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14100142I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10105 S DE ANZA BLVD CONTRACTOR: BAY VALLEY PERMIT NO: 14100142 CONSTRUCTION INC OW'NER'S NAME: PONDEROSA ASSOC LLP 47 RICKBENBACKER CIR DATE ISSUED: 01/26i2015 OWNER'S PHONE: 6507598829 LIVERMORE, CA 94551 PHONE NO: (925)449-7498 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL 0 COMM. T.I REMODEL THROUGH OUT TO INCLUDE License Class,_ Lie. # �n nac4 2 M,E,P'S 1 - f('• (9100 SQ FT) Contractorj�g_�,1, 1 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: $350000 -performance of the work for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 35909017.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to s+ave18YO D FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities judgm _ •- costs, and expenses which may accrue against said City in consequence of th 7 granting of this permit. Additionally, the applicant understands and will comIff' Date: !� 15 wit nt source regulations per the Cupertino Municipal Code, Sec 9 8. RE -ROOFS: Signature_Q.)LR'i Date All roofs shall be inspected prior to any roofing material being installed. If roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (See.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay 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 & Safety9 rs 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this �` (� Owner agent:26- permit is issued. or authorized 1 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 APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code; Section Licensed Professional 9.18. Signature Date CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - buildinclacuperting.org [I NEW CONSTRUCTION El ADDITION El ALTERATION / TI [_1 REVISION / DEFERRED ORIGINAL PERMIT # PROJECTADDRESSAPN9 - � OWNER NAME PHONT F -MAIL C/ S �'I S 'A STRFFA ADDRE-SS CITY, STATE, ZIP T FAX LJ C0NI`A(T N F PHONE 77 E -MALI., STREET ADDRESS CITY, STATE, ZIP FAX ❑ Ok\\LR OWNFR-BUILDER 1:1 OWNER AGENT El CONTRACTOR 1:1 CONTRACTOR AGENT I-] ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT q NTRACTOR N ME Ocic4n,12- LICENSE NU m"fory) LIC TYPE BU�, LIC 4 �_f U COMPANY AME E-MAIL FAX C11 et"\ Q cc V'- L -I LAck -0 CITY STATE ZIP C1 451w) PHONE 0%,"2 5 k -"( yy� Lt Lv"L -t t"i ARCITITfCIVENGINEER NA,54L I -ICE S N.��ER BUS. LIC d " L'I I :� COMPANY NAk4F E-MAIL FAX S I'RI.1-1 ADDRI SS CITY, STATE, ZIP PHONE Sf C' Lk DESCRIPTION OF WORK S r N(i U� PROPOSED USE CONSTR. TYPE 4 STORIES USE TYPE OCC. SQ. Fr. VALUATION (S) EXISIG ARFA VYW FLOOR ARFA DEMO AREA TOTAL NET AREA V Is a BATHROOM KITCHEN OTHER REM ODF1 AREA REMODEL AREA RFNIODELAREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GAR -AGE AREA. DETACH❑ ATTACH J [ 0DINELLIN6 UNITS. ISACEC0NDh4rro YLS SECOND STORY ❑Y ES BEING ADDED? E] No ADDITION? ❑NO - - — - ---------------- - _­.__­­._._.._­____ — -------- -- - I yf� PRE -APPLICATION C3YES IF YFS. PROVIDE. COPY OF IS THE BLDG AN El S V RECEIVED BY: TOT VALLr ION: PLANNING APPL U []NO PLANNING APPROVAL LETTER EICHLER HOME? El NO By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on AI)IgSn, ow"er's behalf. I have read this application and the infon-nation 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 Fig _uIr" "frigconstruction thorize representatives of Cupertino to enter the above -identified property for inspection purposes. ordinances and state laws relating Signature of Applicant/Agent: Da - -------- --- SUPPLEMENTAL INFORMATION REQUIRN) PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER BUILDING PLAN REVIEW Nc,a SFD or Multifamily, dwellings: Apply, for demolition permit for 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 SI'ANDARD El PUBLIC WORKS form if any Ha7ard0LIS Materials are being used as part of this project. El LARGE FIRE DEPT — Copy of Planning Approval Letter or Meeting with Planning prior to El MAJOR El SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL, HEALTH Bldgz4pp_201 I.doc revised 06/21//1 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10105 s de anza blvd DATE: 10/23/2014 REVIEWED BY: menden APN: BP#: ` G l--� *VALUATION: 1$350,000 PERMIT TYPE: Building PermitPLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building PENTAMATION 16 TI USE: PERMIT TYPE: WORK coldwell banker; comm. t.i remodel through out to include m,e p's SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) II-B,111-B,IV,V-B 9,100 $2,654.02 IBTIPLNCK $6,230.85 IBTIIivSP hrs $0.00 PME Plan Check: $0.00 Permit Fee: $6,230.85 Suppl. Insp. Fee:(D Reg. PME Unit Fee: PME Permit Fee: Q OT 0.0 hrs $0.00 $0.00 $0.00 TOTALS: 9,100 $2,654.02 $6,230.85 MECH, HOURLY Yes G No PLUMB, HOURLY Yes (F) No ' ELEC, HOURLY ® Yes (F) No Suppl. PC Fee: Q Reg. C) OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $6,230.85 Suppl. Insp. Fee:(D Reg. PME Unit Fee: PME Permit Fee: Q OT 0.0 hrs $0.00 $0.00 $0.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District_ etc )_ Thace fees are haced an the nreliminary infnrmatinn availahle and are only an Pstimafn_ Contact the Dent for addn'l info_ FEE ITEMS (FeeResolution 1I-053 E: 7,%1,'13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,654.02 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. C) OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $6,230.85 Suppl. Insp. Fee:(D Reg. PME Unit Fee: PME Permit Fee: Q OT 0.0 hrs $0.00 $0.00 $0.00 0 Work Without Permit? Yes E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure G 0 A Strang Motion Fee. IBSEISUICO $98.00 Select an Administrative Item 1 Bld,, Stds Commission Fee: IBCBSC $14.001 SUBTOTAL$: $8,996.87 $0.00 TOTAL FEE; $8,996.87 Revised: 08120/2014 (4iCCt i4 L�z r� U V INDOOR AIR DESIGN, INC. 925 COMMERCIAL STREET, SAN JOSE, CA 951 12 (40(5**-* _8844 • FAX (408) 44 1-9244 • C-20 #472788 PROJECT: IColdwell Bank¢r - 10105 S. De Anza Area Served Outlet # Capacity Zone 1 1 Equipment 2 230 3 (TONS) 4 AC- I 12.5 5000 Area Served Outlet # AC -1 Zone 1 1 185 2 230 3 230 4 405 5 405 G 215 7 300 8 300 9 300 10 200 Zone 2 I 1 325 12 375 13 400 14 350 15 350 IG 350 17 200 18 250 19 350 20 250 21 200 22 250 15 220 TOTAL CFM 4,945 NOMINAL CPM 5,000 OF NOMINAL 99.30% m Equipment Capacity (CFM) ZoneI (TONS) 225 AC -2 12.5 5000 Area Served Outlet # AG-?- C-2Zone ZoneI I 225 3 2 225 AC -3 3 225 G 4 225 Zone 2 5 150 9 G 150 175 7 150 12 8 150 230 9 325 15 10 325 550 II 150 Zone 4 18 12 150 200 13 150 21 14 150 15 220 Zone 3 1 G 125 5,000 17 125 18 125 Zone 4 19 425 20 300 Zone 5 21 185 Zone G 22 185 Zone 7 23 225 TOTAL CFM 4,445 NOMINAL CFM 5,000 OF NOMINAL 93.30% Area Served Outlet # AC -3 Zone I 1 Equipment Capacity (CFM) 3 (TONS) 4 AC -3 12.5 5000 Area Served Outlet # AC -3 Zone I 1 150 2 150 3 175 4 215 5 215 G 95 7 170 8 245 9 175 10 175 II 285 12 285 Zone 2 13 230 14 230 15 305 Zone 3 1 G 550 17 315 Zone 4 18 320 19 200 20 200 21 22 23 TOTAL CFM 4,485 NOMINAL CFM 5,000 OF NOMINAL 93.70% I, ALPREDO OKOZCO, CERTIFY THAT THESE READINGS ARE TRUE AND CORRECT. THESE READINGS WERE TAKEN ON JUNE 15T, 2015. 1 U5ED AN ALNOR BALOMETER. ALFREDO OPROZCO DATE INDOOR AIR DE51GN, INC. 925 COMMERCIAL STREET, 5AN JOSE, CA 951 12 (408) 441-8844 • FAX (408) 44 1-9244 9 C-20 #472788 To: Building Department - City of Cupertino FrO�ictor Lopez e: 10 105 5. De Anza Blvd., Cupertino Permit #: 14100142 bs�e: 2/25/201 -'� Pages Message: F" r Follow ng 15 our itemized response to the Mechanical Feld Inspection comments for the above referenced project: Building Department: Comment: -51heet M-2/ Title 24 Compliance Form MECH 2-C calls for duct insulation to be rated as R-8. Installed duct is R -G.' Form MECH 2-C calls for R-8 duct nsulat on by typographical error. Per 201 3 Building Energy Efficiency Standards, Table 150. 