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X2019-2299 - Misc
Bobbie Garcia Waterproofing and Methane Consultant 23016 Lake Forest Drive, Unit A Laguna Hills, CA 92653 949.254.0089 October 4, 2019 21115 Newport coast Road Newport Beach, CA LADBS PO26796 Methane Membrane Mitigation k2O/9-.229'9 �lll�4ewpod Coos �r Gergen Construction has properly repaired Liquid Boot membrane in trenches and cut outs created for new piping in existing sub slab. Membrane was 60+ dry cure mil. A Smoke and Coupon test was performed and passed. Al mil Polyethylene sheeting was placed as a cap sheet. 2" of clean wash sand with no aggregate will be placed on Monday Oct. 7, 2019 prior to placement of Rebar. All work meets the requirements as per the "Standard Plan for Methane Mitigation" All work approved. OK to continue. espectfully, Bobbie Garcia Consultant / Inspector /O W rV IL Bobbie Garcia Specialty Inspections 23016 Lake Forest Drive, Unit D, Laguna Hills, CA 92653 Date and Day Project Inspector Name 10-4-19 21115 Newport Coast Rd Bobbie Garcia 21115 Newport Coast Rd Methane Saul Hernandez Shernandez@howardbuilding.com Johnbrink@thebedrockco.com Newport Beach permit number X2019-2299 Gergen Construction/JSS Waterproofing 2 Workers on site Smoke test administered through four penetrations Several small leaks observed and patched with Liquid Boot trowel grade over Ebase 205 spray sheet Smoke test passed Chip test collected and measured to 60+ mil dry cure, surpassing manufacturer's standards 2 inches of sand will be placed on Monday over completed liquid applied methane barrier after city inspection Eshield 205 placed down as protective vapor barrier atop liquid boot application Payment received All work approved Okay to continue 4 Hour 1Vlitutnutn Agent Signature 6 — 8 Hollis X Tel: (949) 254-0089 Email: deputybobbie t@t yahoo.coin CITY OF NEWPORT BEACH COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658 www.newportbeachca.gov 1 (949) 644-3200 SPECIAL INSPECTION REPORT Project Address: 21115 Newport Coast Dr. Newport Beach, CA Permit Number: x2019-2299 Inspection Type (s): Epoxy & Rebar check Inspection Date (s): 10-08-19 (X) Periodic ( ) Continuous Arrived on site as scheduled to perform an Observation / Inspection of Epoxy & Rebar check, Reviewed approved plans & details. Observed crew performed drilling holes into (E) concrete slab w/min of 5" embedment then cleaned all holes with air compressor and brush, then placed #4 dowels into holes with Simpson Set XP Epoxy @ 18" O.0 located at trenches inside the building per detail 2/A1.102. Also observed & verified all reinforcing steel for size, grade, lap and clearance prior of concrete pour at trenches inside the building. All observed work is done accordance with the approved plans and specifications. Work is completed. Total Inspection Time Each Day: Dete: 10-08-19 Hours: � 8� ---- ---- ------- -------- List All Items Requiring Correction (Include Previously Listed Uncorrected Items): N/A Comments: N/A To the best of my knowledge, the work inspected was in accordance with the Building Division approved design drawings, specifications and applicable workmanship provisions of the U.B.C. except as noted above. Special lnspe Sig re: Date: 10/08/19 Pr)Kt Full Name: Newporq Beach Registration No.: Khunthy Tuon (Nick) NB -0739 SpeciallnspedionReport 3-2415 AIR BALANCE CO., INC. C PROFESSIONALAIR & HYDRONIC SYSTEM TESTING • BUILDING SYSTEMS COMMISSIONING �,?p19-.2,29q 21115 Mewporj Cenier r CERTIFIED TEST, ADJUST & BALANCE REPORT PROJECT NEWPORT COAST URGENT CARE 21115 NEWPORT COAST DRIVE NEWPORT BEACH CA PROJECT/JOB# 19652 CONTRACTOR CONTROL KOMFORT SYSTEMS, INC. 6840 ORANGETHORPE AVE, STE H, BUENA PARK, CA 90620 ARCHITECT GENSLER ENGINEER TK1SC COLLABORATIVE data presented in this report is a record of system measurements and final adjustments that have been ined in accordance with the current edition of the NEBB Procedural Standard for Testing, Adjusting and ncing of Environmental Systems. The measurements shown, and the information given, in this report are Pied to be accurate and complete, at the time and date the information was gathered. Any variances from In quantities, which exceed NEBB tolerances, are noted in the TAB report project summary. NEBB CERTIFICATION NUMBER 2756 TECHNICIAN F. MUGLIA APPROVED D.FOX DATE 12/30/2019 278(, Exp. 30.11/20 1240 N. Jefferson St., Suite H • Anaheim, CA 92807-1632 • Phone (714) 630-3796 • Fax (714) 630-3998 r 3330 W. Hacienda Ave., Suite 407 • Las Vegas, NV 89118 • Phone (702) 270.2688 • Fax (702) 270.0788 �IC• B113 7525 Mission Gorge Rd., Suite E • San Diego, CA 92120 • Phone (800) 339-3796 www.precisionalrbalance.com Email: sales@precisionairbalance,com CA STATE LICENSE #633805 2'f�/ l,D "AIR BALANCE CO., INC. PROFESSIONALAIR & HYDRONIC SYSTEM TESTING • BUILDING SYSTEMS COMMISSIONING INSTRUMENTATION LIST INSTRUMENT MANUFACTURER MODEL # SERIAL # CALIBRATION DUE DATE VOLT/AMP METER FLUKE 373 23910066 5/21/2020 TACHOMETER HERMAN STICHT 982-552 B83B8024 5/21/2020 AIR DATA MULTIMETER' SHORTRIDGE ADM -860C M11398 5/17/2020 DIGITAL ANEMOMETER ALNOR 5725 T57251918004 5/1/2020 HOOD #6 .also used on flowhoods F. MUGLIA 1240 N. Jefferson St., Suite H • Anaheim, CA 92807-1632 • Phone (714) 630-3796 • Fax (714) 630-3998 - 3330 W. Hacienda Ave., Suite 407 • Las Vegas, NV 89118 • Phone (702) 270-2688 • Fax (702) 270-0788 �.; O� 7525 Mission Gorge Rd., Suite E • San Diego, CA 92120 • Phone (800) 339-3796 J� v .precisionairbalance.com Email: sales@precisionairbalance.com `- w CA STATE LICENSE #633806 W • • AIR BALANCE CO., INC. -� PROFESSIONALAIR & HYDRONIC SYSTEM TESTING • BUILDING SYSTEMS COMMISSIONING MASTER CODE SHEETS AIR DISTRIBUTION CODES CD.................................................................................. CEILING DIFFUSER CG.................................................................................. CEILING GRILLE CR.................................................................................. CEILING REGISTER RG.................................................................................. RETURN GRILLE