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Home My WebLink AboutX2019-0278 - MiscF otingconh l eject Name: HRC FERTILITY CLWIC Enforcement Agency: CITY OF NEWPORT BEACH Permit Number. X2019-047 eject Addm.:500SUPERIORAVE SUITE#Z l0 City: NEWPORTBEACH Zip Code: 92663 XgnfQ.n9_74 1Fv I t vr. IU Enforcement Agency Use: Checked by/Date 500 Sbperi or. Ave. LIGHTING CONTROL ACCEPTANCE DOCUMENT 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). A. Construction Inspection .Fill out Section A to cover spaces 1 through 3 that are functionally tested under Section B. Instruments neededto perform tests include, but are not limited to: hand-held amperage meter, power meter, or light meter 1: Automatic Time Switch Controls Construction Inspection—confirm for all listed in Section B a. All automatic time switch controls are programmed for (check all): r Weekdays r Weekend F Holidays b. Document for the owner automatic time switch programming (check all):. r Weekday settings r. Weekend settings r Holidays settings r Set-up settings r Preference program setting r Verify the correct time and date is properly set in the time switch r Verify the battery is installed and energized. r Override time limit is no more than 2 hours P 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 2. Occupancy Sensor Construction Inspection—confirm for all listed in Section 13 F✓• Occupancy sensors are not located within 4 feet of any HVAC diffuser P7 Ultrasonic Occupancy sensors do not emit audible sound 5 feet from source )t HRC FERUL11 Y CLWIC MORT 9EACn P.—tNmmber. X2019-027 Lary. --w , nnnctt --- Zip Cody. 92663 B. Functional Testing of Lighting Controls For every space, in the building, conduct functional tests 1 through 5 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. EXCEPTION: For buildings with up to seven (7) occupancy sensors, all occupancy sensors shall be tested. (NA7.6.2.3) Representative Spaces Selected Tested space/room name: 226 LAB / DRAW. Space Type (office; corridor, etc) LAB Untested areas/rooms Confirm compliance for all control system types (1-5) present in each space: I. Automatic Time Switch Controls Step 1: Simulate occupied condition a. All lights can be turned on and off by their respective area control switch b. Verify the switch only operates lighting in the ceiling -height partitioned area in which the switch is located. r :: Simulate unoccupied condition a: All lighting, including emergency and egress lighting, turns off. Exempt lighting may remain on per Section 130.1(c)1 and 130.1(a)1. r b. Manual override switch controls only the lights in the selected ceiling height Partitioned space where the override switch is located and the lights remain on no longer than 2 hours (unless serving public areas and override switch is captive key_ type) Ir ystem returned to initial operating conditions r ccupancy Sensors 1: Simulate an unoccupied condition a. Lights controlled by occupancy sensors turn off within a maximum of 20 minutes - from start of an unoccupied condition per Standard Section 110.9(b) r b. The occupant sensordoes not trigger a false 'on' from movementin an area adjacent to the controlled space or from HVAC operation. l- t: Simulate an occupied condition a. Status indicator or annunciator operates correctly r F Lights controlled by occupancy sensors turn on immediately. upon an occupied condition OR sensor indicates space is 'occupied' and lights may be turned on manually r ;hlmgconnol eject AMc.: 500 SUPERIOR AVE, SUITE #210 City: NEWPORT BEACH Step 3:.. System returned to initial operating conditions r- 3. 3. Partial Off Occupancy Sensor Step 1: Simulate an unoccupied condition a. Lights go to partial off state within a maximum of 20 minutes from start of an unoccupied condition per Standard Section 110.9(a) r. b. The occupant. sensor does not trigger a false 'on' from movement in an area adjacent to the controlled space or from HVAC operation. For library book stacks or warehouse aisle, activity beyond the stack or aisle shall not activate the lighting in the aisle or stack. r c. In the partial off state, lighting shall consume no more than 50% of installed 'lighting power, or: No more than 60% of installed lighting power for metal halide or high pressure _ sodium lighting in warehouses. No more than 60%n of installed lighting power for corridors and stairwells in which the installed lighting power. is 800/a 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 r >tep 2: Simulate an occupied condition The occupant sensing controls shall turn lights fully ON in each separately controlled areas, Immediately upon an occupied condition r 4. Partial On Occupancy Sensors Step 1. -Simulate an occupied condition. Verify partial on operation. a. immediately. upon an occupied condition, the first stage activates between 50 to 70%n of the lighting automatically. r b. After the first stage occurs, manual switches allow an occupant to activate the alternate set of lights, activate 100% of the lighting power, and manually deactivate all of the lights. r. Z. Simulate an unoccupied condition a. Both stages (automatic on and manual on) lights turnoff within a. maximum of 20 minutes from start of an unoccupied condition per Standard Section 110.9(a) b. The occupant sensor does not trigger false 'on' from movement in an area adjacent to the controlled space or. from HVAC operation. r �mng Control )jw Name: HRC FERTILITY CLINIC IEnfome=tit Agency: CITY OF NEWPORT BEACH JP.11it Nwnba: X2019-0278 ojectAddress: 500 SUPERIOR AVE, SUITE #210 