1 -A, buildings within Climate Zone 4 may use R -G duct insulation. R-8 duct insulation 15 not recfu red for the project in 6tue5t on. Thank you. STATE OF CALIFORNIA LIGH'TIN'G CONTROL ACCEPTANCE DOCUMENT CFC-NRr..A-t Tl -n9 -A fRPvkPri n5/151 TE OF ACCEPTANCE NRCA-LTI-02-A ,.kTitng Con o tante Document (Page 1 of 5) Project Name; - - ._, Enforcement Agency: Permd Number: ❑ Override time limit is no more than 2 hours ❑ Project Address: 02 City- .q Zip Code: Occupancy sensors are not located within four feet of any HVAC diffuser Note: For Lmore on 3 spaces attach additional sett df pages 2 Enforcement Agency Use: Checked by/Date through S, a equired. Automatic Shut-off Controls: Automatic Time Switch Control and Occupant Sensor Intent: Lights are turned off or set to a lower level when not needed per Section 110.9(a) & 130.1(c). Guidance This acceptance test form must be filled out for all newly -installed lighting control systems of the following types: I. Automatic Time Switch Controls Il. Occupancy Sensors III. Partial -OFF occupancy sensors IV. Partial -ON occupancy sensors (only if used to claim a Power Adjustment Factor) V. Occupanp�,"Sensors serving small zones in large open plan offices (only if used to claim a Power Adjustment Factor) For automatic daylighting controls use acceptance test form NRCA-LTI-03-A; for demand responsive lighting controls, use acceptance test form NRCA-LII-04-A. The tests on this certificate are required by Section 140.6(a)2 and 130.4(a) of the Building Energy Efficiency Standards 2013. The tests themselves are described in Sections 140.6(a)2 and in Reference Appendix NA7.6. A. Construction Inspection Fill out Section A to cover spaces 1 through 3 that are functionally tested under Section B. Make as many copies of pages 2-5 as are required to test all spaces in the building, and attach to page 1. Instruments needed to perform tests include, but are not limited to: hand-held amperage meter, power meter, or light meter 01 Automatic Time Switch Controls Construction Inspection—confirm for all listed in Section B a. All automatic time switch controls are programmed for (check all): ❑ Weekdays ❑ Weekend ❑ Holidays b. Document for the owner automatic time switch programming (check all): ❑ Weekdays settings ❑ Weekend settings ❑ Holidays settings ❑ Set-up settings ❑ Preference program setting CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 ❑ Verify the correct time and date is properly set in the time switch ❑ Verify the battery is installed and energized ❑ Override time limit is no more than 2 hours ❑ Occupant Sensors and Automatic Time Switch Controls have been certified to the Energy Commission in accordance with the applicable provision in Section 110.9 of the Standards, and model numbers for all such controls are listed on the Commission database as Certified Appliance and Control Devices 02 Occupancy Sensor Construction Inspection—confirm for all listed in Section B Occupancy sensors are not located within four feet of any HVAC diffuser Ultrasonic occupancy sensors do not emit audible sound 5 feet from source CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA LIGHTING CONTROL ACCEPTANCE DOCUMENT CFC-NRCA-LTI-O?-A (Revised 05/151 r.Al IPOPPIJIA FldFRAV rnneeni.c.cinry CERTIFICATE OF ACCEPTANCE NRCA-LTI-02-A Lighting Control Acceptance Document (Page 2 of 5) Project Name: Enforcement Agency: Permit Number: Project Address: City: Zip Code: B. Functional Testing of Lighting Controls 1 2 3 Step 1: Simulate an unoccupied condition Representative Spaces Selected Lights turn 30 minutes y r N For every space in the building, conduct functional tests I through V below if applicable. If there are several geometrically similar spaces that use the same lighting controls, test only one space and list in the cells below which "untested spaces" are represented by that tested space. b' sensor The occupantor does not triggerfalse "on from movement in an area adjacent a � EXCEPTION: For buildings with up to seven (7) occupancy sensors, all occupancy sensors shall be tested. (NA7.6.2.3) �'�/ N („Y.,a/ N Tested space/ room name: Space Type (office, corridor, etc) 0 ° a -k ❑ 01 Untested areas/rooms Status indicator or annunciator operates correctly `Y N`/ / N N Tested space/ room name: .' ( ) °: C - Space Type (office, corridor, etc) 04, controlledLights boccupancyturn on gnoccupied an sensors '"oc ❑ 02 w Untested areas/rooms �:„.) Q r", � b. may ymediately d I be turned cond t on ORsnsindicates space isuand iYj/ N�'�/ N Tested space/ room name: k• nA'v- OIN Space Type (office, corridor, etc) tiA, VVI, v-`1 ❑ 03 Step 3: System returned to initial operating conditions (l /N Untested areas/rooms 1 'zg ''k S / N Functional Tests Tested Space Number Confirm compliance (Y/N) for all control system types (I-V) present in each space: 01. Automatic Time Switch Controls 1 2 3 Step 1: Simulate occupied condition a. All lights can be turned on and off by their respective area control switch A(N` N Y% N bVerify the switch only operates lighting in the ceiling -height partitioned area in which/ N Y/ N (l/ N the switch is located Step 2: Simulate unoccupied condition a All lighting, including emergency and egress lighting, turns off. Exempt lighting may N / N / N remain on per Section 130.1(c)1 and 130.1(a)1. Manual override switch allows only the lights int the selected ceiling height b. partitioned space where the override switch is located and remain on no longer than Y"/ IN `Xi/ IN 2 hours (unless serving public areas and override switch is captive key type). Step 3: System returned to initial operating conditions / IN Y' N Y N 02. Occupancy Sensors 1 2 3 Step 1: Simulate an unoccupied condition a' Lights turn 30 minutes y r N (, YJ N (Y„ N Stanoff fromstartofcontrolled ubnocccup ed condition perda d Section 110.9(b)f b' sensor The occupantor does not triggerfalse "on from movement in an area adjacent a � Y�� N �'�/ N („Y.,a/ N to the controlled space or from HVAC operation P w - Step 2: Simulate an occupied condition a. Status indicator or annunciator operates correctly `Y N`/ / N N controlledLights boccupancyturn on gnoccupied an sensors '"oc b. may ymediately d I be turned cond t on ORsnsindicates space isuand iYj/ N�'�/ N �/ N manually Step 3: System returned to initial operating conditions (l /N Qt/ N._' / N CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA LIGHTING CONTROL ACCEPTANCE DOCUMENT ,k CFC-NRCA-1 TI -02-A (Revised 05/1S) (.Al IFCIRNIA FNFRr:V r r)UULeslnrd CERTIFICATE OF ACCEPTANCE NRCA-LTI-02-A Lighting Control Acceptance Document (Page 3 of 5) Project Name: Enforcement Agency: Permit Number: ProjectAddress: City: Zip Code: 03. Partial Off Occupancy Sensor 1 2 3 Step 1: Simulate an unoccupied condition a. Lights go to partial off state within a maximum of 30 minutes from start of an Y N / Y N / Y N / unoccupied condition per Standard Section 110.9(a) The occupant sensor does not trigger a false "on" from movement in an area adjacent b to the controlled space or from HVAC operation. For library book stacks or warehouse Y / N Y / N Y / N aisle, activity beyond the stack or aisle shall not activate the lighting in the aisle or Step 2. Simulate an unoccupied condition stack. Both stages (automatic on and manual on) lights turn off within a maximum of 30 / N Y / N Y / N In the partial off state, lighting shall consume no more than 50% of installed lighting minutes from start of an unoccupied condition per Standard Section 110.9(a) power, or: The occupant sensor does not trigger a false "on" from movement in an area adjacent�;,/ N Y / N Y / N • No more than 60% of installed lighting power for metal halide or high to the controlled space or from HVAC operation 3 C. pressure sodium lighting in warehouses. Y /N Y N / Y N / • No more than 60% of installed lighting power for corridors and stairwells in which the installed lighting power is 80 percent or less of the value allowed under the Area Category Method. Light level may be used as a proxy for lighting power when measurements are taken Step 2: Simulate an occupied condition a The occupant sensing controls shall turn lights fully ON in each separately controlledE�l Y / N Y / N areas, Immediately upon an occupied condition 04. Partial On Occupancy Sensors 1 1 2 3 Step 1. -Simulate an occupied condition. Verify partial on operation. a Immediately upon an occupied condition, the first stage activates between 30 to 70% CY)/ N Y / N Y / N of the lighting automatically. After the first stage occurs, manual switches allow an occupant to activate the b. alternate set of lights, activate 100% of the lighting power, and manually deactivate Y/ N Y / N Y / N all of the lights. Step 2. Simulate an unoccupied condition a Both stages (automatic on and manual on) lights turn off within a maximum of 30 / N Y / N Y / N minutes from start of an unoccupied condition per Standard Section 110.9(a) b The occupant sensor does not trigger a false "on" from movement in an area adjacent�;,/ N Y / N Y / N to the controlled space or from HVAC operation 3 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA LIGHTING CONTROL ACCEPTANCE DOCUMENT le CEC-NRCA-LTI-02-A (Revised 05115) CALIFORNIA FNERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-LTI-02-A Lighting Control Acceptance Document (Page 4 of 5) Project Name: Enforcement Agency: Permit Number: Project Address: City: Zip Code: I Automatic Time Switch Controls (all answers must bey). 