SR.................................................................................. SUPPLY REGISTER RR.................................................................................. RETURN REGISTER DO.................................................................................. DUCTOPENING FG.................................................................................. FLOOR GRILLE FR.................................................................................. FLOOR REGISTER AB.................................................................................. AIR BAR LR.................................................................................. LINEAR RETURN LD.................................................................................. LINEAR DIFFUSER EG.................................................................................. EXHAUST GRILLE ER.................................................................................. EXHAUST REGISTER SG.................................................................................. SUPPLY GRILLE SO.................................................................................. SCREENED OPENING HO.................................................................................. HOOD OPENING LT.................................................................................. LIGHT TROFFER DT.................................................................................. DUCT TRAVERSE 1240 N. Jefferson St., Suite H • Anaheim, CA 92807-1632 • Phone (714) 630-3796 • Fax (714) 630-3998 3330 W. Hacienda Ave., Suite 407 • Las Vegas, NV 89118 • Phone (702) 270-2688 • Fax (702) 270-0788 7525 Mission Gorge Rd., Suite E • San Diego, CA 92120 • Phone (800) 339-3796 AM www.precisionairbalance.com Email: sales@precisionairbalance.com CA STATE LICENSE 9633805 L J AIR BALANCE CO., INC. PROFESSIONALAIR & HYDRONIC SYSTEM TESTING • BUILDING SYSTEMS COMMISSIONING GENERAL REPORTING CODES DNA.................................................................................. DATA NOT AVAILABLE DNL.................................................................................. DATA NOT LISTED NA.................................................................................. NOTACCESIBLE NI.................................................................................. NOT INSTALLED NS.................................................................................. NOT SPECIFIED NT.................................................................................. NOT TESTED, DUE TO ABNORMAL CONDITION NVL.................................................................................. NO VALID LOCATION CD.................................................................................. CEILING DIFFUSER NM.................................................................................. NOT MEASURED NG.................................................................................. NATURAL GAS DX.................................................................................. DIRECT EXPANSION DT.................................................................................. DUCT TRAVERSE LO.................................................................................. LOUVERED OPENING *...................................................................................... MEASURED WITH FLOW HOOD i 12411N. Jefferson St., Suite H • Anaheim, CA 92807-1632 • Phone (714) 6311-3796 • Fax (714) 630-3996 3330 W. Hacienda Ave., Suite 407 -Las Vegas,. NV 89118 • Phone (702) 270-2688 • Fax(702)270-0788 7525 Mission Gorge Rd., Suite E • San Diego, CA 92120 • Phone (800) 339-3796 w .precisionairbalance.com Email: sales@precisionairbalance.com CA STATE LICENSE #633805 AIR BALANCE CO., INC. Project Name: NEWPORT COAST URGENT CARE 21115 NEWPORT COAST DRIVE NEWPORT BEACH CA AIR MOVING EQUIPMENT TEST SHEET Date: 12/30/2019 Page: 1 SYSTEM HP -2E (EXISTING) 1VP44 X 7/8" Equipment Location ROOF Fan Sheave & Shaft Size I Area Served OFFFICES Equipment Manufacturer CARRIER (1 OF) A-43 Model 50HJ0007 Serial Number 5011C82272 Motor Sheave & Shaft Size I 1VP44 X 7/8" Fan Sheave & Shaft Size I AFD 59 X 5/8" Belts 1 (1 OF) A-43 Remarks: CERTIFIED MEMBER - NATIONAL ENVIRONMENTAL BALANCING BUREAU AIR BALANCE CO., INC. DATE: PAGE: SYSTEM M PROJECT: HOAG NEWPORT COAST URGENT CARE 21115 NEWPORT COAST DRIVE NEWPORT BEACH CA AIR DISTRIBUTION 12/30/2019 HP -2E Z 1-4 ROOM NO. CODE SIZE AK FACTOR REQUIRED F.P.M. REQUIRED C.F.M. ACTUAL F.P.M. ACTUAL C.F.M. MIN REQ MIN ACT SUPPLY AIR SYSTEM HP2E-Z1 024 1 CD 2410 1.0 150 135 CORR 2 CD 2410 1.0 250 225 025 3 CD 2410 1.0 275 * 250 TOTAL (675) (610) (60) 65) (1)100% HP2E-Z2 021 1 CD 2408 1.0 * 150 150 022 2 CD 2408 1.0 150 135 023 3 CD 2408 1.0 150 150 TOTAL (450) (435) (90) (95) (1)100% HP2E-Z3 017 1 CD 2410 1.0 * 225 225 016 2 CD 2410 1.0 150 140 TOTAL (375) (365) (60) (62) (1)100% HP2E-Z4 018 1 CD 2410 1.0 275 285 018 2 CD 2410 1.0 275 * 266 018 3 CD 2408 1.0 150 162 TOTAL (700) (713) (40) (44) (1)70% HP2E TOTAL (2200) (2123) REMARKS: *BD-HP2E REFERENCE SP -0.21" (1) PERCENT OPEN. 4B CERTIFIED MEMBER - NATIONAL ENVIRONMENTAL BALANCING BUREAU AIR BALANCE CO., INC. DATE: PAGE: SYSTEM #: PROJECT: HOAG NEWPORT COAST URGENT CARE 21115 NEWPORT COAST DRIVE NEWPORT BEACH CA AIR DISTRIBUTION 12/30/2019 HP -2E REMARKS: CERTIFIED MEMBER - NATIONAL ENVIRONMENTAL BALANCING BUREAU AIR BALANCE CO., INC. Project Name: NEWPORT COAST URGENT CARE 21115 NEWPORT COAST DRIVE NEWPORT BEACH CA AIR MOVING EQUIPMENT TEST SHEET Date: 12/30/2019 Page: 4 SYSTEM FC -2D (EXISTING) Equipment Location ROOF Area Served OFFICES Equipment Manufacturer CARRIER Model 40RMQ012 Serial Number 0113400245 Specified Actual Specified Actual Total CFM - fan 3550 NVL Total CFM - Outlet 3550 3407 R/A CFM 2900 2875 O/A CFM 650 651 Static Pressure Total/Ext) NS 0.52" Inlet Pressure 0.28" Discharge Pressure 0.24" Fan RPM NS 848 Specified Actual Specified Actual Motor Manufacturer MARATHON Motor H.P. NS DNL Phase 3 3 Voltage 460 474/473/474 Amperage 3.4 2.3/2.3/2.4 Motor RPM 1725 NA Motor Service Factor 1.15 I Motor Sheave Pitch 60% CLOSEDJJ I Motor Sheave & Shaft Size