HomeMy WebLinkAbout15-1167CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 PRESS .> (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY BUILDING PERMIT APPLICATION JOB SITE ADDRESS L ,—a7 D VA"y I-3-M mL:'�XN APN LOT TRACT OWNER ADDRESS CITY ZIP TEL APPLICANTC,,WIr`Ihi Q�l_ TELg4 —16-1 CONTRACTOR YINII �xJt L ADDRESS Si S CITY :a�Tlwj ZIP0427TEL 0 ARCH/ENG/DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DEMAIIATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reason(s) indicated below by the checkmadgs) I have placed next to the applicable rthlm(s) [Section 7CM26 Budress and Pic lam Code Any city or county that requires a permit to construct, alter, Improve, demolish, or repair, any structure, prior to his Issaarrs, elm requLm tie applicant for tie permit to file a signed statBmenl that he or she to llterreed purerranl fp the lavhdsbro of the Ce+r6actore Staff L1h Brag Law (Cmift B) Commorcing wBh Section 7000 of Division 3 of the Business and Professions Coda] or that he or she Is exempt from licensure and the basis for the alleged examptim Arty vialation of Section 7031 5 by any applicdm for a permit sublem the appl=nt to a chill penalty of not more than five hundred dollars (S50O) j I, as owner of the property, or my employees with wages as their sole compensation will do U all ofor U portlons of the work and the et x" Is not intended or offered for We (Section 70U Business and Professions Code The Contractors State License Law does net apply to on owner of property who through employees' or personal effort builds or Improves the property pmvsded that the Improvemema are nil Intended or offered for sale If l wmmr fie building or Improvement Is Bold within one year al complaLon the Owner Builder will bare the burden of proving that it was not bull[ or improved for the purpose of sale) U I, as owner of the property, am exclusively Contracting wrath licensed Corrbectom to construct the project 50dim 7044 Business and Pofliaons Code The Contractors' State Lcansa Law does not apply to an owner all propany who builds or Improves chanson and who commis for the prajBets with a licensed Contractor pursuant to the Contractors State License Law) U I am exempt tom licensors under the Contractor's State License law for the following reason(s) By my signature below I acknowledge that, except for my personal residence In which I must have resided for at least one year prior to completion of the Improremarts covered by this permit I cannot legally sell a structure that 1 have built as an owner-bullder if it has not been constructed In dsantirecyby licensed contractors I understand that a copy otthe applicable law Section 7044 of the Business and Professions Code Is evadable upon request when this applicaden Is submitted or at the following Web site htWYwww leginfo ca goo/slaw hbal DATE SIGN LICENSED CONTRACTOR'S DECLARATION I herby affil under penalty of perjury that I am licensed under provlslane of Chapter B (commencing with Section 7000) of Orilslon 3 of the Busi ness and ct Professions Code, and my License is In full force and affe LICENSE CLASS JJ ll CTS LJC NO DATE ( i rk l I C� COKMAC OR K PAL &51 t Il i-�—� WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOMNG DECLARATIONS I have and w4l melntaln a Certfirato all Consent to Self Insure for Worker's Compensation, as provided by Section 37DD of the Labor Cade for the performance of the work for which Lids permit Is Issued I have and will maintaln Worker's Compensation Insurance as required by Section 3700 of the Labor Code, for the performance of the work for which this permit Is issued My Workw's CampenmUDn khw mnm Caller end Policy Number are //�1 6 .