05. Additional test for Occupancy Sensors Serving Small Zones in Office Spaces Larger II Occupancy Sensor (On Off Control) (all answers must be Y). than 250 Square Feet, to Qualify for a Power Adjustment Factor (PAF) 1 2 3 First, complete Functional Test 2 (above) for each controlled zone fi' e„ i p�1 , Step 1. Verify area served and compare actual PAF with claimed PAF. Refer to Functional Test II. a. Area served by controlled lighting (square feet) IVIN b. Enter PAF corresponding to controlled area from line (a) above (<125sf for PAF=0.4, IV Partial On Occupant Sensor for PAF (all answers must be Y). 126-250sf for PAF=0.3, 251-500sf for PAF=0.2). V Occupant Sensor serving small zones for PAF (all answers must be Y). Also must pass Enter PAF claimed for occupant sensor control in this space from the Certificate of Test II C. Compliance d The PAF corresponding to the controlled area (line b), is less than or equal to the PAF Y / N Y / N Y / N claimed in the compliance documentation (line c) e Sensors shall not trigger in response to movement in adjacent walkways or Y / N Y / N Y / N workspaces. f All steps are conducted in Functional Test 2 "Occupancy Sensor (On Off Control)" and Y / N Y / N Y / N all answers are Yes (Y) C. Testing Results PASS / PASS / PASS/ responses are positive (Y - yes) FAIL FAIL I Automatic Time Switch Controls (all answers must bey). II Occupancy Sensor (On Off Control) (all answers must be Y). Y III Partial Off Occupancy Sensor (all answers must be Y). For warehouses, library book stacks, corridors, stairwells in nonresidential buildings must also be accompanied by IVIN passing Test I or Test IL IV Partial On Occupant Sensor for PAF (all answers must be Y). V Occupant Sensor serving small zones for PAF (all answers must be Y). Also must pass Test II D. Evaluation PASS: All applicable Construction Inspection responses are complete and all applicable Equipment Testing Requirements responses are positive (Y - yes) CA Building Energy Efficiency Standards- 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA LIGHTING CONTROL ACCEPTANCE DOCUMENT CEC-NRCA-LTI-02-A (Revised 05/15) CALIFORNIA ENERGY COMMISSION ak, CERTIFICATE OF ACCEPTANCE NRCA-LTI-02-A Lighting Control Acceptance Document (Page 5 of 5) Project Name: v i ,d yp °�J E Enforcement Agency: Permit Number: Project Address: City: Zip Code: DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. . Documentation Author Name: LA �'yk Documentation Author Signature: .W._�._............. Documentation Author Company Name: C4— Date Signed: cip Address: W®4 y CEA/ATT Certification-Iden•ification (If appticable): A. evith 0. City/state/Zip: $ @ Phone: FIELD TECHNICIAN'S 6ECLARATION 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: n Field Technician Signature: Field Technician Company Na e: Position with Company (Title): Address: p ATT Certification Identification (ifa plicable): City/State/Zip: yAs Phone: Date Signed� �¢ (, 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 me: Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Position with Company (Title): a� A Y CA—�7 Address: Address: CSLB License: /y , - t ✓ t City/State/Zip: Phone: Date Signed: CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA AUTOMATIC DAYLIGHTING CONTROL ACCEPTANCE DOCUMENT cGr_nivevr TI -WI -n /P i—I nsr11t rnt icnanttn CIdCDrV rnRARA1eetnni CERTIFICATE OF ACCEPTANCE NRCA-LTI-03-A Automatic Daylighting Control Acceptance Document (Page 1 of 11) Project Name: Enforcement Agency: Permit Number: Project Address: City: Zip Code: Note: Submit one Certificate of Acceptance for each system that Enforcement Agency Use: Checked by/Date must demonstrate compliance. Check boxes for all pages of this NRCA-LTI-03-A completed and included in this submittal N RCA-LTI-03-A ❑ Construction Inspection. This page required for all submittals. Page l&2 N RCA-LTI-03-A ❑ Continuous dimming control functional performance test — watt -meter or amp -meter measurement Page 3 & 4 N RCA-LTI-03-A ❑ Stepped Switching/ Stepped Dimming functional performance test — watt -meter or amp -meter measurement Page 5 & 6 NRCA-LTI-03-A Continuous dimming control functional performance test — light meter power measurement, and default look -up ❑ Page 7 & 8 table of fraction of rated power versus fraction of rated light output. NRCA-LTI-03-A ❑ Stepped Switching/ Stepped Dimming functional performance test — based on light output Page 10 & 11 A. Construction Inspection NA -7.6.1.1 01. Drawing of Daylit Zone(s) must be shown on plans or attached to this form. Select one or both of the following: Shown on plans page Ws i .'—'U XDaylit zones(s) drawn in on as -built plans (attached) page Ws Check box below if sampling method is used in accordance with NA 7.6.1.2, If checked, attach a page with names of other controls in sample (only for buildings with > 5 daylight control systems, sample group glazing some orientation) Plans Page Check if Tested Control is Control System System Name Number Representative of Sample A ❑ Applicable Control System C "e 0 ` C' "� ❑ A B C 02. System Information Zone Type: Skylit (Sky), Primary Sidelit (PS), or Secondary Sidelit (SS) J �y Control Type: Continuous Dimming with more than 10 light levels (C), Stepped Dimming (SD), ., Switching (SW)-" Design Footcandles: (enter number or "Unknown") CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA AUTOMATIC DAYLIGHTING CONTROL ACCEPTANCE DOCUMENT CEC-NRCA-LTI-03-A (Revised 05115) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-LTI-03-A Automatic Daylighting Control Acceptance Document (Page 2 of 11) Project Name: Enforcement Agency: Permit Number: Project Address: City: Zip Code: 03. Sensor and Controls Installation Manuals and Calibration Instructions Provided to Building Owner: (Y/N) Location of Light Sensor on Plans: (Y/N) Control Loop Type: Open Loop (OL), Closed Loop (CL)^.,, Sensor Location: Outside (0), Inside Skylight (IS), Near Windows facing out (NW), In Controlled Zone ' (CZ) Sensor Location is Appropriate to Control Loop Type: (Y/N) If control loop type is Open Loop (OL): Enter yes (Y) if location = Outside (0), Inside Skylight (IS), or Near Windows facing out (NW); otherwise, enter no (N). If Control loop type is Closed Loop (CL): Enter yes (Y) if location = In Controlled Zone (CZ); otherwise, enter no (N). Control Adjustments are in Appropriate Location (Y/N): Yes, If Readily Accessible or Yes if in Ceiling <_ 11 ft , No for all other . w 04. Has documentation been provided by the installer: Installation Manuals and Calibration Instructions Provided to Building Owner: (Y/N) Location of Light Sensor on Plans: (Y/N) Location of Light Sensor on Plans: (Page Number) a; 05. Separate Controls of Luminaires in Daylit Zones: Are luminaires controlled by automatic daylighting controls only in daylit zones: (Y/N) Separately circuited for daylit zones by windows and daylit zones under skylights: (Y/N) ' 06. Daylighting control device certification Daylighting control has been certified in accordance with §110.9: (Y/N)' Construction Inspection PASS/FAIL. If all responses on Construction Inspection pages 1 & 2are complete and all Yes/No questions have a Yes (Y) response, the tests PASS; If any responses on this page are incomplete OR there are any no (N) responses, the tests FAIL CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA AUTOMATIC DAYLIGHTING CONTROL ACCEPTANCE DOCUMENT CEC-NRCA-LTI-03-A (Revised 05/151 CALIFORNIA FNFRC;Y COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-LTI-03-A Automatic Daylighting Control Acceptance Document (Page 3 of 11) Project Name: Enforcement Agency: Permi[ Number: Project Address: City: Zip Code: B. Functional Performance Testing — Continuous Dimming Systems NA -7.6.1.2.1 Power estimation using amp -meter measurement, or