City: NEWPORT BEACH JlLp Cade: 92663 5. Additional test for Occupancy Sensors Serving Small Zones in Office Spaces Larger than 250 ft , to Qualify for a Power Adjustment Factor (PAF) Step 0: First, complete Functional Test 2 (above) for each controlled zone. Step 1: Verify area served and compare actual PAF with claimed PAF. Refer to Functional Test 2. a. Area served by controlled lighting ft2 b. Enter PAF corresponding to controlled area from line (a) above (<125 ft2 for PAF=0.4, 126-250 ft2 for PAF=0.3, 251-500 ft2 for PAF=0.2). c. Enter PAF claimed for occupant sensor control in this space from the Certificate of Compliance. d. The PAF corresponding to the controlled area (line b), is greater than or equal to the PAF claimedin the compliance documentation (line c). r e. Sensors shall not trigger in response to movement in adjacent walkways or workspaces r. f. All steps are conducted in Functional Test 2'Occupancy Sensor (On Off Control)' and all answers are Yes. r RIUm me: HRC FERTILITY CLINIC-m-nmen[ Agency: CITY OF NEWPORT BEACH dress: 500 SUPERIOR AVE, SUITE 4210 City: NEWPORT BEACH C. Testing Results 1. Automatic Time Switch Controls (all answers must be Yes). r 2. Occupancy Sensor (On Off Control) (all answers must be Yes). r 3. Partial Off Occupancy Sensor (all answers must be Yes). For warehouses, library book stacks, corridors, stairwells in nonresidential buildings must also be accompanied by passing Test 1 or Test 2. Tr - 4. Partial On Occupant Sensor for PAF (all answers must be Yes). r 5. Occupant Sensor serving small zones for PAF (all answers must be Yes). Also must pass Test 2.. r Representative Spaces Selected Tested sDace/room name: J75 STOPM-,F Confirm compliance for all control system types (1-5) present in each space: 1. Automatic Time Switch Controls Step 1: Simulate occupied condition a. All lights can be turned on and off by their respective area control switch r b. Verify the switch only operates lighting in the ceiling -height partitioned area in which the switch is located. r Step 2: Simulate unoccupied condition a. All lighting, including emergency and egress lighting, turns off. Exempt lighting may remain on per Section 130.1(c)1 and 130.1(a)1.. r b. Manual override switch controls only the lights in the selected ceiling height partitioned space where the override switch is located and the lights remain on no longer than 2 hours (unless serving public areas and override switch is captive key '.type). r Step 3: .System returned to initial. operating conditions r- 2. 2. Occupancy Sensors Step 1: Simulate an unoccupied condition a. Lights controlled by occupancy sensors turn off within a maximum of 20 minutes lC FERTILITY CLINIC Enforcement Agency: CITY OF NEWPORT BEACH Permit Num6ec X2019-0278 i00 SUPERIOR AVE, SUITE #210 City: NEWPORT HEACH Zip Code: 92663 from start of an unoccupied condition per Standard Section 110.9(b) I W b.: The occupant sensor does not trigger a false 'on' from movement in an area adjacent to the controlled space or from HVAC operation. NO - 2: 2: Simulate an occupied condition 1. Status indicator or annunciator operates correctly r J. Lights controlled by occupancy, sensors turn on immediately upon an occupied condition OR sensor indicates space is 'occupied' and lights may be turned on manually r. itep 3:. System returned to initial operating conditions r 3. Partial Off Occupancy Sensor Step 1: Simulate an unoccupied condition a. Lights go to partial off state within a maximum of 20 minutes from start of an unoccupied condition per Standard Section 110.9(a) r b. The occupant sensor does not trigger a false 'on' from movement in an area adjacent to the controlled space or from HVAC operation. For library book stacks or warehouse aisle, activity beyond the stack or aisle shall not activate the lighting in the aisle or stack, r c. In the partial off state, lighting shall consume no more than 500% of installed lighting ..power, or: No more than 60% of installed lighting power for metal halide or highpressure sodium lighting in warehouses. No more than 60% of installed lighting power for corridors and stairwells in which the installed lighting power is. 80% 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 r itep 2: Simulate an occupied condition The occupant sensingcontrols shall turn lights fully ON in each separately controlled areas, Immediately upon an occupied. condition G 4 Partial On Occupancy Sensors Step 1. -Simulate an occupied condition. Verify partial on operation. a. Immediately upon an occupied. condition, the first stage activates between 50 to 70% of the lighting automatically. r b. After the first stage occurs, manual switches allow an occupant to activate the alternate set of lights, activate 100% of the lighting power, and manually deactivate all of the lights. G Step 2. Simulate an. unoccupied condition )jeer Name: HRC FERTILITY CLINIC Enforcement Agency: CITY OF NEWPORT BEACH Permit N.be,' X2019-0278 .eject Address: 500 SUPERIOR AVE, SUITE 4210 City: NEWPORT BEACH IlZip Code: 92663 a. Both stages (automatic on and manual on) lights turn off within a maximum of 20 Lminutes from start of an unoccupied condition per Standard Section 110.9(a) r b. The occupant sensor does not trigger a false 'on'. from movement in an area adjacent to the controlled space or from HVAC operation. r ,h mg Cwmnl )1ect Neme. HRC FERTILITY CLINIC Enforcement Agency: CITY OF NEWPORT BEACH Permit Number: X2019-0278 >Jc` Address: 5uu 5uPERIOR AVE SUITE 0210 City: NEWPORT BEACH Zip Code: 92663 5: