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14080025CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10500 N DE ANZA BLVD CONTRACTOR: ICOM MECHANICAL INC PERMIT NO: 14080025 OWNER'S NAME: MISSION WEST PROPERTIES LP 1V 477 BURKE ST DATE ISSUED: 09/02/2014 OWNER'S PHONE: 4087835395 SAN JOSE, CA 95112 PHONE NO: (408)792-2292 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ ��rr q License Class620(4(i Lic. # rto Za APPLE- REMOVE (E) HEATING SYSTEM IN BASEMENT MECHANICAL ROOMS AND REPLACE W/ NEW HIGHER �iVt C/}{� Date Contractor �C141-i/•7-+�' �_ 2� / EFFICIENCY EQUIPMENT, RE-PIPE AND REDUCT 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: 1 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: $800000 performance of the work for which this permit is issued. ave and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 31622017.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN Igo RMIT 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 CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, 1 11 - costs, and expenses .ch may accrue against said City in consequence of the granting of this pe Additi pplicant on and will comply Issue Date: with all non-poi urce r ons per e Cupertino Municipal Code, Section 9.18. RE-ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, l agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant Date: 1 hereby affirm that l am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1, 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. I will 1 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 255329, rsould 1 store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally, should I us q ' ment or ' s which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by th a Area Quality Management District I performance of the work for which this permit is issued. will maintain compliance with t perti Munic' a ode, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this the Health & Safety Code, Sect 2550 a - 4. lV 2-1 Owner or authorized agent: Date: . permit is issued. I certify that in the performance of the work for which this permit is issued, l 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, l CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, l must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 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 l 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 CONSTRUCTION PERMIT APPLICATION 11-31 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION lJ 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building(ftypertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 10500 N. De Anza Boulevard APN11 316-22-017 OWNERNAME Apple, Inc. PP PHONE 408,783.5395 E- IL &emetri_gonzalez@apple.com STREET ADDRESS 1 Infinite Loop CITY, STATE, ZIP Cupertino, CA 95014 FAX CONTACT NAME Brett Erickson PHONE 408.792.2203 E-MAIL berickson@icominc.com STREETADDRESS477 Burke Street CITY, STATE, ZIP San Jose, CA 95112 FAX 408.292.4968 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR 17 CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Don Isaacson LICENSE NUMBER 408622 TH`Eld�d,'C36,B BUS. LIC # 21 800 COMPANYNAME ICOM Mechanical, Inc. E-MAIL disaacson@icominc.com FAX 408.292.4968 STREET ADDRESS 477 Burke Street CITY, STATE, ZIP San Jose, CA 95112 PHONE 408 792 2292 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF REMOVE EXISTING HEATING SYSTEM EQUIPMENT IN THE BASEMENT MECHANICAL ROOMS AND REPLACE WITH NEW, HIGHER EFFICIENCY EQUIPMENT. RE -PIPE AND RE -DUCT AS NECESSARY TO CONNECT TO EXISTING EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES I USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ONO ADDITION? ONO PRE -APPLICATION OYES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY: TOTAL VALUATION: PLANNING APPL # ONO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO p $800,000.00 By my signature below, I certify to each of a ollowing: I e roperty owner or authorized agent to act on the pro net's behalf. I have read this d is rte ha read the Description of Work and verify it is accurate. I agree to comply with all applicable local application and the information I havffoi ordinances and state laws relating to o tru ion authorize representatives of Cupertino to enter the above -identified property for inspection purposes. 