alternate option — watt -meter measurement. Complete all tests on page 3 & 4 (No Daylight Test, Full Daylight Test, and Partial Daylight Test) Applicable Control System and fill out Pass/Fail section on Page 4. A B C 01. System Information 0 a• Control Loop Type: Open Loop or Closed Loop? (O or C) Indicate if Mandatory control - M (required for skylit zone or primary sidelit zone with b. installed general lighting power > 120 W); V VV\ or Voluntary -V (M, V) If automatic daylighting controls are mandatory, are all general lighting luminaires in daylit C. zones controlled by automatic daylight controls? (Y/N) d. Documented general lighting design footcandles. (Enter footcandle value or "Unknown" (U)) Power estimation method. Measured Amps Multiplied by Volts, Volt -Amps (VA), alternate e. option is Measured Watts (W) Step 1: Identify Reference Location (location where minimum daylight illuminance is measured in zone served by the controlled lighting.) f• Method Used: Illuminance or Distance? (I or D) Override daylight control system and drive electric lights to highest light level for the following: Highest light level fc — enter measured footcandles (fc) from controlled electric lighting (does "rJ . g not include daylight illuminance) h. Full load Highest light level power. Enter measured Amps times Volts, Volt -Amps (VA) or ) measured Watts(W). i I Indicate whether this is Full Output (FO), or Task Tuned (Lumen Maintenance) (TT) Step 2: No Daylight Test controls enabled & daylight less than 1 fc at reference location I Method Used: Night time manual measurement (Night), Night Time Illuminance Logging (Log), Cover Fenestration (CF), Cover Open Loop Photosensor (COLP)° k Reference Illuminance (footcandles) as measured at Reference Location (see Step 1). Enter CJ L� footcandles Enter Y if either of the following statements are true: I• [Reference Illuminance (line k)] /[Highest light level fc (line g)] > 70% when line i = FOor [Reference Illuminance (line k)] / [design footcandles (line d)] > 80%? (Y/ N) Step 3: Full Daylight Test conducted when daylight greater than reference illuminance (line k) m• Enter measured Amps Multiplied by Volts, Volt -Amps (VA) or measured Watts (W). 7 n. System power reduction enter [1— (line m)/(line h)] enter as percent... o• Is System Power Reduction (line m) > 65% when line i = F0, or > 56% when line i = TT (Y/N) P. With uncontrolled lights also on, no lamps are dimmed outside of daylit zone by same j control mechanism or formula (Y/N) 4• Dimmed lamps have stable output (no perceptible visual flicker) (Y/N) �✓i v< Step 4: Partial Daylight Test conducted when daylight between 60% and 95% of (line k) r. Daylight illuminance (light level without electric light) measured at Reference Location (fc)S. Daylight illuminance divided by the Reference Illuminance = (line r )/ (line k). Enter %.... t• Is Ratio of Daylight illuminance to Ref. illuminance (line s) between 60% and 95%? (Y/N) <-- u. Total (daylight + electric light) illuminance measured at the Reference Location (fc) V. Total illuminance divided by the Reference Illuminance = (line u )/ (line k), Enter % W. Is Total illuminance divided by the Reference illuminance (line u) between 100% and 150%? (Y/N) CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA AUTOMATIC DAYLIGHTING CONTROL ACCEPTANCE DOCUMENT 5 CEC-NRCA-LTI-03-A Revised 05115 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-LTI-03-A Automatic Daylighting Control Acceptance Document (Page 4 of 11) Project Name: Enforcement Agency: Permit Number: Project Address: City: Zip Code: C. Evaluation : ❑ PASS: All applicable Construction Inspection responses on pages 1 & 2 are complete and all applicable Functional Performance Testing Requirements responses are positive (Y - yes) (applicable questions on pages 3 & 4 = c, I, o, p, q, t, w) D. NA7.6.1.2.2 Functional Performance Testing — Stepped Switching/ Stepped Dimming Systems Power estimation using watt -meter or amp -meter measurement Complete all tests on pages 5 & 6 (No Daylight Test, Full Daylight Test, and Partial Daylight Test) and Applicable Control System A B C ill out Pass/Fail section on Page 6. 01. System Information ME a• Control Loop Type. Open Loop or Closed Loop? (O or C1 b Indicate if Mandatory control - M (required f r skylit zo or pri ary sidelit zone with installed general lighting power > 120 W); or oluntary (M, V) If automatic daylighting conti Is are mandat ry, are all eneral Ii luminaires in C. daylight zones controlled by ut atic daylig t control d Power estimation method. easu ed Watts ( ), Measur> d Amps Mul ' lied by Volts, Volt - Amps (VA),' STATE OF CALIFORNIA AUTOMATIC DAYLIGHTING CONTROL ACCEPTANCE DOCUMENT r:Fr:_NRr:A_I TI_n'A_A /R—k—i 01/151 rel 1cnonue rnicor^_v rnccina CERTIFICATE OF ACCEPTANCE NRCA-LTI-03-A Automatic Daylighting Control Acceptance Document (Page 5 of 11) Project Name: Enforcement Agency: Permit Number: Project Address: City: Zip Code: Applicable Control System A B I C First Stage of Control F1 Total (daylight + electric light) illuminance measured at the Reference Location (foot-candles) when stage turns off or dims F2 is the measured total illuminance between 100% and 150% of the Reference Illuminance (line g)? (Y/N) F3 With time delay disabled, control stage does not cycle (i.e. deadband is sufficient)? (Y/N) Second Stage of Control F4 Total (daylight + electric light) illuminance measured at the Reference Location (foot-candles) when stage turns off or dims F5 Is the measured total illuminance between 100% an 150% of h Reference Illuminance (line g)? (Y/N) I F6 I With time delay disabled, control stage does not cycl (i.e. de dban -s sufficient)? (Y/N) Third Stage of Controli F7 Total (daylight +electric light) illumiinanc measured t the Ref re.aae-04tion (foot-candles) when stage turns off or dims F8 Is the measured total illuminance betiw en 1( 0% and 50% of th( Reference)] I u minance (line g)? (Y/N) F9 With time delay disabled, control stage does not c le)(i.e. deadband is sufficient)? (Y/N) Step 5: Time Delay Test (conduct at least 60 minutes after overriding time delay) PASS: All applicable Construction Inspection responses on pages 1 & 2 are complete and all applicable Functional ❑ After change of state from little daylight to full daylight, time in minutes before light output n, F2, F3, F5, F6, F8, F9, s) r. is reduced (N - no) responses in any applicable Functional Performance Testing Requirements section (applicable questions on s. Is the measured time delay (line r) greater than or equal to 3 minutes? (Y/N) before retesting and resubmitting NRCA-LTI-03-A with PASSED test to the enforcement agency. Describe below the E.PASS/FAIL Evaluation (check one): PASS: All applicable Construction Inspection responses on pages 1 & 2 are complete and all applicable Functional ❑ Performance Testing Requirements responses are positive (Y - yes) (applicable questions on pages 5 & 6 are on lines c, I, n, F2, F3, F5, F6, F8, F9, s) FAIL: Any applicable Construction Inspection responses on pages 1 & 2 are incomplete OR there is one or more negative (N - no) responses in any applicable Functional Performance Testing Requirements section (applicable questions on ❑ pages 5 & 6 are on lines c, I, n, F2, F3, F5, F6, F8, F9, s). System does not pass and is NOT eligible for Certificate of Occupancy according to Section 10-103(a)3B. Fix problem(s) and retest until the system(s) passes all portions of this test before retesting and resubmitting NRCA-LTI-03-A with PASSED test to the enforcement agency. Describe below the failure mode and corrective action needed. CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA AUTOMATIC DAYLIGHTING CONTROL ACCEPTANCE DOCUMENT RFGAIRf:4_I Ti -n'3 -A /P—i—i nslir1 nAi iCnoKuA CUConv r^nAAKA 1— CERTIFICATE OF ACCEPTANCE NRCA-LII-03-A Automatic Daylighting Control Acceptance Document (Page 6 of 11) Project Name: Enforcement Agency: permit Number: Project Address: City: Zip Code: F. Functional Performance Testing— Continuous Dimming Systems NA -7.6.1.2.1 Power estimation using light meter measurement Complete all tests on page 7 & 8 (No Daylight Test, Full Daylight Test, and Partial Daylight Test) and Applicable Control System III out Pass/Fail section on Page 8. A B C 01. System Information a• Control Loop Type: Open