HomeMy WebLinkAbout1370 VALLEY VISTA DR (35) �_ , . � ��,.� --'��'—�' CITY OF DIAMOND BAR
� = I . ' i� 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
�'��'" BUILDING PERMIT APPLICATION FIRMLY
g ,r .��f�,� APPLICATION DATE: �S�I-1/I S P/C# IS- I�t�T I
x JOB SITE ADDRESS l��D VP1U-EY V�`��Tl� �.+ KJ�/ L l� � h �p /�- r
� ISSUEDATE: 47�7�Ow' �� PERMIT# I � �J '� f�,/►7
z APN LOT TRACT
�
� OWNER TYPE CONST. OCC GROUP:
�
� ADDRESS I
� CITY ZIP' TEL. Z�NING F ONTCKS RW ❑
s APPLICANI`,�Di.�//J �o�/l� TEL�I49���9-(� REAR ❑
�
� SIDE/SIDE STREEf RW ❑
� CONTRACTOR K�� �l�-��R SIDE ❑
� ADDRESS ���IO� V'��tt3�� � - ��L.� PROP SEDUSE('��'C�.1X� NO�'ST�'iTt/�iL IrC�I�FUI��1I
s CITY���'j�l/� ZI 7 l� TEL.,I��'��'IT►�O
i � �1�tW,Ll�2N_UfM'C Ftac"'u/t1.�S��G,E,/[u�G,-ti[��IN57M�EL�.
� ARCH/ENG/DESIGNER �FX�`(a '�j '(�IS`CP'��C C�-vyTl.IG. (�}Uf��.STrWI A�
= ADDRESS �dS�
� #DWEL.UNITS #STORIES #BEDROOMS
z CITY ZIP TEL.
� DESCRIPTION SQ.F7. FACTOR PSF ADJ.AREANALUATION �
OWNEH-BUILDEH DECLAFIATION
= I hereby affirm under penalry of perjury that I am exempt from the Contractor's State License law for the reason(s) SFFVADD/REM I
o I
� indicated below by the checkmark(s),I have placed next to the applicable item(s)[Section 7031.5,Business and Garage/Carport
� Professlons Code:Any ciry or county that requires a permit to canslruct,alter,improve,demolish,or repair,any I
� structure,prior to its issuance,also requires the applicant for the pertnit to file a signed statement that he ar she � Patio/Deck
i is licensed pursuant to the pravisions of the Cantractor's State�icense Law(Chapter 9)Commencing with Section W
� 7000 aT Division 3 of the Business and Professions Code]or that he or she is exempt from licensure and the basis for � Pool/Spa I
� the alleged ezemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty C7
= of not mare than five hundred dollars($500�. ZQ Re-Roof I
� (,I,as owner of the property,or my employees with wages as their sole compensation,will do(,all of or()portions � Commercial I
y of the work,and the structure is notintended or offered for sale(Sectlon 7044,Business and Professions Code:The m � I
Z Contractors'Sta�License Law does not apply to an owner of property who,through employees'or personal ettort,builds
y or improves the property,provided that the improvements are not intended or offered for sale.If however,the building or I
� improvement is sold within one year of completion,the Owner-Builder will have the burden of proving that it was not built
� or improved for the purpose of sale.�. I
"� (J I,as owner of the property,am exclusively contrading with licensed Contractors to construct the project(Section �
Z 7044,Business and Professions Code:The Contractors'State License Law does not apply to an owner of property who Valuation: Adj.Area: I
.� buildsorimprovesthereon,andwhocontractsforlheprojeclswithalicensedContractorpursuanttotheContractors'State QUANTIIY DESCRIPTION FEE �
License Law.�. i
� (,)I am exempt from licensure under the Contractnr's State License law for the following reason(s): �_� I
� � C\J
ZBy my signature below I acknowledge that,except for my personal residence in which I must have resided for at least one ~ S�� I
= year prior to completion of the improvements covered by this pertnit,l cannot legally sell a struc[ure that I have built as an w I
owner-builder if it has not been construded in its entirety by licensed cont2ctors.I understand that a copy of the applicable
� law,Section 7044 of the Business and Professions Code is available upon request when this application is submitted or at � � I
X the following Web site:http/www.leginfo.ca.gov/calaw.html. Z
= DATE: SIGN: � I
— LICENSED CONTIIACTOfl'S DECLAl1ATI0N � I
a I
y I hereby affirm under penalty of perjury that I am Ilcensed under provisions oi Chapter 9(commencing with Section 7000) "
� of Division 3 of the Business and Professions Code,and my license is in full force and effect. � � C o 1� I
�= 3 C�t C33 �'7�7�3�S�
►--
n LICENSE CLASS: LIC.NO.:� zQ l i '�,V („�T iq- I
� DATE:�_f�s-�� COMAACTOR: IC.W� )�( ��-4 =
U I
a D� WOHI�H'S COMPENSATION DECLAflATION w I
� I HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
y �/ �
� I have and will maintain a Certifcate of Consent to Self-Insure for Worker's Compensation,as provided by CONSTRUCTION: �7��•
� /Section 3700 of the labor Code,for the performance of the work for which this permit is issued. p�qN REVIEW: �� J��_
> � I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,tor - � � ��
z the performance of the work for which this permit is issued.My Worker's Compensation Insurance Carrier and ELECTRIC: �
¢ PolicyNumberare: /� � PLUMBING: (j(J�Q�.
