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B-2017-1932 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1932 2 RESULTS WAY CUPERTINO,CA 95014-5924(357 20 042) TCG BUILDERS INC MILPITAS,CA 95035 OWNER'S NAME: BVK PERIMETER SQUARE RETAIL LLC ET AL DATE ISSUED: 11/09/2017 • OWNER'S PHONE:650-421-1832 PHONE NO:(408)321-6450 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class)3 Lic.#835597 Contractor TCG BUILDERS INC Date 04/30/2018 X BLDG _ELECT _PLUMB MECH_RESIDENTIAL X COMMERCIAL 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. JOB DESCRIPTION: APPLE;2ND FLOOR -T.I.(1100 S.F.) I hereby affirm under penalty of perjury one of the following two declarations: t. 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 • erformance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by - e f Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$157866.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize • 357 20 042 B(Tenant Improvements) 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,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City iri consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all non-point source regulations per th-u.ino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. rgnature MAW Date 11/9/2017 Issued by:Abby Ayende • Date: 11/09/2017 OWNER-BUILDER DECLARATION I hereby affirm that jI am.ezetnpt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1. I,as owner of the property,,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) 2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date: 11/9/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1. 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 performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 3. I certify,that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,S• durt}j�05,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall ��II%es,"-• be deemed revoked. �iN• • w er or authorized •agent: APPLICANT CERTIFICATION _uate: 11/9/2017 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify,and keep harmless the City of Cupertino against liabilities, • judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. I understand my plans shall be used as public records. Licensed Signature . Date 11/9/2017 Professional CONSTRUCTION PERMIT APPLICATION ' �� COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION Lc, 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (/�� 1^^/ yt.i vs\ l L-.. (408) 777-3228 • building@cupertino.org PEMIT#B- - CUPERTINO REV# DEF# ❑ NEW'CONSTRUCTION. ]ADDITION El ALTERATION T.I.sr1=1 MEP ElRE-ROOF ❑SWIMMING POOL/SPA PROJECTADZ,its YA Iv ��` ` , ✓e oi4 poor IAPN# 35 2^U oct-42 OW •NAME • PHONE77 --er A charrechalwur 6 .9-21• tssz E-MAILWIidioI"echthure 3Foie.. S EET A•• S Q�l�p CITY, ST leaf . 0151)14- 7 �, .. hal ITC LOC , ml►GI P ('!/p.�,j�J , G� N.CONTRACTOR NAME ❑OW ER-BUILDER COMPANY NAME ` LICENSE NUMBER LICENSE TYPE STREETADDRESS_ r� M C'C o1 5-t . too CITY S'I'QT'B,I�iP I �pj Nr 1wv1�� N�_I�'f'�i G� a1�3S E-MAILPHONE BUS.LIC# �t 11,nbe-. 10 al(e erS.COM liCgs•08'2.4 4 2.Tg510 1ARCHITECT ❑OWNER ■ • NERJAGENT CONTR'ACTOR AGENT❑ENGINEER❑DEVELOPER❑TENANT ' CONTA�tli ' iCZ\� '+�"eA 0. E-MAIL .A_ III `bCJ--1- Apvt.i ' s 65.rn STREET ADDRESS Oo CITY,ST i ZIP ` •-.^— . PHO4 • 2 • fir4� ��o K M��Y BIM .� ��p�-��, c� -. - J�J 41vC DECRIPTON . TT I. -Fvr ti 1/ 1 OD—& o• o4'ce G -to enginee'"' ' work roomer • Locat'e4 on -floor of (�). 'ktaildel. ❑SINGLE-FAMILY/DUPLEX, El MULTI-FAMILY 0 INDUSTRIAL COMMERCIAL II EXISrING USE EXISTING SF� NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($) '1( I/( ' 1/11.)0 2 , REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED 1 �'y� r^ �n f. . BATHROOM SF SFS SF SF ❑DETACHED Ace I` B 6,,lW. ✓ ac �{' , EXISING ; tgLYES' EIOHLER ❑YES , SECOND STORY ADDmON ❑YES ' FIRE SPRINKLERS 0 NO, 0 NO ❑NO DWELLING SECOND DWELLING ❑YES 0 ATTACHED DETACHED OTHER . UNITS# ' UNIT ADDITOk: ❑NO ' S F POOLSI 0 FIBERGLASS,I ❑VII4YL-LINED ❑GUNTTE ❑PREFABRICATED POOL'-SF SPA-SF:' I SPA ATTACHED OYES 0 NO I TOTAL-SF ' r RECEydIrD BY: p j TpTP LyALr IpT10pI Commercial or Multi-Famih/buildings with Public Swimming