2014.08.04 Signature ofApplicantlAgent:Date: SUPPLEMENT IN RMATI N QUIRED PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPREss ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO Ift, FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10500 n de anza blvd Mech. Plan Check 0,0 hrs $0.00 Mech. Permit Fee: 1MPERMIT Other Mech. Insp. 0.0 �hrs$48.00 DATE: 08/05/2014 REVIEWED BY: mendez APN: BP#: 1W5_ VALUATION: 1$800,000 PERMIT TYPE: Building Permit LAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: hrs PENTAMATION 1CMB i PERMIT TYPE: WORK ale- removea heatin s stem in basement mechanical rooms adreplace w/ new higher efficiency SCOPE equipment, re -pipe and reduct NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. ete.). These fees are based on the preliminary information available and are oniv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-05.1 E : T1 i) Mech. Plan Check 0,0 hrs $0.00 Mech. Permit Fee: 1MPERMIT Other Mech. Insp. 0.0 �hrs$48.00 QTY/FEE Ll NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. ete.). These fees are based on the preliminary information available and are oniv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-05.1 E : T1 i) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 ® # $428.00 Mechanical 1BBOILER(1) Boiler/Comp. <=3hp Suppl. PC Fee: (j) Reg. © OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 F__2__j # $286.00 Mechanical 1BCAIRHA Heat Pump (<=10K cfm) Permit Fee: $0.00 Suppl. Insp. Feer Reg. 0 OT TO.O hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $48.00 T_T_ Administrative Fee: 1ADMIN $45.00 0 Work Without Permit? ® Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure G Q i Travel Documentation Fee: ITRAVDOC $48.00 StronP Motion Fee: 1BSEISMICO $224.00 Select an Administrative Item Bldg, Stds Commission Fee: 1BCBSC $32.00 SUBTOTALS: $397.00 $714.00 TOTAL FEE: $1,111.00 Revised: 07/1012014 U) W H 0) U) Q Q24 J IL Q LL 0 LLJ F V1 v m a E 0 u c v 0 z m 0 v coc in u N W LUm v w C m V ai VI N v 'N •N c N � c. +•� O -•I = CO ❑CL E] [30 GJ ++ N N a D E V Q N (U c c 3 v; m E ° 0 (U k N O J Y 'O C QV u c 0 V ,n M L N N (uO U C E LL O O c r 3 o au a1 c❑❑ > ❑❑ C � 0 U — IZ `0 o U v L > C 41 3: + do c Qj Y U E -CN - ED Q .L ++ f0 c c 0 3z r ❑ ❑ ❑ O O 0 Q. cL C I a v _ c qu N Y L N Y h L �C ` L 0 Ou Q Y u 0 c r a m N Joo N � ❑ ❑ ❑ u sE ° a s oQo '= '3 r to v N p cCi �i o o 3 v v Q m ate`, 2 CO ❑❑❑❑ N O ri yC G T a o u OY U U C y M � CL E 0 - E c n O > m �n m v�- ❑ ❑ ,vi y to r'' ° O V 013 C 0 ai a o o m s ° a 0 a oIn u a 7a a cr C. 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N C a m m W O D N V c m a u.- 0 w ] O0. m j > � E O m aaj `= o aj u c - c ami E c m m 0 w E Y yw ° O E — w - ar y — O O O - m .O O CL v c w u—> Qj ME v m a t; o w "" v c m a' ,w, w v L% u C Y Y OU U C c N O C C m w O u O w E y o O u O O U w v �• 11 N u w o p n Y u =O ^ U E m c o c v :: o c '�, N w (uu `° W� m u U H ,� Y2� m,� w„ z H Z m 'J H rl 0 d d m " o o r N Y H EU F r r a LU F :3w U Z c m O m Z' o f0 V c FC W F� z H H FL' ,, ` w vii .� u O w U In w 0 Ul Cj W w 7 C al d w O C O H Z c Cly a w . v n O o U] O !