Additional test for Occupancy Sensors Serving Small Zones in Office Spaces Larger than 250 ft , to Qualify for a Power Adjustment Factor (PAF) Step 0: First, complete Functional Test 2 (above) for each controlled zone. Step 1: Verity area served and compare actual PAF with claimed PAF. Refer to Functional Test 2. a. Area served by controlled lighting ft2 b. Enter PAF corresponding to controlled area from line (a) above (<125 ft2 for PAF=0.4, 126-250 ft2 for PAF=0.3, 251-500 ft2 for PAF=0.2). c. Enter PAF claimed for occupant sensor control in this space from the Certificate of Compliance. d. The PAF corresponding to the controlled area (line b), is greater than or equal to the PAF claimedin the compliance documentation (line c). r e. Sensors shall not trigger in response to movement in adjacent walkways or workspaces r. f. All steps are conducted in Functional Test 2 'Occupancy Sensor (On Off Control)' and all answers are Yes. Tr— iectNeme: HRC FERTILITY CLIMC Enforcement Agency: CITY OF NEWPORT BEACH Pemilt Number. X2019-0278 ject Address: 500 SUPERIOR AVE SUITE42U) City: NEWPORT BEACH Zip Code: 92663 C. Testing Results Automatic Time Switch Controls (all answers must be Nes). r 2. Occupancy Sensor (On Off Control) (all answers must be Yes). r 3. Partial Off Occupancy Sensor (all answers must be Yes). For warehouses, library book stacks, corridors; stairwells in nonresidential buildings must also be accompanied by. passing Test 1 or Test 2. r Partial On Occupant Sensor for PAF (all answers must be Yes). r S. Occupant Sensor serving small zones for PAF (all answers must be Yes). Also must pass Test 2. r Representative Spaces Selected Testedspace/room name: 223 EXAM Space Type (office, corridor, etc)EXAM Untested areas/rooms Confirm compliance for all control system types (1-5) present in each space: 1. Automatic Time Switch Controls Step 1: Simulate occupied condition a. All lights can be turned on and off by their respective area control switch r b. Verify the switch only operates lighting in the ceiling -height partitioned area in which the switch is located. Rep 2: Simulate unoccupied condition a. All lighting, including emergency and egress lighting, turns off. Exempt lighting may remain on per Section 130.1(c)1 and 130.1(a)1.. r b. Manual override switch controls only the lights in the selected ceiling height partitioned space where the override switch is located and the lights remain on no. longer than 2 hours (unless serving public areas and override switch is captive key type)• r Step 3: System returned to initial operating conditions r 2. Occupancy Sensors Step 1: Simulate an unoccupied condition a. Lights controlled by occupancy sensors turn off within amaximum of 20 minutes - eject Name: HRC FERTILITY CLINIC Enforcement Agency: CITY OF: )jca Address: 500 SUPERIOR AVE, SUITE p210 City: NEWPORT BEACH from start of an unoccupied condition per Standard Section 110.9(b) 3EACH P.,crt Number: X2019-0278 Zip Code: 92663 1 b. The occupant sensor does not trigger a false 'on' from movement in an area adjacent to the controlled space or from HVAC operation. r Step 2: Simulate an occupied condition a. Status indicator or annunciator operates correctly r b. Lights controlled by occupancy sensors turn. on immediately upon an occupied condition OR sensor indicates space is 'occupied' and lights may be turned on manually r Step 3: System returned to initial operating conditions r 3. Partial Off Occupancy Sensor Step 1: Simulate an unoccupied condition a. Lights go to partial off state within a maximum of 20 minutes from start of an unoccupied condition per Standard Section 110.9(a) r b. The occupant sensor does not trigger a false 'on' from movement in an area adjacent to the controlled space or from HVAC operation. For library book stacks or warehouse aisle, activity beyond the stack or aisle shall not activate the lighting in the aisle or stack. r c. In the partial off state, lighting shall consume no more than 50% of installed lighting. power, or: No more than 60% of installed lighting power for metal halide or high pressure sodium lighting in warehouses. No more than 60% of installed lighting power for corridors and stairwells in which the installed lighting power is. 80% 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 r Rep 2: Simulate an occupied condition The occupant sensingcontrols shall turn lights fully ON in each separately controlled areas, Immediately upon an occupied condition r 4 Partial On Occupancy Sensors Step 1. -Simulate an occupied condition. Verify partial on operation. a. Immediately upon an occupied condition, the first stage activates between 50 to . 70% of the lighting automatically. r b. After the first stage. occurs, manual switches allow an occupant to activate the alternate set of lights, activate 100% of the lighting power, and manually deactivate all of the lights. r Step 2. Simulate an. unoccupied condition .eject Name: HRC FERTILITY CLINIC Enforcement Agency: CITY OF NEWPORT BEACH oleo Address: 500 SOPERIOR AVE SOIlE X210Per mit Number. X2019-0278 City: NEWPORT BEACH Zip Code: 92663 a. Both stages (automatic on and manual on) lights turn off within a maximum of 20 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 to the controlled space or from HVAC operation. r eject Name: HRC FERTILITY CLINIC Enforcement Agevcy: CITY OF NEWPORT BEACH Pemdt Numbec X2019-0278 7jeU Address: 500 SUPERIOR AVE SUITE 42t0 City: NEWPORT BEACH Zip Code: 92663 5. Additional test for Occupancy Sensors Serving Small Zones in Office Spaces