used for structural diaphragms. --- X --- 1704.3 2. ❑ Welding of cold -formed steel framing members. --- X 3. ❑ Welding of stairs and railing systems. --- X SpecialnspectionForm_2012.doc revised 09/06/12 VERIFICATION AND INSPECTIONC P REFERENCED IBC STANDARD REFERENCE INSPECTION OF CONCRETE 1. ❑ Inspection of reinforcing steel, including prestressing --- X ACI 318: 3.5, 7.1-7.7 1913.4 tendons and placement. 2. ❑ Inspection of reinforcing steel welding in accordance AWS D1.4 ACI 318: with Table 1704.3 Item 5b. 3.5.2 3. ❑ Inspection of bolts to be installed in concrete prior to and during placement of concrete where allowable X ACI 318: 8.1.3, 1911.5, 1912.1 loads have been increased or where strength design 21.2.8 is used. 4. ❑ Inspection of anchors installed in hardened concrete. --- X ACI 318: 1912.1 5. ❑ Verifying use of required design mix. 1904.2.2,1913.2, --- X ACI 318: 1913.3 6. ❑ At time fresh concrete is sampled to fabricate ASTM C 172 specimens for strength tests, perform slump and air X --- ASTM C 31 1913.10 content tests and determine the temperature of the concrete. ACI 318: 5.6, 5.8 7. ❑ Inspection of concrete and shotcrete placement for X --- ACI 318: 5.9, 5.10 1913.6, 1913.7, proper application techniques. 1913.8 8. ❑ Inspection for maintenance of specified curing X ACI 318: 5.11-5.13 1913.9 temperature and techniques. 9. Inspection of prestressed concrete: ❑ Application of prestressing forces. X --- ACI 318: 18.20 ❑ Grouting of bonded prestressing tendons in the X --- ACI 318: 18.18.4 --- seismic force -resisting system. 10. ❑ Erection of precast concrete members. --- X ACI 318: Ch. 16 --- 11. ❑ Verification of in-situ concrete strength, prior to stressing of tendons in posttensioned concrete and --- X ACI 318: 6.2 --- prior to removal of shores and forms from beams and structural slabs. 12. ❑ Inspect formwork for shape, location, and dimensions --- X ACI 318: 6.6.1 --- of the concrete member being formed. 13. ❑ Bolts Installed in Existing Masonry or Concrete ❑ Direct tension testing of existing anchors. --- X See ICC ES Reports form special inspection requirements for proprietary products ❑ Direct tension testing of new bolts. --- X ❑ Torque testing of new bolts. --- X ❑ Prequalification test for bolts and other types of X anchors. - 14. ❑ Other: SpecialnspectionForm_2012.doe revised 09106112 SpecialnspectionForm 2012. doe revised 09/06/12 REFERENCE FOR CRITERIA VERIFICATION AND INSPECTION C P IBC TMS 402/ACI TMS 402/ACI SECTION 530/ASCE 5 530/ASCE 6 INSPECTION OF LEVEL 1 MASONRY 1. ❑ Compliance with required inspection provisions of the construction documents and the approved --- X --- --- Art. 1.5 submittals shall be verified. 2. ❑ Verification of fm and franc prior to construction X --- --- Art. 1.413 except where specifically exempted by this code. 3. ❑ Verification of slump flow and VSI as delivered to X --- --- --- Art. 1.513.1.b.3 the site for self consolidating grout. 4. As masonry construction begins, the following shall be verified to ensure compliance: ❑ Proportions of site -prepared mortar. --- X --- --- Art. 2.6A ❑ Construction of mortar joints. --- X --- --- Art.3.313 ❑ Location of reinforcement, connectors, --- X --- --- Art. 3.4, 3.6A prestressing tendons, and anchorages. ❑ Prestressing technique. --- X --- --- Art. 3.613 ❑ Grade and size of prestressing tendons and --- X --- --- Art. 2.413, 2AH anchorages. 5. During construction the inspection program shall verify: ❑ Size and location of structural elements. --- X --- --- Art. 3.3F ❑ Type, size, and location of anchors, including Sec. 1.2.2(e), other details of anchorage of masonry to --- X --- 1.16.1 structural members, frames or other construction. ❑ Specified size, grade, and type of reinforcement, anchor bolts, prestressing tendons and -- X --- Sec. 1.15 Art. 2.4, 3.4 anchorages. ❑ Welding of reinforcing bars. X --- --- --- ❑ Preparation, construction and protection of masonry during cold weather (temperature below ___ X Sec. 2104.3, --- Art. 1.8C, 1.81D 40 degrees F) or hot weather (temperature above 2104.4 90 degrees F). ❑ Application and measurement of prestressing X -- --- --- Art. 3.613 force. 6. Prior to grouting the following shall be verified to ensure compliance: ❑ Grout space is clean. --- X --- --- Art. 3.2D ❑ Placement of reinforcement and connectors and --- X --- Sec. 1.3 Art. 3.4 prestressing tendons and anchorages. ❑ Proportions of site -prepared grout and --- X --- --- Art. 2.613 prestressing grout for bonded tendons. ❑ Construction of mortar joints. --- X --- --- Art. 3.313 7. Grout placement: ❑ Grout placement shall be verified ensure X --- --- --- Art. 3.5 compliance. ❑ Observe grouting of prestressing bonded X --- --- --- Art 3.6C tendons. SpecialnspectionForm 2012. doe revised 09/06/12 SpecialnspectionForm_2012.doc revised 09/06/12 REFERENCE FOR CRITERIA VERIFICATION AND INSPECTION C P IBC TMS 402/ACI TMS 402/ACI SECTION 530/ASCE 5 530/ASCE 6 8. ❑ Preparation of any required grout specimens, Sec. mortar specimens, and/or prisms shall be --- X 2105.2.2, --- Art. 1.4 observed. 2105.3 INSPECTION OF LEVEL 2 MASONRY 1. ❑ Compliance with required inspection provisions of the construction documents and the approved --- X --- --- Art. 1.5 submittals. 2. ❑ Verification of fn, and faac prior to construction and for every 5,000 square feet during --- X --- --- Art. 1.413 construction. 3. ❑ Verification of proportions of materials in premixed or preblended mortar and grout as --- X --- --- Art. 1.5B delivered to the site. 4. ❑ Verification of slump flow and VSI as delivered to X ___ -__ -_- Art. 1.5B.1.b.3 the site for self consolidating rout. 5. The following shall be verified to ensure compliance: ❑ Proportions of site -prepared mortar, grout, and --- X ___ --- Art. 2.6A prestressing grout for bonded tendons. ❑ Placement of masonry units and construction of --- X _ --- Art. 3.313 mortarjoints. ❑ Placement of reinforcement, connectors and ___ X --- Sec. 1.15 Art. 3.4, 3.6A prestressing tendons and anchorages. ❑ Grout space prior to grouting. X --- --- --- Art. 3.2D ❑ Placement of grout. X --- --- --- Art. 3.5 ❑ Placement of prestressing grout. X --- --- --- Art. 3.6C ❑ Size and location of structural elements. --- X --- --- Art. 3.3F ❑ Type, size, and location of anchors, including other details of anchorage of masonry to X --- --- Sec.1.2.2(e) structural members, frames and other construction. ❑ Specified size, grade, and type of reinforcement, anchor bolts, prestressing tendons and --- X --- Sec. 1.15 Art. 2.4, 3.4 anchorages. ❑ Welding of reinforcing bars. X--- _ Sec. 2.1.9.7.2, --- 3.3.3.4 (b) ❑ Preparation, construction, and protection of masonry during cold weather (temperature below ___ X Sec. 2104.3, --- Art. 1.8C, 1.8D 40 degrees F) or hot weather (temperature above 2104.4 90 degrees F). ❑ Application and measurement of prestressing X --- --- ___ Art. 3.613 force. 6. ❑ Preparation of any required grout specimens, Sec. mortar specimens, and/or prisms shall be X --- 2105.2.2, --- Art. 1.4 observed. 2105.3 SpecialnspectionForm_2012.doc revised 09/06/12 VERIFICATION AND INSPECTIONC p REFERENCED STANDARD IBC REFERENCE INSPECTION OF WOOD 1. ❑ Inspect prefabricated wood structural elements and assemblies in accordance with Section 1704.2. --- 1704.6 2. ❑ Inspect site built assemblies. --- --- 3. Inspect high -load diaphragms: ❑ Verify grade and thickness of sheathing. --- --- ❑ Verify nominal size of framing members at adjoining panel edges. --- 1704.6.1 ❑ Verify nail or staple diameter and length, --- --- ❑ Verify number of fastener lines, --- --- ❑ Verify spacing between fasteners in each line and at edge margins. 4. ❑ Metal -plate -connected wood trusses spanning 60 feet or greater: Verify temporary installation restraint/bracing and the permanent individual truss --- X --- 1704.6.2 member bracing are installed in accordance with the approved truss submittal package. REQUIRED VERIFICATION AND INSPECTION OF SOIL 1. ❑ Verify materials below footings are adequate to X achieve the desired bearing capacity. _ 2. ❑ Verify excavations are extended to proper depth and X have reached proper material. 3. ❑ Perform classification and testing of compacted fill X materials. --- Table 1704.7 4. ❑ Verify use of proper materials, densities and lift thicknesses during placement and compaction of X --- compacted fill. 5. ❑ Prior to placement of compacted fill, observe subgrade X and verify that site has been prepared properly. REQUIRED VERIFICATION AND INSPECTION OF DEEP DRIVEN FOUNDATION ELEMENTS 1. ❑ Verify element materials, sizes and lengths comply X with the requirements. 2. ❑ Determine capacities of test elements and conduct X additional load tests, as required. 3. ❑ Observe driving operations and maintain complete X and accurate records for each element. 4. ❑ Verify locations of piles and their plumbness, confirm type and size of hammer, record number of blows per --- Table 1704.8 foot of penetration, determine required penetrations to X --- achieve design capacity, record tip and butt elevations and document any damage to foundation element. 5. ❑ For steel elements, perform additional inspections in accordance with Section 1704.3. 6. ❑ For concrete elements and concrete filled elements, perform additional inspections in accordance with --- Section 1704.4. SpecialnspectionForm 2012.doc revised 09/06/12 VERIFICATION AND INSPECTION C P REFERENCED STANDARD IBC REFERENCE 7. ❑ For specialty piles, perform additional inspections as determined by the registered design professional in --- --- --- Table 1704.8 responsible charge. REQUIRED VERIFICATION AND INSPECTION OF CAST -IN-PLACE DEEP FOUNDATION ELEMENTS 1 ❑ Observe drilling operations and maintain complete and X accurate records for each element. 2. ❑ Verify placement locations and plumbness, confirm element diameters, bell diameters (if applicable), lengths, embedment into bedrock (if applicable), and X --- --- Table 1704.9 adequate end -bearing strata capacity. Record concrete or grout volumes. 3. ❑ For concrete elements, perform additional inspections in accordance with Section 1704.4. HELICAL PILE FOUNDATIONS 1. ❑ Record installation equipment used, pile dimensions, X ___ 1704.10 tip elevations, final depth, final installation torque. SPRAYED FIRE-RESISTANT MATERIALS Physical and visual tests 1. Condition of substrates. ❑ Inspect surface for accordance with the approved fire - resistance design and the approved manufacturer's --- --- written instructions. ❑ Verify minimum ambient temperature before and after X application. -__ --- 1704.12.1 ❑ Verify ventilation of area during and after application. --- X 2. ❑ Measure average thickness per ASTM E605 and --- --- Section 1704.12.4. 3. ❑ Verify density of material for conformance with the approved fire-resistant design and ASTM E605. (Ref. --- --- Section 1704.12.5) 4. ❑ Test cohesive/adhesive bond strength per S SpecialnspectionForm_2012.doc revised 09/06112 SVMSilicon Valley Mechanical 2087 Ringwood Ave. Suite 50 San Jose, CA 95131-1785 Test, Adjust & Balance Report PROJECT: Apple Bubb 4 ADDRESS: 10101 Bubb Rd Cupertino, CA. 95014 ARCHITECT: Gensler •� ENGINEER: Silicon Valley Mechanical t GENERAL CONTRACTOR: SC Builders HVAC CONTRACTOR: Silicon Valley Mechanical LEAD BALANCE TECHNICIAN: Scott McClung DATE: 1/11/2016 SVMSilicon Valley Mechanical 2087 Ringwood Ave. Suite 50 San Jose, CA 95131-1785 AIR SYMBOL SHEET PROJECT: Apple Bubb 4 DATE: PAGE 1/11/2016 CFM Cubic Feet Per Minute FPM Feet Per Minute RPM Revolutions Per Minute HP Horse Power BHP Brake Horse Power FLA Full Load Amps SF Service Factor " W.G. Inches of Water gauge SP Static Pressure TSP Total Static Pressure ESP External Static Pressure AP Differential Pressure AT Differential Temperature of Degree Fahrenheit °C Degree Celcius CD Ceiling Diffuser CS Ceiling Supply CR Ceiling Return WS Wall Suppy WR Wall Return CE Ceiling Exhaust WE Wall Exhaust EDS Exposed Duct Supply ODUCT Open Duct DSOX Duct Sox LSD Linear Slot Diffuser HEPA High Efficiency Particulate Air Filter FP-HEPA Fan Powered -High Efficiency Particulate Air Filter DNA Data Not Available DNL Data Not Listed NA Not Applicable LOA Lack of Access NI Not Installed SVMSilicon Valley Mechanical 2087 Ringwood Ave. Suite 50 San Jose, CA 95131-1785 GENERAL NOTES PROJECT: Apple Bubb 4 DATE: 1/11/2016 PAGE: 2 1 1 IUnIess otherwise noted, indicated CFM (Cubic Feet per Minute) is a standard condition. 