I 1VP44 X 5/8" Fan Sheave & Shaft Size I AK 84 X 1" q1 Belts 1 (1 OF) A-39 N]E6CERTIFIED MEMBER - NATIONAL ENVIRONMENTAL BALANCING BUREAU AIR BALANCE CO., INC. DATE: PAGE: SYSTEM #: 12/30/2019 FC -2D Z1-3 PROJECT: HOAG NEWPORT COAST URGENT CARE 21115 NEWPORT COAST DRIVE NEWPORT BEACH CA AIR DISTRIBUTION REMARKS: (1)PERCENTOPEN. CERTIFIED MEMBER - NATIONAL ENVIRONMENTAL BALANCING BUREAU ©m��©moo®ems REMARKS: (1)PERCENTOPEN. CERTIFIED MEMBER - NATIONAL ENVIRONMENTAL BALANCING BUREAU AIR BALANCE CO., INC. DATE: PAGE: SYSTEM #: PROJECT: HOAG NEWPORT COAST URGENT CARE 21115 NEWPORT COAST DRIVE NEWPORT BEACH CA AIR DISTRIBUTION 12/26/2019 6 FC -2D Z4-6 REMARKS: *BD-FC2D REFERENCE SP- 0.22" (1) PERCENT OPEN. CERTIFIED MEMBER - NATIONAL ENVIRONMENTAL BALANCING BUREAU •,. ©m��©moo®�� REMARKS: *BD-FC2D REFERENCE SP- 0.22" (1) PERCENT OPEN. CERTIFIED MEMBER - NATIONAL ENVIRONMENTAL BALANCING BUREAU J AIR BALANCE CO., INC. DATE: PAGE: SYSTEM #: 12/30/2019 FC -2D PROJECT: HOAG NEWPORT COAST URGENT CARE 21115 NEWPORT COAST DRIVE NEWPORT BEACH CA AIR DISTRIBUTION REMARKS: CERTIFIED MEMBER - NATIONAL ENVIRONMENTAL BALANCING BUREAU i AIR BALANCE CO., INC. Project Name: NEWPORT COAST URGENT CARE 21115 NEWPORT COAST DRIVE NEWPORT BEACH CA AIR MOVING EQUIPMENT TEST SHEET Date: 12/30/2019 Page: 8 SYSTEM EF -1 FC -1 Equipment Location CEILING WALL Area Served GENERAL EXHAUST IT ROOM Equipment Manufacturer COOK LG Model 100 SQN 100SQN28DVF LSN243HLV Serial Number 1385145674-00/000070 162279 Motor Sheave & Shaft Size I DIRECT DRIVE DIRECT DRIVE Fan Sheave & Shaft Size DIRECT DRIVE DIRECT DRIVE 71 Belts DIRECT DRIVE DIRECT DRIVE Remarks: 446 CERTIFIED MEMBER - NATIONAL ENVIRONMENTAL BALANCING BUREAU AIR BALANCE CO., INC. DATE: 12/30/2019 PAGE: 9 SYSTEM #: EF -1 PROJECT: HOAG NEWPORT COAST URGENT CARE 21115 NEWPORT COAST DRIVE NEWPORT BEACH CA AIR DISTRIBUTION REMARKS: CERTIFIED MEMBER - NATIONAL ENVIRONMENTAL BALANCING BUREAU mm REMARKS: CERTIFIED MEMBER - NATIONAL ENVIRONMENTAL BALANCING BUREAU AIR DATE: CO., INC. 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NRCI-MCH-01-E Mechanical HVAC (Page 1 of 2) "'°'e""' --'Newport Coast Urgent Care Hoag E Dl Ment Age W. NIntNumbec '"'e"°"tlm21115 Newport Coast Dr "`Newport Beach zoc d.` 92657 A. GENERAL INFORMATION DATE OF BUILDING PERMIT 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. BUILDING TYPE Applicable Sheets or Pages, Tables, Schedules, etc. Date Approved By the Enforcement Agency Nonresidential HgtrRiw Residendal 110"Nutel PHASE OF CONSTRUCTION Nm Conwixtm ElAddibon © Abmdw If more than one person has responsibility for building construction, each person shall prepare and sign on Installation Certificate document applicable to the portion of construction for which they are responsible; alternatively, the person with chief responsibilityfor construction shall prepare and sign the Installation Certificate document(s) for the entire construction. B. SCOPE OF RESPONSIBILITY Date of approval by the enforcement agency of the Certificate of Compliance that provides the 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 Title 24 M0.000, MO.001, MO.002, M2.001, M3.001, M5.001, M6.0)1 CA Building Energy Efficiency Standards- 2013 Nonresidential Compliance May 2015 r STATE OF CALIFORNIA MECHANICAL CEC-NRCI-MCN.n1.F IRmrleed nsrin roil CALIFORNIA OF INSTALLATION 'COMMISSIONCERTIF�- cchaICATE Mechanical HVAC NRCI-MCH-01-E Newport Coast Urgent Care Hoag P (Page 2 of 2) Enforcementngenry: Add(ess: 6840 Oran ethor a Ave. Ste. H Pa,me ry°mm.: oa'21115 Newport Coast Dr "" Newport Beach RESPONSIBLE PERSON'S DECLARATION STATEMENT DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Installation documentation is accurate and complete. Dreu entation Anthor Name: Bo R. Youngsma Documentation or , mature: - _._._ Documentatlon Author Company Name: ControIKomfortS ems Inc. Date Signed: /a-36�9 Add(ess: 6840 Oran ethor a Ave. Ste. H CEA/ HERS certification Idemitmation IV applicable): N q `" ueria Park, CA 90620 Pt?f4) 994-4232 RESPONSIBLE PERSON'S DECLARATION STATEMENT 1 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 builderfinstal ler. 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. S. I 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 building owner at Occu pa nc. aegoD'IZ BVoungsma ame: ¢qt�sh¢¢eL� Respon Ie Builder/Inrtailer5lgna[ure: _ - Cory Name:(InstallinSubcontracmrurGenatal Contractor orauilder/Owner) Control Komfo Systems, Inc. Position With Company (Title): Operations Manager -6940 Orangethorpe Ave., Ste. H E1en7 C200 C 745195 CitState/p: Park, CA 90620 Phone (714) (714) 994-4232-1 Date Signed - W eunamg energy [ardency standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA MECHANICAL CEC-NRCI-MCH.n1-C nciin CALIFORNIA ENERGY COMMISSION '� OF INSTALLATION NRCI-MCH-01-E anical HVAC ECERTIFICATE (Page 1 of 2) (Paaare2:1115 'm°Newport Coast Urgent Care Hoag Newport Coast Dr 'Newport Beach ""�'P0 92657 A. GENERAL INFORMATION DATE OF BUILDING PERMIT BUILDING TYPE NonreSldentlal High -Rise Rsidentlal HaWMo@II PHASE OF CONSTRUCTION New Construction Addtion ©AILLYation If more than one person has responsibilityfor building construction, each person shall prepare and sign on installation Certificate document applicable to the portion of construction for which they are responsible; alternatively, the person with chief responsibilityfor 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 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 far the scope of responsibility for this Installation Certificate. Document Title or Description Title 24 Applicable Sheets or Pages, Tables, Schedules, etc. M0.000, MO.001, M0.002, M2.001, M3.001, M5.001, M6.0)1 Date Approved By the Enforcement Agency ..H ommNtg Energy cn¢lenty 5tanaaras - 2013 Nonresidential Compliance May 2015 _ STATE OF CALIFORNIA MECHANICAL CEC-NRCI•MCH-Ot-E (Rev'Betl 05175) I CERTIFICATE nF mlc CALIFORNIA ENERGY COMMISSION _._ Mechanical HVAC NRCI-MCH-01-E Pm;eRN.me(Page 2 of 2) Newport Coast Urgent Care Hoag EnforcementASena: remit Number Pro........21115 New ort Coast Dr p `l" Newport Beach ��Z' �a DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. ; certify that this Certificate of Installation documentation is accurate and complete. Dau entation Author Name; Document ion Author Signature: Bob R. Youn sma D.c.mentad.n Author Company Name: Date Si etl: Control Komfort S stems Inc. AddmP s: 6840 Oran etho Ave. Ste.H CEA/ HERS Cen fitdtion lden[ifia .n (If appli able): Ci state/ip N A %uena Park, CA 90620 ntYN) 994-4232 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/instaHer. 