Loop or Closed Loop? (O or C) 0 Indicate if Mandatory control - M (required for skylit zone or primary sidelit zone with b. installed general lighting power > 120 W); �"A for Control Credit — CC; or Voluntary not for credit -V (M, CC, V) controlsare all lighting luminaires in C. daylight ones coingtlrolng ll dtomat c dayylight controls? (Y/N)I d Documented general lighting design footcandles. If design footcandles not documented leave blank (enter fc) Power estimation method. (see line r) Default ratio of power to light (Dfc), cut -sheet ratio e. of power to light (CSfc) If CSFc — attach cut -sheet. Enter Dfc or CSfc, Step 1: Identify Reference Location (locatioq where minimum daylight illuminance is measured in zone served by the controlled lig ting.). f• I Method Used: Illuminance o Distance. (I r Override daylight control system anj*ive ele�trid(lt s -to full light output for highest light level g. Highest light level fc — enter '- asu.:d ntr fled �Jectric lighting footcandles (fc) h. Indicate whether this is Full Ou ut F,, p ( r Ta6 Tuned (Lumen Maintenance) (TT) Step 2: No Daylight Test i. Method Used: Night time manu6l measurement (Night), Night Time Illuminance Logging (Log), Cover Fenestration (CF), Cover Open Loop Photosensor (COLP) Reference Illuminance (footcandles) measured at Reference Location (Illuminance of general lighting at the reference location) Enter Y if either of the following statements are true: k. If line h = F0; [Reference Illuminance (line j)] / [Full Output fc (line g)] > 70%? or [Reference Illuminance (line j)] / [design footcandles (line d)] > 80%? (Y/ N) Step 3: Full Daylight Test conducted when daylight > reference illuminance (line j) Daylight illuminance (light level with electric lighting turned off) measured at Reference Location (fc) m. Daylight illuminance (line 1) greater than Reference Illuminance (line j) ? (Y/N) n. Fraction controlled wattage turned off. Enter %. o. Fraction of controlled wattage dimmed [1— (line n)] Enter %. CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA AUTOMATIC DAYLIGHTING CONTROL ACCEPTANCE DOCUMENT CEC-NRCA-LTI-03-A (Revised 05/15) CALIFORNIA FNFRGv Cnmmi.-iSlnN CERTIFICATE OF ACCEPTANCE NRCA-LTI-03-A Automatic Daylighting Control Acceptance Document (Page 7 of 11) Project Name: Enforcement Agency: Permit Number: Project Address: City: Zip Code: Fill out lines p through s only if fraction of controlled wattage turned off (line n) < 100%. PASS: All applicable Construction Inspection responses on pages 1 & 2 are complete and all applicable Functional Performance Testing Requirements responses are positive (Y - yes) (applicable questions on pages 7 & 8 = c, k, m, u, v, w, z, cc) P. Total (daylight + electric light) illuminance measured at the Reference Location (fc) (N - no) responses in any applicable Functional Performance Testing Requirements section (applicable questions on q• Electric lighting illuminance at the Reference Location (fc) [(line p) — (line 1)] resubmitting NRCA-LTI-03-A with PASSED test to the enforcement agency. Describe below the failure mode and r• Electric lighting illuminance (line q) divided by Highest Light Level fc (line g). Enter % S. Dimmed luminaire fraction of rated power. Attach manufacturer's cut -sheet or use default graph of rated power to light output on page 9. Label applicable control system (column A, B or C) on cut -sheet or graph. Enter fraction of rated power in %. t• System Power Reduction = [1— (line o) * (line s)] U. Is System Power Reduction (line t) > 65% when line h = F0, or > 56% when line h = TT (Y/N) V. With uncontrolled lights also on, no lamps dimmo outsidefVf lllalit zone by control (Y/N)( W. Dimmed lamps have stable output, no perceptibl ` Ncker ( f < � Applicable Control System A B C Step 4: Partial Daylight Test conducted when daylight betwee' 60% d 95% of (line i) X. Daylight illuminance (light level without electriclight) measured at Reference Location (fc) Y. Daylight illuminance divided by the Reference Illuminance = (line x)/ (line j). Enter % Z. Is Ratio of Daylight illuminance to Ref illuminance (line y) between 60% and 95%? (Y/N) aa. Total (daylight + electric light) illuminance measured at the Reference Location (fc) bb. Total illuminance divided by the Reference Illuminance = (line as )/ (line j). Enter % cc. Is Ratio of Total illum. to Reference illum. (line bb) between 100% and 150%? (Y/N) G. PASS/FAIL Evaluation (check one): PASS: All applicable Construction Inspection responses on pages 1 & 2 are complete and all applicable Functional Performance Testing Requirements responses are positive (Y - yes) (applicable questions on pages 7 & 8 = c, k, m, u, v, w, z, cc) FAIL: Any applicable Construction Inspection responses on pages 1 & 2 are incomplete OR there is one or more negative (N - no) responses in any applicable Functional Performance Testing Requirements section (applicable questions on pages 7 & 8= c, k, m, u, v, w, z, cc). System does not pass and is NOT eligible for Certificate of Occupancy according to Section 10-103(a)3B. Fix problem(s) and retest until the system(s) passes all portions of this test before retesting and resubmitting NRCA-LTI-03-A with PASSED test to the enforcement agency. Describe below the failure mode and corrective action needed. CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA AUTOMATIC DAYLIGHTING CONTROL ACCEPTANCE DOCUMENT rcr-NBCA-f TI -f13 -A (P—i¢arf f1511 S1 rai IFnRNIa FAfCArvrnKARA I RR Inhl CERTIFICATE OF ACCEPTANCE NRCA-LTI-03-A Automatic Daylighting Control Acceptance Document (Page 8 of 11) Project Name: Enforcement Agency: Permit Number: Project Address: City: Zip Code: Default fraction of rated power to fraction of light output (used on line r on page 7 of 10) 100% CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA AUTOMATIC DAYLIGHTING CONTROL ACCEPTANCE DOCUMENT le CFC-NRr.A-1 TI -n'; -A M—i—]!15/151 rel MnoniiA ❑nioocv rnr,er,eKC1nn1 CERTIFICATE OF ACCEPTANCE NRCA-LTI-03-A Automatic Daylighting Control Acceptance Document (Page 9 of 11) Project Name: Enforcement Agency: Permit Number. Project Address: City: Zip Code: o• With uncontrolled lights also on, no lamps controlled outside of daylit zone (Y/N) P. Dimmed lamps have stable output, no perceptible visual flicker (Y/N) Step 4: Partial Daylight Test Method Used: Light Logging (Log), Partially Cover Fenestration (PCF), Open Loop Setpoint q Adjustment (OLSA) If the control has three steps of control or less, all steps of control are tested. If the r. control has more than three steps, testing three steps of control is sufficient for showing compliance. Tests have been conducted at various daylight levels that correspond to steps of electric lighting control. (Y/N) CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA AUTOMATIC DAYLIGHTING CONTROL ACCEPTANCE DOCUMENT CEC-NRCA-LTI-03-A (Revised 05/15) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-LTI-03-A Automatic Daylighting Control Acceptance Document (Page 10 of 11) Project Name: Enforcement Agency: Permit Number. ProjectAddress: City: Zip Code: I. PASS/FAIL Evaluation (check one): PASS: All applicable Construction Inspection responses on pages 1 & 2 are complete and all applicable Functional ❑ Performance Testing Requirements responses are positive (Y - yes) (applicable questions on pages 10 & 11 are on lines c, n, o, p, r, F2, F3, F5, F6, F8, F9, t) FAIL: Any applicable Construction Inspection responses on pages 1 & 2 are incomplete OR there is one or more negative (N - no) responses in any applicable Functional Performance Testing Requirements section (applicable questions on ❑ pages 10 & 11 are on lines c, n, o, p, r, F2, F3, F5, F6, F8, F9, t). System does not pass and is NOT eligible for Certificate of Occupancy according to Section 10-103(a)3B. Fix problem(s) and retest until the system(s) passes all portions of this test before retesting and resubmitting NRCA-LTI-03-A with PASSED test to the enforcement agency. Describe below the failure mode and corrective action needed. CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA AUTOMATIC DAYLIGHTING CONTROL ACCEPTANCE DOCUMENT CEC-NRCA-LTI-03-A (Revised 05/151 (:AI IFORNIA FNFRr Y C C)MMICAInN CERTIFICATE OF ACCEPTANCE NRCA-L-I-I-03-A Automatic Daylighting Control Acceptance Document (Page 11 of 11) Project Name: }} pp y e Q� , Enforcement Agency: Permit Number: � r^� Project Address;O'S— k W �'^"" "S" AC +.r` city: c Zip Code: DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentationme: '���Author Na Documentation Author Signatur DCompany Name: _ 0�.wjv' � ar.r%..ti,i3 a C ytg� Cion Author c' sm"a x �I xy Date Signed: Address: CEA/ATT Certification Identification (If applicable): City/State/Zip: { W, Phone: 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: Field Technician Signature: Field Technician Com an Name: /AYVWP Y "'� L,4'vw. ,iw.