Pools requires Department of Environmental Heath approval (`�,I,�D J- r1'Q 1 --- "'i({,0'1/fnG/Y2 i 0 . , AS RE-ROOF!EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGL ❑T -E OTHER(SPECIFY) • 111 REMOVE/REPLACE❑NO IF NO PLYWOOD ❑'�Z� ❑3/8" PLYWOOD TYPE: j PITCH:El YES CLASS YES #'OF LAYERS THICKNESS❑5/8" OTHER OSB CDX OTHER '12 A PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES ❑OTHER ' *Provide a signed copy of the Cupertino's Tear-Off Policy SF #61 SQUARES By My signature below.1 certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I ' . have read this application and the information I have provided is correct. I have read the Description of Work and!verify it is accurate. I agree ' to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. I acknowledge and authorize all information contained on this application form to be made available for public record.'t ,n,J Signature of Applicant/Agent:, '--c r.. �'`U' ya(l1� Date: SUPPLEMENTAL INFORMATION REQUIRED J ; *New SFD/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction. . *Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. *Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. *HOA-Provide a letter of approval from the Home Owner's Association , BldgApp_2017.doc revised 08/01/17 • ;,i J CONSTRUCTION PERMIT APPLICATION \\ / COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ..r.Itk/ 10300 TORRE AVENUE • CUPERTINO,CA 95014-3255 e.tysr (408)777-3228 • building@cupertino.org PEMIT:B- - CUPERTINO REV: DEF: ❑NEW CONSTRUCTION ❑ADDITION ❑ALTERATION Q T.1. 0 MEP ❑RE-ROOF ❑SWIMMING POOL/SPA PROJECT ADDRESS IAPN: • - Results Wav 2 OWNER NAME. PHONE E-MAIL Roger Anchartechahar 650-421-1832 ranchartechahar@apple.com STREET ADDRESS . CITY,STATE,ZIP Lhmwmaiiitadstt$cri®-DDC rtit 115011415014 I]CONTRACTOR NAME ❑OWNER-BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE TCG Builders TCG Builders &mow B STREET ADDRESS CITY,STATE,ZIP -890 II ID3tecaultttjn j laGi aite000 NillititstsQC9 5 • E-MAIL PHONE 'BUS.LIC: ashlimtll@tcgbuilt#bresnmmi 408-582-4840 27856 0 ARCHITECT D OWNER ❑OWNER AGENT I]CONTRACTOR AGENT ENGINEER 0 DEVELOPER 0 TENANT CONTACT NAME E-MAIL Ashlin Braddock ashlinb@tcgbuilders.com STREET ADDRESS CITY,STATE,ZIP PHONE 890 N McCarthy Blvd Suite 100 Milpitas,CA 95035 408-582-4840 DECRIPTON , 'II , Tenant improvement for-1,100 SF of office space to offices and engineering work rooms. Located on the 2nd floor of ' existing building. ,• ❑SINGLE-FAMILY/DUPLEX ❑MULTI-FAMILY ❑INDUSTRIAL I]COMMERCIAL ' I EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES$ TOTAL NET SF USE TYPE OCC SQ.FT. I VALUATION(5) Mae ; Imo 2 1171700 REMODEL.' REMODEL KITCIIEN REMODEL OTHR GARAGE 0 ATTACHED 'Q� q Qy��+ BATHROOM SF ,j 'I SF SF SF 0 DETACHED alftee office B1;100 i /r;386V EXISINGD YFS ` 0\ ,EICIILER;' SECOND STORY ❑tF5 FIRE SPRINKLERS 0 NO 1. , . ; 0 NO ❑No office office - DWELLING SECOND- DWELLING AYES ❑ATTACHED❑DETACHED OTHER UNITS$ IUNRADD1TON':; El No SF office office POOLS' , 'D FIBERGLASS..0 VINYL-LINED 0 GUNITE 0 PREFABRICATED POOL-SF ." SF' SPA!- I SPA ATTACHED❑YES 0 NO I TOTAL-SF office office I i i ;1 I . RECEIVED BY: . TOTAL VALUATION: CammrmaI oi.Ifrai Fant I,,RuiIfnrc<«drI PrrI Ir Swimming Pmt<rr,luir,-Drrmrtn,rnI n(Ertriro,mrn,S l Hmtlr mrcwor,d 5157,866 REiROOFIE(ISTINGROOETYPE I❑.BU11.T-UP ROOF ASPHALT SHINGLES WOOD SHAKES❑WOOD SIII\GLES0TILE OTHER`(SI'ECIFY) office i REMOVE/RR I?LACE NO ,IFNO PLYWOODr.. TIS" PLYWOOD TYPE: (!ITCH: I - ❑�'�.� 0 0• ROOF CLASS ' ',I,, :`.�; pyo $OF LAYERS THICKNESS❑5/5' OTHER DOSE 0 CDX OTHER •12 A PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPI!ALT SJINGLES D WOODSHAKES DWOOD SHINCLEI.S ❑OTHER 'Provide$,signed copy of the Cupertino's Tear-Off Policy SF ;o1 SQUARES B,1 imy signature below I certify'to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read.this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree . tdcompl• v;with all Applicable,local ordi inces •• ate I-A s relating 1. building construction. I authorize representatives of Cupertino to enter thelabove-identified property or insp•' ion purpose . ��m l•t.e and authorize all information contained on this application form •to:be marle available for public re ord. {�� / , �, Signature of Applican/Agent:! - Y \�R Is, t 1 `�' Date: t 1/8/r/ I SUPPLEMENTAL INFORMATION REQUIR�D) 1t I I ;, Nese SID/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit forlall-new construction. 