HomeMy WebLinkAboutX2018-3736 - MiscSTATE OF CALIFORNIA
LIGHTING CONTROL ACCEPTANCE DOCUMENT
CEC-NRCA-LTI-02-A laemaedwnn
CALIFORNIA ENERGY COMMISSION
PROJECT NUMBER' 19nAMOF3
x2oig-3736
,2 Milano Dr
�`� MNorIDI LIVI1tIn4CpnhuxYors �'
iMt.C/L>,,V A u-teeon nr Ane as
e� r
CERTIFICATE OF ACCEPTANCE - NRCA-LTI-02-A
Occupancy Sensor Acceptance Test
Project Name: NEWPORT NORTH Enforcement Agency: CITY OF
LEASING NEWPORT BEACH
Permit Number: X2018-3736
Project Address: 2 MILANO DRIVE City: NEWPORT BEACH
Zip Code: 92660
Building: 1 Floor: 1
Room: WOMEN RR
' Nofe: Svbmil ane CertiOcafe ofAccepfance {oroach syskm that must tlemonshate compliance. Enforcement Agency Use: Cbecketl by/Dale:
A. Construction Inspection
> 02
Occupancy Sensor Construction Inspection— confirm for all listed in Section
f b.
I
Occupancy sensors are not located within 4 feet of any HVAC diffuser
Yes
Ultrasonic occupancy sensors do not emit audible sound 5 feet from source
Yes
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
B. Functional Testing of Lighting Controls
If there are several geometrically similar spaces that use the same lighting controls, test only one. space and provide an attached page
listing "untested areas" which are represented by the tested space.
EXCEPTION:. For buildingswith up to seven (7) occupancy sensors, all occupancy sensors shall be tested. (NA7.6.2.3)
Confirm compliance (Yes/No). -
02. Occupancy Sensors
Stop 1:. Simulate an unoccupied condition -
a. Lights controlled by occupancy sensors turn off within a maximum of 20 minutes from start of an unoccupied Yes
6ndition per Standard Section 110.9(b)
The occupant sensor does not trigger a false "on" from movement in an area adjacent to the controlled space or Yes
from HVAC operation j
Step 2: Simulate an occupied condition
a.
Status indicator or annunciator operates correctly
Yes
f b.
I
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
Yes
Step 3: System returned to initial operating conditions
Yes
C. Testing Results - - PASS / 1
FAIL
2 Occupancy Sensor (On Off Control) (all answers must be Y). Passe
D. Evaluation
Pass PASS: All applicable Construction Inspection responses are complete and all applicable Equipment Testing
Requirements responses are positive (Y - yes).
Page 1 of 9
STATE OF CALIFORNIA
LIGHTING CONTROL ACCEPTANCE DOCUMENT
CEC-NRCA-LTI-02-A (ream:ed W17{
CALIFORNIA ENERGY COMMISSION
PROJECT NUMBER' 1807-nnn0..4
`3. p PEI
y N barn{1-10H, co llraetore
{4
r<NI-�'AP`tF AsoeroHon of Am'<a �
CERTIFICATE OF ACCEPTANCE - NRCA-LTI-02-A
Occupancy Sensor Acceptance Test
Project Name: NEWPORT NORTH
LEASING
Enforcement Agency: CITY OF
NEWPORT BEACH
Permit Number: X2018-3736
Project Address: 2 MILANO DRIVE
City: NEWPORT BEACH
Zip Code: 92660
Building: 1
Floor: 1
Room: MENS RR
Note: Submiteme CadihcateofAceeptance foreach system thatmust demonstrate emormse. Enforeemont Atimm, Use; Checkedby/Defe: j
A. Construction inspection -
--a
02 Occupancy Sensor Construction Inspection — confirm for all listed in Section B
O
Occupancy sensors are not located within 4 feet of any HVAC diffuser
✓J
Ultrasonic occupancy sensors do not emit audible sound 5 feet from source
EXCEPTION: For buildings with up to seven (7) occupancy sensors, all occupancy sensors shall be tested. (NA7.6.2.3)
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
f3. Functional Tes¢ing of Lighting Controls
{ if there are several geometrically similar spaces that use the same lighting controls, test only one space and provide an attached
page
listing untested areas' which are represented by the tested space
EXCEPTION: For buildings with up to seven (7) occupancy sensors, all occupancy sensors shall be tested. (NA7.6.2.3)