�rs CARRIER �rlr `OfA'i f Ewrtr'TlASiy li-�AX— it vob POLICY NUMBER `a,- lx(il (TEAS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($1 DO) OR LEM I call that in the performance of the vrork for win h this pamdt Is seed I Shall rot employ any pwsah In any minrmr so its lo became subject to the Workers Compensathn Ifomia And a rae that d I should bermre subject to the Wokarls Camp4sapori �d Setllar 3700 d the Code paah^wltrlf� prwl5iah9 DATE rQ(`/-[—J— APPLJ WARMN Fallur to secure Worker s sa rage io unlawful and shall subject so employer m criminal pent les anti civil lines up to one hundred the d W (31000DD), In addition to the cost of the componsabon damages as provided for In section 370E of the labor code, Interest and attorneft fees CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a Construction Lending Agency for the performance of the work for which this perm{ Is Issued (Sec 3097 Cry C ) LENDER S NAME LENDER S ADDRESS I certify that I have read this application and state that the above information Is correct I agree to comply with all city and county ordinances and state laws relathhg to building construction and hereby authorize representatives of this county to enter upon the above -mad property for Inspection purposes PERMI O "jGl SIGNATURE OF MITTEE DATE APPLICATION DATE C 4/rs PIC# iS— ll i � ISSUE DATE b��/I III PERMfT# i TYPE CONST OCC GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROP SED USE 'S ti1�1 Aftm-r194. PQ L Flaw iGi -Cc STO ' t►JL S"� MU4 1 UNIT # STORIES A BEDROOMS DESCRIPTION SO FT FACTOR PSF Al AREAAIALUATION SFFVADD/REM Garage/Carport co Pall PQQUSpa ZRa-Roof O 7 Commercial m Valuation Adf Area QUANTITY DESCRIPTION FEE 1 uLi:R. CM z m a 11 *Goad 'f 1 s TOAJ 50&1 r 4 U CONSTRUCTION PLAN REVIEW Sf . ELECTRIC rX PLUMBING I MECHANICAL 60, lit INSPECTION FEE ISSUANCE 1 SMIP ENERGY P/C I.t S• 13 ENERGY PERMIT RETENTION FEE �.OI PRE-ALT FEE BSAF N=y noN : - 63 1 TOTAL FEES COMMENTS ` l G RECEIPT p7� PAID BY 7 VALIDATION V WHITE — Department Copy YELLOW —Finance Copy PINK — Asiam r Copy, GOLDENROD — Rio Copy GREEN — Applicant's Copy SETBACK/LETTER FOOTINGS FORMS SLAB UG PLUMBING UG ELECTRICAL LIFER GROUND SEWER LATERAL MAIN WATER LINE SEWER CLEANOUT ROOF SHEATHING FLOOR SHEATHING SHEAR WALLS EXTERIOR SHEAR WALLS INTERIOR FRAMINGNENTiNG ROUGH MECHANICAL ROUGH ELECTRICAL W( ) C { ) ROUGH PLUMBING INSULATION WALL INSULATION CEILING DRYWALL LATH (PRE) LATH EXTERIOR LATH INTERIOR GAS TEST SCRATCH COAT . ELECTRIC METER RELEASE GAS METER RELEASE SPECIAL INSPECTION FINAL BUILDING FINAL MECHANICAL FINAL ELECTRICAL FINAL PLUMBING T C of OCCUPANCY CERT. at OCCUPANCY COMMENTS CITY OF DIAMOND BAR INSPECTION RECORD TRACT AND LEDGER SWITCH GEAR COMMERCIAL HOOD T-BAR INTERCEPTER HOT MOP/SHOWERPAN SEPTIC/CESSPOOL HERS REPORT RECEIVED DEMDLITION ROOF DRAINS ROUGH CONDUIT POOL/SPA ROUGH PLUMBING ROUGH ELECTRICAL r ROUGH MECHANICAL GAS TEST PRE GUNITE POOL PRE HECK BONDING P-TRAP FENCE / GATE/ ALARM FINAL POOL WALLS WALL FOOTING/STEEL WALL STEEL 1IT( ) 2N0( ) LIFT WALL BOND BEAM WALL DRAW SEAL WALL FINAL RO FRAMING PLANNING APPROVAL ROUGH FIRE APPROVAL FINAL FIRE DEPARTMENT FINAL PLANNING FINAL ENGINEERING/ PW FINAL COMMUNITY SERVICES FINAL HEALTH DEPT FINAL INDUSTRIAL WASTE STATE OF CAUFORNIA INDOOR LIGHTING C! C-NRCIWLTWI-E (Royflied0711C CALIFORNIA ENERGY COMMISSION * CERTIFICATE OF INSTALLATION NRCI-LTI-01-E Indoor Lighting (Page 1 of 2) P60a Nstm APR CONSULTING fnfnmemerft Apancy DIAMOND BAR 17/\f1 PenaM Number ".°�A° —1370 VALLEY' VIEW SUITE 280 `"' DIAMON! D�YBA/RM1./ zopco* 91765 GENERAL INFORMATION DATE OF BUILDING PERMIT PERMIT # BUILDING TYPE gKonresidentlat ❑ HtgF�FUse Res (Common Area) ❑ Hotel/Motel (Common Area) PHASE OFPHASTRUCTIC}N CON ❑ New Constru can ❑ Addibon 4l tratwri ❑ Unconditioned SCOPE OF RESPONSIBIL "IY Enter the dote of opproml by enforcement agency of the Certrfrcote of Compliance that provides Date the specifications for the energy efficiency iciency measures for the scope of responsibility for this lnstollation Certificate In the Coble below identify all applicable construction documents thot specify the requirements for the scope of responsibility reported by this Installation Certificate (continued] Document Title or Description Applicable Sheets or Pages, Tables, Schedules, etc Date Approved By the Enforcement Agency 3 E CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance July 2014 STATE OF CALIFORMA INMOR LIGHTING CEC-NRCI-Lit-ill-E ikevisW 071141 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF INSTALLATION NRCI-LTI-01-E indoor Ughfang (Page 2 of 4 14W APR CONSULTING enforatmMt Kr DIAMOND BAR Permit Number ftl°d"dd'�1370 VALLEY VIEW, SUITE 280 law DIAMOND BAR ZIPCode 91765 DOCUMENTAMON AUTHOR'S DECLARATION STATEMENT ') i certify that this Certificate of installation documentation is accurate and complete Documentation Author Name Michael Helm Do umemanan Author Signature ,...