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 $p ptht�e�ebuuiilding owner at occupancy. Ret3001 iQ.ai U/lnetailer ngsmaame: Responsib Builder/lmmlersignatore: Cam ny Name: Houalli sukontmaor or General Contract., or Boilder Ovmer _—�—' G�ontrol Komfor Systems, Inc. 1 PosidonwithC.mpany Ttlep Operations Manager Aa�rys;:, Orangethorpe Ave., Ste. H este unease: eltOs afeUe/z p: C20 745195 Buena Park, CA 90620 W104) 994-4232 Date Signed: /,,_oa9. g tnergy tnlnency standards - 2013 Nonresidential Compliance May 2015 Enforcement Agency Use: Checked by/Date 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 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): r Weekdays r Weekend r 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 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 Occupancy sensors are not located within 4 feet of any HVAC diffuser Ultrasonic occupancy sensors do not emit audible sound 5 feet from source 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: Restroom Space Type (office, corridor, etc) restroom 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. r Step 2: Simulate unoccupied condition a. All lighting, including emergency and egress lighting, turns off. Exempt lighting may r remain on per Section 130.1(c)1 and 130.1(a)1. 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 r type). 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 a maximum of 20 minutes from start of an unoccupied condition per Standard Section 110.9(b) 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. 17 Step 2: Simulate an occupied condition a. Status indicator or annunciator operates correctly I 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 mi .:..:..____ o ,.r 0 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 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 Step 2: Simulate an occupied condition The occupant sensing controls shall turn lights fully ON in each separately controlled r areas, Immediately upon an occupied condition 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 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 5. Add}tional 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 ft` I -I 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. 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. - G m6;_ ;_ ---- n _rG 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). I w, 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. 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. f Representative Spaces Selected Tested space/room name: Janitors Space Type (office, corridor, etc) Janitor 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. 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. 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) I 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. 17 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 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 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 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 r deactivate all of the lights. TL :..:.......... 4 -Pi Step 2. Simulate an unoccupied condition 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. F 5. Add}tional 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 ft` 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 fL2 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). r7— e. e. Sensors shall not trigger in response to movement in adjacent walkways or workspaces G f. All steps are conducted in Functional Test 2 'Occupancy Sensor (On Off Control)' and all answers are Yes. r Ti .:..:..---- 0 ,.c 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. 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. r 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 r remain on per Section 130.1(c)1 and 130.1(a)1. 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 mi .:..:.......... n ,.r 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) F 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 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 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 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 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 5. Add}tional 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 ft4 1- 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 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). r7. 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 S. Occupant Sensor serving small zones for PAF (all answers must be Yes). Also must pass Test 2. r Confirm compliance for all control system types (1-5) present in each space: I 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 f 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. 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) 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. "F 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 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 Step 2: Simulate an occupied condition The occupant sensing controls shall turn lights fully ON in each separately controlled r areas, Immediately upon an occupied condition 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 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 J. The occupant sensor does not trigger a false 'on' from movement in an area r adjacent to the controlled space or from HVAC operation. 44.:..:...x--- 1 G ..F ^ 5. Add ai"tional 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 7-1 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). e. Sensors shall not trigger in response to movement in adjacent walkways or workspaces F, f. All steps are conducted in Functional Test 2 'Occupancy Sensor (On Off Control)' and all answers are Yes. r 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. 