-' U W o m 0 h u w w v U W g u U) mm wY O O Off O N a c M w W G- z O C� g _m v o a aci a a c m �^ u 0 U l� u c w' v E Y c• w m '>_ z O Q H Cn w o o O U dl C!1 _� y, c O � n 7 c_ u u o Q H u v Z 3 a w ocr c oo 5° a d Q L Z N c0 C j9 w a1 L m Z O 7 w L O U Y— w C Z O Y 0 L W a a w -" da w m Y E7. � o o o m m o .w Z O p m E d0 N O a LU " u > N C y p �� '0 F-- °uH 3 3 m_a C _' N u _ ' q v W a 0 V Q V cc c -I N Mui w V Q iu Q) c a E O u Fa w N L C O Z m 0 N N m c C m u v w` C W OD C m u STATE OF CALIFORNIA HVAC SYSTEM REQUIREMENTS ;EC-NRCC-MCH-02-E (Revised 06/14) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-MCH-02-E HVAC Dry System Requirements (Page 1 of 3) Project Nam XPPLE, INC. - DA03 - HEATING EQUIPMENT UPGRADE1 Date Prepared: 2014.08.14 Equipment Tags and System Description AH -3, AH -4 MANDATORY MEASURES T-24 Sections Reference to the Requirements in the Contract Documents2 Heating Equipment Efficiency3 110.1 or 110.2(a) MP -601 Cooling Equipment Efficiency3 110.1 or 110.2(a) N/A HVAC or Heat Pump Thermostats 110.2(b), 110.2(c) N/A Furnace Standby Loss Control 110.2(d) N/A Low leakage AHUs 110.2(f) N/A Ventilation 120.1(b) N/A Demand Control Ventilations 120.1(c)4 N/A Occupant Sensor Ventilation Contr016 120.1(c)5, 120.2(e)3 N/A Shutoff and Reset Controls' 120.2(e) YES Outdoor Air and Exhaust Damper Control 120.2(f) N/A Isolation Zones 120.2(g) N/A Automatic Demand Shed Controls 120.2(h) N/A Economizer FDD 120.2(i) N/A Duct Insulation 120.4 MP -001 PRESCRIPTIVE MEASURES Equipment is sized in conformance with 140.4(a & b) Y/N Y/N Y/N 140.4(a&b) Supply Fan Pressure Control 140.4(c) YES Simultaneous Heat/Cool$ 140.4(d) NO Economizer 140.4(e) NO Heat and Cool Air Supply Reset 140.4(f) NO Electric Resistance Heating9 140.4(8) NO Duct Leakage Sealing and Testing.10 140.4(1) NO Notes: 1. Provide equipment tags (e.g. AHU 1 to 10) and system description (e.g. Single Duct VAV reheat) as appropriate. Multiple units with common requirements can be grouped together. 2. Provide references to plans (i.e. Drawing Sheet Numbers) and/or specifications (including Section name/number and relevant paragraphs) where each requirement is specified. Enter "N/A" if the requirement is not applicable to this system. 3. The referenced plans and specifications must include all of the following information: equipment tag, equipment nominal capacity, Title 24 minimum efficiency requirements, and actual rated equipment efficiencies. Where multiple efficiency requirements are applicable (e.g. full- and part -load) include all. Where appliance standards apply (110.1), identify where equipment is required to be listed per Title 201601 et seq. 4. identify where the ventilation requirements are documented for each central HVAC system. Include references to both central unit schedules and sequences of operation. If one or more space is naturally ventilated identify where this is documented in the plans and specifications. Multiple zone central air systems must also provide a MCH -03-E form. 5. If one or more space has demand controlled ventilation identify where it is specified including the sensor specifications and the sequence of operation. 6. If one or more space has occupant sensor ventilation control identify where it is specified including the sensor specifications and the sequence of operation Z If the system is DDC identify the sequences for the system start/stop, optimal start setback (if required) and setup (if required). For ail systems identify the specification for the thermostats and time clocks (if applicable). 8. Identify where the heating, cooling and deadband airflows are scheduled for this system. Include a reference to the specification of the zone controls. Provide a MCH -03-E form. 9. Enter N/A if there is no electric heating. If the system has electric heating indicate which exception to 140.4(g) applies. 10. If duct leakage sealing and testing is required, a MCH -04-A form must be submitted. CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 STATE OF CALIFORNIA HVAC WET SYSTEM REQUIREMENTS 'EC-NRCC-MCH-02-E (Revised 06/14) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-MCH-02-E HVAC Wet System Requirements (Page 2 of 3) Project NameA PPLE, INC. - DA03 - HEATING EQUIPMENT UPGRADE Date Prepared: 2014. 