2 IUnless otherwise noted, indicated GPM (Gallons per Minute) is a standard condition. Unless otherwise noted, all sizes are measured in inches. SVMSilicon Valley Mechanical 2087 Ringwood Ave. Suite 50 San Jose, CA 95131-1785 AIR APPARATUS REPORT PROJECT: Apple Bubb 4 DATE: 1/8/2016 SYSTEM: AC -1 & AC -2 PAGE: 3 EQU1PMENT DATA......... , . ;. QG. t <....... :. AC -2. LOCATION ROOF ROOF SERVICE GENERAL BUILDING GENERAL BUILDING MANUFACTURER TRANE TRANE MODEL NUMBER TCH360 TCH360 SERIAL NUMBER C15K06818 C15KO6819 ...... .. FAN DATA .....:... DESIGN ..::. . II... .TESTED ......< .......;; ...... .. .DESIGN <: ... TESTED ...,,: TOTAL AIR CFM 8980 9183 9350 9517 RETURN AIR CFM DNA NM DNA NM OUTSIDE AIR CFM 1290 1302 1570 1703 RPM DNA 628 DNA 560 ESP " W.G. 2.25 1.32 2.25 1.08 DISCHARGE SP " W.G. DNA 1.18 DNA 0.96 SUCTION SP " W.G. DNA 0.59 DNA 0.46 COIL AP " W.G. DNA 0.37 DNA 0.27 FILTER AP " W.G. DNA 0.08 DNA 0.07 MC1?dpi:D�tTA...;.>.' ....,;;NA[rAEPLATE..;; ........ _ TESTED ::::::.NAMEPLATE:::::::: FE.Sm. :_ ... MOTOR MFG/FRAME CENTURY/S215T CENTURY /S215T HORSEPOWER 10 10 RPM 1755 1585 1755 1400 VOLTAGE/PHASE 208/3 211/213/213 208/3 213/2101212 AMPERAGE/SF 29/1.15 21.2/20.8/19.9 29/1.15 14.1/11.7/11.9 NO. BELT / SIZE 1 / BX103 1 / BX103 MOTOR SHEAVE x BORE BK67H x 1-3/8 BK67H x 1-3/8 FAN SHEAVE x BORE BK 160 x 1-7/16 BK160 x 1-7/16 NO. FILTER / TYPE / SIZE 16 / PLEATED / 16 x 20 x 2 16 / PLEATED / 16 x 20 x 2 REMARKS: SVMSilicon Valley Mechanical 2087 Ringwood Ave. Suite 50 San Jose, CA 95131-1785 VAV DISTRIBUTION REPORT PROJECT: Apple Bubb 4 DATE: 1/11/2016 SYSTEM: AC -1 PAGE: 4 :: AEtA .. .... .SERVEQ Ou> i# E uaLEE .: ;:i:i:i:i:>i3�S�faN .:: ;; Pi3� FiNa� F:PT� .. . :::NQ .... >TYFF :: SIZE. : M1N:C G ' :NfAaC�iTG : . AAAX CLG : kIA1f 0.G IHIN CLG % %MAX.HTG • NfA)C LG 131 1 CD 10 DNA DNA 360 320 37 105 350 132 2 CD 6 DNA DNA 90 120 26 35 90 RH-01 TOTAL 40 130 450 440 63 140 440 133 1 CD 6 DNA DNA 90 195 19 42 99 134 2 CD 6 DNA DNA 90 150 6 40 98 135 3 CD 8 DNA DNA 210 40 37 82 215 RH-02 TOTAL 60 160 390 385 62 164 412 130 1 EDS 14 DNA DNA 425 445 40 80 445 130 2 EDS 14 DNA DNA 425 425 38 77 425 130 3 EDS 14 DNA DNA 425 410 37 74 410 130 4 EDS 14 DNA DNA 425 425 38 77 425 130 5 EDS 14 DNA DNA 425 410 37 74 410 130 6 EDS 14 DNA DNA 425 390 35 70 390 130 7 EDS 14 DNA DNA 425 450 41 81 450 130 8 EDS 14 DNA DNA 425 455 41 82 455 RH-07 TOTAL 320 620 3400 3410 307 615 3410 REMARKS: SVMSilicon Valley Mechanical 2087 Ringwood Ave. Suite 50 San Jose, CA 95131-1785 VAV DISTRIBUTION REPORT PROJECT: Apple Bubb 4 DATE: 1/11/2016 SYSTEM: AC -1 PAGE: 5 A[tEA SERVED::NO:TPE: r N < ... ...... . ? . : SIZE:% . :M1NCLG;NAX:HTG , . `MAXCLGMA:GLG. INCLG:: M. <MAX:ffGMAC .NQT�: LG.. 130 1 EDS 14 DNA DNA 215 205 36 40 205 130 2 EDS 14 DNA DNA 215 195 34 38 195 130 3 EDS 14 DNA DNA 215 225 40 44 225 130 4 EDS 14 DNA DNA 215 195 34 38 195 130 5 EDS 14 DNA DNA 215 200 35 39 200 130 6 EDS 14 DNA DNA 215 220 39 42 220 130 7 EDS 14 DNA DNA 215 220 39 42 220 130 8 EDS 14 DNA DNA 215 235 41 45 235 RH-08 TOTAL 320 350 1720 1695 298 328 1695 114 1 CD 10 DNA DNA 290 410 185 185 300 114 2 CD 10 DNA DNA 290 115 165 165 275 RH-12 TOTAL 350 350 580 525 350 350 575 116 1 CD 16 30 30 1310 920 30 30 1295 RH-13 TOTAL 30 30 1310 920 30 30 1290 140 1 CD 12 DNA DNA 300 245 26 76 275 139 2 CD 6 DNA DNA 90 100 12 25 115 RH-15 TOTAL 40 100 390 345 38 101 390 REMARKS: SVMSilicon Valley Mechanical 2087 Ringwood Ave. Suite 50 San Jose, CA 95131-1785 VAV DISTRIBUTION REPORT PROJECT: Apple Bubb 4 DATE: 1/6/2016 SYSTEM: AC -1 PAGE: 6 A$EA/:IN SERVED ............... i .................... f�{OTE ..,,,..... NO. `;:::TYPE::::: ................................. SIZE::: : M1N:CLG ............. : MAX:HTG : .............. : MAX CLG ............. : WIAX:CLG: .............. ::MIN CLG:< .............. :MAX:HTG: ............. : MAX CLG : .............. 138 1 CD 6 DNA DNA 90 90 25 37 90 137 2 CD 6 DNA DNA 90 85 0 28 85 136 3 CD 6 DNA DNA 90 95 30 40 95 RH-16 TOTAL 60 100 270 270 55 105 270 113 1 CD 10 70 70 270 260 70 70 265 RH-18 TOTAL 70 70 270 260 70 70 265 REMARKS: SVMSilicon Valley Mechanical 2087 Ringwood Ave. Suite 50 San Jose, CA 95131-1785 VAV DISTRIBUTION REPORT PROJECT: Apple Bubb 4 DATE: 1/6/2016 SYSTEM: AC -2 PAGE: 7 AREA ...::. .... SERVED ..., OU7Lt f li1VL�rt.......2 ... ... ..::. 3 SIGN ::< <: Pf E.. < �iNAt:... ? T E i , :: NO. :: :;TYPE %'SIZE SIZE::::: MiN CLG :NfA....ITG MAX CLG 144AX GLG %..... ... ;MAX HTG MAX CLG 121 1 CD 10 DNA DNA 340 235 26 140 325 122 2 CD 10 DNA DNA 230 340 12 90 225 RH-04 TOTAL 40 230 570 575 38 230 550 123 1 CD 10 DNA DNA 230 215 19 105 215 124 2 CD 10 DNA DNA 250 270 19 130 270 RH-05 TOTAL 40 230 480 485 38 235 485 100A 1 SW 14 DNA DNA 430 470 75 150 430 100 2 SW 14 DNA DNA 430 250 65 145 390 100 3 SW 14 DNA DNA 430 530 68 150 390 1008 4 SW 14 DNA DNA 430 460 69 150 390 104 5 CD 6 DNA DNA 80 50 13 28 72 RH-09 TOTAL 300 660 1800 1760 290 623 1672 REMARKS: <: iuFd r •�co 0000 6i ¢ 6i a- a- �m U � O ■� �o w I� L �N O LO Z O a) U m n <: iuFd 7: O O O oO LnO o to O O O o o N C O N N fV N O N N O N M N N NN ti N N N N V N N N N C N NC:) M W U: " Z M N 0) CO 0) V Cl) - M N Cl) 0) h N0) ti O (tl iL M M M V M c} M O O (n O (D (n co (oCD U: J U M to V N V MO n In O V co (n V Co co 00 M co M M M M M M N M M M M M M M M N U: W J' ta: (n o 0 o n (n o o o (n o 0 0 0 0 (n c O O O M N N N N 7 N V MN N N N N N N N N N N N N N N CD I J U: tfi (D 1n (n (_n (n (17 (n N O O O O O O O O 7vv 7 N N NN N N N N M N M N M N M N M N M N M N M N :Z AD X a a a a a a a¢ O a a a a a a a a o Z Z z z z z z z M z z z z z z z z 0 s a s o a s a a a a a o Z. z O z z ❑ z ❑ z ❑ z ❑ z ❑ z ❑ co N z O z ❑ z ❑ z ❑ z ❑ z ❑ z ❑ z ❑ 00 N ItJ: N v v v v v v v v v v v v v V 7 v J .. W' a. U) U) (n cn (n cn cn (n Cl) (n (n to Cl) (n V) (n a W 0 W ❑❑ W W ❑ W ❑ W ❑ W ❑ W ❑ W ❑ W ❑ W ❑ W ❑ W ❑ W ❑ W ❑ W U" N co V (n (D t-- aoO N M r (n O ti W Z. O F H o 0 0 0 0 0 0 0 C. _ h: SVMSilicon Valley Mechanical 2087 Ringwood Ave. Suite 50 San Jose, CA 95131-1785 VAV DISTRIBUTION REPORT PROJECT: Apple Bubb 4 DATE: 1/6/2016 SYSTEM: AC -2 PAGE: 9 AREA ........ . . SERVED , . OVTLET i:INLEf i3ESiGN::::: E�#it .. FINAL:::::::::: :. NOTE : _ : NO. TYPE:: :. SIZE:: MIN CLG : MAX HTG : MAX CLG MAX:CLG ::MIN CLG:: :MAX:HTG MAX CLG 101 1 CD 8 DNA DNA 190 180 125 125 205 101 2 CD 8 DNA DNA 190 1 150 105 105 175 RH-14 TOTAL 230 230 380 330 230 230 380 111 1 CD 6 DNA DNA 60 65 6 16 64 110 2 CD 6 DNA DNA 60 75 5 14 55 109 3 CD 6 DNA DNA 60 110 5 16 66 108 4 CD 6 DNA DNA 60 130 5 14 58 107 5 CD 6 DNA DNA 60 75 6 15 62 106 6 CD 6 DNA DNA 60 40 6 15 61 112 7 SW 14 DNA DNA 715 790 68 190 770 112 8 SW 14 DNA DNA 715 460 58 165 655 RH-19 TOTAL 160 480 1790 1740 157 445 1791 102 1 CD 8 90 90 130 125 88 88 130 RH-20 TOTAL 90 90 130 125 88 88 130 103 1 CD 10 70 70 270 265 69 69 265 RH-21 TOTAL 70 70 270 265 69 69 265 REMARKS: SVMSilicon Valley Mechanical 2087 Ringwood Ave. Suite 50 San Jose, CA 95131-1785 VAV DISTRIBUTION REPORT PROJECT: Apple Bubb 4 DATE: 1/6/2016 SYSTEM: AC -2 PAGE: 10 At2iei... SERVE&.... OutLf i:INL'E> ....' ........ NO. ::'TYPE `: SIZE::: MIN CLG : MAXHTG: ;MAX CLG .:MAX:CLG_ : UN CLG: :MAX:WG:: MAX CLG 128 1 CD 6 DNA DNA 100 30 24 39 100 127 2 CD 6 DNA DNA 100 165 20 35 95 RH-22 TOTAL 40 70 200 195 44 74 195 126 1 CD 6 DNA DNA 110 100 20 44 100 125 2 CD 6 DNA DNA 1 100 100 22 47 100 RH-23 TOTAL 40 90 210 200 42 91 200 REMARKS: SVMSilicon Valley Mechanical 2087 Ringwood Ave. Suite 50 San Jose, CA 95131-1785 AIR APPARATUS REPORT PROJECT: Apple Bubb 4 DATE: 1/11/2016 SYSTEM: AC -3 PAGE: 11 EQUtPAAENT:DATA :: ..a :AC.3:::: .. LOCATION ROOF SERVICE IDF ROOM MANUFACTURER TRANE MODEL NUMBER YCD060 SERIAL NUMBER 154511477L .............. FAN. DATA..::::::: .. .................................................................. DESfGN..;.;., : <::TESTED:.:..: .. ................................ ................_ ..,,,......,,.. DESIGN ::::: ::.... TESTED::: TOTAL AIR CFM 1310 1565 RETURN AIR CFM DNA NM OUTSIDE AIR CFM 30 60 (1) RPM DNA HIGHSPEED ESP " W.G. DNA 2.14 DISCHARGE SP " W.G. DNA 1.23 SUCTION SP " W.G. DNA 0.91 COIL AP " W.G. DNA 0.08 FILTER AP " W.G. DNA 0.10 M( TdFt:DATA,. .;:. NAMEPLATE. ` .. TESTED::::::::::::: NAMEPLATE::::::. ..:... TESTEQ MOTOR MFG/FRAME GENTEQ/DNA HORSEPOWER 1 RPM DNA HIGHSPEED VOLTAGE/PHASE 208/3 2131212/211 AMPERAGE/SF 9.0 / DNA 8.6 / 8.7 / 8.6 NO. BELT / SIZE DIRECT DRIVE MOTOR SHEAVE x BORE DIRECT DRIVE FAN SHEAVE x BORE DIRECT DRIVE NO. FILTER / TYPE / SIZE 4/ PLEATED/ 16 x 25 x 2 REMARKS: (1) Outside air damper set to 0% open. SVMSilicon Valley Mechanical 2087 Ringwood Ave. Suite 50 San Jose, CA 95131-1785 AIR DISTRIBUTION REPORT PROJECT' Apple Bubb 4 DATE: 1/11/2016 SYSTEM: AC -3 PAGE: 12 .. .. .... .. ... .. AREA:::::: Oi�TLET I INLET... DESIGN: PRELIMINARY RELIMiNARY FINAL. NATE . NO...: ` 'LYRE : SIZE::::::: » : CFM ::::CFM :.. ::: CFM ::: CF?X ::: . SERVED ,... IDF 1 CD 16 1310 1565 AC -3 TOTAL 1310 1565 REMARKS: SVMSilicon Valley Mechanical 2087 Ringwood Ave. Suite 50 San Jose, CA 95131-1785 AIR APPARATUS REPORT PROJECT: Apple Bubb 4 DATE: 1/7/2016 SYSTEM: EF -1 & EF -2 PAGE: 13 ................ -11.1.......... . EQUIPMENTDAT.A. I . ..... I ............................................................................................ EF 4. ......... : EF -2:: ::::::: ........ .. .......... ..... ..... ................... ......... LOCATION ROOF ROOF SERVICE RESTROOMS & JANITOR BREAKROOM MANUFACTURER GREENHECK GREENHECK MODEL NUMBER G -099 -VG G -098 -VG SERIAL NUMBER 14361443 14361444 TYPE MUSHROOM MUSHROOM MOTOR MFG / FRAME VARIGREEN VARIGREEN MOTOR HP 0.25 0.25 MOTOR RPM 1725 1725 VOLTAGE/PHASE 115/1 115/1 FULL LOAD AMPS / SF 3.5 / DNA 3.5 / DNA MOTOR SHEAVE x BORE DIRECT DRIVE DIRECT DRIVE FAN SHEAVE x BORE DIRECT DRIVE DIRECT DRIVE NO. BELT / SIZE DIRECT DRIVE DIRECT DRIVE SHEAVE CL DISTANCE DIRECT DRIVE DIRECT DRIVE .......... ........ .............. ... :::::::::TEST:DATA:::::::: ............. I .. ............. ........ ... DESIGN .:: ::::'-MSTE1Y..::: ........................ ...... I ............... ....................... ...................... :::::]jES]GN::: :'::TESTED :: -..:D.ErRGN::::': :::::TESTED V:::: TOTAL CFM 835 859 200 97 MOTOR RPM 1725 1507 1725 630 FAN RPM DNA 1507 DNA 630 ESP " W.G. 0.75 0.17 0.75 0.29 DISCHARGE SP " W.G. DNA 0.05 DNA 0.05 SUCTION SP " W.G. DNA 0.12 DNA 0.24 VOLTAGE 115 119 115 119 AMPERAGE 3.5 2.0 3.5 0.2 ,PHASE 1 1 1 1 REMARKS: SVMSilicon Valley Mechanical 2087 Ringwood Ave. Suite 50 San Jose, CA 95131-1785 AIR DISTRIBUTION REPORT PROJECT: Apple Bubb 4 DATE: 1/7/2016 SYSTEM: EF -1 & EF -2 PAGE: 14 .. AREA :::SERVED:::: ...... Oi1TLET/INLET..... ................... QESiGN?%., ................... .PREL1MMAR1E: .................. PRELIMINARY ...................................... FINAL: : NOTE :::NO.::: TYRE:... . ::::. SIZE::: ;.CFM::::: .. ...»