�� DowmeitatimAuthor CompamfMame Helmca Electnc, Inc. Date5,gned 7/6P2015 Address 17985 Sky Park Circle, Ste. J CWHERS CrrMfiswanMentificotnn(if rsame) ATE-0156 Ciryl5watemp Irvine, CA 92614 ` 949 872-215 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of Cattfornta 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 builderrinstaller), otherwise I am an authorized representative of the responsible builder/installer 3 The constructed or Installed features, materials, components or manufactured devices (the installation) identified on this Certificate of installation conforms to all applicable codes and regulations, and the installation conforms to the requirements given on the plans and specifications approved by the enforcement agency 4 1 reviewed a copy of the CertifE€ate of Compliance approved by the enforcement agency that Identifies the specific requirements for the scope of construction or Installation uientrfied 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 Installatton shall be posted, or made available with the budding permdjs) 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 budder provides to the building owner at occupancy RespongbieBulkilwiin"krN."e Michael Helm RespansibleDuadeNlnstaller5igtatur�1� Company Hine (istaping Subcontractor or Genera Contactorar FoaRlon with Company (Title) witia-lone") Helmco Electnc, Inc. President Address 17985 Sky Park Circle Ste J CUB license 933623 /statemp Irvine CA 92614 Pone ( 9) 87 !-2155 Dated702015 CA Burling Energy Efficiency Standards - 2013 Nonresidential Compliance July 2014 STATE OF CAUFQRNIA ENERGY MANAGEMENT CONTROL SYSTEM OR LIGHTING CONTROL SYSTEM CEr-NRCI-LTI-02-E lRemsed 071141 C:Ai_li:ORNIA I"NFRaY CTM19Sli3ht CERTIFICATE OF INSTALLATION NRCI-LTI.02-E Energy Management Control System or Ughiang Control System (rage 6 of 6) p"4- ka- APR CONSULTING En4nrrs Wfftlsengr DIAMOND BAR Pe mh Number Wraj-AddtwIDa., 1370VALLEY VIEW, SUITE 290 W DIAMOND BAR ZPCOde 91765 DOCUMENTA71ON AUTHOWS DECLARATION STATEMENT 1 1 certify that this Certificate of Installation documentation is accurate and complete Documentation Author Name Mittel F1eNrrT i litntaparr Author Signature iiommenindo„ Author rompaoy Nwm teImm Electric, Inc oaie 7tfi>'2015 Address 17985 Sky Park Cwde, Ste J r-W HERS Certl6catim Idendfipttm jif applicable] ATE-0156 CatY/state/71p Irvine, CA W614 "or* (949) 672-2155 RESPONSIBLE PERMS DECU !' 77ON 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 Identifled on this Certificate of Installation and attest to the declarations in this statement (responsible budder/installer), otherwise I am an authorized representative of the responsible builder/installer 3 The constructed or Installed futures, 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 buttdtng permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections I understand that a completed signed copy of this Certificate of Installation Is required to be included with the documentation the builder provides to the building owner at ocrcu pancy Responsible Builder/installer Name II w)i eel Heim Responsible Builder/installer mature CoMpargr Name jinstalGng Subcor&aaur or General Contractor or position W th company {Title] Builder/twined Helmoo Mectnc, Inc ftnElo dent Address 17985 Sky Park Circle, Ste J CUR i,aease 933623 Gty/5tateAti) Irvine, CA 92614 phone(849) 872-2155 1 Oift SWPed 7r5=15 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance July 2014 STATE OF CAtJF{IWA 4 LIGHTING CONTROL ACCEPTANCE DOCUMENT r.r-C_NRrAj TUt9..A tRn_gM rr iA, r'Ai MCIRMIA FNr-QnY t:1' UU1.4-0J(1N CERTIFICATE OF ACCEPTANCE NRCA-LT02-A Ughting Control Acceptance Document (Page 1 of 5) �4t" APR CONSULTING Er"%"M*1'Afte"V DIAMOND BAR Penaigumb" Proj►ctt AMr**L 1370 VALLEY VISTA SUITE 280 CW DIAMOND BAR Zip cafe 1 91765 Note For mare than 3 spaces attach additional sets of pages 2 Enforcement Agency Use Checked by/Date through 5, as required Automatic Shut-off Controls: Automatic Time Switch Control and Occupant Sensor Intent, tights are turned off or set to a lower level when not needed per Section 110 9(0) & 2301(c) Guidance This acceptance test form