08. 14 Equipment Tags and System Description B- 1 . 1-B- 1.4 1 HWP-1, 2 MANDATORY MEASURES T-24 Sections Reference to the Requirements in the Contract Documents2 Heating Hot Water Equipment Efficiency3 110.1 MP -601 MP -601 Cooling Chilled and Condenser Water 110.1, 140.4(i) / / Equipment Efficiency3 N/A N/A Open and Closed Circuit Cooling Towers 110.2(e) 1 N/A N/A conductivity or flow -based controls Open and Closed Circuit Cooling Towers 110.2(e) 2 Maximum Achievable Cycles of N/A Concentration (LSI)6 Open and Closed Circuit Cooling Towers 110.2(e) 3 N/A N/A Flow Meter with analog output Open and Closed Circuit Cooling Towers 110.2(e) 4 N/A N/A Overflow Alarm Open and Closed Circuit Cooling Towers 110.2(e) 5 N/A N/A Efficient Drift Eliminators Pipe Insulation 120.3 MP - 0 0l MP -001 PRESCRIPTIVE MEASURES Cooling Tower Fan Controls 140.4(h)2, 140.4(h)5 Y/N Y/N Y/N Cooling Tower Flow Controls 140.4(h)3 Centrifugal Fan Cooling Towers4 140.4(h)4 Air -Cooled Chiller Limitations 140.4(j) Variable Flow System Design 140.4(k) Chiller and Boiler Isolation 140.4(k) CHW and HHW Reset Controls 140.4(k) YES WLHP Isolation Valves 140.4(k) VSD on CHW, CW & WLHP Pumps>5HP 140.4(k) DP Sensor Location 140.4(k) Notes: 1. Provide equipment tags (e.g. CH 1 to 3) or system description (e.g. CHW loop) as appropriate. Multiple units with common requirements can be grouped together. 2. Provide references to plans (i.e. Drawing Sheet Numbers) and/or specifications (including Section name/number and relevant paragraphs) where each requirement is specified. Enter "N/A" if the requirement is not applicable to this system. 3. The referenced plans and specifications must include all of the following information: equipment tag, equipment nominal capacity, Title 24 minimum efficiency requirements, and actual rated equipment efficiencies. Where multiple efficiency requirements are applicable (e.g. full- and part -load) include all. For chillers operating at non-standard efficiencies provide the Kadj values. For chillers also note whether the efficiencies are Path A or Path B. 4. Identify if cooling towers have propeller fans. If towers use centrifugal fans document which exception is used. 5. If air-cooled chillers are used, document which exceptions have been used to comply with 140.4(j) and the total installed design capacity of the air-cooled chillers in the chilled water plant. 6. Identify the existence of a completed MCH -06-E I when open or closed circuit cooling towers are specified to be installed, otherwise enter "N/A". CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 STATE OF CALIFORNIA HVAC SYSTEM REQUIREMENTS CEC-NRCC-MCH-02-E (Revised 06/14) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-MCH-02-E HVAC Wet System Requirements (Page 3 of 3) Project Na"APPLE, INC. — DA03 — HEATING EQUIPMENT UPGRADE I Date Prepared: 2014.08.14 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signatu DON ISAACSON Company: ICOM MECHANICAL, INC. signature Date: 2014.08.14 Address: 477 BURKE STREET CEA/ HERS Certification Identification (if applicable): City/State/Zip: SAN JOSE, CA 95112 Phone: 408-792-2292 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Compliance is true and correct. 2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer). 3. The energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations. 4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. 5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a completed signed copy of this Certificate of Compliance is required to be included with the documentation the builder provides to the bumiridwrier at occupancy. Responsible Designer Name: DON I SAACS ON Responsible Designer Signature: oe Company: ICOM MECHANICAL, INC. 