-:CFM. >« :: CFM : ::CFM: : 117 1 CEG 10 360 380 380 119 2 CEG 10 360 430 355 119 3 CEG 6 90 93 97 118 4 SE 6 25 110 27 EF -1 TOTAL 835 1013 859 100C 1 CEG 6 100 320 97 EF -2 TOTAL 100 320 97 REMARKS: STATE OF CALIFORNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 05/151 CALIFORNIA ENERGY COMMISSION 0 CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Enforcement Agency: Permit Number: Apple Bubb 4 City: Cupertino Project Address: 10101 Bubb Rd Zip Code: 95014 System Name or Identification/Tag: AC -1 System Location or Area Served: Roof Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Verify measured outside airflow reading is within t 10% of the total required outside airflow. Required for all newly installed HVAC Intent: units. Reference MECH-3C (Column H or Column 1) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH -02-A can be performed in conjunction with MCH -07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a. Start -Up Sheets or Balancing Reports). b. 2013 Building Energy Efficiency Standards Nonresidential Compliance ManuL'Nent)i.lation ms: Variable Air Systems At -A -Glance and NA 7.5.1.2 Constant Volume Systems Outdoor Air Acceptan C. 2013 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pri. Method and equipment used: Vel rid, Air Data Multimeterii. Equipment calibration date (must be within one year): 5-20-2015( �� 3. System type (check either VAV or CAV): S/ VAV ❑ CAV a. Check if Variable Air Volume (VAV) and complete the following: I. Outside airflow is either factory calibrated or field calibrated. V Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): V, 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) V Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ 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 ducted to either (check one of the following): ❑ Within five ft. of the unit. ❑ Within 15 ft. of the unit, with the air directed substantially toward the unit. V Return air plenum is NOT used to distribute outside air to the unit. Le. outside air is ducted directly to the unit or outside air is provided independent of the unit. 5. Pre -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): a. The conditioned floor area times the ventilation rate from the 2013 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is less. b• 3 complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA OUTDOOR AIR ACCEPTANCE CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: Apple Bubb 4 Project Address: 10101 Bubb Rd System Name or Identification/Tag: AC -1 GALII-UKNIA ENEKUY GUMMIJSIVN N RCA -MCH -02-A _- — (Page 2 of 3) Enforcement Agency: Permit Number: City: Zip Code: Cupertino 95014 System Location or Area Served: Roof B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing ❑ CAV VVAV Step 1: Disable demand control ventilation (if applicable) Step 2: Verify unit is not in economizer mode during test (economizer disabled). ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow 4&&, -- Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). 48 Hz b. Measured outdoor airflow reading (cfm) cfm 1302 cfm Required outdoor airflow (cfm) (from MECH-3C, Column 1, or C. Mechanical Equipment Schedules). cfm 1290 cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min 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 airflow. Record VFD speed (Hz). b. Measured outdoor airflow reading (cfm) 15 Hz 1310 cfm C. Required outdoor airflow (cfm) (from MECH-3C, Column 1, or mechanical equipment schedules). 1290 cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): 1 min Step 5: Return to initial conditions (check) ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 2 a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow (Step2b/Step2c) % 101 % b. %OAFA is within 10% of design Outside Air. (%OAFA:g 110%) Y / N Y N C. Outside air damper position stabilizes within 5 minutes (Step 2d < 5 minutes) Y N Determine Percent Outside Air at reduced supply airflow (%OAFA) for Step 3 (VAV only) a. %OAm = Measured outdoor airflow reading /Required outdoor airflow reading (Step3b/Step3c) 102 b. %OARA is within 10% of design Outside Air. (OAm 5 110%) Y N C. Outside air damper position stabilizes within 5 minutes (Step 3d < 5 minutes) MN Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and controls to avoid over ventilation. 2) VAV air handlers use dynamic D. Evaluation PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive (Y - yes) CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A Revised 05115 CALIFORNIA ENERGY COMMISSION -94EPr— CERTIFICATE OF ACCEPTANCE N RCA -MCH -02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Apple Bubb 4 Enforcement Agency: Permit Number: _ Project Address: City: Zip Code: 10101 Bubb Rd Cupertino 95014 System Name or Identification/Tag: System Location or Area Served: AC -1 Roof DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Scott McClung Documentation Author Signature: Documentation Author Company Name: Silicon Valley Mechanical Date Signed: 1-11-2016 Address: 2115 Ringwood Ave ATT Certification Identification (If applicable): BB1093975TMT City/state/Zip: San Jose, CA 95131 Phone. 408.943.0380 FIELD TECHNICIAN'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 Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. 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. 4. 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: Scott McClung Field Technician Signature: Field Technician Company Name: Silicon Valley Mechanical Position with Company (Title): SVM /TAB Superisor Address: 2115 Ringwood Ave ATT Certification Identification (if applicable): BB1093975TMT City/State/Zip: San Jose, CA 95131 Phone. 408.943.0380 Date Signed: 1-11-2016 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 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. 2. 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). 3. 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. 4. 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. 5. 1 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 Person Name: Scott McClung Responsible Acceptance Person Signature: - Responsible Acceptance Person Company Name: Silicon Valley Mechanical Position with Company (Title): SVM /TAB Supervisor Address: 2115 Ringwood Ave CSLB License` 992731 City/State/Zip: San Jose, CA 95131 Phone: 408.943.0380 Date Signed: 1-11-2016 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA OUTDOOR AIR ACCEPTANCE CFC-NRCA-MCH-02-A (Revised 05/151 CALIFORNIA ENERGY COMMISSION 0 CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Enforcement Agency: Permit Number: Apple Bubb 4 Project Address: 10101 Bubb Rd City: Cupertino Zip Code: 95014 System Name or Identification/Tag: AC -2 System Location or Area Served: Roof 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 t 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MECH-3C (Column H or Column 1) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH -02-A can be performed in conjunction with MCH -07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a. Start -Up Sheets or Balancing Reports). b. 2013 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2013 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). L Method and equipment used: Velgrid, Air Data Multimeter ii. Equipment calibration date (must be within one year).. 5-20-2015 3. System type (check either VAV or CAV): V 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): V, 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) S/ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ 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 ducted to either (check one of the following): ❑ Within five ft. of the unit. ❑ Within 15 ft. of the unit, with the air directed substantially toward the unit. V Return air plenum is NOT used to distribute outside air to the unit. Le. outside air is ducted directly to the unit or outside air is provided independent of the unit. S. Pre -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): a. The conditioned floor area times the ventilation rate from the 2013 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is less. b• 3 complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA OUTDOOR AIR ACCEPTANCE CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Enforcement Agency: Permit Number: Apple Bubb 4 Project Address: City: Zip Code: 10101 Bubb Rd Cupertino 95014 System Name or Identification/Tag: System Location or Area Served: AC -2 Roof B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing ❑ CAV VVAV Step 1: Disable demand control ventilation (if applicable) Step 2: Verify unit is not in economizer mode during test (economizer disabled). ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). E 4 Hz b. Measured outdoor airflow reading (cfm) cfm 1703 cfm Required outdoor airflow (cfm) (from MECH-3C, Column 1, or C. Mechanical Equipment Schedules). cfm 1570 cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): 1 min Step 4: VAV testing at reduced supply airflow 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). C. Required outdoor airflow (cfm) (from MECH-3C, Column 1, or mechanical equipment schedules).OCAV b. Measured outdoor airflow reading (cfm) 1 5 Hz 1645 cfm 1570 cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): 1 min Step 5: Return to initial conditions (check) ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 2 a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow (Step2b/Step2c) % 108 % b. %OAFA is within 10% of design Outside Air. (%OAFA 5110%) Y / N Y N C. Outside air damper position stabilizes within 5 minutes (Step 2d < 5 minutes) Y N Determine Percent Outside Air at reduced supply airflow (%OARAA) for Step 3 (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading (Step3b/Step3c) 104 % b. %OARA is within 10% of design Outside Air. (OARA 5110%) r7 In N C. Outside air damper position stabilizes within 5 minutes (Step 3d < 5 minutes) M N Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and controls to avoid over ventilation. 2) VAV air handlers use dynamic D. Evaluation PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive (Y - yes) CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STAT F OF CALWORNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A Revised 05/15 _ CALIFORNIA ENERGY COMMISSION T CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Apple Bubb 4 Enforcement Agency: Permit Number: Project Address: City: Zip Code: 10101 Bubb Rd Cupertino 95014 System Name or Identification/Tag: System Location or Area Served: AC -2 Roof DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Scott McClung Documentation Author Signature: Documentation Author Company Name: Silicon Valley Mechanical Date Signed: 1-11-2016 Address: 2115 Ringwood Ave ATT Certification Identification (If applicable): BB1093975TMT City/State/Zip: San Jose, CA 95131 Phone: 408.943.0380 FIELD TECHNICIAN'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 Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. 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. 4. 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: Scott McClung Field Technician Signature: Field Technician Company Name: Silicon Valley Mechanical Position with Company (Title): SVM / TAB Supervisor Address: 2115 Ringwood Ave ATT Certification Identification (if applicable): BB 1093975TMT City/State/zip: San Jose, CA 95131 Phone: 408.943.0380 Date Signed: 1-11-2016 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 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. 2. 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). 3. 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. 4. 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. 5. 1 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 Person Name: Scott McClung Responsible Acceptance Person Signature: ;5 Responsible Acceptance Person Company Name: Silicon Valley Mechanical Position with Company (Title): SVM /TAB Supervisor Address: 2115 Ringwood Ave CSLB License: 992731 City/State/Zip: Phone: Date Signed: San Jose, CA 95131 408.943.0380 1-11-2016 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA OUTDOOR AIR ACCEPTANCE w1) CEC-NRCA-MCH-02-A Revised 05/15 GALIYVKNIA tNtKUY GVMMItJIVN CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Enforcement Agency: Permit Number: Apple Bubb 4 Project Address: City: Zip Code: 10101 Bubb Rd Cupertino 95014 System Name or Identification/Tag: System Location or Area Served: AC -3 Roof Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: I Verify measured outside airflow reading is within ± 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MECH-3C (Column H or Column I) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH -02-A can be performed in conjunction with MCH -07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2013 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2013 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). i. Method and equipment used: Velgrid, Air Data Multimeter ii. Equipment calibration date (must be within one year): 5-20-2015 3. System type (check either VAV or CAV): ❑ VAV V CAV a. Check if Variable Air Volume (VAV) and complete the following: i. Outside airflow is either factory calibrated or field calibrated. 