y CARRIER � lOt���IF�A"�'W� �/JS�/.�CL� �"L3V{U MECHANICAL: �a (�7 I
� POUCYNUMeER 1��I���� INSPECTION FEE:
� � (THIS SEC110N NEED NOT BE COMPLETED IFhIE PFAMR IS F9R ONE HUNDRED DOLLARS($100)OR LESS). �
ISSUANCE:
= I certify that in me pertortnance of ihe work for ich tl�is pertntt is issued,I shall not employ any person in any manner so as fi J . / I
� c�
become subject to tl�e Worker's CompensaUon ifomia.Md a 2e mat if I should become subjed to the Worker's SM IP: I
J Compensa'on prov'ions of Section 3700 of the � Code, wi� �y�riYi��provisions. ENERGY P/C: � �.Z-J• ���
y DATE: APPIICA ENERGY PERMIT: '
� WARNIN :Failur to secure Worker's nsati n o rage is unlawful,and shall subject an employer to criminal �O�
ipenalties and civil fines up to one hundred thous d rs($700,000�,in addition to the cost of the compensation, RETENTION FEE:
= damages as provided for in section 3708 of the labor code,interes[,and attomey's fees. PRE-ALT FEE:
i CONSTHUCTION LENDING AGENCY BSAF: �,d
= I hereby aftirm under penalty of perjury that there is a Conshuction Lending Agency for the performance of the work for �(j'�Ej�J'J]Q�; � •��
� which this permit is issued(Sec.3097,Civ.C.).
LENDER'S NAME:
= LENDER'SADDRESS:
i I certity that I have read this application and state that me above information is correct.I agree to compty with all city and TOTAL FEES zvVz �Q�, � ��f�.' i
=� county ordinances and state laws relating to building construdion,and hereby authorize 2presentatives of this county to COMMENTS:
z
� enter upon the above-me ioned property for inspection purposes.
� <,' Sc_ `'��
= r�
¢ PERMITfE
n G �
„ O 'Z o l '/�
= SIGNATURE OF MITTEE.�—�.-. DATE RECEIPT#��L_��_ PAID BY: � �7
VALIDATION:
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy
CITY OF DIAMOND BAR � , , ' . ,,,
INSPECTION RECf�RD "
• , � � - • � � e � .
se[ � �� � . .��, �. , �� ,x � ����� ��
, ��BAGK/�LEfTER,��;�,;�, ,�� , T ; ,_� , �_ . � ' TRACT AND LEDGER
FQOT(NGS-FORMS��`��� ���.�, - �� ��, , � � � SWITCH GEAR
5�.� .� i:��� ^,,;.�.- � ���a, , ; ,� _: . ;- � � ,� COMMERCIAL HOUD
�U�:���RLUMBING � :�:.�- �.. � '�� � � � � � , T-BAR �
$11G;ELECTRIGAL������ ` �� . ` < ' � � °� � INTERCEPTER
_. . .
������.