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OCo m '� Y v u m •- u o Gi O Z Q Q z c O Q V r n w n v o c U) = U) U O" F -c (� 2 W W N o co u v w 0-0 Q V W Y W W Y� z_�'uY c" 0 c c ° W cA ° O m E~ m .m O m o w c v a °: a u Z m C Z O Z g c v° ma p O r� Z '^ K m O U � u Lu E «' a w 7 •� v = w t-, It �a/� N o c O O in 7 C m u° �_ u0 j u d Z a n v w .� 5 i° a m d r z 'O^ c°— 7 v t v ° L N W m z z O Y Y O K W O W Y ,F y� !— c N m o/ yj o) m 2 F L a c y1 E L_ ��� y� 0 0 m Q" a m o .O° v E g L c> c N Z ° a {ALU V C N t4 =_ C O y a d c > d Z O_ w L m oma/ t p L ° 3 °to D H_ H u H 3_ m m n c > 0 n E G y H 00 a d vt {'.i 0 E v` H w E i o u 'a GC .--i eqni 4 vi w u° a u STATE OF CALIFORNIA FAN POWER CONSUMPTION GEC-NRCC-MCH-07-E (Revised 07/14) CALIFORNIA ENERGY COMMISSION ""`x'""' CERTIFICATE OF COMPLIANCE NRCC-MCH-07-E Power Consumption of Fans Requirements (Page 1 of 2) Project Nam APPLE, INC. - DA03 - HEATING EQUIPMENT UPGRADEJ Date Prepared: 2014. 08. 14 Constant Volume Fans Systems NOTE: Provide one copy of this worksheet for each fan system with a total fan system horsepower greater than 25 hp of Constant Volume Fan Systems when using the Prescriptive Approach. See Power Consumption of fans §140.4(c). A B C D E F FAN DESCRIPTION DESIGN BRAKE HP EFFICIENCY NUMBER OF FANS PEAK WATTS BxEx746/ (C x D) MOTOR DRIVE AH -3 12.61 .895 .97 2 21,625 B) Calculate Fan Adjustment and enter on line 6. 6) Fan Adjustment = 1-(Spa—1)/SP, C) Calculate Adjusted Fan Power Index and enter on Row 7 7) ADJUSTED FAN POWER INDEX (Line 3 x Line 6)1 1 , 0 $ W/CFM 1. TOTAL FAN SYSTEM POWER INDEX orAD1USTED FAN POWER INDEX must not exceed 0.8 w/cfm for Constant Volume systems or 1.25 w/cfm for VA systems. Variable Air Volume Fans Systems NOTE: Provide one copy of this worksheet for each fan system with a total fan system horsepower greater than 25 hp of Variable Air Volume (VAV) Systems when using the Prescriptive Approach. See Power Consumption of fans §140.4(c). A B C I D E F FAN DESCRIPTION DESIGN BRAKE HP EFFICIENCY NUMBER OF FANS PEAK WATTS g x E x 746 / (C x D) MOTOR DRIVE AH -3 12.61 .895 .97 2 21,625 B) Calculate Fan Adjustment and enter on line 6. 6) Fan Adjustment = 1-(Spa—1)/SP, C) Calculate Adjusted Fan Power Index and enter on Row 7 7) ADJUSTED FAN POWER INDEX (Line 3 x Line 6)1 1 , 0 $ W/CFM 1. TOTAL FAN SYSTEM POWER INDEX orAD1USTED FAN POWER INDEX must not exceed 0.8 w/cfm for Constant Volume systems or 1.25 w/cfm for VA systems. Totals and Adjustments FILTER PRESSURE ADJUSTMENT Equation 140.4-A in §140.4(c) of the Building Energy Efficiency 1) TOTAL FAN SYSTEM POWER (WATTS, SUM COLUMN F) 21,625 W 2) SUPPLY DESIGN AIRFLOW 20,000 CFM Standards. A) If filter pressure drop (SP.) is greater than 1 inch W. C. or 245 Pascal then enter SP, on line 4. Enter 3) TOTAL FAN SYSTEM POWER INDEX (Row 1 / Row 2)1 1.08 W/CFM Total Fan pressure drop across the fan (SPt) on Line 5 4) SPa in W.0 or Pa 5) SPf in W.0 or Pa B) Calculate Fan Adjustment and enter on line 6. 6) Fan Adjustment = 1-(Spa—1)/SP, C) Calculate Adjusted Fan Power Index and enter on Row 7 7) ADJUSTED FAN POWER INDEX (Line 3 x Line 6)1 1 , 0 $ W/CFM 1. TOTAL FAN SYSTEM POWER INDEX orAD1USTED FAN POWER INDEX must not exceed 0.8 w/cfm for Constant Volume systems or 1.25 w/cfm for VA systems. CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance July 2014 STATE OF CALIFORNIA FAN POWER CONSUMPTION CEC-NRCC-MCH-07-E (Revised 07/14) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-MCH-07-E Power Consumption of Fans Requirements (Page 1 of 2) Project Nam APPLE, INC. - DA03 - HEATING EQUIPMENT UPGRADE Date Prepared: 2014. 08. 