1 Confirm compliance (Yes/No).
02. Occupancy Sensors
1Stel p 1: Simulate an unoccupied condition
�
a. Lights controlled by occupancy sensors turn off within a maximum of 20 minutes from start of an unoccupied
Yes
condition per Standard Section 110.9(b)
b. The occupant sensor does not trigger a false "on" from movement in an area adjacent to the controlled space or
Yes
from HVAC operation
Step 2: Simulate an occupied condition
a, Status indicator or annunciator operates correctly
Yes
b. i Lights controlled by occupancy sensors turn on immediately upon an occupied condition OR sensor indicates
Yes
I `; space is "occupied" and lights may be turned on manually
I Step 3: System returned to initial operating conditions
Yes- a
C. Testing Results PASS 1 ;
i
FAIL
i 2 Occupancy Sensor (On Off Control) (all answers must be Y). ( Pass i
D. Evaluation
Pass PASS: All applicable Construction Inspection responses are complete and all applicable Equipment Testing
Requirements responses are positive (Y -yes).
Page 2 of 9
STATE OF CALIFORNIA
LIGHTING CONTROL ACCEPTANCE DOCUMENT
CEC-NRCA-LTI-02-A (Ravisae oono
CALIFORNIA ENERGY COMMISSION
PROJECT NUMBER: 1907-00083
f
4 SCu
0An{ Nat oval Ligh1m, C.rml.noll
1i of Aruar,nu
Enforcement Agency: CITY OF Permit Number: X2015-3736
I NEWPORT BEACH
Project Address: 2 MILANO DRIVE
City: NEWPORT BEACH Zip Code: 92660
RTIFICATE OF ACCEPTANCE - NRCA-LTI-02-A
E.Dcupancy Sensor Ac ceptancee Test
Project Name: NEWPORT NORTH
LEASING
Enforcement Agency: CITY OF Permit Number: X2015-3736
I NEWPORT BEACH
Project Address: 2 MILANO DRIVE
City: NEWPORT BEACH Zip Code: 92660
Building: 1
Floor: 1 Room: ASST MGR OFFICE
Nate: submitene CoMficaleofAcceptanre foreach system that must demonstrate compliance. Enforcement Agency Use: Chackedby?Jate
A. Construction Inspection - 1
02 1 Occupancy Sensor Construction Inspection — confirm for all listed in Section B
❑✓ Occupancy sensors are not located within 4 feet of any HVAC diffuser
1 2 Ultrasonic occupancy sensors do not emit audible sound 5 feet from source
O 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
S. Functional Testing. of Lighting Controls
If there are several geometrically similar spaces that usethe same lighting controls, test only one space and provide an attached page
listing "untested areas" which are represented by the tested space.
EXCEPTION: For buildings with up to seven (7) occupancy. sensors, all occupancy sensors shall be tested. (NA7.6.2.3)
Confirm compliance (Yes/No).
"
1 02. Occupancy Sensors
Step 1: Simulate an unoccupied condition
a. Lights controlled by occupancy sensors turn off within a maximum of 20 minutes from start of an unoccupied
Yes s
condihon per Standard Section 110.9(6)
b. The occupant sensor does not trigger a false "on" from movement in an area adjacent to the controlled space or
Yes
i from HVAC operation
I Step 2: Simulate an occupied condition
"..
a.
Status indicator or annunciator operates correctly
Yes
b.
Lights controlled by occupancy sensors turn on immediately upon an occupied condition OR sensor indicates
Yes
space is "occupied" and lights may be turned on manually
Step 3: System returned to initial operating conditions
Yes
C. Testing Results
PASS 1
I rralL
2 Occupancy Sensor (On Off Control) (all answers must be Y). Pass
13. Evaluation
I Pass PASS: All applicable Construction Inspection responses are complete and all applicable Equipment Testing
Requirements responses are positive (Y - yes).