�UFER G€iOiIND�` � �" _. �,,° . �� � � � �"���� �`� HOT MOP/SHOWERPAN
SEWERIATERAI SEPTIC/CESSPOOL
MAIN WATER LINE � HERS REPORT RECEIVED
SEWER CLEANOUT DEMOUTION
RQQF SHEATNING ROOF DRAINS
FLOOR SHEATHING ROUGH CONDUIT
'SHFI�R WAL;L�S EXTERIOR "�'b°' �_ = `" - � � � � _ �, �, �, � ',POOUSPA, .� s � `� `
; �,: �• �k� � m� �.. :� �.�., � ,� . r, � �� � '��ROUGH PLUMBINC� � �,� � :. . __
SNEAR WA.,,L�S INTERIOFi,�.,� ,,;
FRRMIN�IV��JTING�� �' - „ � � , � � „ � = � 'ROUGH,ELE,CTRICAL � � . � � �"
i �� _ ,� � ,� � .� ��
u
.�� � � ��� � ;� �� � - �W. ��ROUGH�MECHANICAL . _ �._ ,
ROUGH.MECHANICAL �� ,� ,
; � ��', � �� � _ ,. �. , `
; �
ROIJ�H�E�ECTRICAE W( �}�C�{ �} - ,a,� _ �,�� �� � � 'GAS TEST' - t ° � � - m
_ ¢ � P M � n
,RD!'1GHrPLUM6ING"��` . '- ��- _' � �, i, .� � � � , �� � � � , � �, �PRE GUt�I�TE , , _
INSULATION WALL °POOL PRE dECK BONDING : � �
INSl1LATI0N CEILING • . ��p-T�P� . � _ � `
DRYWALL ��� ' ' 'FENCE I GATFJ AL4RM
LATH(PRE) .��.FINAL POOL e
LATH EXTERIOR WALLS:
LATH INTERIOR WALL FOOTING/STEEL
GAS TEST WALL STEEL 1 s'( )2Ne( )LIFT
SCRATCH COAT WALL BOND f3EAM
ELECTRIC METER RELEASE WALL ORAIN!SEAL �
GAS METER RELEASE WALL FINAL
SPECIAL INSPECTION pO.FRAMINGPI.tNJNINGAPPROUAL �
„�., -_ ,, ,.
FINAL BUIL.OING�=' �° ,�, "��`` "� ;� � �. ROUGH FIREAPPRdVAL e ; , , , , , `
EINAI MEGNANfCAL. ��. � .� , ;� � � � FINAL FIRE DEPARTMENT �
�<�� .� _ .. � „ : °
�FIHALELEGTRICAL,. �� � �� '�� .� , �.� � � u . , � „ ,:, FINAL�PLANNING " ' ' � °
� � ���W, ,. -� a ��� ,�� �. , �. � < ��� „ll� � � � - � �
,Ij�1AL PL M,�1NG �•�� � � . � � � �FINAL.ENGINEERING/PNL ,� �-
"f:GC ofi UGCUFANCY^�� � A`��.V ra �� � � � � , r.�F �� FINAL GOMMUNITY SERVICES £ 5 A � °
� � a , . �
°CEFiT of,OCCUPANCY �" ,� �' � �°� ` �,� � FINAL HEALTH DEPT. F
FINAC"1NdUS7RIAL WASTE
COMMENTS:
STATE OF GALIFORNIA
INDOOR LIGHTING ��
CEGNRCI-LTI-01-E Revised 07l14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF INSTALLATION NRCI-LTI-01-E
Indoor Lighting (Page 1 of 2)
PfOJeCNa'"e: APR CONSULTING E"`°"e"'e"`�e^": DIAMOND BAR PermitNumber:
``°'e"Ad°`e55:1370 VALLEY VIEW SUITE 280 `'"� DIAMOND BAR Z`°`°de: 91765
GENERAL INFORMATION
DATE OF BUILDING PERMIT PERMiT#
BUILDING TYPE �"Nonresidential ❑ High-Rise Res(Common Area) ❑ Hotel/Motel(Common Area)
PHASE OF
CONSTRUCTION � New Construction ❑Addition Alteration ❑ Unconditioned
SCOPE OF RESPONSIBILITY
Enier the date of approval by enforcement agency of the Certificate of Compliance that provides Date:
the specifications for the energy efficiency measures for the scope of responsibility for this
Installation Certificate.
In the[able below identify all applicable construction documents that specify the requirements for the scope of
responsibility reported by this Installation Certificate(continued).