Larger than 250 ft , to Qualify for a Power Adjustment Factor (PAF) step 0: First, complete Functional Test 2 (above) for each controlled zone. Step 7.: Verify area served and compare actual PAF with claimed PAF. Refer to.Functional Test 2. a. Area served by controlled lighting ft2 b. Enter PAF corresponding to controlled area from line (a) above (<125 ft2 for 7-1 PAF=0.4, 126-250 ft2 for PAF=0.3, 251-500 ft2 for PAF=0.2). c. Enter PAF claimed for occupant sensor control in this space from the Certificate of Compliance. d. The PAF corresponding to the controlled area (line b), is greater than or equal to the PAF claimed in the compliance documentation (line c). r e. Sensors shall not trigger in response to movement in adjacent walkways or workspaces ll f. All steps are conducted in Functional Test 2 'Occupancy Sensor (On Off Control)' and all answers are Yes. Mr- .eject Name: HRC FERTILITY CLINIC eject Address: 500 SUPERIOR AVE, SUITE 4210 C. Testing Results =Enforcement Agency: CITY OF NEWPORT BEACH Penait Number: X2019-0278 City: NEWPORT BEACH Zip Code: 92663 1. Automatic Time Switch Controls (all answers must be Yes). r 2. Occupancy Sensor (On Off Control) (all answers must be Yes). r 3. Partial Off Occupancy Sensor (all answers must be Yes). For warehouses, library. book stacks, corridors, stairwells in nonresidential buildings must also be accompanied by passing Test 1 or Test 2, r 4. Partial On Occupant Sensor for PAF (all answers must be Yes). r 5.. Occupant Sensor serving small zones for PAF (all answers must be Yes). Also must pass Test 2. i - Untested areas/rooms Confirm compliance for all control system types (1-5) present in each space: 1. Automatic Time Switch Controls Step 1: Simulate occupied condition a. All lights can be turned on and off by their respective area control switch r o.: Verify the switch only operates lighting in the ceiling -height partitioned area in which the switch is located. r :tep 2: Simulate unoccupied condition a. All lighting, including emergency and egress lighting, turns off. Exempt lighting may remain on per Section 130.1(c)1 and 130.1(a)1. :::r b. Manual override switch controls only the lights in the selected ceiling height partitioned space where the override switch is located and the lights remain on no longer than 2 hours (unless serving public areas and override switch is captive key. type). r >tep 3: System returned to initial operating conditions r btep 1: 51mmate an unoccupied condition a. Lights controlled by occupancy sensors turn off within a maximum of 20 minutes �pU Name: HRC FERTILITY CLINIC Enforcement Agency: C717 OF NEWPORT BEACH Permit Numbee: X2019-0278 ,pd Address: 500 SUPERIOR AVE, SUITE H2t0 IlCity NEWPORT BEACH Zip Code:92663 from start of an unoccupied condition per Standard Section 110.9(b) l.. b. The occupant sensor does not trigger a false 'on' from movement in an area adjacent to the controlled space or from HVAC operation. r Step 2: Simulate an occupied condition a. Status indicator or annunciator operates correctly r b. Lights controlled by occupancy, sensors turn. on immediately upon an occupied condition OR sensor indicates space is 'occupied' and lights may be turned on manually r Step 3: System returned to initial operating conditions r 3. Partial Off Occupancy Sensor Step 1: Simulate an unoccupied condition a. Lights go to partial off state within a maximum of 20 minutes from start of an unoccupied condition per Standard Section 110.9(a) r b. The occupant sensor does not trigger a false 'on' from movement in an area adjacent to the controlled space or from HVAC operation. For library book stacks or warehouse aisle, activity beyond the stack or aisle shall not activate the lighting in the aisle or stack. r c. In the partial off state, lighting shall consume nomore than 50% of installed .lighting. power, or: No more than 60% of installed lighting power for metal halide or high pressure sodium lighting in warehouses. No more than 60% of installed lighting power for corridors and stairwells in. which the installed lighting power is 809/o 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 r Step 2: Simulate an occupied condition The occupant sensing controls shall turn lights fully ON in each separately controlled areas, Immediately upon an occupied condition r 4. Partial On Occupancy Sensors Step 1. -Simulate an occupied condition. Verify partial on operation. a. Immediately. upon an occupied condition, the first stage activates between 50 to 70% of the lighting automatically. r p. After the first stage occurs, manual switches allow an occupant to activate the alternate set of lights, activate 100% of the lighting power, and manually deactivate all of the lights. Irv— Step 2. Simulate an unoccupied condition ghtut& ConnW eject Name: HRC FERTILITY CLINIC lEnfomement Agency: CITY OF NEWPORT BEACHPemut Number: X2019-0278 rject Address: 500 SUPERIOR AVE, SUITE #210 City: NEWPORT BEACH Zip Code: 92663 a. Both stages (automatic on and manual on) lights turn off within a maximum of 20 minutes from start of an unoccupied condition per Standard Section 110.9(a) r b. The occupant. sensor does not trigger a false 'on' from movement in an area adjacent to the controlled space or from HVAC operation. r JmnBCounnl 3ject Name: HRC FERTILITY CLINIC &tforcemen[ Agency: CITY OF NEWPORT BEACH Permit Number: X2019-0278 )ject Address: SOO SUPERIOR AVE SOITE N210 City: NEWPORT BEACH Zip Code: 92663 5. Additional test for Occupancy Sensors Serving Small Zones in Office Spaces Larger than 