Page 3 of 9
STATE OF CALIFORNIA
LIGHTING CONTROL ACCEPTANCE DOCUMENT
CEC-NRCA-LTI-02-A (Revised 64117)
CALIFORNIA ENERGY COMMISSION
PROJECT NUMBER: 1907-00083
a
.,� Mhopnit.191ienq Mnlmctots
�ICC�J A OGatiOn OrA 1. f4a
CERTIFICATE OF ACCEPTANCE - NRCA-LTI-02-A
Occupancy Sensor Acceptance Test
Project Name: NEWPORT NORTH Enforcement Agency: CITY OF
LEASING NEWPORT BEACH
Permit Number: X2018-3736
Project Address: 2 MILANO DRIVE City: NEWPORT BEACH
Zip Code: 92660
Building: 1 Floor: 1
Room: COMMUNITY MGR OFFICE
Nola: Svbmlt one Carti/icare ofAcceplanre/or each system (bat must tlemonahate compliance. Enforcement Agency Use; Checked by/Dafw
A. Construction Inspection
02 1 Occupancy Sensor Construction Inspection— confirm for all listed in Section B !
if them are several geometricallysimilar spaces that use the same lighting controls, test only one space and provide an aftachcu
Occupancy sensors are not located within 4 feet of any HVAC diffuser
<]✓
Ultrasonic occupancy sensors do not emit audible sound 5 feet from source
0
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
S. Funcroonal Testing of Lighting Controls
if them are several geometricallysimilar spaces that use the same lighting controls, test only one space and provide an aftachcu
pageif ,
listing "untested areas" which are represented by the tested space.
EXCEPTION: For buildings with up. to seven (7) occupancy sensors, all occupancy sensors shall be tested. (NA7.6.2.3)
Confirm compliance (Yes/No).
02. Occupancy Sensors -
i
�- p 1: Simulate an unoccupied condition
a.
Lights controlled by occupancy sensors turn off within a maximum of 20 minutes from start of an unoccupied
Yes
!
jcondition per Standard Section I10.9(b)
b. The occupant sensor does not trigger a false "on" from movement in an area adjacent to the controlled space or
Yes
1 Prom FIVAC operation
Seep 2: Simulate an occupied condition
I a.
Status indicator or annunciator operates correctly
Yes
b.
Lights controlled by occupancy sensors turn on immediately upon an occupied condition OR sensor indicates
Yes
I
space is "occupied" and lights may be turned on manually
Step 3: System returned to initial operating conditions
Yes
I C. Testing Results PASS I
AiL
2 Occupancy Sensor (On Off Control) (all answers must be Y). 1 Pass
D. Evaluation
Pass PASS: All applicable Construction Inspection responses are complete and all applicable Equipment Testing
Requirements responses are positive (Y - yes).
Page 4 of 9
STATE OF CALIFORNIA
LIGHTING CONTROL ACCEPTANCE DOCUMENT
CEC-N RCA-LTI-02-A (Revised mrn)
CALIFORNIA ENERGY COMMISSION
PROJFGTNIIMRFP i9n7-nnnA3
f
N�CAX N4o1r11191,111114ail cto
AII.Ciallehod AUUma
CERTIFICATE OF ACCEPTANCE - NRCA-LTI-02-A
Occupancy Sensor Acceptance Test
Project Name: NEWPORT NORTH
LEASING
Enforcement Agency: CITY OF
NEWPORT BEACH
Permit Number: X2016-3736
Project Address: 2 MILANO DRIVE
City: NEWPORT BEACH
Zip Code: 92660
Building: 1
Floor: 1
Room: COPY ROOM
Note: Submi!one Certilicete o/Acceptance for each system that must demonskets compliance. Enkmement Agency Use: Checked by/Date:
A. Construction Inspection
02
Occupancy Sensor Construction Inspection— confirm for all listed in Section B
j
0
Occupancy sensors are not located within 4 feet of any HVAC diffuser
l✓J
Ultrasonic occupancy sensors do not emit audible sound 5 feet from source
f b.IThe
occupant sensor does not trigger a false "on" from movement in an area adjacent to the controlled space or
,from HVAC operation
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
3, Functional Testing of Lighting Controls i
If there are several geometrically similar spaces that use the same lighting controls, test only one. space and provide an attached page
listing "untested areas" which are represented by the tested space.
EXCEPTION: For buildings with up to seven (7) occupancy sensors, all occupancy sensors shall be tested. (NA7.6.2.3)
Confirm compliance (Yes/No).
j 02. Occupancy Sensors
Stop 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)
Yes
f b.IThe
occupant sensor does not trigger a false "on" from movement in an area adjacent to the controlled space or
,from HVAC operation
Yes
Step 2: Simulate an occupied condition
n. Status indicator or annunciator operates correctly
Yes
b. Lights controlled by occupancy sensors turn on immediately upon an occupied condition OR sensor indicates
I space is "occupied" and lights may be turned on manually
Yes
Step 3: System returned to initial operating conditions
Yc s
C. Testing Results
PASS I
FAIL
2 Occupancy Sensor (On Off Control) (all answers must be Y).
Pass
D. Evaluation
�.