14 Constant Volume Fans Systems NOTE: Provide one copy of this worksheet for each fan system with a total fan system horsepower greater than 25 hp of Constant Volume Fan Systems when using the Prescriptive Approach. See Power Consumption of fans §340.4(c). A B C D E F FAN DESCRIPTION DESIGN BRAKE HP EFFICIENCY NUMBER OF FANS PEAK WATTS BxEx746/ (C x D) MOTOR DRIVE DRIVE AH -4 12.61 .895 .97 2 21,625 B Calculate Fan Adjustment and enteron line 6. 6) Fan Adjustment = 1-(SPa —1)/SPf C) Calculate Adjusted Fan Power Index and enter on Row 7 7) ADJUSTED FAN POWER INDEX (Line 3 x Line 6)1 1.08 W/CFM 1. TOTAL FAN SYSTEM POWER INDEX or ADJUSTED FAN POWER INDEX must not exceed 0.8 w/cfm for Constant Volume systems or 1.25 w/cfm for VA systems. Variable Air Volume Fans Systems NOTE: Provide one copy of this worksheet for each fan system with a total fan system horsepower greater than 25 hp of Variable Air Volume (VAV) Systems when using the Prescriptive Approach. See Power Consumption of fans §140.4(c). A B C I D E F FAN DESCRIPTION DESIGN BRAKE HP EFFICIENCY NUMBER OF FANS PEAK WATTS BxEx746/ (C x D) MOTOR DRIVE AH -4 12.61 .895 .97 2 21,625 B Calculate Fan Adjustment and enteron line 6. 6) Fan Adjustment = 1-(SPa —1)/SPf C) Calculate Adjusted Fan Power Index and enter on Row 7 7) ADJUSTED FAN POWER INDEX (Line 3 x Line 6)1 1.08 W/CFM 1. TOTAL FAN SYSTEM POWER INDEX or ADJUSTED FAN POWER INDEX must not exceed 0.8 w/cfm for Constant Volume systems or 1.25 w/cfm for VA systems. Totals and Adjustments FILTER PRESSURE ADJUSTMENT Equation 140.4-A in §140.4(c) of the Building Energy Efficiency 1) TOTAL FAN SYSTEM POWER (WATTS, SUM COLUMN F) 21,625 W 2) SUPPLY DESIGN AIRFLOW 20,000 CFM Standards. A) If filter pressure drop (SPa) is greater than 1 inch W. C. or 245 Pascal then enter SPa on line 4. Enter 1 3) TOTAL FAN SYSTEM POWER INDEX (Row 1 /Row 2) 1.08 W/CFM Total Fan pressure drop across the fan (SPf) on Line 5. 4) SPa in W.0 or Pa 5) SP) f in W.0 or Pa B Calculate Fan Adjustment and enteron line 6. 6) Fan Adjustment = 1-(SPa —1)/SPf C) Calculate Adjusted Fan Power Index and enter on Row 7 7) ADJUSTED FAN POWER INDEX (Line 3 x Line 6)1 1.08 W/CFM 1. TOTAL FAN SYSTEM POWER INDEX or ADJUSTED FAN POWER INDEX must not exceed 0.8 w/cfm for Constant Volume systems or 1.25 w/cfm for VA systems. CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance July 2014 STATE OF CALIFORNIA FAN POWER CONSUMPTION CEC-NRCC-MCH-07-E (Revised 07/14) CALIFORNIA ENERGY COMMISSION —4"— CERTIFICATE OF COMPLIANCE NRCC-MCH-07-E Power Consumption of Fans Requirements (Page 2 of 2) Project NamAP PLE, INC. - DA03 - HEATING EQUIPMENT UPGRADE Date Prepared: 2014.08.14 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. ( certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: DON I SAACSON Documentation Author SignatuW8100� company: ICOM MECHAN I CAL , INC. Signature Date: 2 O 1 . O Address: 477 BURKE STREET CEA/ HERS Certification Identification (if applicable): City/State/Zip: SAN JOSE, CA 95112 Phone: 408-792-2292 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Compliance is true and correct. 2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer). 3. The energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations. 4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. 5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a co pleted signed copy of this Certificate of Compliance is required to be included with the documentation the builder provide to b . ing owner at occupancy. Responsible Designer Name: DON I SAACS ON Responsible Designer Signat e, Company: ICOM MECHANICAL, INC. Date Signed: 2014.08.14 Address: 477 BURKE STREET License: M 28351 City/State/Zip: SAN JOSE, CA 95112 Phone: 408-792-2292 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance July 2014 STATE OF CALIFORNIA WATER HEATING SYSTEM GENERAL INFORMATION GEC-NRGC-PLB-01-E (Revised 06114) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-PLB-01-E Water Heating System General Information (Page 1 of 2) P`oj? VVM�E, INC. - DA03 - HEATING EQUIPMENT UPGRADE ..,ePmpmd: 2014. 