0 Check if factory calibrated and attach calibration certification. 0 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) ❑ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: 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 the following): ❑ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to either (check one of the following): ❑ Within five ft. of the unit. ❑ Within 15 ft. of the unit, with the air directed substantially toward the unit. V Return air plenum is NOT used to distribute outside air to the unit. Le. outside air is ducted directly to the unit or outside air is provided independent of the unit. 5. Pre -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): a. The conditioned floor area times the ventilation rate from the 2013 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is less. b• 3 complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 05/15) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: ADDIe Bubb 4 10101 Bubb Rd System Name or Identification/Tag: AC -3 City: Cupertino System Location or Area Served: Roof N RCA -MCH -02-A (Page 2 of 3) Permit Number: Zip 95014 B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing VCAV ❑ VAV Step 1: Disable demand control ventilation (if applicable) Step 2: Verify unit is not in economizer mode during test (economizer disabled). ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Hz Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). b. Measured outdoor airflow reading (cfm) 60 cfm cfm Required outdoor airflow (cfm) (from MECH-3C, Column 1, or C. Mechanical Equipment Schedules). 30 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): _ min 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 airflow. Record VFD speed (Hz). b. Measured outdoor airflow reading (cfm) Hz cfm C. Required outdoor airflow (cfm) (from MECH-3C, Column 1, or mechanical equipment schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 2 a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow (Step2b/Step2c) 200 % % b. %OAFA is within 10% of design Outside Air. (%OAFA15 110%) Y N Y / N C. Outside air damper position stabilizes within 5 minutes (Step 2d < 5 minutes) Y / N Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 3 (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading (Step3b/Step3c) % b. %OARA is within 10% of design Outside Air. (OAm S 110%) Y / N C. Outside air damper position stabilizes within 5 minutes (Step 3d < 5 minutes) Y / N Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and controls to avoid over ventilation. 2) VAV air handlers use dynamic D. Evaluation PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive (Y - yes) Damper is 100% closed there is leakage within the dampers that cannot be helped. CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA OUTDOOR AIR ACCEPTANCE cFc_niRcn_nncum_n Ro"I�o� nsns CAI IFORNIA ENERGY COMMISSION 'e CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Apple Bubb 4 Enforcement Agency: Permit Number: Project Address: 10101 Bubb Rd City: Cupertino Zip Code: 95014 System Name or Identification/Tag: AC -3 System Location or Area Served: Roof DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Scott McClung Documentation Author Signature: Documentation Author Company Name: Silicon Valley Mechanical Date signed: 1-11-2016 Address: 2115 Ringwood Ave ATT Certification Identification (If applicable): B61093975TMT city/State/zip: San Jose, CA 95131 Phone. 408.943.0380 FIELD TECHNICIAN'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 Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. 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. 4. 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: Scott McClung Field Technician Signature: Field Technician Company Name: Silicon Valley Mechanical Position with Company (Title): SVM /TAB Supery sor Address: 2115 Ringwood Ave ATT Certification Identification (if applicable): 13131093975TMT City/State/Zip: San Jose, CA 95131 Phone. 408.943.0380 Date Signed. 1-11-2016 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 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. 2. 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). 3. 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. 4. 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. 5. 1 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 Person Name: Scott McClung Responsible Acceptance Person Signature: �- Responsible Acceptance Person Company Name: Silicon Valley Mechanical Position with Company (Title): SVM /TAB Supervisor Address: 2115 Ringwood Ave CSLB License: 992731 City/State/Zip: San Jose, CA 95131 Phone: 408.943.0380 Date Signed: 1-11-2016 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALII-ORNIA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS ' CFC-NRCA-MCH-03-A (Revised 05/151 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 1 of 4) Project Name: Apple Bubb 4 Enforcement Agency: Permit Number: Project Address: 10101 Bubb Rd City: Cupertino Zip Code: 95014 System Name or Identificationfrag: AC -3 System Location or Area Served: Roof 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 Manual (NA7.5.2 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: a. Temperature Meter b. Amp Meter 3. Installation (check if applies): V Thermostat is located within the space -conditioning zone that is served by the HVAC system. 4. Programming (check all those that apply): I/ Thermostat meets the temperature adjustment and dead band requirements of 2013 Building Energy Efficiency Standards Manual section 120.2(b). Minimum heating setpoint: 68 OF. Maximum cooling setpoint 72 OF. Deadband: 4 OF. S/ 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 -occupancy purge: ❑ Lesser of: conditioned floor area times ventilation rate from 2013 Building Energy Efficiency Standards TABLE 120.1-A or 15cfm per person times the expected number of occupants. 7� 3 complete air changes. Notes: CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CF('-NRCA-MCH-03-A (Revised 05/151 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 1 of 4) Project Name: Apple Bubb 4 Enforcement Agency: Permit Number: Project Address: 10101 Bubb Rd City: Cupertino Zip Code: 95014 System Name or Identification/Tag: AC -3 System Location or Area Served: Roof B. Functional Testing Requirements I 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 3 2 Step 2 — 8: Check and verify the following for each simulation mode required a. Supply fan operates continually P b. Supply fan turns off P C. Supply fan cycles on and off P d. System reverts to "occupied" mode to satisfy any condition P e. System turns off when manual override time period expires P f. Gas-fired furnace, heat pump, or electric heater stages on fir, g. No heating is provided by the unit P P P P h. No cooling is provided by the unit IX P P X i. Compressor stages on P P j. Outside air damper is open to minimum position P P 2 P X k. Outside air damper closes completely X P Step 9: System returned to initial operating conditions after all tests have been completed: Y / N C. Testing Results 8 7 6 S 4 3 2 Indicate if Passed (P), Failed (F), or N/A (X), fill in appropriate letter P P x P P P x 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 May 2015 STATE OF CALIFORNIA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS 10 CEC_NRnn_nncu_03_A rRe-ise l 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 1 of 4) Project Name: Apple Bubb 4 Enforcement Agency: Permit Number: Project Address: 10101 Bubb Rd City: Cupertino Zip Code: 95014 System Name or Identification/Tag: AC -3 System Location or Area Served: Roof DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Scott McClung Documentation Author Signature: Documentation Author Company Name: Silicon Valley Mechanical Date Signed: 1-11-2016 Address: 2115 Ringwood Ave ATT Certification Identification (If applicable) : BB1093975TMT clty/state/zip: San Jose, CA 95131 Phone: 408.943.0380 FIELD TECHNICIAN'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 Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. 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. 4. 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: Scott McClung Field Technician Signature: Field Technician Company Name: Silicon Valley Mechanical Position with Company (Title): SVM / TAB Supervisor Address` 2115 Ringwood Ave ATT Certification Identification (if applicable): BB1093975TMT City/State/Zip: San Jose, CA 95131 Phone: 408.943.0380 Date Signed: 1-11-2016 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 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. 2. 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). 3. 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. 4. 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. 5. 1 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 Person Name: Scott McClung Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Silicon Valley Mechanical Position with Company (Title): SVM /TAB Supervisor Address: 2115 Ringwood Ave CSLB License: 992731 City/State/Zip: San Jose, CA 95131 Phone: 408.943.0380 Date Signed' 1-11-2016 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA AIR ECONOMIZER CONTROLS ACCEPTANCE CEC-NRCA-MCH-05-A Revised 05/15 CALIFORNIA ENERGY COMMISSION 0 CERTIFICATE OF ACCEPTANCE NRCA-MCH-05-A Air Economizer Controls Acceptance (Page 1 of 3) Project Name: Enforcement Agency: Permit Number: Apple Bubb 4 Project Address: 10101 Bubb Rd City: Cupertino Zip Code: 95014 System Name or Identification/Tag: System Location or Area Served: AC -1 Roof 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: a. 2013 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.4 Air Economizer Controls Acceptance At -A - Glance). b. 2013 Building Energy Efficiency Standards. 2. Instrumentation to perform test includes: a. Hand-held temperature probe Calibration Date: 5-20-2015 (must be within last year) b. Device capable of calculating enthalpy Calibration Date: 5-20-2015 (must be within last year) c. 1.2 k Ohm Resistor ( when specified by the manufacturer) 3. Installation: (all of the following boxes should be checked) Economizer high limit shutoff control complies with Table 140.4-13 found in the 2013 Building Energy Efficiency Standards Section 140.4(e)3. Economizer reliability features are present per 2013 Building Energy Efficiency Standards Section 140.4(e)4: a. 5 -year manufacturer warranty of economizer assembly b. Provide a product specification sheet proving capability of at least 60,000 actuations c. Provide a product specification sheet proving compliance with AMCA Standard 500 damper leakage at 10 cfm/sf at 1.0 in w.g. A product specification sheet showing the manufacturer's results after following the testing procedures of AMCA Standard 500 or AMCA certification by a third party under AMCA Publication 511 can be used to satisfy this requirement (Class 1A, 1, and 2 are acceptable). d. If the high limit setpoint is fixed dry-bulb or fixed enthalpy + fixed dry-bulb then the control shall have an adjustable setpoint e. Outdoor air, return air, mixed air, and supply air sensors shall be calibrated as follows: i. Drybulb and wetbulb temperatures accurate to ±2°F over the range of 40°F to 80°F ii. Enthalpy accurate to ±3 Btu/Ib over the range of 20 Btu/Ib to 36 Btu/Ib iii. Relative humidity (RH) accurate to ±5% over the range of 20% to 80% RH f. Check that the sensor performance curve(s) is provided by the factory and sensor output values measured during sensor calibration are plotted on the performance curve(s) g. Sensors used for high limit control shall be located to prevent false readings, including