Pass PASS: All applicable Construction Inspection responses are complete and all applicable Equipment Testing
i Requirements responses are positive (Y-ves).
Page 5 of 9
STATE OF CALIFORNIA
LIGHTING CONTROL ACCEPTANCE DOCUMENT
CFC-NRCA-LTI-02-A (Revised 04117)
CALIFORNIA ENERGY COMMISSION
PROJECT NUMBER: 1907-90981
$p O
NLCA/tiola
n canal Lighting Comrackes,
!/ A stionof 1
® b
CERTIFICATE OF ACCEPTANCE - NRCA-LTI-02-A
Occupancy Sensor Acceptance Test
Project Name: NEWPORT NORTH
LEASING
Enforcement Agency: CITY OF Permit Number: X2018-3736
NEWPORT BEACH
Project Address: 2 MILANO DRIVE
City: NEWPORT BEACH Zip Code: 92660 --II
Building: 1
Floor: 1 Room: BREAK ROOM
Note: Submit one Chi(cate o/Accammeefor each system that must kmechadme compliance Enforcement Agency Use: Checked by/Date:
j A. Construction Inspection -
02
Occupancy. Sensor Construction Inspection— confirm for all listed in Section 8-'
02. Occupancy Sensors:
❑�
Occupancy sensors are not located within 4 feet of any HVAC diffuser
I]
Ultrasonic occupancy sensors do not emit audible sound 5 feet from source
Yes
[✓1
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
B. Functional Testing of Lighting Controls
If there are several geometrically similar spaces that use thesame lighting controls, test only one space and provide an attached page
listing "untested areas" which are represented by the tested space.
EXCEPTION: for buildings with up to sever.. (7) occupancy sensors, all occupancy sensors shall be tested. (NA7.6.2.3)
Confirm compliance (Yes/No).
02. Occupancy Sensors:
Step 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)
Yes
b.
The occupant sensor does not trigger a false 'can" from movement in an area adjacent to the controlled space or
from HVAC operation
Yes
Step 2: Simulate an occupied condition -
T
a. Status indicator or annunciator operates correctly
Yes
b. I 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 i
Yes
Step 3: System returned to initial operating conditions I
Yes
C. Testing Results PASS;
FAIL
2 Occupancy Sensor (On Off Control) (all answers must be Y). Pass
D. Evaluation
Pass PASS: All applicable Construction Inspection responses are complete and all applicable Equipment Testing
Requirements responses are positive (Y - yes). !
Page 6 of 9
STATE OF CALIFORNIA
LIGHTING CONTROL ACCEPTANCE DOCUMENT
CEC-NRCA-LTI-02-A iaemeednarrr)
CALIFORNIA ENERGY COMMISSION
Pdn1P?eTtd1JAAR9P lk(17-Mnel4
CERTIFICATE OF ACCEPTANCE - NRCA-LTI-02-A
0-1-1.
t Ph nonol laelitinf dPNracYors�
hILC/1 A' q odutlon
Enforcement Agency: CITY OF Permit Number: X2018-3736
NEWPORT BEACH
olgmmica
City: NEWPORT BEACH Zip Code: 92660
Building: 1
Floor: 1 Room: PUBLIC RR
CERTIFICATE OF ACCEPTANCE - NRCA-LTI-02-A
Occupancy Sensor Acceptance Test
Project Name: NEWPORT NORTH
LEASING
Enforcement Agency: CITY OF Permit Number: X2018-3736
NEWPORT BEACH
Project Address: 2 MILANO DRIVE
City: NEWPORT BEACH Zip Code: 92660
Building: 1
Floor: 1 Room: PUBLIC RR
Note: Submit one Certificate otAccepterae for each system beemust eiukkie be compliance. Enfamement Agency Use: Chocketlby/Date'
A. Construction Inspection
02
Occupancy Sensor Construction Inspection — confirm for all listed in Section 8 j
Yes�i
IV)
I Occupancy sensors are not located within 4 feet of any HVAC diffuser i
j b. The occupant sensor does not trigger a false "on" from movement in an area adjacent to the controlled space or
L7✓
Ultrasonic occupancy sensors do not emit audible sound 5 feet from source
Step 2: Simulate an occupied condition
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
B. Functional Testing of Lighting Controls -
If there are severalgeometrically similar spaces that use the same lighting controls, test onlyone space and provide an attached pago ;
listing ''untested areas" which are represented by the tested space..