Date Approved By '
Document Title or Description Applicable Sheets or Pages,Tables,Schedules,etc. the fnforcement ;
`Agency
l.�.r,.�1�� ,J c?�S
S n1�L—s allo �'P�c. , �I
T-r,� Z-'--1 �Z
T-t��� Z Co �. �-3
L����� PL� E- � �
u c��-r,� c o�..���o�
OFLStG_� �v �S�
CA Building Energy EfFiciency Standards-2013 Nonresidential Compiiance July 2014
�TATE OF CALIFORNIA
INDOOR LIGHTING ``�,�
CEGNRCI-LTI-01-E Revised 07/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF INSTALLATION NRCI-LTI-01-E
Indoor Lighting (Page 2 of 2)
PfOJeCNd^� APR CONSULTING E^`°"e^'e^t,�e^n: DIAMOND BAR PermitNumber:
P'°;e"^dd`e55:1370 VALLEY VIEW, SUITE 280 ""` DIAMOND BAR Z�p�°°e 91765
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. I certify that this Certificate of Installation documentation is accurate and complete.
Documentation Author Name: DocumentaHon Author Signature:
Michael Helm
Documentation Author Company Name: Date Signed: 7�6�2��5
Helmco Electric, Inc.
Address: CEA/HERS Certification Identification(If applicable):
17985 Sk Park Circle, Ste. J ATE-0156
City/State/Zip�INlfle, CA 92614 Ph��e� 949 872-2155
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. I am eligible under Division 3 of the eusiness 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 authori2ed 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. I 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. 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.1 understand that a
completed signed copy of this Certificate of Installation is required to be included with the documentation the builder provides to
the building owner at occupancy.
Responsible Builder/Installer Name: Responsible Builder/Installer Signature:
Michael Helm
Company Name: (Installing Subcontractor or General Contractor or Position With Company(Title):
B���de�io�,�e�► Helmco Electric, Inc. President
Address: CSLB License:
17985 Sk Park Circle, Ste. J 933623
City/State�p:INI�Ie CA 92614 Phone �949) 872-2155 DateSigned:7/6IZO��J
CA Building Energy Efficienty Standards-2013 Nonresidential Compliance July 2014
S7ATE OF CALIFORNIA
ENERGY MANAGEMENT CONTROL SYSTEM OR LIGHTING CONTROL SYSTEM
CEGNRCI-LTI-02-E Revised 07/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF INSTALLATION NRCI-LTI-02-E
Energy Management Control System or Lighting Control (Page 6 of 6)
System
projectName: APR CONSULTING EnforcementAgency: DIAMOND BAR vermitNumber:
v�o�ectnddre:s: �370 VALLEY VIEW,SUITE 280 ��lv� DIAMOND BAR Z�P�e 91765
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. I certify that this Certificate of Installation documentation is accurate and complete.
Documentation Author Name: Documentation Author Signature:
Michael Helm
Documentation Author Company Name: Date Signed:
Helmco Electric,Inc. 7/6/2015
a,ddress: �7985 Sky Park CirGe,St6..l CEA/HERS Certification Identification(If appliwble): ATE-0156
City/state/zip: Irvine,CA 92614 vhone: ��9�872_2�55
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. I am eligible under Division 3 of the eusiness 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/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. I 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 Ceriificate of Installation,and I have ensured that the requirements
that apply to the construction or installation have been met.
5. I wi►I ensure that a completed signed copy of this Certificate of Installation shall be posted,or made available with the building
permit�s)issued for the building,and made available to the enforcement agency for all applicable inspections.I understand that a
completed signed copy of this Certificate of Installation is required to be included with the documentation the builder provides to
the building owner at occupancy.
Responsible Builder/Inrtaller Name:MICh861 HBIltI Responsible Builder/Installer Signature:
Company Name: (Installing Subcontrec[or or General Contractor or Positlon With Company(Title):
Builder/Owner) Helmco Electric,Inc. President
Address: �7985 Sky Park Circle,Ste.J CAB License: g33623
City/state/zip: Irvine,CA 92614 Phone�gq9)872-2155 Date Signed: 7/6/2015
CA Building Energy Efficiency Standards-2013 Nonresidential Compliance July 2014
STATE OF CALIFORNIA '�� I
LIGHTING CONTROL ACCEPTANCE DOCUMENT
CEC-NRCA-LTI-02-A Revised 06/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF ACCEPTANCE NRCA-LTI-02-A
Lighting Control Acceptance Document (Page 1 of 5)
P`°'e""a`"e: APR CONSULTING E°f°"eme°`�e°`": DIAMOND BAR PermitNumber:
ProjectAddress: - City: ZipCode:
1370 VALLEY VISTA SUITE 280 DIAMOND BAR 91765
Note: For more than 3 spaces attach additional sets of pages 2 Enforcement Agency Use: Checked by/Date '
through 5,as required.