'Commercial Buildings,''Provide a completed Hazardous Materials Disclosure form if any I-fazardous Materials are being used as part of this project. 'Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. ' 16A-Proi'ide a letters of approval from the Home Owner's Association I • 131dgrlpp O!7.doc revised 08+Y71f17 , STATE OF CALIFORNIA INDOOR LIGHTING CEC-NRCI-LTI-01-E (Revised 01/16) .f 1'. FF CAI IFORNIA NR( Y MRAN R 10ri CERTIFICATE OF INSTALLATION NRCI-LTI-01-E Indoor Lighting Page 1 of 2 Project Name:A04 R -W 07.Enforc nt gency: q gh N ¢ ®� Project Address: --r city q F '"—rmit ZiPCode: p01q GENERAL INFORMATION DATE OF BUILDING PERMIT Applicable Sheets or Pages, Tables, Schedules, etc. PERMIT NUMBER. Date: BUILDING TYPE.] Nonresidential ❑ High -Rise Residential (common area) ❑ Hotel/Motel (Common Area) PHASE OF CONSTRUCTION ❑ New Construction ❑ Addition [ Alteration ❑ Unconditioned SCOPE OF RESPONSIBILITY Enter the date of approval by enforcement agency of the Certificate of Compliance that provides the Applicable Sheets or Pages, Tables, Schedules, etc. specifications for the energy efficiency measures for the scope of responsibility for this Installation Date: Certificate. In the table below identify all applicable construction documents that specify the requirements for the scope of responsibility reported by this Installation Certificate (continued). Document Title or Description Applicable Sheets or Pages, Tables, Schedules, etc. Date Approved by Enforcement Agency Add Row I Rerr)ove Last CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 STATE OF CALIFORNIA INDOOR LIGHTING CEC-NRCI-LTI-01-E (Revised 01/16) CERTIFICATE OF INSTALLATION NRCI-LTI-01-E Indoor Lighting Page 2 of 2 Project Name:) , (J- Enfor men Agency: Q�' & ' emit Nu er: -.a Project Add I V City; a} _ Zip Code: 's—ol DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. I certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name: \\ (( � O o Documentation Au or1signature`A i6 / Documentation Author Company Name: /t / Date Signed: �" , tij x Address:. - CEA Certification Identification (If applicable): City/State/Zip: g S-0 I Phone: ^ -. S �J 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 Installation is true and correct. 2: I 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 Installation and attest to the declarations in this statement (responsible builder/installer), otherwise I am an authorized representative of the responsible builder/installer. 3. The constructed or installed features, materials, components or manufactured devices (the installation) identified on this Certificate of Installation conforms to all applicable codes and regulations, and the installation conforms to the requirements given on the plans and specifications approved by the enforcement agency. 4. 1 reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the specific requirements for the scope of construction or installation identified on this Certificate of Installation, and I have ensured that the requirements that apply to the construction or installation have been met. 5. 1 will ensure that a completed signed copy of this Certificate of installation 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 completed signed copy of this Certificate of Installation is required to be included with the documentation the builder provides to the building owner at -occupancy. Responsible Builder/Installer Name: Responsible Builder/Installer Signatures Company Name: (Installing Subcontractor or General Contractor or Builder/owner) Position With Company (Title): Address: CSLB License: _ City/State/Z,ip; Phone Date Signed: CA Building Energy Efficiency Standards -2016 Nonresidential Compliance January, 2016 STATE OF CALIFORNIA ENERGY MANAGEMENT CONTROL SYSTEM OR LIGHTING CONTROL SYSTEM CEC-NRCI-LTI-02-E (Revised 01116) CAi iFn RNIA