EXCEPTION: For buildings with up to seven (7)occupancy sensors all occupancy sensors shall be tested. (NA7.6.2.3)
Confirm compliance (Yes/No).
02. Occupancy Sensors.
Step 1: an unoccupied condition
a. Lights controlled by occupancy sensors turn off within a maximum of 20 minutes from start of an unoccupied
Yes�i
condition per Standard Section. 110.9(b)
j b. The occupant sensor does not trigger a false "on" from movement in an area adjacent to the controlled space or
Yes
l 'horn HVAC operation
Step 2: Simulate an occupied condition
a. Status indicator or annunciator operates wrrectly
Yes
b. Lights controlled by occupancy sensors turn on immediately upon an occupied condition OR sensor indicates
Yes I
space is "occupied" and lights may be turned on manually
I Step 3: System returned to initial operating conditions
Yes
C. Testing Results I. PASS I I
FAOL
j2 Occupancy Sensor (On Off Control) (all answers must be Y). Pass �!
D. Evaluation
Pass PASS: All applicable Construction Inspection responses are complete and all applicable Equipment Testing
Requirements responses are positive (Y - yes).
Page 7 of 9
STATE OF CALIFORNIA
LIGHTING CONTROL ACCEPTANCE DOCUMENT
CEC-NRCA-LTI-02-A taamsea oanp
CALIFORNIA ENERGY COMMISSION
PROJECT NUMBER: 1907-00083
CERTIFICATE OF ACCEPTANCE - NRCA-LTI-02-A
Q 1
Iy N ou,Is,, t iGtlnlrkcltns
A ttLNmt
4 s
'
gGAmvr(cu
u�
Ov.
CERTIFICATE OF ACCEPTANCE - NRCA-LTI-02-A
Occupancy Sensor Acceptance Test
Project Name: NEWPORT NORTH
LEASING
Enforcement Agency: CITY OF
NEWPORT BEACH
Permit Number: X2018-3736
Project Address: 2 MILANO DRIVE
City: NEWPORT BEACH
Zip Code: 92660
Building: 1
Floor: 1
Room: RSO
Note: Submit one Certificate ofAcceptanceke each system that must demonshate compliance. Enlacement Agency Use: Checkadby/Date:
A. Construction Inspection
r02 Occupancy Sensor Construction Inspection— confirm for all listed in Section
S. Functional Testing of Lighting. Controls
! if there are several geometrically similar spaces that use the same lighting controls, test only one space and provide an attached page
;listing "untested areas" which arerepresented by the tested space.
EXCEPTION: For buildings with up. to seven (7) occupancy sensors, all occupancy sensors shall be tested. (NA7.6.2.3)
Confirm compliance (Yes/No).
Occupancy sensors are not located within 4 feet of any HVAC diffuser
T�Ultrasonic
occupancy sensors do not emit audible sound 5 feet from source
j
Occupant Sensors and Automatic Time Switch Controls have been certified to the Energy Commission in
j
accordance with the applicable provision in Section 110.9 of the Standards, and model numbers for all such controls
j
are listed on the Commission database as Certified Appliance and Control Devices
Page 8 of 9
S. Functional Testing of Lighting. Controls
! if there are several geometrically similar spaces that use the same lighting controls, test only one space and provide an attached page
;listing "untested areas" which arerepresented by the tested space.
EXCEPTION: For buildings with up. to seven (7) occupancy sensors, all occupancy sensors shall be tested. (NA7.6.2.3)
Confirm compliance (Yes/No).
r� 02. Occupancy Sensors
i
j Step 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)
Yes
b.
The occupant sensor does not trigger a false "on" from movement in an area adjacent to the controlled space or
�frorn I-IVAC operation
Yes
Step 2: Simulate an occupied condition
P. Status indicator or annunciator operates correctly
Yes
y b. ,. Lights controlled by occupancy sensors turn on immediately upon an occupied condition OR sensor indicates
j space is "occupied" and lights may be turned on manually
Yes
S 3: System returned to initial operating conditions
j . C. Testing Results
/
PASSFAIL
2 Occupancy Sensor (On Off Control) (all answers must be Y).
—;
Pass
i�. C -valuation
Pass
PASS: All applicable Construction Inspection responses are complete and all applicable Equipment Testing
Requirements responses are positive (Y - yes).