4. Partial On Occupant Sensor for PAF (all answers must be Yes). r- 5. 5. Occupant Sensor serving small zones for PAF (all answers must be Yes). Also must r pass Test 2. Representative Spaces Selected Tested space/room name: Exam Space Type (office, corridor, etc) Room 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. 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. Occupancy Sensors Step 1: Simulate an unoccupied condition mM - ;........_ 1 v ..r i ightiog Comm) mject Name: Haag Evforcemevt Agency: CITY OF NEWPORT BEACH Permit Number. X2019-2299 mjeet Address: 21115 Newport Coast Dr ICity: Newport Beach Zip Code: 92657 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 sensor does not trigger a false 'on' from movement in an area adjacent to the controlled space or from HVAC operation. P" 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 P✓ 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 Step 2: Simulate an occupied condition The occupant sensing controls shall turn lights fully ON in each separately controlled r areas, Immediately upon an occupied condition 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 r 70% of the lighting automatically. b. After the first stage occurs, manual switches allow an occupant to activate the alternate set of lights, activate 1009/h of the lighting power, and manually deactivate all of the lights. r Step 2. Simulate an unoccupied condition 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 step u: 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). I 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` mi.:,.:...,..—„ in ..ca 5. Additional test for Occupancy Sensors Serving Small Zones in Office Spaces Larger than 250 ft , to Qualify for a Power Adjustment Factor (PAF) 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. r 4. Partial On Occupant Sensor for PAF (all answers must be Yes). r- 5. 5. Occupant Sensor serving small zones for PAF (all answers must be Yes). Also must pass Test 2. r_ - Confirm 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. I•:••-• 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 a maximum of 20 minutes from start of an unoccupied condition per Standard Section 110.9(b) r J. The occupant sensor does not trigger a false 'on' from movement in an area adjacent to the controlled space or from HVAC operation. P, 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 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 Step 2: Simulate an occupied condition The occupant sensing controls shall turn lights fully ON in each separately controlled r areas, Immediately upon an occupied condition 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. I- b. 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 r deactivate all of the lights. TU._:.. __Oil_V Step 2. Simulate an unoccupied condition 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 J. The occupant sensor does not trigger a false 'on' from movement in an area adjacent to the controlled space or from HVAC operation. r TM- 11 ..0 LIP 5. Add}tional test for Occupancy Sensors Serving Small Zones in Office Spaces Larger than 250 ft , to Qualify for a Power Adjustment Factor (PAF) Step o: 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 J. Enter PAF corresponding to controlled area from line (a) above (1125 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). 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„ mi .:..:.......... 'n ,.oa C. Testing Results 1. Automatic Time Switch Controls (all answers must be Yes). 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 r pass Test 2. Representative Spaces Selected Tested space/room name: Lobby Space Type (office, corridor, etc) Lobby 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, r Step 2: Simulate unoccupied condition a. All lighting, including emergency and egress lighting, turns off. Exempt lighting may r„ remain on per Section 130.1(c)1 and 130.1(a)1. 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). IT Step 3: System returned to initial operating conditions r 2. Occupancy Sensors Step 1: Simulate an unoccupied condition T :..:..«...... nc..F^ 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) i I 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. 17 Step 2: Simulate an occupied condition a. 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 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 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 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 a. Both stages (automatic on and manual on) lights turn off within a maximum of 20 r 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 thecontrolled space or from HVAC operation. 5. Add 1tional test for Occupancy Sensors Serving Small Zones in Office Spaces Larger than 250 ft r 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 r the PAF claimed in the compliance documentation (line c). 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. I r 44.:..:.. «--- 10 ..F 9 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). 17 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 r pass Test 2. Representative Spaces Selected Tested space/room name: Hallway Space Type (office, corridor, etc) Hallway 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 7r - b. b. Verify the switch only operates lighting in the ceiling -height partitioned area in r which the switch is located. 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. Occupancy Sensors Step 1: Simulate an unoccupied condition �:..:,.---- �n .,c ^. 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) I '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 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 Step 31 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) 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 Step 2: Simulate an occupied condition The occupant sensing controls shall turn lights fully ON in each separately controlled r areas, Immediately upon an occupied condition 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. 