FmF=Pr.y cnAAnAFSSinri - — - - - CERTIFICATE OF INSTALLATION -- ------ NRCI-LTI-02-E - Energy Management Control System or Lighting Control System (Page 1 of 6) Project Name:Apo-. Enforcement Agency: da P it Nu beY• - f Project Address: u S City: Zipe ade: 10 (LI GENERAL INFORMATION `Enter the date of approval by enforcement agency of the Certificate of Compliance that provides OF BUILDING PERMIT PERMIT# 32 -BUDATE 1-7 — 10132 - BUILDING ILDING TYPE [' 'Nonresidential ❑ High -Rise Res (Common Area) ❑ Hotel/Motel (Common Area) PHASE OF CONSTRUCTION ❑ New Construction ❑ Addition El Alteration ElUnconditioned SCOPE -OF RESPONSIBILITY `Enter the date of approval by enforcement agency of the Certificate of Compliance that provides Date: the specifications for the energy efficiency measures for the scope of responsibility for this ' 1 Installation Certificate. 0 Requirements in the Standards: §130.4(b) Before an Energy Management Control System (FMCS), or Lighting Control System can be recognized for compliance with the lighting control requirements in Part b of Title 24, the person who is eligible under Division 3 of the Business and Professions Code to accept responsibility for the construction or installation of features, materials, components, or manufactured devices shall sign and submit this Installation Certificate. If any of the requirements in this Installation Certificate fail the Energy Managem System or Lighting Control System installation requirements, these options for controlling lighting sh n t be -recognized fo corn with the Building Energy Efficiency Standards, 1517 Check all that apply- PART 1 What type of Lighting Control System has been instal ed?417 A. Energy Management Control System (FMCS) -Is a computeriz . \d contro s�designd toregulate the _energy consumption of a building by controlling the operation of ergy consuming systems, such as the heating, ventilation and air conditioning (HVAC), lighting, and water heating s stems, and is capable of monitoring environmental and system loads, and adjusting HVAC operations in order to optimize energy usage and respond to demand response signals. ❑ The Energy Management Control System has been installed to function as a lighting control required by Part 6 and functionally meets all applicable requirements for each application for which it is installed, in accordance with Sections 110.9, 130.0 through 130.5, 140.6 through 150.0, and 150.2; and complies with Reference Nonresidential Appendix NA7.7.2. The EMCS has been separately tested for each respective lighting control system for which it is installed to function as. B. Lighting Control System -Requires two or more components to be installed in the building to provide all of the functionality required to make up a fully functional and compliant lighting control. D( The installed Lighting Control System complies with the requirements checked below; and all components of the system considered together as installed meet all applicable requirements for the application for which they are installed as required in Sections 130.0 through 130.5, Sections 140,6 through 140.8, Section 141.0, and Section 150.0(k). CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 STATE OF CALIFORNIA ENERGY MANAGEMENT CONTROL SYSTEM OR LIGHTING CONTROL SYSTEM CEC-NRCI-LTI-02-E (Revised 01/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF INSTALLATION NRCI-LTI-02-E Energy Management Control System or Lighting Control System (Page 2 of 6) Project. Name; - - - Enforcement Agency: - - Permit Number. Project Address: - - City: Zip Code: PART 2 Lighting Control_ Functional requirements; Check all that apply when verifying the installation of an EMCS or Lighting Control System. A. All lighting controls and equipment have been installed in accordance with the manufacturer's instructions. B. The manufacturer has provided instructions for calibration. C. If indicator Eights are integral to any components, such indicator lights consumes no more than l watt of power per indicator light. D. Components that are regulated by the Title 20 Appliance Efficiency Regulationshave been certified to the Energy