250 ft , to Qualify for a Power Adjustment Factor (PAF) Step 0: First, complete Functional Test 2 (above) for each controlled zone. Step 1: Verify area served and compare actual PAF with claimed PAF. Refer to Functional Test 2. a. Area'served by controlled lighting ft2 b. Enter PAF corresponding to controlled area from line (a) above (125 ft2 for PAF=0:4, 126-250 ft2 for PAF=0.3, 251-500 ft2 for PAF=0.2). c. Enter PAF claimed for occupant sensor control in. this space from the Certificate of Compliance. d. The PAF corresponding to the controlled area (line b), is greater than or equal to the PAF claimed . in the compliance documentation (line c). r e. Sensors shall not trigger in response to movement in adjacent walkways or workspaces r f. All steps are conducted in Functional Test 2 'Occupancy Sensor (On Off. Control)' and all answers are Yes. r JIM: 500 SUPERIOR AVE SUITE M210 City: NEWPORT HEACH C. Testing Results Permit Number: X2019-0278 Zip U0&:92665 1. Automatic Time Switch Controls (all answers must be Yes). r- 2. 2. Occupancy Sensor (On Off Control) (all answers must be Yes). r 3. Partial Off Occupancy Sensor (all answers must be Yes). For warehouses, library book stacks, corridors, stairwells in nonresidential buildings must also be accompanied by. passing Test 1 or Test 2. Tr - 4. Partial On Occupant Sensor for PAF (all answers must be Yes). r 5.. Occupant Sensor serving small zones for PAF (all answers must be Yes). Also must pass Test 2. Dr - D. Evaluation : P-* PASS:. All applicable Construction Inspection responses are complete and all applicable Equipment Testing Requirements responses are positive. L .,y.. DOCUMENTATION AUTHOR'S DECLARATION STATEMENT I certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Company Name Name John Stoicescu Address 16011 Legacy Rd City Zip Code 92782 Phone CEA/ATT Certification Author Signature Identification (if TA116 applicable) fff {II Tell Someone Lighting Controls Tustin .(949)365-6641 (Date of Signature: 04/2 2019 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. I 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 John SCoCompany Name icescu Tell Someone Lighting Controls Address: 16011 Legacy Rd City Tustin Zip Code 92782 Phone (949)365-6641 ATT Certification T 17016 Position with Company ATT-TECHIdentification (Title) Field Technician Signature Date of Signature: 0, I I RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify The following under penaltyofperjury, under the laws of the State of California: 1. I am the Field Technician, or the. Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classificationto 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 enforcementagency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. I. 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. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy.. Responsible Acceptance Company Name Person Name john Stoicescu Tell Someone Lighting Controls Address: City 16011 Legacy Rd. Tustin - Zip Code 92782 ..Phone (949)365-6641 CSLB License TC -A2 7016 Position with Company (Title) ATT -TECH Responsible Acceptance rso S nature/ Date of Signature: 04/25/2019 ;hmia Conhol __ __ ___ ___ ___ __ W, L•ghung General Information Building Type: r. Nonresidential r High -Rise Res (Common Area) r Hotel/Motel (Common Area) Phase of Construction: r New Construction r Addition r Alteration r Unconditioned Scope of Responsibility Enter the date of approval by enforcement agency of the Certificate of Compliance that provides the specifications for the energy efficiency measures for the scope of responsibility for this Installation Certificate. Date: 3/7/2019 12:00:00 AM Document Title or Description Applicable Sheets or Pages, Tables, Schedules, etc. Date Approved By the Enforcement Agency TITLE24 FORMS E4.0 0 3/7/2019 12;00:00 AM ELECTRICAL LIGHTING E2.0 3/7/2019 12:00:00 AM ------ locr Lighting IS Enforcement Agency: CITY OF NEWPORT BEACH Permit Number. X2019-0278 oiect AddFERTR.IOR AVE afx[ Address: SOO SUPERIOR AVE, SUITE#210 City: NEWPORT BEACH Zip Cod.: 92663 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT I certify that this Certificate of Acceptance document Is accurate and complete. Documentation Author Company Name Name John Stalcescu Tell Someone Lighting Controls Address 16011 Legacy Rd City Tustin Zip Code .92782 Phone .(949)365-6641 CEA/ATT Certification Author Signature Identification (if E2177016 applicable) Date of Signature: 04/25/2019 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. I am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the Information provided on this Certificate of Acceptance. 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 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. I 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. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be Included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Compare Name Person Name BEACH CITY ELECTRIC Y Beach City Electric, Inc. Address: 8941 Atlanta Ave City Huntington Beach Zip Code 92646 Phone (714)848-2872 CSLB License Position with Company (Title) INSTALLER Responsible Acceptance Person Signature Date of Signature: 04/25/2019. INDOOR LIGHTING NRCI_LTI_02_E HRC FERTILITY CLINIC Orange General Information Building Type: r Nonresidential r High -Rise Res (Common Area) r Hotel/Motel (Common Area) Phase of Construction: r New.. Construction r Addition r Alteration r. Unconditioned Scope of Responsibility Enter the date of approval by enforcement agency of the Certificate of Compliance that provides the specifications for the energy efficiency measures for the scope of responsibility for this Installation Certificate. Date: 3/7/2019 12:00:00 AM §130.4(b) Before an Energy Management Control System (EMCS),.or Lighting Control System can be recognized for compliance with the lighting control requirements in Part 6 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 Management Control System or Lighting Control System installation requirements, these options for controlling lighting shall not be recognized for compliance with the Building Energy Efficiency Standards. Check all that apply PART 1 What type of Lighting Control System has been installed? r A. Energy Management Control System (EMCs) - Is a computerized control system designed to regulate the energy consumption of a building by controlling the operation of energy consuming systems, such as the heating, ventilation and air conditioning (HVAC), lighting, and water heating systems, 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: r 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. r The EMCS has been separately tested for each respective lighting control system for which it is installed to function as. r 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. ACS nr.OW—fnnh ] 9voem—��- eject Nnme: HRC FERTILITY CLINIC JFnfoxemmt Agency: CITY OF NEWPORT BEACH Permit Number. X2019-0278 oject Address: 500 SUPERIOR AVE, SUITE 4210 City: NEWPORT BEACH Zip Cad .92667 FF 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). PART 2 Lighting Control Functional requirements: Check all that apply when verifying the installation of an EMCS or Lighting Control System. F A. All lighting controls and equipment have been installed in accordance with the manufacturer's instructions. W B. The manufacturer has provided instructions for calibration. r C. if indicator lights are integral to any components, such indicator lights consumes no more than I watt of power per indicator light. r D. Components that are regulated by the Title 20. Appliance Efficiency Regulations have been certified to the Energy Commission. F_ 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: r 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: L 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. r 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 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 orsunset. r 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. r F. The EMCS or Lighting Control System functions as one or more of the Daylighting Controls listed below: r 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 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 percent of full scale adjustment; e. Has a light sensor that has a linear response within 5 percent 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 calibrated in 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. r 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. r G. The FMCS or Lighting Control System functions as a Dimmer and meets all requirements for a. 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 percent 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 modulationof less than 30 percent 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 EMCS 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. fights 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 S. 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 7. The EMCS or Lighting Control System functions as one or more of the Occupant Sensing Controls Checked Below: r a. Occupant Sensors meeting all applicable requirements for Occupant Sensor Control devices in the Title 20 Appliance Efficiency Regulations r 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. r c. Vacancy Sensors meeting all applicable requirements for Vacancy Sensor Controls devices in the Title 20 Appliance Efficiency Regulations, including the following: 1. Does not turn on lighting automatically and does not incorporate DIP switches, or other manual means, for conversion between manual and automatic functionality; N. 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. ACS m Lighting Control System .i ..1 FFR TIT nN IT M11 /TTV/1C 1111�.7`.11 d ITT r 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. r e. Partial -OFF Sensors meet all applicable requirements for partial off sensing devices in the Title 20 Appliance Efficiency Regulations, including the following: L. Has two poles; li. Has one pole that is manual -on and manual off; and iii. Has one pole that is automatic -on and automatic -off and isnot capable of conversion by the user to manual -an only functionality. r f. Occupant Sensing Control systems consist of a combination of single or multi-levelOccupant, 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.. 