+" ,• °�°9 ,61/YJ L+.�, j u— Position with Company (Title): �"bti'.k �""v`+�✓"r'v. Address:ATT Certification identification ( applicable): City/State/Zip; / Phone: p Date Signed: RESPONSIBLE PERSON' 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 ciInsfa ation 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: Responsible Acceptance Person Signature: Responsible Acceptance Person Company wNa e: Position with Company (Title):(�„�� p Address: vis CSL8 License: 75y1-state/zip: e -fa tr Phone, GA— .z,, 0. Date Signed: CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 Udl<ra2 GEOTECHNIC-AL EP CONSTRUCTIONTI ;ociotes, Inc. DATE; '7174, 7— b -44*"* CONTRACTOR: PROJECT # C LO.R.: PROJ E, PRESENT AT SITE: 6 4- LOC 'ON:, COPIES TO: L F 't 1V K AN PROJECT MANAGER: WEATHER: K TEMP STRUCTURAL STEEL fit" 1 M:fXf4G- V.T. 1:1 MATERIAL ID D U.T. 0 M . n P,T. ftem(s)linspected c' Locationi— 611111,111— e`f"1'.""":-' 't,,"' ,Lq, Welder qualification/certification verified for; ,CR Position: FLAT VERT11-111111CAL, ... . ... . ............. V RA EA" Dll Fillet Metal: PT'Process: SM AW CAW GMAW SAW Ej Other: WeIdType: I LLET' C.P. P. P. PLUG D Other: Weld Size: 3/16" 1/41' 5116, 3l8''Other,'41�12L Codes: AWS) AISC TITLE 21 TITLE 24 BS ASME To the best of my knowledge, the above, ,WA"" S" )WS1V0T performed in accordance with the approved plans, specifications, and regulatory requirements . Superintp,n,dp,nVRepresentative: Techniclan�:"" � 00011 '0 0 A, 0, Serving the Western United States Washington • Oregon • California Arizona BAY VALLEY Sb/Mb # 52556 (� �f License # 600062 Portion of Work Electrical 925-449-7498 Fax 925-449-0379 Coldwell Banker Cupertino Subcontractors List Subcontractor (P57 3 American Power & Communications 209-833-1369 818350 HVAC 01 Indoor Air 408-441-8944 Acoustical Ceiling � e Acoustics O� 510-489-2985 Fire Protection �_ "vire Protection Inc 209-599-5400 Glass/Glazing P Bob Smith Glass 925-828-9670 Flooring � Terry Jester Floor Covering ''//�)D 925-673-9500 I' V ` 40,MWJ X�7w Place of Business 1416 Mariam Ct Ste 130 Tracy Ca 953 76 925 Commerical St San Jose Ca 95112 30998 Huntwood Ave 104 Hayward Ca 94544 P.O. Box 226 Ripon Ca 95366 6355 Scarlett Ct 4 1 Dublin Ca 94568 1027 Pebble Beach Dr Clayton Ca 94517 CUPERTINO PURPOSE: CALGREEN NON-RESIDENTIAL CHECKLIST -- MANDATORY ITEMS COMvIMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION ALBERT SALVADOR, P.E.. C.B.Q., BUILDING OFFICIAL 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • build!r�raC2� g�t�rian�.ora The non residential provisions of the 2013 CalGreen Code outline planning, design and development methods that include environmentally responsible site selection, building design, building siting and development to protect, restore and enhance the environmental quality of the site and respect the integrity of adjacent properties; establishes the means of conserving water used indoors, outdoors and in wastewater conveyance; outlines means of achieving material conservation and resource efficiency; and outlines means of reducing the quantity of air contaminants. Project Name: COLDWELL BANKER CUPERTINO Project Address: 10105 S. DE ANZA BLVD. Project Description: INTERIOR REMODEL FOR EXISTING TENANT Instructions: 1. The Owner or the Owner's agent shall employ a licensed professional experienced with the 2013 California Green Building Standards Codes to verify and assure that all required work described herein is properly planned and implemented in the project. 2 The licensed professional, in collaboration with the owner and the design professional shall initial Column 2 of this checklist, sign and date Section 1 - Design Verification at the end of this checklist and have the checklist printed on the approved plans for the project. 3. Prior to final inspection by the Building Department, the licensed professional shall complete Column 3 and sign and date Section 2 - Implementation Verification at the end of this checklist and submit the completed form to the Building Inspector. Column 2 Column 3 MANDATORY FEATURE OR MEASURE Project Verification Reauirements . �tier�l ��:cluirmet�t ;. ,.: . The project meets all the requirements of Divisions 5.101 through 5.508. ®X❑ ) it rling 0rtd o sign S t 06,v1;,0pI" 6nrt 5.106.1 Storm water pollution prevention. For projects of one qace or Mess, develop a Storm Water Pollution Prevention Pian (SWPPP) that has been designed, specific to its site conforming to the State Storni v,,ater NPDES Construction Permit or local ordinance, whichever is stricter, as is required for ❑X f°J,'�; ❑ projects over one acre. The plan should cover prevention of soil loss by storm water run-off andlor vAnd erosion, of sedirnentatk:-n and/or of dustlpartieulate matter air pollution. 1 ort) Ced(rt-aen,Von-u c(7ria:ck'lis!,docrcrisod01/_,3114 5.106.4 Bicycle parking. Comply with Sections 5.106.4.1 and 5 106.4.2; or meet local ordinano..e, whichever is stricter. 0 i',S 'A ❑ 5.106.4.1.1 Short -Term tricycle parking. If the qualified project is ;F.1A C ( ` A [')ED F., anticipated to genc,�rate visitor traffic, provide permanently anchored bicycle racks within 200 feet of the visitors' entrance, readily visible to passers-by, 0 i, r° ❑ for 5 percent of visitor' motorized vehicle parking spaces being added, with a mmimufn of one two -bike capacity rack. 5.106.4,1.2 Long -Terni bicycle parking. For qualified buildings with over � '� ^t ❑ 10 tenant -occupants, provide secure tricycle parking for 5 percent of tenant vehicle parking spaces 'being added. with a minimum of one space. � 5.106.5.2 Designated parking. Provide designated parking for any combination of low-ernitting, fuel-efficient and carpool/van pool vehicles as ® shown in Table 5.106.5.2. FI F'lKk+'AC:, E A D F:. L 5,106.8 Light pollution reduction. Outdoor lighting systems shall be ❑ i,i e"'^ ❑ designed and installed to comply with the following: 1. The minimum requirements in the California Energy Code for lighting zones ❑X IN❑ 1 — 4 as defined in Chapter 10 of the Califomia Administrative Code; and 'A 2. Backlight, Uplight and Glare (BUG) ratings as defined in IES TM -15-11, and Q t ii o� ❑ 3. Allow✓abte BUG rating not exceeding those shown in Table S. 106.8, or r'_1 i'Ji,` ❑ Cornply with a local ordinance lawfully enacted pursuant to Section 101.7, whictrever is more stringent. 5.106.10 Grading and paving. The site shall be planned and developed to keep surface water away from buildings. Construction plans shall indicate how site grading or, a drainage system with manage all surface water flows. �e�tS4�5A1G4 ���Y�1��4I1..�!i J; 5.201.1 Scope. The California Energy Comrnission will continue to adopt © ❑ mandatory building standards. 5.303.1 Meters. Separate meters shall be installed for the rases described in Seu°tk)ns 503,1 -1 and 503.1.2. 5.303.1.1 New building or additions in excess of 50,000 square feet. ❑ �-,� ❑ Se➢parate submeters shall be ir°rstalled as follows: 1. For each indivt dual leased ranted or other tenant space within the � �'' ❑ building projeCted to consume more than 100 gal/day, t^1 2. VVhec e separate submeteis are unfeasible, for water supplied to the; following systems: a. Makeup water for coofong towers where flow through is greater- reaterthan 0 i ❑ than500 gpnl. b. Makeup water for evaporative coolers greater than 6 gpm. c_ Stearn and hot-water boilers with energy input > 500,000 Stu/h. l'<%:.:C 2 ayq ) i"a. i 8. c`Cda..i)%;23Il=i 5.303.1,2 Excess co-, ris urn-p't-io-n-7 A- all be" - ---------- --- -------- fore any tenant within a new building or within an addition that is projected to consume > 1,000 gal/day. -N 5.303.2 Water reduction. Plumbing fixtures shall rneet the maximum flo%v rate Vakl(rS shown in Table 5,303.2.3. FX1 'r" ❑ Exception: Building that demonstrate 20-percent overall water use reduction. 