Automatic Shut-off Controls: Automafic 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).
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
II. Occupancy Sensors
III. Partial-OFF occupancy sensors
IV. Partial-ON occupancy sensors(only if used to claim a Power Adiustment Factor)
V. Occupancy Sensors serving small zones in large open plan offices(onlv if used to claim a Power Adiustment Factor)
For automatic daylighting controls use acceptance test form NRCA-LTI-03-A;for demand responsive lighting controls,use
acceptance test form NRCA-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 2-5 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
� 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 ro erl set in the time switch
P P
Y
❑ 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
p 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 four feet of any HVAC diffuser
Ultrasonic occupancy sensors do not emit audible sound 5 feet from source
CA Building Energy Efficiency Standards-2013 Nonresidential Compliance June 2014
STATE OF CALIFORNIA
LIGHTING CONTROL ACCEPTANCE DOCUMENT �� '
CEC-NRCA-LTI-02-A Revised 06/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF ACCEPTANCE NRCA-LTI-02-A
Lighting Control Acceptance Document (Page 5 of S)
P`o'e"Name:APR CONSULTING E°`°�eme°`�e°": DIAMOND BAR PermitNumber:
Projec[Address: City: Zip Code:
1370 VALLEY VIEW, SUITE 280 DIAMOND BAR 91765
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. I certify that this Certificate of Acceptance documentation is accurate and complete.
Documentation Author Name: Documentation Author Signature:
Michael Helm
Documentation Author Company Name: Date Signed: 7/c/�O�C
Helmco Electric Inc. � �
Address: CEA/HERS/ATT Certification Identification(If applicable):
17985 Sk Park Circle Ste. J ATE-0156
City/State�p: Phone:
Irvine CA 92614 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 corred.
2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance(Field Technician).
3. The construdion 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 7echnician Name: Field Technician Signature:
Samual Gent � �
Field Technician Company Name: Position with Company(Title): !
Helmco Electric Inc. Journe man
Add`ess: 17985 Sky Park Circle, Ste. J An`e"'f`at`°"'de""``a"°"�'fapp'"ab'er TC-A813875
City/State/Zip� INlfl@, CA 92614 Pn��e� 949 872-2155 oates�g�ed.7/6/2015
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 Fiefd Technician is acting on my behalf as my employee or my agent and I have reviewed the
information provided on this Certificate of Acceptance.
2. I am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system
design,construction or installation of features,materials,components,or manufactured devices for the scope of work identified on this
Certificate of Acceptance and attest to the declarations in this statement(responsible acceptance person).
3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this
Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the
enforcement agency,and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential
Appendix NA7.
4. I have confirmed that the Certificate(s)of Installation for the construction or installation identified on this Certificate of Acceptance has
been completed and is posted or made available with the building permit(s)issued for the building.
5. I will ensure that a completed,signed copy of this Certificate of Acceptance shall be posted,or made available with the building
permit(s)issued for the building,and made available to the enforcement agency for all applicable inspections. 1 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: Responsible Acceptance Person Signature:
Michael Helm �_
Responsible Acceptance Person Company Name: Position with Company(Title):
Helmco Electric Inc. President
Address: CSLB License:
17985 Sk Park Circle, Ste. J 933623
City/State�p: INllle, CA 92614 Ph°"e� (949) 872-2155 oates'g"ed: 7/6/2015
CA Building Energy Efficiency Standards-2013 Nonresidential Compliance June 2014
STATE OF CALIFORNIA
AUTOMATIC DAYLIGHTING CONTROL ACCEPTANCE DOCUMENT �, �,
CEGNRCA-LTI-O�A Revised 06H4 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF ACCEPTANCE NRCA-LTI-03-A
Automatic Daylighting Control Acceptance Document (Page 1 of 12)
vrojectName: APR CONSULTING Enforcementnqenq: DIAMOND BAR PermitNumber:
v�o�e�cnedre::: 1370 VALLEY VIEW,SUITE 280 °�" DIAMOND BAR Z'P�e' 91765
Note: SubmiY one Certificote of Acceptance for eoch system that Enforcement Agency Use:: Checked by/Date °
must demonstrate compliance.