must be filled out for all newly -installed lighting control systems of the following types I Automatic Time Switch Controls It Occupancy Sensors III Partial -OFF occupancy sensors IV Partial -ON occupancy sensors(only if used to claim a Power Adjustment Factor V Occupancy Sensors serving small zones in large open plats offices(only if used to claim a Power Ad ustment Factor For automatic daylighting controls use acceptance test form NRCA-LTI-03-A, for demand responsive lighting controls, use acceptance test form NACA-LTI-04-A The tests on this certificate are required by Section 140 6(a)2 and 130 4(a) of the Building Energy Efficiency Standards 2013 The tests themselves are described in Sections 140 6(a)2 and in Reference Appendix NA7 6 A. Construction Inspection Fill out Section A to cover spaces 1 through 3 that are functionally tested under Section B Make as many copies of pages 2-S as are required to test all spaces in the building, and attach to page 1 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) ❑ Weekdays ❑ Weekend ❑ Holidays b Document for the owner automatic time switch programming (check all) ❑ Weekdays settings ❑ Weekend settings ❑ Holidays settings ❑ Set-up settings ❑ Preference program setting ❑ Verify the correct time and date is properly set in the time switch ❑ Verify the battery is installed and energized ❑ Override time limit is no more than 2 hours ❑ 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 8 occupancy sensors are not located within four feet of any HVAC diffuser Ultrasonic occupancy sensors do not emit audible sound S feet from source CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 STATE OF CALIFORNIA LIGHTING CONTROL ACCEPTANCE DOCUMENT CEC-NRCA.LTW2-A rRewsed 081141 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-LTI-02-A Lighting Control Acceptance Document (Page S of S) PrairctNam* APR CONSULTING EnfawmaientAv"�` DIAMOND BAR PerrnaNumber kojed Addmm Cr* 1370 VALLEY VIEW SUITE 280 DIAMOND BAR nP CW6 91765 DOCUMENTATION AUTHOWS DECUMTtON STATEMENT f I certify that this Certificate of Acceptance documentation is accurate and complete Daoumentatm ALabor Name Michael HeimQommentatlon Author Signature RotjmerstetwnAuthor C(M"nyName Helrrl Electrlt: Inc. tWeSlgned 7/6/2015 Addrw 17985 Sky Park Circle, Ste J CEA%HERS/ATTCertificabon Identification (if applicable) ATE-01 % Irvine —CA 92614 Phone949 872-2155 FIELD TEOiNICIAN'S DECLARATION STATEMENT I certify the followng under penalty of perjury, under the lags 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 requ cements 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 builderAnstaller and has been posted or made available with the building permit(s) issued for the budding Field Teehnaaan Name Field TechnlcJen Sign"u"' aat"tlual Cent Field Tedmldan Company Name Ppfton with Company (Me) Heimrr>I Electric Inc. .iotame man Address 17985 Sky Perk Circle, Ste J ATrCeMfi IdenTIR tItit(ifappilabk) - C-A813875 Clcyjstate/Yip Irvine CA 92614 Phone 949 872-2155 Date 7/6i2015 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of Caltfornia 1 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or city agent and I have reviewed the information provided on this Certificate of Acceptance 2 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibdity 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 spectfied in Reference Nonresidential Appendix NA7 4 1 have confirmed that the Certt icate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made avattable with the building permit(s) issued for the building S t will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permtt(s) issued for the building, and made available to the enforcement agency for all applicable inspections t 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 ..f, 11� Responsible AcmplNipmPerson NW* Michael(���lelm A "p°wWbleACmprancePeuS nSignatwe�'�" PcsporWbie AcEeptance Person Company Name Poshion with Camp" M&I He1mc>�a Electric,Inc. President Adder 17985 Sky Park Circle Ste. J CSuBucease 933623 aty/statetrp Irvine, CA 92614 chant (949) 872-2155 tlateIlp-d 7/6/2015 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 STA"M OF MIFORNK AUTOMATIC DAYLIGHTING CONTROL ACCEPTANCE DOCUMENT CI GNRCA•t TI-U3-A