5.303.2.1 Areas of addition or alteration. For those occupancies within the authority of the California Building Standards Commission. as specifir,.d in Section 103, the provisions of Section 5.303.2 and Section 5.303.3 shale. El apply to new fixtures in additions or areas of alterations to the buildings. 5.303.4 Wastewater reduction. Each building shall reduce by 20 percent wastewater by one of the following methods: i. The installation of water-conserving fiXtUres or Ml I A ❑ 2. Utilizing non-potable water systems. 5.303.6 Standards for plumbing fixtures and fittings. Plumbing fixtures and fittings shall be installed in accordance With the California Plumbing Code t,CPC), and shall meet the appli;able standards referenced in CPC Table 1401.1 and CalGreen Chaptw,,r 6. Outdoor Water Use 5.304.1 Water budget. A %vater budget shall be developed for landscape irrigation use. 5.304.2 Outdoor potable water use, For new water service or for addition or alteration requiring upgraded water service for landscaped areas of at least NEI 1,000 sq,ft, but not more than 5,000 ,;gA., separate subinelefs of metering devices shall be installed for Outdoor potable water use_ 5.304.3 Irrigation design. In new nonresidential construction or building; addition or alteration with at least 1,000 but not more than 2,500 sq.ft, of cumulative landscaped area, install irrigation controllers acid sonsois vvhich Q r, A ❑ include the fallowing cnt(,,,ria, and meet manufacturer's recommendations 5.304.3.1 Irrigation controllers. Automatic irrigation system controllers installed at the time of final inspection shall comply with the folla%�Jngl 1. Controllers sh".0 he .veather- Of Sol[ rnGiStL.Ire-based controHers that automatically adjust m,igation in response to changes in plants' needs as M weatj"ie,rconditions change. 2. Weather-based controllers without integral rain sensors or coffirriumcation systems that account for local rainfall shall have a separato wirrad or wireless rain sensor which connects ar communicates M\/ LJ ❑ wiffi the cr,,)ntroller(s). SW moisture-basedcontiollers are not required to have rain SQ11sol 1` titer Resistance and Moisture Management 5.407.1 Weather protection. Provide a weather resistant exterior wall and foundation errvekpe as fequiired by California Budding Code Section 1403,2 t,4, "n, El LMX and California Energy Code Section 150, manufacturer's installation instructions or Vocal ord i na rice, wNchever is more stringcnt. I a Ex3 of 9 'u!Greeki Von -Res ( 7ieckhstdoc revovd QL,2344 5.407.2 Moisture control. Employ moisture control measures by the following methods: 5.407.2.1 Sprinklers, Prevent irrigation spray on structures. 5.407,2.2 Entries and openings. Design exterior entries andlor openings l j A ❑ to prevent water- intrusion into buildings. 5.407.2-2.1 Exterior door protection. Primary exterior entries shall be covered to prevent water intrusion by using nonabsorbent floor and wall finishes within at least 2 ft around and perpendicular to such openings plus at least one of the following, 1. An instaked awning at least 4 ft in depth, 2. The dooi is protected by a roof overhang at least 4 ft in depth. 3. The door- is recessed at least 4 ft. 4. Other methods which provide equivalent protection. 5.407.2.2.2 Flashing. Install flashings integrated with a drainage I,,41 A plane. ❑ 5.408.1 Construction waste management. Recycle and/or salvage for reuse a rninimurri of 50 percent of the nonhazardous construction and demolition waste in accordance with Section 5.408.1,11, 5.408.1.2, or 5,408.1.3; or meet a local construction and demolition waste managen,,ent ordinance, whichever is more stringent. 5.408.1.1 Construction waste management plan. Submit plan per this section to enforcement authority. ❑ 5.403.1.2 Waste management company. Utilize a waste management cornpariy that can provide verifiable documentation that the percentage of construction and demolition waste material diverted from the landfill corup(ies with CalGreen Section 5.408. 5.408.1.3 Waste stream reduction alternative. The combined weight Of new construction disposal that does not exceed tWO pounds per square El foot of building area may be deemed to meet the 50 perces it minimum requirement as approved by the enforcing agency. 5.408.1.4 Documentation. Provide documentation of the waste F I R management plan that rneets the requirements listed in Section 5,408. 1.1 through 5,408,1.3 5.408.3 Excavated soil and land clearing debris. 100 percent of trees, stumps, rocks and associated vegetation and soils resulting primarily from land clearing snail be reused or recycled. Lai d Op6ratioji 5.410.1 Recycling by a ccupants. Provide readily accessible are -as that sei've the entire building and redentfied for the depositing, storage and collection dus Pnate,als for recycling. 5.410.2 Commissioning. For new buildings 10,000 square feet and over, building corrimissioning for all building systems covered by T24, Part 6, arras,/ s s systerns and renewable energy systerrts shall be included in the design and constmiction processes of the building project. Commissioning requirements shall include items listed in Section 5.410.2 I laue -1 oll Ij Vm-Hc,( hccOv�tdrw re vvyed 01, '3,14 5.410,2.1 Owner's Project Requirements (OPR). Documented before the design phase of the project begins the CCPR shall include items listed in El i,,l, A, El Section 5.410.4. 5.410.2,2 Basis of Design (BOD). A written explanation of how the design of the building systems meets the,, CPR shall be cornpleted at the design phase of, the building project and updated periodically to cover the systems El f i", ❑ listed in Section 5.410.2.2. 5.410.2.3 Commissioning plan. A commissioning plan describing how the project will be commissioned shall be started during the design phase of ❑ the building prqect and shall include items listed in Section 5-410.2.3. J 5.410.2.4 Functional performance testing. Functional performance testing shall demonstrate the correct installation and operation of each component, system and system -to -system interface in accordance with the Lai approved plans and, specifications. 5.410.2.5 Documentation and training. A Systems manual and -systems operations training are required. 5.410.2.5.1 Systems manual. The systems manual shall be delivered to the building owner or representative and facilities operator and shall include the items listed in Section 5.410.2.5.1. 5.410.2.5.2 Systems operations training. The training of the ,apptopriate mainterianoe staff for each equipment type and/or system shall include iterTis listed in Section 5.410.2.5 2. 5.410,2.6 Commissioning report. A cornplete repor', of cornmissioning process activities undertaken through the design, construction and M-7 El reporting recommendations for pest -construction pha,Fts of the building U N project shall be corrilateted and provided to the owner or representative. 5.410.4 Testing and adjusting. Testing and adjusting of systems shalt be required for buildings less than 10,000 square feet or new systems to serve an addition or alteration subject to Section 303.1. 5.4110.4.2 Systems. Develop a written plan of procedures for testing and .adjusting systems. Systems to be included for testing and adjusting shad include, as applicable to the prow !ct, the systems listed in Section rx-� 5.410.3-2- 5.410.4.3 Procedures. Perform testing and adjusting procedures in accordance with industry best practices and applicable national standard on each system. I [-X� f �J /"� F� 5.410.43.1 HVAC balancing. Before a new space -conditioning system sctving a building or space is operated for norinal use, the system should be balanced in accordance with the procedures defined by® I,l A ❑ national standards Iiste,d in Section 5.410.3-3.1 5.410.4.4 Reporting. After completion of testing, adjusting and balancing, provide a final report of testing sie ned by the individual responsible for peiforrning these services, 5,410,4.5 Operation and maintenance manual. Provide the building owner with detailed operating and maintenance instructions and copies of nX El guaranties)warranties for each system prior to final inspection. 5.410.4.5.1 Inspections and reports. include a copy of all inspection verifications and reports required by the enforc6ng agency. L,2J 17\71 M I ri u,t <If 9 ( '(11(f,rccn Vol?