Commission. E. The EMCS or Lighting Control System functions as one or more of the Time -Switch Lighting Controls checked` below, and complies with all of the following requirements: [ 1. Automatic Time -Switch Controls meeting all requirements for Automatic Time Switch Control devices in the Title 20 Appliance Efficiency Regulations, including the requirements below: a; Residential automatic time -switch controls have program backup capabilities that prevent the loss of the device's schedule for at least 7 days, and the device's date and time for at least 72 hours if power is interrupted. b. Commercial automatic time -switch controls meet the following requirements: i. Has program backup capabilities that prevent the loss of the device's schedule for at least 7 days, and the device's date and time for at least 72 hours if power is interrupted ii. Is capable of providing manual override to each connected load and shall resume normally scheduled operation after manual override is initiated within 2 hours for each connected load; and iii. Incorporates an automatic holiday shutoff feature that turns off all connected loads for at least 24 hours and then resumes normally scheduled operation. ❑ 2. Astronomical Time -Switch Controls meeting all requirements for Astronomical Time -Switch Control devices in the Title 20 Appliance Efficiency Regulations, including the requirements below: a. Meets the requirements of an automatic time -switch control; b. Has sunrise and sunset prediction accuracy within plus -or -minus 15 minutes and timekeeping accuracy within 5 minutes per year; c. Is capable of displaying date, current time, sunrise time, sunset time, and switching times for each step during programming; d. Has an automatic daylight savings time adjustment; and e. Has the ability to independently offset the on and off for each channel by at least 99 minutes before and after sunrise or sunset. Fj 3. Multi -Level Astronomical Time -Switch Controls, in addition to meeting all of the requirements for Astronomical Time -Switch Controls, includes at least 2 separately,programmable steps per zone. F. The EMCS or Lighting Control System functions as one or more of the Daylighting Controls listed below: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 STATE OF CALIFORNIA ENERGY MANAGEMENT CONTROL SYSTEM OR LIGHTING CONTROL SYSTEM CEC-NRCI-LTI-02-E (Revised 01/16) CALIFORNIA ENFRGY MIUMIssION CERTIFICATE OF INSTALLATION NRCI-LTI-02-E Energy Management.Control System or Lighting Control System (Page 3 of 6) Project Name: - - - Enforcement Agency: _ - - - - Permit Number; Project Address: - - - city: 'Zip Code: El 1. Automatic Daylight Controls meet all requirements for Automatic Daylight Control devices in the Title 20 Appliance Efficiency Regulations, including the following: a. Is capable of reducing the power consumption in response to measured daylight either directly or by sending and receiving signals; b. If the system includes a dimmer, complies with the Dimmer Control :device requirements in the Title 20 Appliance Efficiency Regulations. c. Automatically return to its most recent time delay settings within 60 minutes when put in calibration mode; d. Has a set point control that easily distinguishes settings to within 10% of full scale adjustment; e. Has a light sensor that has a linear response within 5% accuracy over the range of illuminance measured by the light sensor; f. Has a light sensor that is physically separated from where the calibration adjustments are made, or is capable of being calibratedin a manner that the person initiating the calibration is remote from the sensor during calibration to avoid influencing calibration accuracy; and g. Complies with the Title 20 requirements for photo controls if the system contains a ,photo control' component. ❑ 2. Photo Controls meet all requirements for Photo Control devices in the Title 20 Appliance Efficiency Regulations, including the following that it does not have a mechanical device that permits disabling of the control. K G. The EMCS or Lighting Control System functions as a Dimmer and meets all requirements fora Dimmer Control device in the Title 20 Appliance Efficiency Regulations, including the following: 1. Is capable of reducing power consumption by a minimum of 65% when the dimmer is at its lowest level; 2. Includes an off position which produces a zero lumen output; and 3. Does not consume more than 1 watt per lighting dimmer switch leg when in the'off position. 