trtmnsed OW141 CALIFORNIA ENERGY COMMISSION - CERTIFICATE OF ACCEPTANCE NRCA-LTI.03-A Automatic Daylrghtmg Control Acceptance Document (Page 1 of 12) ptood Name APR CONSULTING Efts'4 ftenEy DIAMOND BAR permit Number "Jednddmw 1370 VALLEY VIEW, SUITE 280 alyDIAMOND BAR 110C°de 91765 Nate submit one Cerbff'cate of Acceptance for � system that Enforcement Agency use Checked byf Date mUsr demonstrate compliance Check boxes for all pages of this NRCA LTt--A completed and included In this submittal © 2 R ILn-t13-A page Coristruchon Inspection This page required for all submittals © � 4 tTI-03 A' Page Continuous damming control fun�onaI performance test -watt -meter or amp -meter measurement CI 5 R-LTI-03-A Page Stepped Switching/ Stepped Dimming functional performance test — watt -meter or amp -meter measurement Vr,'NRCA-01-03-A Page Continuous dimming control functional performance test — fight meter power measurement, and default look -up 7 & B table of fraction of rated power versus fraction of rated light output 0 NRCA-tT1-03-A Page ifl & 11 Ste ed Switching/ St pp gl eppecl Dimming functional performance test -based on limit output 1. Construction Inspection NA-7.6.1.1 1 Drawing of Da lit Zone(Q must be shown on plans or attadied to this form. Select one or both of the following. k"Shown on plans page #'s 0 Daylit zones(s) drawn in on as -built plans (attached) page #"s Check box below if sampling method is used in accordance with NA7 6 12 if checked, attach a page with names of other controls in sample f only for buildings with > 5 daylight control systems, sample group glazing some orientation) Control System System Name Flans Page Check If Tested Control Is Number Repiriesentatltre of Sample -I Applicable Li p C fl FA Control System B C System Information one Type Skylrt (Sky), Primary Sidelii PS), or Secondary Sidelit (SS) ntrol Type Continuous Dimming with more than 10 light levels (C), Stepped Dimming (SD), witching (SW) Ign Foot€andles (enter number or "unknown") CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 STATE OF CALIFORNIA AUTOMATIC DAYLIGHTING CONTROL ACCEPTANCE DOCUMENT r CEC-NRCA-Ln-o3-A (Revised 081141 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-LTI-03-A Automatic Dayllghting Control Acceptance Document (Page 12 of 12) P"i""Name APR CONSULTING EMa wrr*nx Agencir DIAMOND BAR Permit Number Piollect Address 1370 VALLEY VIEW, SUITE 200 ctr DIAMOND BAR Zip Code 91765 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1 I certify that this Certificate of Acceptance documentation is accurate and complete Documentation Author Name MICHAEL HELM Documentation Author Signature Documentation Author Company Name HELMCO ELECTRIC, INC Date signed 7/6/2015 Address 17985 SKY PARK CIRCLE, STE J CEA/HERS/ATT Certification identification (if applicable) ATT-0156 City/State/Zip IRVINE, CA 92614 Phone 949-872-2155 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 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician) 3 The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7 4 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building Field Technician Name SAMUAL GENTRY Field Technician Signature Field Technician Company Name HELMCO ELECTRIC, INC Position with Company (Tide) JOUNEYMAN Address 17985 SKY PARK CIRCLE, STE J ATT Certification Identification (if applicable) TC-A813875 City/state/rp IRVINE, CA 92614 Phone 94M72-2155 DateSlgned 7/6/2015 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of Califomla 1 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance 2 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person) 3 The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7 4 1 have confirmed that the Certificate(s) of Installation for the construction or installation Identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building 5 1 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 Person Name MICHAEL HELM Responsible Acceptance Person Signature Responsible Acceptance Person Comparry Name HELMCO ELECTRIC, INC Position with eomparry (11tle} PRESIDENT Address 17985 SKY PARK CIRCLE, STE J License 933623 rcity/state/zip IRVINE, CA 92614 Phone 949-872-2155 DateSigned 7/6/2015 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014