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.. i✓ A. Section 130.1(a) Area Controls. W, B. Section 130.1(b) Multi -Level Lighting Controls P C. Section 130.1 (c). Shut -OFF Controls r D. Section 130.1,(d) Automatic Daylighting Controls. r E. Section 130.1 (e) Demand Responsive Controls. r F. Section 130.5 (d) Circuit Controls for 120 -Volt Receptacles. r G. To qualify for the PAF for a Partial' -ON Occupant Sensing Control in TABLE 140.6-A fR H. To qualify for the PAF for an occupant sensing control controlling the general lighting in large open plan office areas above workstations, in accordance with TABLE 140.6-A r I. To qualify for the PAF for a Manual Dimming System PAF or a Multiscene Programmable Dimming System PAF in TABLE 140.6-A r J. To qualify for the PAF for a Demand Responsive Control in TABLE 140.6-A r K. To qualify for the PAF for Combined Manual Dimming plus Partial -ON Occupant Sensing Control in TABLE 140.6'-A ------- WS or Lighting Control System 3ject Name: FIRC FERTILITY CLINIC Enforcement Agency: CITY OF NEWPORT BEACH Pemut Nmnber: X2019-0278 aject Address: 500 SUPERIOR AVE, SUITE #210 City: NEWPORT BEACH Zip Cade: 92663 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT I certify that this Certificate of Acceptance document is accurate and complete. Documentation Author Company Name John Stoicescu Tell Someone Lighting Controls Name Address City 16011 Legacy Rd Tustin Zip Code Phone 92782 (949)365-6641 CEA/ATT Certification Author Signature Identification (if TC A217016 applicable) 4d Date of Signature: 04/25/2019 RESPONSIBLE PERSON'S DECLARATION STATEMENT P 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 at my agent and I have reviewed the information provided on this Certificate of Acceptance. 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 ofwork identifiedon 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 installationidentified 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. I 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) issuedfor the building. 5. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building perm¢(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 BEACH CITY ELECTRIC Company Name Person Name Beach City Electric, Inc. Address: City 8941 Atlanta Ave Huntington Beach Zip Code 92646 Phone (714)848-2872 CSLB License Position with Company INSTALLER ..(Title) Responsible Acceptance Person Signature. Date of Signature: 04/25/2019 x:U N - 07-1s Soo 5vperiov Aw I 440 W. Crowther Ave. Placentia, CA 92870 Ph:(714) 937-5305 coma�crm�s ueeueaaawa TEST AND BALANCE ANALYSIS REPORT Hoag Fertility Clinic 500 Superior Ave, Suite 210_ Newport Beach, CA John Anderson, President HVAC Mechanical Air Balance Report meets TABS and NEBB Standards Contractor: I-IN.A.C. Mechanical, Inc. JOB# 8579 COMPLETION DATE: 4.27.19 Tech: Fernando Sanch, * UNLESS OTHERWISE NOTED, INDICATED CFM IS AT STANDARD CONDITIONS. * FLOW HOOD USED ON ALL CEILING SUPPLY AND RETURN TERMINAL UNITS, AND SIDEWALL REGISTERS AND GRILLES WHERE APPLICABLE. Page 1 440 W. Crowther Ave. Placentia, CA 92870 Ph: (714) 937-5305 GENERAL REPORTING CODES DNA DNL NA NI NS NT NVL = DATE NOT AVAILABLE = DATA NOT LICENSED = NOT ACCESIBLE = NOT INSTALLED = NOT SPECIFIED = NOT TESTED DUE TO ABNORMAL CONDITIONS = NO VALID LOCATION FOR ACCURATE TESTING Page 2 MASTER CODE SHEET CSD = CEILING SUPPLY DIFFUSER CEG = CEILING EXHAUST GRILLE CER = CEILING EXHAUST REGISTER CRG = CEILING RETURN GRILLE CSR = CEILING SUPPLY REGISTER CRR = CEILING RETURN REGISTER EDO = EXHAUST DUCT OPENING EAR = EXHAUST AIR REGISTER FEG = FLOOR EXHAUST GRILLE FER = FLOOR RETURN REGISTER FRG = FLOOR RETURN REGISTER FSR = FLOOR SUPPLY REGISTER RAB = RETURN AIR BAR RAG = RETURN AIR GRILLE RDO = RETURN DUCT OPENING PLD = RETURN LINEAR DIFFUSER SAB = SUPPLY AIR BAR SDO = SUPPLY DUCT OPENING SLD = SUPPLY LINEAR DIFFUSER WE = WALL EXHAUST GRILLE WE = WALL EXHAUST REGISTER WR = WALL RETURN GRILLE WR = WALL RETURN REGISTER WS = WALL SUPPLY GRILLE WS = WALL SUPPLY REGISTER GENERAL REPORTING CODES DNA DNL NA NI NS NT NVL = DATE NOT AVAILABLE = DATA NOT LICENSED = NOT ACCESIBLE = NOT INSTALLED = NOT SPECIFIED = NOT TESTED DUE TO ABNORMAL CONDITIONS = NO VALID LOCATION FOR ACCURATE TESTING Page 2 440 W. Crowther Ave. Placentia, CA 92870 Ph`.(714) 937-5305 INDICATED CERTIFICATE OF CALIBRATION INDICATED ACTUAL CUSTOMER: HVAC MECHANICAL: PLACENTIA, CA CALIBRATION DATE: 08/31/18 ACTUAL AIRFOIL "NUMBER: N/A CALIBRATION DUE: 08/31/19 - GRID OM STD. INST. MANUFACTURER: TSI I ALNOR PROCEDURE: NAVAIR 17-20MG-02 OM STD. FT /MIN INR. OESCRIPTION: 9ALOMETER CALIBRATION FLUID: AIR @ 14.7 PSI 70°F FT/MIN FT/MIN MODEL NUMBER: E9T731 RECEIVED CONDITIONS: WITHIN MFG. SPECS "X20 105 SERIAL NUMBER: EBT731510004 LER CONDITIONS: WITHIN MFG, SPECS 31 32 "TED UNCERTAINTO SEE NOTES" AMBIENT CONDITIONS: 759mmHGA 48%RH 70°F 0.000 512 UNCERTAINTY GIVEN: 10.796% RD K=2 CERTITICATEDLEA: 486770.20 65 66 NOTES: VEL:±3%RD+±7FT/MINI.PRESS:±2%RD;Y.OI-H20IVEL±3%+±7FT/MIN (TEMP:±0,5°F 6.324 INDICATED ACTUAL INDICATED ACTUAL INDICATED ACTUAL AIRFOIL DM STD. - GRID OM STD. EBT 781 OM STD. FT /MIN FT/MIN FT/MIN FT/MIN "H2O "X20 105 106 31 32 0.00 0.000 512 514 65 66 5.32 6.324 1044 1049 213 215 10.21 10.221 1513 1521 532 537 20.48 20.537 2547 2563 1180 1191 40.30 40.442 4976 5014 2491 2518 59.76 59.991 STANDARDS USED: A220: 12' WIND TUNNEL 0 -0000 FPM I CMC±.203%RO.I TRACE# 1520423238 DUE - 05/23/2019 A24:NART SCIENTIFIC TEMP. STANDARD 1 ±.024 F I TRACE# 1520423238 1 DUE 03/07/2019 A321: CEG PRESSURE STD.O-800 PSI I ±.011% RD ITMMCCff 15203494291519224431 I DUE 04/02/2019 All insummeat, used in the licobintanee ol'.Ihe shdtrn calibnaion law imeaahllity to the Nalimial llLStllute ul SUmdanis mut-I'cchiutloua (NIS'I'1. 111e uncrrtalmy ratio Ill the calibl'atinn standards (IMLS I'D.) used and the unit tall lest Will) is a minlmmn (it '4:1. unless olhel-%%ke lulled. Calihratma ha> been perkaled per the shores procedure number. in accordance eith Iso 10012:2003, ISO 171125;211115. ANSIiNC'SI-/.-5!(1.3.:md/or b411-S'I'11-15G(i2:\. 