08. 14 A. GENERAL INFORMATION/SYSTEM INFORMATION For detailed instructions on the use of this and all Energy Efficiency Standards compliance forms, refer to the 2013 Nonresidential Manual 1. Water Heater System Name: HEATING HOT WATER B-1.1 TO B-1.4 2. Water Heater System Configuration: CENTRAL 3. Water Heater System Type: HYDRONIC 4. Building Type: NONRESIDENTIAL 5. Total Number of Water Heaters in Systems: 4 6. Central DHW Distribution Type: OTHER 7. Dwelling Unit DHW Distribution Type: RDRsc B. WATER HEATER INFORMATION Each water heater type requires a separate form. For detailed instructions on the use of this and all Energy Efficiency Standards compliance forms, refer to the 2013 Nonresidential Manual 1. Water Heater Type: CONDENSING BOILER 2. Fuel Type NATURAL GAS 3. Number of Identical Water Heaters: 4 4. Efficiency: 94% 5. 1 Required Minimum Efficiency: 82% 6. Standby loss percent or Standby loss total: N/A 7. Rated Input 1000 MBH 8. Pilot Energy: N/A 9. Water Heater Tank Storage Volume: N/A 10. Exterior Insulation On Water Heater: N/A 11. Volume of Supplemental Storage: N/A 12. Internal Insulation on Supplemental Storage: N/A 13. Exterior Insulation on Supplemental Storage: N/A PLUMBING COMPLIANCE FORMS & WORKSHEETS (check box if worksheet is included) For detailed instructions on the use of this and all Energy Efficiency Standards compliance forms, refer to the 2013 Nonresidential Manual Note: The Enforcement Agency may require all forms to be incorporated onto the building plans. YES NO Form/Worksheet # Title ® ❑ NRCC-PLB-01-E Certificate of Compliance, Declaration. Required on plans for all submittals. 041 ❑ NRCI-PLB-01-E Certificate of Installation. Required on plans for all submittals. ❑ ❑ NRCI-PLB-02-E Certificate of Installation, required on central systems in high-rise residential, hotel/motel application. ❑ ❑ NRCI-PLB-03-E Certificate of Installation, required on single dwelling unit systems in high-rise residential, hotel/motel application. ❑ ❑ NRCI-PLB-21-H Certificate of Installation, required on HERS verified central systems in high-rise residential, hotel/motel application. ❑ ❑ NRCI-PLB-22-H Certificate of Installation, required on HERS verified single dwelling unit systems in high-rise residential, hotel/motel application. ❑ ❑ NRCI-STH-01-E Certificate of Installation, required on any solar water heating CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 STATE OF CALIFORNIA WATER HEATING SYSTEM GENERAL INFORMATION CERTIFICATE OF COMPLIANCE NRCC-PLB-01-E Water Heating System General Information (Page 2 of 2) Proj'XVPIZE, INC. — DA03 — HEATING EQUIPMENT UPGRAD Date Prepared: 2014.08.14 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. 1.01 Documentation Author Name: DON I SAACSON Documentation Author Signatur Company: ICOM MECHANICAL, INC. Signature Date: 408—'792-2292 Address: 477 BURKE STREET CEA/ HERS Certification Identification (if applicable): City/State/Zip: SAN JOSE, CA 95112 phone: 2014.08.14 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Compliance is true and correct. 2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer). 3. The energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations. 4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. 5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a completed signed copy of this Certificate of Compliance is required to be included with the documentation the buil Vr provides to the building owner at occupancy. Responsible Designer Name: DON I SAACSON Responsible Designer Sign at Company: ICOM MECHANICAL, INC. Date Signed: 2014.08.14 Address: 477 BURKE STREET License: M 28351 City/State/Zip: SAN JOSE, CA 95112 Phone: 408-792-2292 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance lune 2014