but not limited to being properly shielded from direct sunlight. V Unitary systems with an economizer have control systems, including two-stage or electronic thermostats, that cycle compressors off when economizers can provide partial cooling V System has return fan speed control, relief dampers, or dedicated relief fans to prevent building over pressurization in full economizer mode. V For systems with DDC controls, sensor used for economizer lockout has been factory or field calibrated. V For systems with non -DDC controls, manufacturer's startup and testing procedures have been applied. CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA AIR ECONOMIZER CONTROLS ACCEPTANCE rcr_r.iore_nnrusG_a ioe.,i�e.a nGij CAI IFORNIA FNFRr;Y COMMISSI(NJ 10 CERTIFICATE OF ACCEPTANCE NRCA-MCH-05-A Air Economizer Controls Acceptance (Page 2 of 3) Project Name: Enforcement Agency: Permit Number: Apple Bubb 4 ON C. For systems that meet the criteria of 2013 Building Energy Efficiency Standards Section 140.4(e)1, verify that the economizer remains 100% open with the use of mechanical cooling. This occurs when the cooling demand can no longer be met by the economizer alone. Protea Address: _ City: Zip Code: 10101 Bubb Rd Cupertino 95014 System Name or Identification/Tag: System Location or Area Served: AC -1 Roof B. Functional Testing Results Step 1: Disable demand control ventilation systems (if applicable) Step 2: Enable the economizer and simulate a cooling demand large enough to drive the economizer fully open. Verify the following: a• Economizer damper modulates 100% open. Y N b. Return air damper modulates 100% closed. ON C. For systems that meet the criteria of 2013 Building Energy Efficiency Standards Section 140.4(e)1, verify that the economizer remains 100% open with the use of mechanical cooling. This occurs when the cooling demand can no longer be met by the economizer alone. OY N d• All applicable fans and dampers operate as intended to maintain building pressure. Y N e• The unit heating is disabled (if applicable). Y / N / A Step 3: Disable the economizer and simulate a cooling demand. Verify the following: a• Economizer damper closes to its minimum position. ON b. All applicable fans and dampers operate as intended to maintain building pressure. Y N C. The unit heating is disabled (if applicable). Y / N / A Step 4: If the unit is equipped with heating, simulate a heating demand and enable the economizer. Verify the following: a• Economizer damper closes to its minimum position. Y / N fa b. Return air damper opens. I Y / N / A Step 5: Turn off the unit and verify the following: a. Economizer damper closes completely. Lj N Step 6: System returned to initial operating conditions Y N C. Testing Results PASS / FAIL Step 2: Simulate cooling load and enable the economizer (all answers are Y). PASS Step 3: Simulate cooling load and disable the economizer (all answers are Y). PASS Step 4: Simulate heating demand and enable the economizer (all answers are Y). PASS Step 5: Turn off the unit (all answers are Y). PASS D. Evaluation PASS: All Construction Inspection responses are complete and all Testing Results responses are "Pass" Notes: CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STAT F OF CALFORNIA AIR ECONOMIZER CONTROLS ACCEPTANCE CFC-NRCA-MCH-05-A IReviseti 05/151 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-05-A Air Economizer Controls Acceptance (Page 3 of 3) Project Name: Apple Bubb 4 Enforcement Agency: Permit Number: Project Address: 10101 Bubb Rd City: Cupertino Zip Code: 95014 System Name or Identification/Tag: AC -1 System Location or Area Served: Roof DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: SCOtt McClung Documentation Author Signature: Documentation Author Company Name: Silicon Valley Mechanical Date signed: 1-11-2016 Address. 2115 Ringwood Ave ATT Certification Identification (If applicable). BB1093975TMT Phone. 408.943.0380 City/State/Zip: San Jose, CA 95131 FIELD TECHNICIAN'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 Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. 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. 4. 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: Scoff McClung Field Technician Signature: Field Technician Company Name: Silicon Valley Mechanical Position with Company (Title): SVM / TAB Supervisor Address: 2115 Ringwood Ave ATT Certification Identification (if applicable): BB1093975TMT City/State/Zip: San Jose, CA 95131 Phone: 408.943.0380 Date Signed: 1-11-2016 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 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. 2. 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). 3. 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. 4. 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. 5. 1 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 Person Name: Scott McClung Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Silicon Valley Mechanical Position with Company (Title): SVM /TAB Supervisor Address: 2115 Ringwood Ave CSLB License: 992731 City/State/Zip: San Jose, CA 95131 Phone: 408.943.0380 Date Signed: 1-11-2016 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STAN E OF CALIFORNIA AIR ECONOMIZER CONTROLS ACCEPTANCE (:FC`-NR('.A-M(:H-05-A (Revised 05/151 CALIFORNIA ENERGY COMMISSION le CERTIFICATE OF ACCEPTANCE NRCA-MCH-05-A Air Economizer Controls Acceptance (Page 1 of 3) Project Name: Enforcement Agency: Permit Number: Apple Bubb 4 Project Address: 10101 Bubb Rd City: Cupertino Zip Code: 95014 System Name or Identification/Tag: AC -2 System Location or Area Served: Roof Note: Submit one Certificate of Acceptance for each system that must Enforcement Agency Use: Checked by/Date demonstrate compliance. A. Construction Ins 1. Supporting documentation needed to perform test includes: a. 2013 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.4 Air Economizer Controls Acceptance At -A - Glance). b. 2013 Building Energy Efficiency Standards. 2. Instrumentation to perform test includes: a. Hand-held temperature probe Calibration Date: 5-20-2015 (must be within last year) b. Device capable of calculating enthalpy Calibration Date: 5-20-2015 (must be within last year) c. 1.2 k Ohm Resistor ( when specified by the manufacturer) 3. Installation: (all of the following boxes should be checked) Economizer high limit shutoff control complies with Table 140.4-B found in the 2013 Building Energy Efficiency Standards Section 140.4(e)3. !� Economizer reliability features are present per 2013 Building Energy Efficiency Standards Section 140.4(e)4: a. 5 -year manufacturer warranty of economizer assembly b. Provide a product specification sheet proving capability of at least 60,000 actuations c. Provide a product specification sheet proving compliance with AMCA Standard 500 damper leakage at 10 cfm/sf at 1.0 in w.g. A product specification sheet showing the manufacturer's results after following the testing procedures of AMCA Standard 500 or AMCA certification by a third party under AMCA Publication 511 can be used to satisfy this requirement (Class 1A, 1, and 2 are acceptable). d. If the high limit setpoint is fixed dry-bulb or fixed enthalpy + fixed dry-bulb then the control shall have an adjustable setpoint e. Outdoor air, return air, mixed air, and supply air sensors shall be calibrated as follows: L Drybulb and wetbulb temperatures accurate to ±2"F over the range of 40°F to 80'F ii. Enthalpy accurate to ±3 Btu/Ib over the range of 20 Btu/Ib to 36 Btu/Ib iii. Relative humidity (RH) accurate to ±5% over the range of 20% to 80% RH f. Check that the sensor performance curve(s) is provided by the factory and sensor output values measured during sensor calibration are plotted on the performance curve(s) g. Sensors used for high limit control shall be located to prevent false readings, including but not limited to being properly shielded from direct sunlight. V Unitary systems with an economizer have control systems, including two-stage or electronic thermostats, that cycle compressors off when economizers can provide partial cooling V System has return fan speed control, relief dampers, or dedicated relief fans to prevent building over pressurization in full economizer mode. For systems with DDC controls, sensor used for economizer lockout has been factory or field calibrated. V For systems with non -DDC controls, manufacturer's startup and testing procedures have been applied. CA Building Energy Efficiency Standards- 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA AIR ECONOMIZER CONTROLS ACCEPTANCE CFC-NRCA-MCH-05-A (Revised 05/15) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-05-A Air Economizer Controls Acceptance (Page 2 of 3) Project Name: Apple Bubb 4 Enforcement Agency: Permit Number: Project Address: 10101 Bubb Rd City: Cupertino Zip Code: 95014 System Name or Identification/Tag: AC -2 System Location or Area Served: Roof B. Functional Testing Results Step 1: Disable demand control ventilation systems (if applicable) Step 2: Enable the economizer and simulate a cooling demand large enough to drive the economizer fully open. Verify the following: a. Economizer damper modulates 100% open. Y N b. Return air damper modulates 100% closed. Y N C. For systems that meet the criteria of 2013 Building Energy Efficiency Standards Section 140.4(e)1, verify that the economizer remains 100% open with the use of mechanical cooling. This occurs when the cooling demand can no longer be met by the economizer alone. OY N d• All applicable fans and dampers operate as intended to maintain building pressure. Y N e• The unit heating is disabled (if applicable). Y / N / A Step 3: Disable the economizer and simulate a cooling demand. Verify the following: a. Economizer damper closes to its minimum position. ON b. All applicable fans and dampers operate as intended to maintain building pressure. M N C. The unit heating is disabled (if applicable). Y / N / A Step 4: If the unit is equipped with heating, simulate a heating demand and enable the economizer. Verify the following: a. Economizer damper closes to its minimum position. I Y / N / A b. Return air damper opens. Y / N / A Step 5: Turn off the unit and verify the following: a. Economizer damper closes completely. I Y N Step 6: System returned to initial operating conditions I Y N C. Testing Results PASS / FAIL Step 2: Simulate cooling load and enable the economizer (all answers are Y). PASS Step 3: Simulate cooling load and disable the economizer (all answers are Y). PASS Step 4: Simulate heating demand and enable the economizer (all answers are Y). PASS Step 5: Turn off the unit (all answers are Y). PASS D. Evaluation V PASS: All Construction Inspection responses are complete and all Testing Results responses are "Pass" Notes: CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA AIR ECONOMIZER CONTROLS ACCEPTANCE r..Fr:-NRCA-Mr.H-01;-A tR—i—i n5F1F1 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-05-A Air Economizer Controls Acceptance (Page 3 of 3) Project Name: Enforcement Agency: Permit Number: Apple Bubb 4 Address: 2115 Ringwood Ave ATT Certification Identification (If applicable): 661093975TMT Project Address: City: Zip Code: 10101 Bubb Rd Cupertino 95014 System Name or Identification/Tag: System Location or Area Served: AC -2 Roof DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: SCOtt McClung Documentation Author Signature: �GB Documentation Author Company Name: Silicon Valley Mechanical Date Signed: 1-11-2016 Address: 2115 Ringwood Ave ATT Certification Identification (If applicable): 661093975TMT City/state/zip: San Jose, CA 95131 Phone: 408.943.0380 FIELD TECHNICIAN'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 Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. 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. 4. 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: SCOtt McClung Field Technician signature: Field Technician Company Name: Silicon Valley Mechanical Position with Company (Title): SVM / TAB Supervisor Address. 