4. Dimmer controls that can directly control lamps provide electrical outputs to lamps for reduced flicker operation through the dimming range so that the light output has an amplitude modulation of less than 30% for frequencies less than 200 Hz without causing premature lamp failure. 5. If designed for use in three way circuits is capable of turning lights off, and to the level set by the dimmer if the lights are off. R] H. The EWICS or Lighting Control System meets the following requirements: 1. Is capable of automatically turning off controlled lights in the area no more than 30 minutes after the area has been vacated; 2. Allows all lights to be manually turned off regardless of the status of occupancy; and 3. Has a visible status signal that indicates that the device is operating properly, or that it has failed or malfunctioned. The visible status signal may have an override switch that turns off the signal. 4. All occupant sensing devices that utilize ultrasonic radiation for detection of occupants meet the Ultrasound Maximum Decibel Values in the Title 20 Appliance Efficiency Regulations 5, All occupant sensing devices that utilize microwave radiation for detection of occupants meet the radiation requirements in the Title 20 Appliance Efficiency Regulations 6. Occupant sensing devices incorporating dimming comply with the requirements for dimmer controls in the Title 20 Appliance Efficiency Regulations CA Building Energy Efficiency Standards 2016 Nonresidential Compliance January 2016 STATE OF CALIFORNIA ENERGY MANAGEMENT CONTROL SYSTEM OR LIGHTING CONTROL SYSTEM rFr_nicri_i -n_m_F rve,a�e,nvaacnr IFnanun FniFRr_v rtnnnnmscinnt CERTIFICATE OF INSTALLATION NRCI-LTI-02-E Energy Management Control System or Lighting Control System (Page 4 of 6) Project Name: - _ Enforcement Agency: Permit Number: Project Address: City: _ - Zip. Code: 7. The FMCS or Lighting Control. System functions as one or more of the Occupant Sensing Controls Checked Below: a. Occupant Sensors meeting all applicable requirements for Occupant Sensor Control devices in the Title 20 Appliance Efficiency Regulations. b, Motion Sensors meeting all applicable requirements for Motion Sensor Controls devices in the Title 20 Appliance Efficiency Regulations, including that motion sensors are rated for outdoor use. c. Vacancy Sensors meeting all applicable requirements for Vacancy Sensor Controls devices in the Title 20 Appliance Efficiency Regulations, including the following: i. Does not turn on lighting automatically and does not incorporate DIP switches, or other manual means, for conversion between manual and automatic functionality; ii. Has a grace period of no more than 30 seconds and no less than 15 seconds to turn on lighting automatically after the sensor has timed out; and iii. Does not have an override switch that disables the sensor. d. Partial -ON Sensors meeting all applicable requirements for partial on sensing devices in the Title 20 Appliance Efficiency Regulations, including the following: i. Has two poles each with automatic -off functionality; ii. Has one pole that is manual -on and does not incorporate DIP switches, or other manual means, for conversion between manual and automatic functionality; and iii. Has one pole that is automatic -on and is not be capable of conversion by the user to manual -on functionality. 