1 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" mi .:..:..____ an ,.0 Step 2. Simulate an unoccupied condition a. Both stages (automatic on and manual on) lights turn off within a maximum of 20 f 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. 5. Add }tional 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. 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 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). 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. 5. Occupant Sensor serving small zones for PAF (all answers must be Yes). Also must r pass Test 2. D. Evaluation : F PASS: All applicable Construction Inspection responses are complete and all applicable Equipment Testing Requirements responses are positive. lh;.. ;..---- 11 ..0 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT I certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Company Name Name Bernardo Torres Advance Lighting and Electric Inc Address City 6305 Corona ave Bell Zip Code 90201 Phone (323)338-1040 CEA/ATT Certification TC- 81303 Author Signature Identification (if applicable) ?0 Date of Signature: 12/26/2019 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. 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 Bernardo Torres Advance Lighting and Electric Inc Address: 6305 Corona ave City Bell Zip Code 90201 Phone (323)338-1040 ATT Certification TC -A813034 Position with Company Identification (Title) owner Field Technician Signature Date of Signature: 12/26/2019 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. f 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 atl 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 Bernardo Torres Advance Lighting and Electric Inc Address: 6305 Corona ave City Bell Zip Code 90201 Phone (323)338-1040 CSLB License Position with Company (Title) owner Responsible Acceptance Person Signature Date of Signature: 12/26/2019 �:_ �- ----I c -P� AUTOMATIC DAYLIGHTING CONTROL ACCEPTANCE DOCUMENT Enforcement Agency Use: Checked by/Date Check boxes for all pages of this NRCA-LTI-03-A completed and included in this submittal NRCA-..LTI-03-A Page 1&2 Construction Inspection. This page required for all submittals. 13 NRCA-LTI-03-A Page 3&4 Continuous dimming control functional performance test— watt -meter oramp-meter measurement NRCA-LTI-03-A Page Stepped Switching/ Stepped Dimming functional performance test — watt -meter or amp -meter measurement 5&6 13 NRCA-LTI.03-A Page Continuous dimming control functional performance test— light meter power measurement, and default look -up 7&8 table of fraction of rated power versus fraction of rated light output. C NRCA-LTI-03-A Page 9&10 Stepped Switching/ Stepped Dimming functional performance test—based on light output 1. NA7.li.1.1 Construction Inspection: 1. Drawing of Daylit Zone(s) must be shown on plans or attached to this compliance document. By checking this box, technician certifies that plans have been attached to this webform r - Document Name and Page #'s Add Control Systems below. If sampling method is used In accordance with NA7.6.1.2. If adding, attach a page with names of other controls in sample (only for buildings with > 5 daylight control systems, sample group glazing same orientation) Lobby Plans Page Number Check if Tested Control is Representative of Sample Zone Type: Skylit (Sky), Primary Sleight (PS), or Secondary Sidelit (SS) Control Type: Continuous Dimming with more than 10 light levels (C), Stepped Dimming (SD), Switching (SW) Design Footcandles: (Enter footcandle (ft) value or "U" If unknown): 3. SPncarc and Control Loop Type: Open Loop (OL), Closed Loop (CL) Sensor Location: Outside (0), Inside Skylight (IS), Near Windows facing out (NW), In Controlled Zone (CZ) Sensor Location is Appropriate to Control Loop Type: (Yes/No) If control loop type is Open Loop (OL): Enter yes (Y) if location = Outside (0), Inside Skylight (IS), or Near Windows facing out (NW); otherwise, enter no (N). If Control loop type is Closed Loop (CL): Enter yes (Y) if location = in Controlled Zone (CZ); otherwise, enter no (N). Control Adjustments are in Appropriate Location (Yes/No): Yes, If Readily Accessible or Yes If in Ceiling less than or equal to 11 It, Lobby r PS CL CZ Yes Yes -r'I.:..:,.____ t ..F No for all other. 4. Has Documentation Been Provided by the Installer: Installation Manuals and Calibration Instructions Provided to Building Owner: (Yes/No) Yes Location of Light Sensor on Plans: (Yes/No) Yes Location of Light Sensor on Plans: (Page Number) E2.0 S. Separate Controls of Luminaires in Daylit Zones: Are luminaires controlled by automatic daylighting controls only in tlaylit zones: (Yes/No) Yes Separately circuited for daylit zones by windows and tlaylit zones under skylights: (Yes/No) Yes 6. Daylighting Control Device Certification Daylighting control has been certified in accordance with §110.9: (Yes/No) Yes Construction Inspection PASS/FAIL. If all responses on Construction Inspection pages 1 & 2 are complete and all Yes/No questions Pass have a Yes response, the tests PASS; If any responses on this page are incomplete OR there are any No responses, the tests FAIL PA55/FAIL Evaluation (check one): (t PASS: If all responses on Construction Inspection pages 1 & 2 are complete and all Yes/No questions have a Yes (Y) response, the tests PASS r FAIL: Any applicable Construction Inspection responses are incomplete OR there is one or more negative (N - no) responses in any applicable Functional Performance Testing Requirements section. System does not pass and is NOT eligible for Certificate of Occupancy according to Section 10- 103(a)3B. Fix problem(s) and retest until the system(s) passes all portions of this test before retesting and resubmitting NRCA-LTI-03-A with PASSED test to the enforcement agency. Describe below the failure mode and corrective action needed. 