2115 Ringwood Ave ATT Certification Identification (if applicable): BB1093975TMT City/State/zip: San Jose, CA 95131 Phone. 408.943.0380 Date Signed: 1-11-2016 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 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. 2. 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). 3. 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. 4. 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. 5. 1 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 Person Name: Scott McClung Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Silicon Valley Mechanical Position with Company (Title): SVM /TAB Supervisor _ Address: 2115 Ringwood Ave CSLB License: 992731 City/State/Zip: San Jose, CA 95131 Phone: 408.943.0380 Date Signed: 1-11-2016 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA AIR ECONOMIZER CONTROLS ACCEPTANCE rI r_nRrn_nnrus5_n 1pe..ori ()111R! CALIFORNIA ENERGY COMMISSION 0 ------------------------------- CERTIFICATE OF ACCEPTANCE NRCA-MCH-05-A Air Economizer Controls Acceptance (Page 1 of 3) Project Name: Enforcement Agency: Permit Number: Apple Bubb 4 Project Address: 10101 Bubb Rd City: Cupertino Zip Code: 95014 System Name or Identification/Tag: System Location or Area Served: AC -3 Roof 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: a. 2013 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.4 Air Economizer Controls Acceptance At -A - Glance). b. 2013 Building Energy Efficiency Standards. 2. Instrumentation to perform test includes: a. Hand-held temperature probe Calibration Date: 5-20-2015 (must be within last year) b. Device capable of calculating enthalpy Calibration Date: 5-20-2015 (must be within last year) c. 1.2 k Ohm Resistor ( when specified by the manufacturer) 3. Installation: (all of the following boxes should be checked) Economizer high limit shutoff control complies with Table 140.4-B found in the 2013 Building Energy Efficiency Standards Section 140.4(e)3. V Economizer reliability features are present per 2013 Building Energy Efficiency Standards Section 140.4(e)4: a. 5 -year manufacturer warranty of economizer assembly b. Provide a product specification sheet proving capability of at least 60,000 actuations c. Provide a product specification sheet proving compliance with AMCA Standard 500 damper leakage at 10 cfm/sf at 1.0 in w.g. A product specification sheet showing the manufacturer's results after following the testing procedures of AMCA Standard 500 or AMCA certification by a third party under AMCA Publication 511 can be used to satisfy this requirement (Class 1A, 1, and 2 are acceptable). d. If the high limit setpoint is fixed dry-bulb or fixed enthalpy + fixed dry-bulb then the control shall have an adjustable setpoint e. Outdoor air, return air, mixed air, and supply air sensors shall be calibrated as follows: I. Drybulb and wetbulb temperatures accurate to ±2°F over the range of 40"F to 80°F ii. Enthalpy accurate to ±3 Btu/Ib over the range of 20 Btu/Ib to 36 Btu/Ib iii. Relative humidity (RH) accurate to ±5% over the range of 20% to 80% RH f. Check that the sensor performance curve(s) is provided by the factory and sensor output values measured during sensor calibration are plotted on the performance curve(s) g. Sensors used for high limit control shall be located to prevent false readings, including but not limited to being properly shielded from direct sunlight. V Unitary systems with an economizer have control systems, including two-stage or electronic thermostats, that cycle compressors off when economizers can provide partial cooling V System has return fan speed control, relief dampers, or dedicated relief fans to prevent building over pressurization in full economizer mode. I/ For systems with DDC controls, sensor used for economizer lockout has been factory or field calibrated. V For systems with non -DDC controls, manufacturer's startup and testing procedures have been applied. CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA AIR ECONOMIZER CONTROLS ACCEPTANCE CERTIFICATE OF ACCEPTANCE Air Economizer Controls Acceptance Project Name: Apple Bubb 4 Project Address: 10101 Bubb Rd System Name or Identification/Tag: AC -3 Enforcement Agency: System Location or Area Served: Roof CALIFORNIA ENERGY COMMISSION T N RCA -MCH -05-A (Page 2 of 3) Permit Number: Zip Code: 95014 B. Functional Testing Results Step 1: Disable demand control ventilation systems (if applicable) Step 2: Enable the economizer and simulate a cooling demand large enough to drive the economizer fully open. Verify the following: a• Economizer damper modulates 100% open. Y N b. Return air damper modulates 100% closed. ON C. For systems that meet the criteria of 2013 Building Energy Efficiency Standards Section 140.4(e)1, verify that the economizer remains 100% open with the use of mechanical cooling. This occurs when the cooling demand can no longer be met by the economizer alone. 0 d• All applicable fans and dampers operate as intended to maintain building pressure. Y N e. The unit heating is disabled (if applicable). Y / N /IqA Step 3: Disable the economizer and simulate a cooling demand. Verify the following: a• Economizer damper closes to its minimum position. Y N b. All applicable fans and dampers operate as intended to maintain building pressure. Y N C. The unit heating is disabled (if applicable). Y / N / A Step 4: If the unit is equipped with heating, simulate a heating demand and enable the economizer. Verify the following: a• Economizer damper closes to its minimum position. I Y / N / A b. Return air damper opens. Y / N / A Step 5: Turn off the unit and verify the following: a. Economizer damper closes completely. f—Yn N Step 6: System returned to initial operating conditions Y N C. Testing Results PASS / FAIL Step 2: Simulate cooling load and enable the economizer (all answers are Y). PASS Step 3: Simulate cooling load and disable the economizer (all answers are Y). PASS Step 4: Simulate heating demand and enable the economizer (all answers are Y). PASS Step 5: Turn off the unit (all answers are Y). PASS L. Evaluation PASS: All Construction Inspection responses are complete and all Testing Results responses are "Pass" Notes: CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STA I E OF CALIFORNIA AIR ECONOMIZER CONTROLS ACCEPTANCE CERTIFICATE OF ACCEPTANCE Air Economizer Controls Acceptance Project Name: ADDle Bubb 4 10101 Bubb Rd System Name or Identificationfrag: AC -3 coMMISS N RCA -MCH -05-A (Page 3 of 3) Enforcement Agency: Permit Number: City: Lp Code: Cupertino 95014 System Location or Area Served: Roof DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: SCOft McClung Documentation Author Signature: Documentation Author Company Name: Silicon Valley Mechanical Date signed: 1-11-2016 Address. 2115 Ringwood Ave ATT Certification Identification (if applicable): BB1093975TMT City/State/Zip: San Jose, CA 95131 Phone: 408.943.0380 FIELD TECHNICIAN'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 Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. 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. 4. 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: SCOft McClung Field Technician Signature: Field Technician Company Name: Silicon Valley Mechanical Position with Company (Title): CZ SVM / TAB Supervisor Address. 2115 Ringwood Ave ATT Certification Identification (if applicable): BB1093975TMT City/State/Zip: San Jose, CA 95131 Phone: 408.943.0380 Date Signed: 1-11-2016 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 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. 2. 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). 3. 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. 4. 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. 5. 1 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 Person Name: Scott McClung Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Silicon Valley Mechanical Position with Company (Title): SVM /TAB Supervisor Address: 2115 Ringwood Ave CSLB License: 992731 City/State/Zip: San Jose, CA 95131 Phone: 408.943.0380 Date Signed: 1-11-2016 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA DEMAND CONTROL VENTILATION SYSTEMS ACCEPTANCE CEC-NRCA-MCH-06-A (Revised 05/15) CALIFORNIA ENERGY COMMISSION Is CERTIFICATE OF ACCEPTANCE NRCA-MCH-06-A Demand Control Ventilation Systems Acceptance (Page 1 of 2) Project Name: Enforcement Agency: Permit Number. Apple Bubb 4 Project Address: City: Zip Code: 10101 Bubb Rd Cupertino 95014 System Name or Identification/Tag: System Location or Area Served: AC -1 Roof Note: Submit one Certificate of Acceptance for each system that Enforcement Agency Use: Checked by/Date must demonstrate compliance. Intent: Led that systems required to employ demand Controlled ventilation (refer to §121(c)3) can vary outside ventilation flow rates ased on maintaining interior carbon dioxide (CO,) concentration setpoints A. Construction Inspection 1 Instrumentation to perform test may include, but not limited to: a. Calibrated hand-held CO2 analyzer b. Manufacturer's calibration kit c. Calibrated CO2/air mixtures 2 Installation 6i The sensor is located in the high density space between 3ft and 6 ft above the floor or at the anticipated level of the occupants' heads. 3 Documentation of all carbon dioxide control sensors includes (check one of the following): a. Calibration method V Factory -calibration (certificate calibration cert must be attached) 0 Field calibrated b. Sensor accuracy N/ Certified by manufacturer to be no more than +/- 75 ppm calibration cert must be attached B. Functional Testing Results a. Disable economizer controls b. Outside air CO2 concentration (measured dynamically using CO2 sensor) 620 ppm c. Interior CO2 concentration setpoint (Outside CO2 concentration + 600 ppm) 1220 ppm Step 1: Simulate a signal at or slightly above the CO2 setpoint or follow manufacturers recommended testing procedures. ❑ For single zone units, outdoor air damper modulates opens to satisfy the total ventilation air called for in the Certificate of Compliance. I/ For multiple zone units, either outdoor air damper or zone damper modulate open to satisfy the zone ventilation requirements. Step 2: Simulate signal well below the CO2 setpoint or follow manufacturers recommended procedures. ❑ For single zone units, outdoor air damper modulates to the design minimum value. E/ For multiple zone units, either outdoor air damper or zone damper modulate to satisfy the reduced zone ventilation requirements. Step 3: System returned to initial operating conditions I Y / N C. Testing Results PASS / FAIL I/ Step 1: Simulate a high CO2 load (check box complete) PASS I( Step 2: Simulate a low CO2 load (check box complete) PASS D. Evaluation PASS: All Construction Inspection responses are complete and all Testing Results responses are "Pass" CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA DEMAND CONTROL VENTILATION SYSTEMS ACCEPTANCE rGr_niprn_nnru-na-a rP—i—H nrmr) CAI IFORNIA FNERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-06-A Demand Control Ventilation Systems Acceptance (Page 2 of 2) Project Name: Apple Bubb 4 Enforcement Agency: _ Permit Number: Project Address: 10101 Bubb Rd City: Cupertino Zip Code: 95014 System Name or Identification/Tag: AC -1 System Location or Area Served: Roof DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Scott McClung Documentation Author Signature: Documentation Author Company Name: Silicon Valley Mechanical Date Signed: 1-11-2016 Address. 2115 Ringwood Ave ATT Certification Identification (If applicable): BB1093975TMT City/State/Zip: San Jose, CA 95131 Phone: 408.943.0380 FIELD TECHNICIAN'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 Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. 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. 4. 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: Scott McClung Field Technician Signature: �CeZL` Field Technician Company Name: Silicon Valley Mechanical Position with Company (Title): SVM / TAB Supervisor Address: 2115 Ringwood Ave ATT Certification Identification (if applicable) : BB1093975TMT City/State/zip: San Jose, CA 95131 Phone. 