Page 8 of 9
STATE OF CALIFORNIA
LIGHTING CONTROL ACCEPTANCE DOCUMENT
CEC-NRCA-LTI-02-A (Rev.sad wre)
CALIFORNIA ENERGY COMMISSION
Mmranal liehcin9 contrxcrors
�Cl�Ag A voaaimn olAmerkn
CERTIFICATE OF ACCEPTANCE - NRCA-LTI-02-A
Lighting Control Acceptance Document
Project Name: NEWPORT NORTH
LEASING
Enforcement Agency: CITY OF NEWPORT
BEACH
I Permit Number: X2018-3736
Project Address: 2 MILANO DRIVE
City: NEWPORT BEACH
IZip Code: 92660
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1, 1 certify that this Certificate of Acceptance documentation is accurate and complete.
Documentation Author Name:
Gary Ducros
Documentation Author Signature:
Documentation Author Company Name:
Ducros Electrical Contracting & Design Inc.
Date Signed: July 24 2019
.Address: 2500 E. Imperial Hwy. 201-520
CEA/ATT Certification Identification (if applicable): ATT -1706-00001
City/State/Zip: Brea, CA 92821
Phone: 714-688-7000
FIELD TECHNICIAN'S DECLARATION STATEMENT
I certify the following under penalty of perjury, under the laws of the State of California:
I. The information provided on this Certificate of Acceptance is true and correct.
2. 1 aim 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 NAT
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 permits) issued for the building.
Field lachnician Name: (Field Technician Signature �--t
Gary Ducros
i Field Technician Company Name: Position with Company (Title):
Ducros Electrical Contractinq & Design Inc. I Acceptance Test Technician
'',Address: 2500 E. Imperial Hwy. 201-520 (ATT Certification Identification (if applicable): ATT -1706-00001
City/State/Zip* Brea, CA 92821 Phone: 714-688-7000 I Date Signed: July 24 2019
RESPONSIBLE PERSON'S DECLARATION STATEMENT
certify the following under penalty of perjury, under the laws of the State of California:
1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the
irrformation provided on this Certificate of Acceptance.
2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for
the system design, construction or installation of features, materials, components, or manufactured devices for the scope of
work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance; -
person).
3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this
Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the
enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference
Nonresidential Appendix NAT
4. 1 have confirmed that the Certificate(s) of Installation for the construction or Inst ilaticn identified on this Certificate of
Acceptance has been completed and is posted or made available with the building permit(s) issued for the building.
5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building
permits) 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
buildinq owner at occupancy.
Acceptance Person Name: IResponsible Acceptance Person
j Gary Ducros i �Lj�p
1ResPonsi le Acceptance Person Company Position with Company (Title):
'Name: Ducros Electrical Contracting & Acceptance Test Employer
Design Inc.
Address: 2500 E. Imperial Hwy, 201-520 JCSLB License: C70 #750903
Page 9 of 9
City/State/Zip: Brea, CA 92821 Phone: 714-688-7000 Date Signed: July 24 2019
STATE OF CALIFORNIA
SUMMARY SHEET 10 O
5 NaM1onal G91¢Inq Contmctgs
CALIFORNIA ENERGY COMMISSION N4CAQ�q atioelaron o6.anmden � �
D°
Project Name:
Newport north leasing
Enforcement Agency:
City of newport beach
Permit Number:
X2018-3736
Project Address:
2 milano drive
City:
Newport beach
Zip Code:
92660
Project Number:
1907-00083
Acceptance Test Employer:
Gary Ducros - ATE -1704-00002
Acceptance Test Technician:
Gary Ducros, - ATT -1 706-00001
CNRCA-LTI-02-A
0 NRCA-LTI-03-A
O NRCA-LTB-04-A
(� NP.CA-LTi-05-A
O NRCA-LTO.02-A
#
FORM
BUILDING
FLOOR
NAME
1-
Occupancy Sensor Acceptance Test".
1
1
WOMEN RR '
2
Occupancy Sensor Acceptance Test
1
1
MENS FR
3
Occupancy Sensor Acceptance Test`
7
1
ASST. UGR.
OFFICE
4
Occupancy Sensor Acceptance Test
1
1
COMMUNITY MGR
OFFICE
5
Occupancy Sensor Acceptance Test`
1
COPY ROOM '
6
Occupancy Sensor Acceptance Test
- 1
1
BREAK ROOM
7'"
Occupancy Sensor Acceptance Test:
_ 1
1
PUBLIC RR
8
Occupancy Sensor Acceptance Test
1
1
RSO
*Sample untested areas are attached in different document.
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