Check boxes for all pages of this NRfA-LTI-03A completed and included in this submittal
� 1&2-LTI-03-A Page Construction Inspection. This page required for all submittals.
� 3&4 LTI-03-A Page Continuous dimming control functional performance test—watt-meter or amp-meter measurement
NRCA-LTI-03-A Page
� 5&6 Stepped Switching/Stepped Dimming functional performance test—watt-meter or amp-meter measurement
,e/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.
� NRCA-LTI-03-A Page Stepped Switching/Stepped Dimming functional performance test—based on light output
10&11
I.Construction Inspection NA-7.6.1.1
1 Drawing of Daylit Zone(s)must be shown on p�ans or attached to this form.Select one or both of the following:
�hown on plans page#'s ���
❑ Daylit zones(s)drawn in on as-built plans(attached)page#'s
Check box below if sompling method is used in accordance with NA7.6. 1.Z If checked,attach a page with names of other contro/s
in sample(only for buildings with>5 daylight control systems,sample group glazing same orientationJ
Plans Page Check if Tested Control is
Control System System Name Number Representative of Sample
A � Applicable Control System
B �
I � ❑ A B C
System Information
one Type:Skylit(Sky), Primary Sidelit(PS),or Secondary Sidelit(SS) �
Control Type:Continuous Dimming with more than 10 light levels(C),Stepped Dimming(SD),
witching(SW)
Design Footcandles:(enter number or"Unknown")
CA Building Energy Efficiency Standards-2013 Nonresidential Compliance June 2014
STATE OF CALIFORNIA
� AUTOMATIC DAYLIGHTING CONTROL ACCEPTANCE DOCUMENT
CEGNRCA-LTI-03A Revised 06/14 CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF ACCEPTANCE NRCA-LTI-03-A
Automatic Daylighting Control Acceptance Document (Page 12 of 12)
vrojectName: APR CONSULTING Enforcementnqency: DIAMOND BAR vermitNumber:
I
v�oie�cndd�eu: 1370 VALLEY VIEW,SUITE 280 ���" DIAMOND BAR ziPcode: g1765
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. I certify that this Certificate of Acceptance documentation is accurate and complete.
DocumentationAuthorName: MICHAEL HELM DocumentationAuthor5ignature:
�ocumentationa,uthorcompanyName: HELMCO ELECTRIC, INC. Datesigned: 7/6/2015
Address: 17985 SKY PARK CIRCLE,STE.J CEA/HERS/AT7 Certification Identification(If appliw6le): ATT-O'I�JF)
city/state/zip: IRVINE,CA 92614 Phone: �9_$72-2155
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 corred.
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: SAMUAL GENTRY Field Technician Signature:
Field Technician Company Name: Position with Company(Title): ��UNEYMAN
HELMCO ELECTRIC, INC.
nddress: 17985 SKY PARK CIRCLE, STE.J A1T Certification Identification(if applicable): TC-AH'I387�J
city/state/ziP: �RVINE, CA92614 Phone:949-872-2155 �atesigned: 7�6/2015
RESPONSIBLE PERSON'S DECLARATION STATEMENT
t certify the following under penalty of perjury,under the laws of the State of California:
1. I am the Field Technician,or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the
information provided on this Certificate of Acceptance.
2. I am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the
system design,construction or installation of features,materials,components,or manufactured devices for the scope of work
identified on this Certificate of Acceptance and attest to the declarations in this statement(responsible acceptance person).
3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this
Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the
enforcement agency,and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential
Appendix NA7.
4. I have confirmed that the Certificate(s)of Installation for the construction or installation identified on this Certificate of Acceptance has
been completed and is posted or made available with the building permit(s)issued for the building.
5. I will ensure that a completed,signed copy of this Certificate of Acceptance shall be posted,or made available with the building
permit�s)issued for the building,and made available to the enforcement agency for all applicable inspections. I understand that a
signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building
owner at occupancy.
Responsible Acceptance Person Name: MICHAEL HELM Responsible Acceptance Person Signature:
Responsible Acceptance Person Company Name: Position with Company(Title):
HELMCO ELECTRIC, INC. PRESIDENT
Address: CSLB License:
17985 SKY PARK CIRCLE,STE.J 933623
City/state/zip: IRVINE,CA 92614 Phone: DateSigned: 7�6IZO'I5
949-872-2155
CA Building Energy Efficiency Standards-2013 Nonresidential Compliance June 2014