408.943.0380 Date signed. 1-11-2016 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 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. 2. 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). 3. 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. 4. 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. 5. 1 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 Person Name: SCOtt McClung Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Silicon Valley Mechanical Position with Company (Title): SVM /TAB Supervisor Address. 2115 Ringwood Ave CSLB License. 992731 City/State/Zip: San Jose, CA 95131 Phone: 408.943.0380 Date Signed: 1-11-2016 CA Building Energy Efficiency Standards- 2013 Nonresidential Compliance May 2015 SI ATE OF CALII-ORNIA DEMAND CONTROL VENTILATION SYSTEMS ACCEPTANCE CEC-NRCA-MCH-06-A Revised 05115 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-06-A Demand Control Ventilation Systems Acceptance (Page 1 of 2) Project Name: Enforcement Agency: Permit Number: Apple Bubb 4 Documentation of all carbon dioxide control sensors includes (check one of the following): a. Calibration method V Factory -calibration (certificate calibration cert must be attached) El Field calibrated b. Sensor accuracy Certified by manufacturer to be no more than +/- 75 ppm calibration cert must be attached Project Address: 10101 Bubb Rd City: Zip Code: Cupertino 95014 System Location or Area Served: Roof System Name or Identification/Tag: AC -2 Note: Submit one Certificate of Acceptance for each system that Enforcement Agency Use: Checked by/Date must demonstrate compliance. Intent: Verify that systems required to employ demand Controlled ventilation (refer to §121(c)3) can vary outside ventilation flow rates Lased on maintaining interior carbon dioxide fCO,) concentration setpoints A. Construction Inspection 1 Instrumentation to perform test may include, but not limited to: a. Calibrated hand-held CO2 analyzer b. Manufacturer's calibration kit c. Calibrated CO2/air mixtures 2 installation td The sensor is located in the high density space between 3ft and 6 ft above the floor or at the anticipated level of the occupants' heads. 3 Documentation of all carbon dioxide control sensors includes (check one of the following): a. Calibration method V Factory -calibration (certificate calibration cert must be attached) El Field calibrated b. Sensor accuracy Certified by manufacturer to be no more than +/- 75 ppm calibration cert must be attached B. Functional Testing Results a. Disable economizer controls b. Outside air CO2 concentration (measured dynamically using CO2 sensor) 622 ppm c. Interior CO2 concentration setpoint (Outside CO2 concentration + 600 ppm) 1222 ppm Step 1: Simulate a signal at or slightly above the CO2 setpoint or follow manufacturers recommended testing procedures. ❑ For single zone units, outdoor air damper modulates opens to satisfy the total ventilation air called for in the Certificate of Compliance. I,( For multiple zone units, either outdoor air damper or zone damper modulate open to satisfy the zone ventilation requirements. Step 2: Simulate signal well below the CO2 setpoint or follow manufacturers recommended procedures. ❑ For single zone units, outdoor air damper modulates to the design minimum value. V For multiple zone units, either outdoor air damper or zone damper modulate to satisfy the reduced zone ventilation requirements. Step 3: System returned to initial operating conditions I Y / N C. Testing Results PASS / FAIL Step 1: Simulate a high CO2 load (check box complete) PASS Step 2: Simulate a low CO2 load (check box complete) PASS D. Evaluation PASS: All Construction Inspection responses are complete and all Testing Results responses are "Pass" CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA DEMAND CONTROL VENTILATION SYSTEMS ACCEPTANCE " ('.• CEC-NRCA-MCH-06-A Revised 05/15) GALIFUKNIA ENEKUY GUMMISSIUN CERTIFICATE OF ACCEPTANCE NRCA-MCH-06-A Demand Control Ventilation Systems Acceptance (Page 2 of 2) Project Name: Enforcement Agency: Permit Number: Apple Bubb 4 Project Address: City: Zip Code: 10101 Bubb Rd Cupertino 95014 System Name or Identification/Tag: System Location or Area Served: AC -2 Roof DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: SCOtt McClung Documentation Author Signature: Documentation Author Company Name: Silicon Valley Mechanical Date Signed: 1-11-2016 Address. 2115 Ringwood Ave ATT Certification Identification (If applicable): BB 1093975TMT City/State/Zip: San Jose, CA 95131 Phone: 408.943.0380 FIELD TECHNICIAN'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 Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. 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. 4. 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: Scott McClung Field Technician Signature: r Field Technician Company Name: Silicon Valley Mechanical Position with Company (Title): SVM / TAB Supervisor Address: 2115 Ringwood Ave ATT Certification Identification (If applicable): BB1093975TMT City/state/zip: San Jose, CA 95131 Phone. 408.943.0380 Date Signed: 1-11-2016 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 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. 2. 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). 3. 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. 4. 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. S. 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 Person Name: SCOtt McClung Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Silicon Valley Mechanical Position with Company (Title): SVM /TAB Supervisor Address: 2115 Ringwood Ave CSLEI License: 992731 City/State/Zip: San Jose, CA 95131 Phone. 408.943.0380 Date signed: 1-11-2016 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE 01 CALIFORNIA DEMAND CONTROL VENTILATION SYSTEMS ACCEPTANCE CFC-NRCA-MCH-06-A (Revised 05/151 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-06-A Demand Control Ventilation Systems Acceptance (Page 1 of 2) Project Name: Enforcement Agency: Permit Number: Apple Bubb 4 Documentation of all carbon dioxide control sensors includes (check one of the following): a. Calibration method Factory -calibration (certificate calibration cert must be attached) Field calibrated b. Sensor accuracy N/ Certified by manufacturer to be no more than +/- 75 ppm calibration cert must be attached Project Address: 10101 Bubb Rd City: Cupertino Zip Code: 95014 System Name or Identification/Tag: AC -3 System Location or Area Served: Roof Note: Submit one Certificate of Acceptance for each system that Enforcement Agency Use: Checked by/Date must demonstrate compliance. Verify that systems required to employ demand Controlled ventilation (refer to §121(c)3) can vary outside ventilation flow rates Intent: used on maintainina interior carbon dioxide (COQ) concentration setpoints A. Construction Inspection 1 Instrumentation to perform test may include, but not limited to: a. Calibrated hand-held CO2 analyzer b. Manufacturer's calibration kit c. Calibrated CO2/air mixtures 2 Installation The sensor is located in the high density space between 3ft and 6 ft above the floor or at the anticipated level of the occupants' heads. 3 Documentation of all carbon dioxide control sensors includes (check one of the following): a. Calibration method Factory -calibration (certificate calibration cert must be attached) Field calibrated b. Sensor accuracy N/ Certified by manufacturer to be no more than +/- 75 ppm calibration cert must be attached B. Functional Testing Results a. Disable economizer controls b. Outside air CO2 concentration (measured dynamically using CO2 sensor) 618 ppm c. Interior CO2 concentration setpoint (Outside CO2 concentration + 600 ppm) 1218 ppm Step 1: Simulate a signal at or slightly above the CO2 setpoint or follow manufacturers recommended testing procedures. For single zone units, outdoor air damper modulates opens to satisfy the total ventilation air called for in the Certificate of Compliance. ❑ For multiple zone units, either outdoor air damper or zone damper modulate open to satisfy the zone ventilation requirements. Step 2: Simulate signal well below the CO2 setpoint or follow manufacturers recommended procedures. V For single zone units, outdoor air damper modulates to the design minimum value. ❑ For multiple zone units, either outdoor air damper or zone damper modulate to satisfy the reduced zone ventilation requirements. Step 3: System returned to initial operating conditions I Y / N C. Testing Results PASS / FAIL Step 1: Simulate a high CO2load(check box complete) PASS Step 2: Simulate a low CO2 load (check box complete) PASS D. Evaluation l� PASS: All Construction Inspection responses are complete and all Testing Results responses are "Pass" CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA DEMAND CONTROL VENTILATION SYSTEMS ACCEPTANCE ror_niDr-A_nnru na_o rDe. i—A nen Gt CAI IFORNIA FNFRr.Y COMMIRSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-06-A Demand Control Ventilation Systems Acceptance (Page 2 of 2) Project Name: Apple Bubb 4 Enforcement Agency: Permit Number: Project Address: 10101 Bubb Rd City: Cupertino Zip Code: 95014 System Name or Identification/Tag: AC -3 System Location or Area Served: Roof DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Scott McClung Documentation Author Signature: Documentation Author Company Name: Silicon Valley Mechanical Date Signed: 1-11-2016 Address: 2115 Ringwood Ave ATT Certification Identification (If applicable): BB1093975TMT City/state/Zip: San Jose, CA 95131 Phone. 408.943.0380 FIELD TECHNICIAN'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 Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. 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. 4. 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: Scoff McClung Field Technician Signature: Field Technician Company Name: Silicon Valley Mechanical Position with Company (Title): SVM / TAB Supervisor Address: 2115 Ringwood Ave ATT Certification Identification (if applicable): BB1093975TMT City/State/zip: San Jose, CA 95131 Phone. 408.943.0380 Date signed: 1-11-2016 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 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. 2. 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). 3. 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. 4. 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. 5. 1 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 Person Name: Scoff McClung Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Silicon Valley Mechanical Position with Company (Title): SVM /TAB Supervisor Address: 2115 Ringwood Ave CSFB License. 992731 City/State/Zip: San Jose, CA 95131 Phone. 408.943.0380 Date Signed: 1-11-2016 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CFC-NRCA-MCH-07-A IRevisarf 05/151 CALIFORNIA ENERGY COMMISSION 10 CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 1 of 3) Project Name: Apple Bubb 4 Enforcement Agency: Permit Number: Project Address: 10101 Bubb Rd City: Cupertino Zip Code: 95014 System Name or Identification/Tag: AC -1 System Location or Area Served: Roof Note: Submit one Certificate of Acceptance for each system that must Enforcement Agency Use: Checked by/Date demonstrate compliance. Intent: I Verify that the supply fan speed in a variable air volume system modulates to meet system airflow demand. A. Construction Inspection Note: MCH -07 can be performed in conjunction with MCH -02 Outdoor Air Acceptance since testing activities overlap. 1. Supporting documentation needed to perform test includes: a. As -built and/or Design Documents including Mechanical Equipment Schedules. b 2013 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.6 Supply Fan Variable Flow Controls Acceptance At -A -Glance). C. 2013 Building Energy Efficiency Standards. 