0 e. Partial -OFF Sensors meet all applicable requirements for partial off sensing devices in the Title 20 Appliance Efficiency Regulations, including the following: i. Has two poles; ii. Has one pole that is manual -on and manual off; and iii. Has one pole that is automatic -on and automatic -off and is not capable of conversion by the user to manual -on only functionality. f. Occupant Sensing Control systems consist of a combination of single or multi-level Occupant, Motion, or Vacancy Sensor Controls, and all components installed to comply with manual -on requirements are not capable of conversion by the user from manual -on to automatic -on functionality. CA Building Energy Efficiency Standards -2016 Nonresidential Compliance January 2016 P STATE OF CALIFORNIA ENERGY MANAGEMENT CONTROL SYSTEM OR LIGHTING CONTROL SYSTEM , RFR_nIRRI_I TI -09-F (P—i—H rMHR1 CAI IF()aA11A FNFRGV Crl6AhdICC1()Al CERTIFICATE OF INSTALLATION NRCI-LTI-02-E Energy Management Control System or Lighting Control System (Page 5 of 6) Project Name: Enforcement Agency: - Permit Number: Project Address: - City: Zip Code: PART 3 Requirements for which the control is being installed to complied with: Identify all requirements in the Standards for which the EMCS or Lighting Control System is installed to function as and complies with: Check all that are applicable A. Section 130.1(a) Area Controls. B. Section 130.1(b) Multi -Level Lighting Controls C. Section 130.1 (c) Shut -OFF Controls El D. Section 130.1 (d) Automatic Daylighting Controls. ❑ E. Section 130.1 (e) Demand Responsive Controls. El F. Section 130.5 (d) Circuit Controls for 120 -Volt Receptacles. If installed to qualify for a Power Adjustment Factor, submit this Installation Certificate in addition to the PAF Installation Certificate. ❑ G. To qualify for the PAF for a Partial -ON Occupant Sensing Control in TABLE 140.6-A. ❑ H. To qualify for the PAF for an occupant sensing control controlling the general lighting in large open pian:office areas above workstations, in accordance with TABLE 140.6-A ❑ 1. To qualify for the PAF for a Manual Dimming System PAF or a Multiscene Programmable Dimming System PAF in TABLE 140.67A ❑ J. To qualify for the PAF fora Demand Responsive Control in TABLE 140:6-A K. To qualify for the PAF for Combined Manual Dimming plus Partial -ON Occupant Sensing Control in TABLE 140.6-A CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 STATE OF CALIFORNIA ENERGY MANAGEMENT CONTROL SYSTEM OR LIGHTING CONTROL SYSTEM CEC-NRCI-LTI-02-E (Revised 01/16) r'Al iFnanuA rK1r-P -'V rnRAKAICCIn Al _.._.. _...... ...... -........... CERTIFICATE OF INSTALLATION NRCI-LTI-02-E Energy Management Control System or Lighting Control System (Page 6 of 6) Project Name: - - - - ": Enforcement Agency: Permit Number: Project Address: City: Zip. Code: DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name: -- 0 - Documentation Author Signature:. Documentation Author Company Name: L��-Dae Signed: i/ Address: i `� y' sr CEA Certification Identification (If applicable): y g g City/State/Zip: •�'�`" ., < • (�. � 5 (. i �' Phone: (� " _0 x'12 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 Installation is true and correct. 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 Installation and attest to the declarations in this statement (responsible builder/installer), otherwise I am an authorized representative of the responsible builder/installer. 3. The constructed or installed features, materials, components or manufactured devices (the installation) identified on this Certificate of installation conforms to all applicable codes and regulations, and the installation conforms to the requirements given on the plans and specifications approved by the enforcement agency. 4. I reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the specific requirements for the scope of construction or installation identified on this Certificate of Installation, and I have ensured that the requirements that apply to the construction or installation have been met. 5. 1 will ensure that a completed signed copy of this Certificate of Installation 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 completed signed copy of this Certificate of Installation is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Builder/Installer Name: Responsible Builder/Installer Signature: Company Name: (Installing Subcontractor or General Contractor or Position With Company (Title): Builder/Owner) Address: - CSLB License: City/State/Zip: Phone Date Signed: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016