2. NA7.6.1.2.1 Functional Performance Testing - Continuous Dimming Systems: Power estimation using amp -meter measurement, or alternate option - watt -meter measurement Complete all tests on page 3 & 4 (No Daylight Test, Full Daylight Test, and Partial Daylight Test) and fill out Pass/Fail section on Page 4. Lobby Svstem Information a. Control Loop Type: Open Loop or Closed Loop? (O or C) �r C b. Indicate if Mandatory control - M (required for skylit zone or primary sidelit zone with installed general lighting power > 120 W); L� for Control Credit - CC; or Voluntary -V (M, CC, V) c. If automatic daylighting controls are mandatory, are all general lighting luminaires in daylit zones controlled by automatic Yes daylight controls? (Yes/No) d. General lighting design footcandles. (Enter footcandle (fc) value or "U" if Unknown) e. Power estimation method. Measured Amps Multiplied by Volts, Volt -Amps (VA), alternate option is Measured Watts (W) a[ep 1: ioenary Kererence Location (location where minimum daylight illuminance is measured in zone served by the controlled lighting.) f. Method Used: Illuminance or Distance? (I or D) Override daylight control system and drive electric lights to highest light level for the following: g. Highest light level fc: Enter measured footcandles (fc) from controlled electric lighting (does not include daylight illuminance) 147 h. Full load Highest light level power: Enter measured Amps times Volts, Volt -Amps (VA) or measured Watts (W). 5.4 1. Indicate whether this is Full Output (FO), or Task Tuned (Lumen Maintenance) (TT) FO Ste 2: No Daylight Test controls enabled & daylight less than 1 fc at reference location j. Method Used: Night time manual measurement (Night), Night Time Illuminance Logging (Log), Cover Fenestration (CF), Cover CF Open Loop Photosensor(COLP) k. Reference Illuminance (footcandles) as measured at Reference Location (see Step 1). Enter footcandles 125 I. Enter Y if either of the fallowing statements are true: [Reference Illuminance (line k)] /[Highest light level fc (line g)] > 70% Yes when line i = FO or [Reference Illuminance (line k)] / [design footcandles (line d)] > 80%? (Yes/No) Sten 3: Full Davliaht Test conducted when daviiaht !,. 9 5n01 of rafaranra illuminanra fling 1,1 m. Enter measured Amps Multiplied by Volts, Volt -Amps (VA) or measured Watts (W). 1.2 n. System power reduction enter [I - (line m)/(line h)], Enter Wa. 77.77777777777719 o. Is System Power Reduction (line n) > 65% when line i = FO, or > 56% when line 1 = TT (Yes/No) Yes p. With uncontrolled lights also on, no lamps are dimmed outside of daylit zone by same control mechanism or formula (Yes/No) Yes q. Dimmed lamps have stable output (no perceptible visual flicker) (Yes/No) Yes r. Daylight Dimming plus OFF Controls PAF (This portion of the hill daylight test applies to lighting systems that are claiming a PAF for daylight dimming plus OFF controls. This portion of the full daylight test shall be conducted instead of steps m. thru q.) Does the system automatically turn OFF the luminaires when full daylight is available? (Yes/No) between 60% and s. Daylight illuminance (light level without electrlc light) measured at Reference Location (fc) ------------------------ 77 99 utomaec Daylighting Control rojmt Name: Haag Enforcement Agency: CITY OF NEWPORT BEACH Pemit Number X2019-2299 mject Address: 21115 Newport Coast Or City: Newport Beach - Zip Code: 91657 I. Daylight illuminance divided by the Reference Illuminance = (line s )/ (line k). Enter %. I 79,2 u. Is Ratio of Daylight illuminance to Ref. illuminance (line t) between 60% and 95%? (Yes/No) Yes v. Total (daylight + electric light) Illuminance measured at the Reference Location Fc) 179 w. Total Illuminance divided by the Reference Illuminance = (line v )/ (line k), Enter %. 139.2 x. Is Total illuminance divided by the Reference illuminance (line w) between 100% and 1500/o? (Yes/No) Yes PASS/FAIL Evaluation (check one): r PASS: All applicable Construction Inspection responses are complete and all applicable Functional Performance Testing Requirements responses are positive (Y - yes) r FAIL: Any applicable Construction Inspection responses are incomplete OR there is one or more negative (N - no) responses in any applicable Functional Performance Testing Requirements section. System does not pass and is NOT eligible for Certificate of Occupancy according to Section 30- 103(a)38. Fix problem(s) and retest until the system(s) passes all portions of this test before retesting and resubmitting NRCA-LTI-03-A with PASSED test to the enforcement agency. Describe below the failure mode and corrective action needed, TAi- 1.. ---- A -V DOCUMENTATION AUTHOR'S DECLARATION STATEMENT I cerafy that this Certificate Of Acceptance documentation is accurate and complete. Documentation Author Name Company Name BarneMO Torres Advance Lighting and Electric Inc Add., City 6305 Corona ave Bell Zip Code Phone 90201 (323)338-1040 CEA/ATT Certiflcatlon Identification (If Author Signature applicable) TV813034 f4v Date of Signature: 12/26/2019 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the fallowing under penalty of perjury, under the laws of the State of California: 1. The Information provided on this Certificate of Acceptance is true antl correct. 2, lam the person he pertormed 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 Pat, 4. I have Confirmed that the Con ificatets) of Installation for the construction nr Installation identified On this CertiFlcate of Acceptance has been Completed and signed by the responsible builder/Installer and has been posted or made available with the b0ilding permit(s) Issued for the building, Field Technician Name Bernardo Torres Company Name Advance Lighting and EleRri[Inc Address: City 6305 Corona ave Bell Zip Code 90201 ATT Certincatlon Identification TC-AB1303i Field Technician Signature Date of Signature: 12/26/2019 Phone Position with Company (Title) (323)338-1040 RESPONSIBLE PERSON'S DECLARATION STATEMENT 1 certify the following under penalty of perjury, under the Iaws of the State of California: 1, lam the Fleld Technician, or the Field Technician is acting on my behalf as my employee Or my agent and have reviewed the Information practiced on this CertiFlcate of Acceptance. 