HomeMy WebLinkAboutX2019-0105 - MiscACCEPTANCE
Vola -0105
rIGHTING CONTROL ACCEPTANCE DOCUMENT 700 �ASj 14wy W �7�/
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 needed to 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):
17 Weekdays G' Weekend F Holidays
b. Document for the owner automatic time switch programming (check all):
F Weekday settings r Weekend settings r Holidays settings rw Set-up settings
r Preference program setting V Verify the correct time and date is properly set in the time switch
F Verify the battery is installed and energized r Override time limit is no more than 2 hours
r 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 B
7 Occupancy sensors are not located within four feet of any HVAC diffuser
F Ultrasonic occupancy sensors do not emit audible sound 5 feet from source
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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)
D. Evaluation :
I7 PASS: All applicable Construction Inspection responses are complete and all applicable
Equipment Testing Requirements responses are positive (Y - yes)
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DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
I certify that this Certificate of Acceptance documentation is accurate and complete.
Documentation Author Company Name
Name John Berokoff
Address 13934 Vaina Or City
Zip Code 90605
Phone
CEA/ATT Certification TC AS 14202 Author Signature
Identification (if
applicable) t
Date of Signature: 05/01/2019
Berokoff Electric
Whittler
(562)254-5255
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 an 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. I 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 Company Name
, John Berokoff Berokoff Electric
Address:
Zip Code
ATT Certification
Identification
13934 Vaina Dr
90605
TC-AS14202
Field Technician Signature
9��
Date of Signature: 05/01/2019
City
Whittier
Phone
(562)254-5255
Position with Company
(Title) Owner
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. 1 have confirmed that the Certificate(s) of Installation for the construction or installation Identified on this Certificate of Acceptance has been completed and Is
posted or made available with the building permit(s) Issued for the building.
5. 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 Berokoff Berokoff Electric
Address: City
13934 Vaina Or Whittier
Zip Code 90605 Phone (562)254-5255
CSLB License Position with Company
434107 (Title) Owner
Responsible AjiMR or= QQon Signature -
of Signature: 05/01/2019
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