-Rk^. ( 'heckliSt'dew r"I 'Ised 01; 23114 FireptalGes 5.603.1 Install oNy a direct -vent sealed -combustion gas or seated wood - burning fireplace or a sealed woodstove and refer to residential requirements N A in the California Energy Code, Title 24, Pail 6, Subchapter 7, Section 150. 5.503.1.1 Woodstoves, iAloodstoves shall comply with US EPA Phase it 177'71 emission limits. Pollutant Control 5.504.3 Covering of duct openings and protection of rri&chanical equipment during construction. At the time of rough installation or during storage on the construction site and until final startup of the heating and W01JIg eqUiprnent, all duct and other related air distribution cornponent El openings shall be covered v -.11h 'ape, plastic, sheet metal of other niethods acceptable to the enforcing agency to reduce the amount of dust or debris which may collect in the system, 5.504.4 Finish material pollutant control. Finish materials shall comply with Sec.tions 5.504.4.1 thrOUgh 5,504,4,4. 5.504.4.1 Adhesives, sealants, caulks. Adhesives and sealants used on the project shall meet the iequirefrients of the following standards. 1. Adhesives, adhesive bonding primers, adhesive primers, sealants, sealant primers arid caulks shall comply with local or regional air pollution conlrO or air quality managernent district rules where applicable or SCAQMD Rule 1168 VOC limits, as shown in Tables S,504.4.1 and 5.504.4.2. 2. Aerosol adhesives arid smaller unit sizes of adhesives and sealant or caulking compounds (in units of product, less packaging, which do not ;,veigh more than one pound and do riot consist of more than 16 fluid ounces) shall comply with statewide VOC standards and other 6X requirements, including prohibitions on use of certain tOXIC COC91POLInds, of Cafifofoia (,-o(je of Regufafions� Title 17, comrr;,2.,ncing Section 94507. 5.504.4.3 Paints and coatings. Architectural paints and coatings shall comply with Table 5.504.4.3 unless more stringent local limits apply. 6.504.4.3.1 Aerosol paints and coatings. Aerosol paints and coatirgs shall meet the Product -Weighted MIR Limits for ROC in Section 94522(a)(3) and other requirements, including prohibitions on use of tit 13 cetl,qin toxic compounds and ozone depleting substances (CCR, Title 17, Section 94520 et seq). 5.504,4.3,2 Verification. Ve) ificalion of comphance with this section shall be piovided at the request of the enforcing agency. 5.504.4.4 Carpet systems. All carpet inslatted in the building interior shall meet the testing and product requirements of at least one of the standards FX1 ❑ fisted in Section 5.504.4.4. j 5.504.4.4.1 Carpet cushion. All carpet cushion instailed in 9ne,, building interior shall meet the requires -eats of the Carpet and Rug Institute Gied n Label pigmni. 5,504.4.4.2 Carpet adhesive. All carpet adhesi,e shall lure:) requ(iements of Table 5.504,41. Yon-ReT ( 7aLcklwJoc regi ,i,wel O1.'3 3,'14 5.504.4.5 Composite wood products. Hardv,,00cl plywood, particleboard and mediUm density fiberboard composite vood products used on the interior of, extenor of the building shall meat the requirements for formaldehyde as specified in Table 5.504.4.5. 5.504.4.5.3 Documentation. Verificition of compliance with this section shall be provided as requested by the enforc,ng agency. Documentation shall include at least one of the following standards listed in Section 5-504.5.3. 5.504,4.6 Resilient flooring systems. For 80 percent of floor area receiving resilient floonng, installed resilient finr)ring shah meet at least one of the following standards listed in Section 5.504.4-6. 5,504.5.3 Filters, In rnechanically ventilated buildings, provide regularly occupied areas of th"_ building with air fftr2tion media for ,.-;utside and relurri air prior to occupancy that provides at least a MERV of 8. 5.504.7 Environmental tobacco smoke (ETS) control. Prohibit smoking Within 25 feet of building entries, Outdoor air intakes and operable �,jndovis where outdoor areas are provided for smoking and in buildings- or as enforced by ordinances, regulations or policies of any city, County, city and county, California Community College, campus of the California State University or carnpus of the University of California, whichever are more stringent. Indoor Moisture and Radon Control 5.505.1 Indoor moisture control. BL]iidings shall meet or exceed the provisions of California Budding Code, CCR, Title 24, Pail 2, Sections 1203 and Chapter 14.1. Air Quality and Exhaust 5.5061 Outside air delivery. For mechanically or naturally ventilated spaces in buildings, meet the minimum requirements of Section 121 of the California El Energy Code, CCR, Title 24, Pail 6 end Chapter 4 of CCR, Title 8 or, the applicat;e load code,, whir-hever is more stringent. 5,506.2 Carbon dioxide (CO2) monitoring. For buildings equipped with deniand control ventilation, CO2 sensors and ventilation controls shall be specified and installed in accordance with the requirements of the latest edition of the Cafifomia Energy Code, CCR, Titile 24, Parl 6, Section 121(c).' Environmental Comfort 5.507.4 Acoustical control. Employ building assemblies and components with STC vatues determined iii accordance with ASTM E 90 and ASTM E 413 5.507.4.1 Exterior noise transmission. Wall and floor-ceiling assemblies making up the building envOope shall have in STC of at least 50 and exterior windows shall have a rnintimum STC of 30 for any of the building oc,,ations listed in lten-is 1 through 3 in Section 5.507,5 1. 5,507.4,2 Interior sound .'flali and assernblia5 se Da ra tj n g tenan,t space,, and tenant ;�paces and rublic placfas shall have an STC of at least 40. Pae ^ 7 (� 1 1) (hakhw.docr(vi,scd 611- 3,x)4 Out floor Air Quality 5.508.1 Ozone depletion and greenhouse gas reductions. lnstallatuons of HVAC, refrigeration and fire suppression equipment shall comply with Sections 5.508. 11 and 5.508.1.2, 5.508.1.1 Chlorofluorocarbons (CFCs). InstaN HVAC and reffigeration Z,; ,, I El L'(iUipfflent that does not contain CFCs. 5.508.1.2 Halons. Install fire suppression equipment that does not contain E -I Habris. I Pave hof 1) ( '116'rool N"m4&'s ( ry,t.wd 01" - , ," I" CALGREEN SIGNATURE DECLARATIONS Project Narne: COLDWELL BANKER CUPERTINO Project Address: 10 105 S. DE ANZA BLVD. Project Description.- INTERIOR REMODEL FOR EXISTING TENANT SECTION I — DESIGN VERIFICATION Complete ail lines of Section I — "Design Verification" and submit the completed checklist (Cotumns 1 and 2) with the plans and Duilding permit application to the Building Department. The owner and design professional responsible for compliance with CalGreen Standards have revised the plans and (,-,eitify that the items checked above are hereby incorporated into the project plans and will be implemented plemented into the project in accordance with the requirements set forth in the 2013 California Green Building Standards Code as a Opted by the City of Cupertino. "r,- I r 7Z Y 1r Y sitz C-- , ?. /;" I'll, 'A n&< Owner's Signature Oviner's Natne Please Print) Design Professional's Signature Caivin Lurn - Vitae Architecture Professional's Name (Please Print) of License Professional responsible for CalGreen compliance Paul Hackett - Vitae Architecture (C- 12415) Name of License Professional responsible for CalGreen compliance (Please Print) Ernwl Address for License Professional responsible for GaiGreen compliance SECTION 2 — IMPLEMENTATION VERIFICATION Date �111�b Date /z,// Date 415-356-6400 Phone Complete, sign and submit the competed checklist, including column 3, together with ail original signatures on Section 2 to the Building Department prior to Building Department final inspection. I have inspected the work and have received sufficient documentation to verify and certify that the project identified above was constructed in accordance With this Green Building Checklist and in accordance with the requirements of the 2013 California Green Building Standards Code is adopted by the City of Cupertino - Signature of License Professional resfx)nsible for CalGreen compliance Date Name of License Professional responsible for CalGreeri compliance (Pflase Print) Phone Email Address for License Professional responsible for CalGreen comp?iance 1,zitP., 1) ol"9 Cal(;reen,Von-Rcs Chceklist.,h,,c ivviscd 01, 23,14