2. Ism eligible under Division 3 of the Business and Prefesslons Code in the applicable doesifcabon to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices Far the scope of work identified on this Certificate of Acceptance and attest to the dedisatiore In this statemect(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 NA]. 4. 1 have confirmed that the Certificate(') Of Installation for the construction or installation Identified On this Certificate of Acceptance has been completed antl is pasted or made available with the building permit(') Issued for the budding. S. I will ensure that a completed, signed copy of this Certificate Of Acceptance shall be poseetl, or made ousideble with the Fiction, permit(') issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certiodate Of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name Bernardo Tomes Company Name Advance la9hting and Electric lot Address: City 6305 Carona ave Bell Zip Code 90201 CSLB License Responsible Acceptance Person Signature Date Of Signature: 12/26/2019 Phone Position with COmpany(Till,) (323)330-1040 General Information Building Type: F Nonresidential High -Rise Res (Common Area) F 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: 9/9/2019 12:00:00 AM 'Document Title or Description Applicable Sheets or Pages, Tables, Schedules, etc Date Approved 9/9/2019 12:00:00 By the Enforcement Agency 12:00:00 AM 9/9/2019 12:00:00 ® r 000 AM ®_ 00 AM mom:..:..____ 1 ,.c DOCUMENTATION AUTHOR'S DECLARATION STATEMENT I certify that this Certificate of Acceptance document is accurate and complete. Documentation Author Company Name Name Josue Baca Fineline Electric Address 1130 Palmyrita Ave ste 340 Zip Code 92507 CEA/ATT Certification Identification (If applicable) ------ ----- Date of Signature: City Phone Author Signature Riverside (714)744-2600 RESPONSIBLE P RSO 'S DECLARATION STATEMENT I certify the following un er pen ty of perjury, under the laws of the State of California: 1. I am the Field Tech ician, r 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 Acode once. 2. I am eligible under ivi on 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of fee s, 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. 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 perm it(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 Josue Baca Company Name Person Name Finance Electric Address: City 1130 Palmyri[a Ave ste 340 Riverside Zip Code Phone 92507 (714)744-2600 CSLB License Position with Company (Title) Project Manager Responsible Acceptance Person Signature Date of Signature: INDOOR LIGHTING NRCI_LTI_02_E Hoag Orange General Information Building Type: r Nonresidential r High -Rise Res (Common Area) F Hotel/Motel (Common Area) Phase of Construction: P' 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: 9/9/2019 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? P, 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. 17 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. W The EMCS has been separately tested for each respective lighting control system for which it is installed to function as. r 8. 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. 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. P A. All lighting controls and equipment have been installed in accordance with the manufacturer's instructions. P B. The manufacturer has provided instructions for calibration. WW C. If indicator lights are integral to any components, such indicator lights consumes no more than 1 watt of power per indicator light. f D. Components that are regulated by the Title 20 Appliance Efficiency Regulations have been certified to the Energy Commission. r 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: F 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 M. 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 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. 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: I✓ 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 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. G. The EMCS 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 modulation of 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. 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 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 7. The EMCS or Lighting Control System functions as one or more of the Occupant Sensing Controls Checked Below: W a. Occupant Sensors meeting all applicable requirements for Occupant Sensor Control devices in the Title 20 Appliance Efficiency Regulations F 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; 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. F 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. 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; U. 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` 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. 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. r A. Section 130.1(a) Area Controls. [3 B. Section 130.1(b) Multi -Level Lighting Controls P C. Section 130.1 (c) Shut -OFF Controls ( D. Section 130.1 (d) Automatic Daylighting Controls. r E. Section 130.1 (e) Demand Responsive Controls. F 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 F 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 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT I certify that this Certificate of Acceptance document is accurate and complete. Documentation Author Company Name Name Josue Baca Fineline Electric Address City 1130 Palmyrita Ave sts 340 Riverside Zip Code Phone 92507 (714)744-2600 CEA/ATT Certification Author Signature Identification (If applicable) x Date of Signature: (12/26/2( 19 RESPONSIBLE PERS 'S DECLARATION STATEMENT I certify the following andpe alty of perjury, under the laws of the State of California: 1. 1 am the Field Techn i 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. J 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 permits) issued for the building. S. 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 Josue Baca Fineline Electric Address: City 1130 Palmyrita Ave ste 340 Riverside Zip Code 92507 CSLB License Responsible Acceptance Person Signature Date of Signature: Phone Position with Company (Title) (714)744-2600 Project Manager