2. Instrumentation to perform test includes: a. Calibrated differential pressure gauge. Date of calibration: 5-20-2015 (must be within one year) b. Static Pressure Probe c. Drill d. Rubber Plugs 3. Installation: a. The static pressure location, setpoint, and reset control meets the requirements of 2013 Building Energy Efficiency Standards section 140.4(c)2B and 140.4(c)C: (check all the following that apply). If sensor is located downstream of major duct splits, multiple sensors are installed in each major branch with fan capacity controlled to satisfy the sensor furthest below its setpoint. Set point is no greater than one-third of the total design fan static pressure. Design TSP: in. w.c. Setpoint: ►. 3 in.w.c. If system has DDC to the zone level it has reset control complying with 2013 Building Energy Efficiency Standards Section 140.4(c) 2C. Reset is based on the zone requiring the most pressure; i.e., the set point is reset lower until one zone damper is nearly wide open. b. Supply fan includes a device for modulating airflow, such as variable speed drive or electrically commutated motor. 4. Field calibrate all discharge static pressure sensors: Performed field -calibration using calibrated differential pressure gauge and static pressure probe. Calibration complete, all pressure sensors ± 10% of calibrated reference sensor (provide supporting documentation). Notes: CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 05/15) CERTIFICATE OF ACCEPTANCE Supply Fan Variable Flow Controls Acceptance Project Name: Enforcement Agency: Apple Bubb 4 Project Address: City: 10101 Bubb Rd Cupertino System Name or Identification/Tag: System Location or Area Served: AC -1 Roof IA ENERGY COMMISSION T N RCA -MCH -07-A (Page 2 of 3) Permit Number: Zip Code: 95014 B. Functional Testing Step 1: Drive all VAV boxes to full design airflow. a. Refer to design documents and record system design airflow. _ b. Supply fan speed modulates to increase capacity. C. Record fan frequency: Results 8980 cfm FYI N 48 Hz d Supply fan maintains discharge static pressure ± 10% of the current operating set point. If NA, indicate reason in Notes section. ON/NA Note: If NOT performing this test in conjunction with MECH-2A, other methods for verifying Variable Flow operation include increasing static pressure setpoint or putting all the VAV boxes into full cooling. Was one of these methods used? Due to diversity in system design, static pressure setpoint will likely not be achieved when all VAV boxes are in full cooling. If this occurs, verify fan speed is 60 Hz and indicate NA in step I.d. O N e. Verify that supply fan controls stabilize within a 5 minute period. I Y N Notes: Step 2: Drive all VAV boxes to reduced or minimum airflow. a. Supply fan speed modulates to decrease capacity. Y N b. Record fan frequency: 15 Hz C. Current operating static pressure setpoint has decreased (for systems with DDC to the zone level). Y / N MA d. Supply fan maintains discharge static pressure ± 10% of the current operating setpoint. Y N e. Supply fan controls stabilize within a 5 minute period. Y N Notes: Step 3: System returned to initial operating conditions ON C. Testing Results PASS / FAIL Step 1: Drive all VAV boxes to achieve full design airflow (Pass if all answers are Yes) `er 1 ❑ Step 2: Drive all VAV boxes to minimum flow (Pass if all answers are Yes) ❑ D. Evaluation I/ PASS: All Construction Inspection responses are complete and all Testing Results responses are "Pass" Notes: CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CFC-NRr.A-MrH-n7-A (R—i—d nFP151 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 3 of 3) Project Name: Enforcement Agency: Permit Number: Apple Bubb 4 City: ATT Certification Identification (if applicable): BB1093975TMT Project Address: Zip Code: 10101 Bubb Rd Cupertino 95014 System Name or Identification/Tag: System Location or Area Served: AC -1 Roof DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: SCOtt McClung Documentation Author Signature: �GB Documentation Author Company Name: Silicon Valley Mechanical Date Signed: 1-11-2016 Address. 2115 Ringwood Ave ATT Certification Identification (if applicable): BB1093975TMT City/State/Zip: San Jose, CA 95131 Phone: 408.943.0380 FIELD TECHNICIAN'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 Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. 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. 4. 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: SCOtt McClung Field Technician Signature: CdC.C. Field Technician Company Name: Silicon Valley Mechanical Position with Company (Title): SVM / TAB Supervisor Address: 2115 Ringwood Ave ATT Certification Identification (if applicable): BB1093975TMT city/state/zip: San Jose, CA 95131 Phone` 408.943.0380 Datesigned: 1-11-2016 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 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. 2. 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). 3. 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. 4. 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. 5. 1 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 Person Name: Scott McClung Responsible Acceptance Person Signature: Position with Company (Title): SVM / TAB Supervisor Responsible Acceptance Person Company Name: Silicon Valley Mechanical Address: 2115 Ringwood Ave CSLB License: 992731 City/State/Zip: San Jose, CA 95131 Phone` 408.943.0380 Date Signed: 1-11-2016 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE (11)" 11 rt1 GFG-NRGA-MGH-U7-A ReVISed US/15 L AL1rVKIV1A CIVCKUT L,VMIVIIJJIVK CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 1 of 3) Project Name: Enforcement Agency: Permit Number: Apple Bubb 4 Project Address: City: Zip Code: 10101 Bubb Rd Cupertino 95014 System Name or Identification/Tag: System Location or Area Served: AC -2 Roof Note: Submit one Certificate of Acceptance for each system that must Enforcement Agency Use: Checked by/Date demonstrate compliance. Intent: I Verify that the supply fan speed in a variable air volume system modulates to meet system airflow demand. A. Construction Inspection Note: MCH -07 can be performed in conjunction with MCH -02 Outdoor Air Acceptance since testing activities overlap. 1. Supporting documentation needed to perform test includes: a. As -built and/or Design Documents including Mechanical Equipment Schedules. b 2013 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.6 Supply Fan Variable Flow Controls Acceptance At -A -Glance). C. 2013 Building Energy Efficiency Standards. 2. Instrumentation to perform test includes: a. Calibrated differential pressure gauge. Date of calibration: 5-20-2015 (must be within one year) b. Static Pressure Probe c. Drill d. Rubber Plugs 3. Installation: a. The static pressure location, setpoint, and reset control meets the requirements of 2013 Building Energy Efficiency Standards section 140.4(c)2B and 140.4(c)C: (check all the following that apply). If sensor is located downstream of major duct splits, multiple sensors are installed in each major branch with fan capacity controlled to satisfy the sensor furthest below its setpoint. Set point is no greater than one-third of the total design fan static pressure. Design TSP: %T' in. w.c. Setpoint: _L0_0 in.w.c. If system has DDC to the zone level it has reset control complying with 2013 Building Energy Efficiency Standards Section 140.4(c) 2C. Reset is based on the zone requiring the most pressure; i.e., the set point is reset lower until one zone damper is nearly wide open. b. Supply fan includes a device for modulating airflow, such as variable speed drive or electrically commutated motor. 4. Field calibrate all discharge static pressure sensors: Performed field -calibration using calibrated differential pressure gauge and static pressure probe. Calibration complete, all pressure sensors ± 10% of calibrated reference sensor (provide supporting documentation). Notes: CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE } r KIDrA_nnrum_A nGn Gf CAI IFr)RNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 2 of 3) Project Name: Apple Bubb 4 Enforcement Agency: Permit Number: Project Address: 10101 Bubb Rd City: Cupertino Zip Code: 95014 System Name or Identification/Tag: AC -2 System Location or Area Served: Roof B. Functional Testing Results Step 1: Drive all VAV boxes to full design airflow. Step 2: Drive all VAV boxes to minimum flow (Pass if all answers are Yes) a. Refer to design documents and record system design airflow. 9350 cfm b. Supply fan speed modulates to increase capacity. Y N C. Record fan frequency: 54 Hz d' Supply fan maintains discharge static pressure ± 10% of the current operating set point. If NA, indicate reason in Notes section. O N / NA Note: If NOT performing this test in conjunction with MECH-2A, other methods for verifying Variable Flow operation include increasing static pressure setpoint or putting all the VAV boxes into full cooling. Was one of these methods used? Due to diversity in system design, static pressure setpoint will likely not be achieved when all VAV boxes are in full cooling. If this occurs, verify fan speed is 50 Hz and indicate NA in step I.d. O N e. Verify that supply fan controls stabilize within a 5 minute period. i ON Notes: Step 2: Drive all VAV boxes to reduced or minimum airflow. a. Supply fan speed modulates to decrease capacity. FIN b. Record fan frequency: 15 Hz C. Current operating static pressure setpoint has decreased (for systems with DDC to the zone level). Y / N MA d. Supply fan maintains discharge static pressure ± 10% of the current operating setpoint. Y N e. Supply fan controls stabilize within a 5 minute period. Y N Notes: Step 3: System returned to initial operating conditions MN C. Testing Results PASS / FAIL Step 1: Drive all VAV boxes to achieve full design airflow (Pass if all answers are Yes) ❑ Step 2: Drive all VAV boxes to minimum flow (Pass if all answers are Yes) ❑ D. Evaluation PASS: All Construction Inspection responses are complete and all Testing Results responses are "Pass" Notes: CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CP('._iJRCA-Mr:H-n7-A tP-A orl n51111 CAI IFORNIA FNFRGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 3 of 3) Project Name: Apple Bubb 4 Enforcement Agency: Permit Number: Project Address: 10101 Bubb Rd City: Cupertino Zip Code: 95014 System Name or Identification/Tag: AC -2 System Location or Area Served: Roof DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Scott McClung Documentation Author Signature: Documentation Author Company Name: Silicon Valley Mechanical Date signed: 1-11-2016 Address: 2115 Ringwood Ave ATT Certification Identification (If applicable): BB1093975TMT City/State/Zip: San Jose, CA 95131 Phone: 408.943.0380 FIELD TECHNICIAN'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 Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. 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. 4. 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: Scott McClung Field Technician Signature: Field Technician Company Name: Silicon Valley Mechanical Position with Company (Title): SVM /TAB Supe lsor Address. 2115 Ringwood Ave ATT Certification Identification (if applicable): BB1093975TMT City/State/Zip: San Jose, CA 95131 Phone: 408.943.0380 Date Signed: 1-11-2016 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 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. 2. 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). 3. 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. 4. 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. 5. 1 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 Person Name: Scott McClung Responsible Acceptance Person Signature:�� Responsible Acceptance Person Company Name: Silicon Valley Mechanical Position with Company (Tittle): SVM /TAB Supervisor Address: 2115 Ringwood Ave CSLB License: 992731 City/state/Zip: San Jose, CA 95131 Phone` 408.943.0380 Date signed: 1-11-2016 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015