'fest methods: AP12530-92 r ASMI' MFC -3M-1989. - 4 MRnns Compang 11133 Winners Circle • Los Alstliiios. CA 90720 If P e 4) 827-1215 • Pax (714) 827-0823 .. ,1, �T 1M f hniean Pa"cit o1 Page 3 PITOT 1 DM STD- 1 " UUT c V DM STD. FT/MIN FT/MIN °F 'F 2571 2554 89 71.8 - 71.3 6099 61 109.0 1 108.7 STANDARDS USED: A220: 12' WIND TUNNEL 0 -0000 FPM I CMC±.203%RO.I TRACE# 1520423238 DUE - 05/23/2019 A24:NART SCIENTIFIC TEMP. STANDARD 1 ±.024 F I TRACE# 1520423238 1 DUE 03/07/2019 A321: CEG PRESSURE STD.O-800 PSI I ±.011% RD ITMMCCff 15203494291519224431 I DUE 04/02/2019 All insummeat, used in the licobintanee ol'.Ihe shdtrn calibnaion law imeaahllity to the Nalimial llLStllute ul SUmdanis mut-I'cchiutloua (NIS'I'1. 111e uncrrtalmy ratio Ill the calibl'atinn standards (IMLS I'D.) used and the unit tall lest Will) is a minlmmn (it '4:1. unless olhel-%%ke lulled. Calihratma ha> been perkaled per the shores procedure number. in accordance eith Iso 10012:2003, ISO 171125;211115. ANSIiNC'SI-/.-5!(1.3.:md/or b411-S'I'11-15G(i2:\. 'fest methods: AP12530-92 r ASMI' MFC -3M-1989. - 4 MRnns Compang 11133 Winners Circle • Los Alstliiios. CA 90720 If P e 4) 827-1215 • Pax (714) 827-0823 .. ,1, �T 1M f hniean Pa"cit o1 Page 3 440 W. Crowther Ave. Placentia, CA 92870 Ph:(714) 937-5305 COXINLLYOiY 4CEM2F 6BEEEE FLOW HOOD HOOD: A COLLECTOR TYPE WHICH READS IN CFM METER: ALONOR VELOMETER WITH EIGHT RANGE SELECTIONS, THREE EACH FOR SUPPLY AND RETURN. ONE POSITION SELECTOR IS ADJUSTABLE TO CORRECT FOR ALTITUDE AND TEMPERATURE; THE OTHER TWO CALIBRATED AND SEALED TO READ OUT DIRECTLY IN CUBIC FEET PER MINUTE AT CONSTANT VOLUME STANDARD CONDITIONS. RANGE: 30-500, 100-1000, 200-2000 0-500, 200-1000, 500-2000 FLOW SENSOR: DUAL %" DIA. PIEZOMETER GRID SUSPENDED AT RADIUS OF AVERAGE VELOCITY. Page 4 DIFFUSER & GRILLE TEST SHEET 440 W. Crowther Ave. Placentia, CA 92870 Ph:(714) 937-5305 Page 5 SYSTEM: VAV-1 REQUIRED ACTUAL REQUIRED ACTUAL Tor "M TIMANA Page 5 STATE OF CALIFORNIA MECHANICAL cFc-uRa-ndn14-n1-F iao„med m n m x,wILf uz I� 500 Superior Ave CERTIFICATE OF INSTALLATION NRCI-MCH-01-E Mechanical (Page 1 of 2) Project Name: Hoag Fertility Clinic Enforcement A,..,: Permit Number: Project Addr":. 500 Superior Ave, Suite 210 city: Newport Beach Zp code: A. GENERAL INFORMATION DATE OF BUILDING PERMIT: Applicable Sheets or Pages, Tables, Schedules, etc. BUILDING. TYPE Nonresidential ❑ High -Rise Residential ❑ Hotel/Motel PHASE OF ❑ New Construction ❑ Addition ITAlteration CONSTRUCTION HVAC Plan If more than one person has responsibility for building construction, each person shall prepare and sign an Installation Certificate document applicable to the portion of construction for which they are responsible; alternatively, the person with chief responsibility for construction shall prepare and sign the Installation Certificate documents) for the entire construction._ B. SCOPE OF RESPONSIBILITY Date of approval by the enforcement agency of the Certificate of Compliance that provides the Date: specifications for this Installation Certificate. In the table below identify all applicable construction documents that specify the features, materials, components, manufactured devices, or system performance diagnostic results required for the scope of responsibility for this Installation Certificate. Document Title or Description Applicable Sheets or Pages, Tables, Schedules, etc. Date Approved By the Enforcement Agency M-1 Note, Schedule M-2 HVAC Plan CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 STATE OF CALIFORNIA MECHANICAL CFC-NRra-MCH-n1-F IReviaed 01110.1 ral IFn RnIIG FnIFRnv CERTIFICATE OF INSTALLATION NRCI-MCH-01-E Mechanical. (Page 2 o 2) Project Name: Hoag Fertility Clinic Enforcement Agenry: Permit Number. Pmjed Address: 500 Superior Ave, Suit 210 city Newport Beach 2lpcode: DOCUMENTATION AUTHOR'S. DECLARATION STATEMENT 1. 1 certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name: Dennis Brlsco Documentation Author Signature: Dennis Brisco Documentation Author Com an Nae: Mmechanical Date Signed:' 4 .29.19 HVA Inc. .Address: 440 West. Crowther Ave. CEA/ HERS Certification Identification(if applicable): N/A oty/nate/zip: Placentia, CA 92870 Phone' 714-937-5305 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 Cade 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: Jose Martinez Responsible Builder/Installer Signature: Jose Martinez Company Name:m Su ntratoror General ont ctoror Builder/Owner) ti�%� �ec enc. Position With Company (Title): Foreman' anicaf Address: 440 West Crowther Ave. CStBucensei 682002 City/state/zip:placentia, CA 92870 Phone: 714-937-5305 Date Signed: 4,29.19 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 CERTIFICATE OF INSTALLATION—USER INSTRUCTIONS NRCI-MCH-01-E Mechanical (Page 1 of 1) NRCI-MCH-01 User Instructions Section A. General Information 01. Enter the date on the building permit. 02. Indicate the appropriate building type. 03. Indicate the appropriate phase of construction. Section B. Scope of Responsibility 01. Enter the date the enforcement agency approved the Certificate of Compliance (NRCC-MCH-XX) that is used as the basis of the specifications used to demonstrate compliance. 02. Enter the construction document that specifies the installed feature, material, component, manufactured device or system performancediagnostic results required for compliance as specified on the certificate of compliance. 03. As needed, this row shall be filled according to the instructions for row B.02 04. As needed, this row shall be filled according to the instructions for row B.02 05. As needed, this row shall be filled according to the instructions for row B.02 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016