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HomeMy WebLinkAboutNo Permit Number (46230)CC CC w CL Z 0 0 LU J N 0 i 0 0 0 LL 0 z 0 O Z M 1a 0 0 0 z N U) so O U Z C) 0 U F— O z ]C 2 O LL_ Z O Q rs d O I— H U M m N 0 a 0 a a J Cn 0 LU ca H 0 Cn LLJJ cc d O z w 2 F- H rr w CL U' z 0 M U3 H 4 w r CITY OF IDhMOND BAr4_► c i DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 PRESS may (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-70 FIRMLY BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarca.gov JOB SITE ADDRESS 1320/� V m " %/ V APN LOT TRACT OWNER R6&tk S ADDRESS 11'71'10 CITY 12("iAI P 3A-('- ZIP'1t_1&P TEL. APPLICANT C+gScp 90 (GA TEL. I��! CONTRACTOR04k960 GO N 4�D 2 S ADgRESS /G7L5l 5Cl CNTI4�7/G w CITY l ✓r ^�� ZI GJV TEL. 9 01- % �4 ARCH/ENG/ ,r / DESIGNER " 1'�✓( G ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 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 checkmark(s), I have placed next to the applicable item(s) [Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair, any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9) Commencing with Section 7000 of Division 3 of the Business and Professions Code] or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). U 1, as owner of the property, or my employees with wages as their sole compensation, will do ( 1 all of or U portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale. If however, the building or 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.). U 1, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law.). U I am exempt from licensure 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 improvements covered by this permit,l cannot legally sell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. 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 the following Web site: http/www.leginfo.ca.gov/calaw.html. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. LICENSE CLASS: ' LIC. NO.::77 0./ DAT . CONTRACTOR: ..yy/JJ/�� WORKER'S COMPENSATION DECLARATION I HERE FFIR Ut�ER•PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by ASection 3700 of the Labor Code, for the performance of the work for which this permit is issued. _ I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this p r it is issued. My Worker's Comp nsation Insurance Carrier and Policy Number CARRIER �' ' •�w �Me'S. �V POLICY NUMBER , (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100) OR LESS). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation Laws of California. And agree that if I should become subject to the Worker's Compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. DATE: APPLICANT: WARNING: Failure to secure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of the compensation, damages as provided for in section 3708 of the labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a Constmc' n Lending Agency for the performance of the work for which this permit is issued (Sec. 3097, Civ, Q. 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 relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for i ection purpose B 2� PERMITTEE NAME DATE C APPLICATION DATE: //' P/C# /0 [//I ISSUE DATE: PERMIT# : TYPE CONST. T_.LOCC GROUP: liCln.ss Scope of Work Tewo Pit-rLnno,i DLb'f_• 6 -Lr,. l�K /c. -O D Ni cJ .vises/ P�F2T/Tio �/f' At , gst/c GGG # DWEL. UNITS # STORIES Z # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM Garage/Carport CO Patio/Deck LL Pool/Spa ZRe -Roof Fn Commercial Tr,J Z) 00 Valuation: 00 Adj. Area: QUANTITY DESCRIPTION FEE 1 r I V U iz t U w J - w ' Z M 2 L) CONSTRUCTION: PLAN REVIEW: ELECTRIC: � PLUMBING: MECHANICAL: % INSPECTION FEE: ISSUANCE: �r SMIP:k, ENERGY P/C: -),S4,0 9 ENERGY PERMIT: 10 yY RETENTION FEE: PRE -ALT FEE: BASF: f y D(1 PLOT PLAN: ZONING CLEARANCE: TOTAL FEES 0967 `73 I COMMENTS: P/C: ti7eKTJ V PAID BY: VALIDATION: RECEIPT # PAID BY VALIDATION: WHITE —Department Copy, YELLOW —Finance Copy, PINK —Assessor Copy M CITY OF DIAMID D 84R �.,.t INSPECTION RECORD INSPECTIONDA-INSPECTOR SETBACK/ LETTER FOOTINGS FORMS SLAB UG. PLUMBING UG. ELECTRICAL UFER GROUND SEWER LATERAL MAIN WATER LINE SEWER CLEANOUT ROOF SHEATHING FLOOR SHEATHING SHEAR WALLS EXTERIOR SHEAR WALLS INTERIOR FRAMINGNENTING y Zo �Co ROUGH MECHANICAL ROUGH ELECTRICAL W C ROUGH PLUMBING S t•� �� 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 ft T.C. of OCCUPANCY CERT. of OCCUPANCY S: ©�%moi - �' �. • •� - INSPECTION,DAM, INSPECTOR TRACT AND LEDGER SWITCH GEAR COMMERCIAL HOOD T -BAR �p INTERCEPTER HOT MOP/SHOWERPAN l SEPTIC/CESSPOOL HERS REPORT RECEIVED DEMOLITION ROOF DRAINS ROUGH CONDUIT POOUSPA ROUGH PLUMBING ROUGH ELECTRICAL ROUGH MECHANICAL GAS TEST PRE GUNITE POOL PRE DECK BONDING P -TRAP FENCE / GATE/ ALARM FINAL POOL WALLS: WALL FOOTING/STEEL WALL STEEL 1sT( ) 2ND( ) LIFT WALL BOND BEAM WALL DRAIN/ SEAL WALL FINAL R0. FRAMING PLANNING APPROVAL ROUGH FIRE APPROVAL FINAL FIRE DEPARTMENT FINAL PLANNING FINAL ENGINEERING/ PW FINAL COMMUNITY SERVICES FINAL HEALTH DEPT. FINAL INDUSTRIAL WASTE DI��HO�D B�1R CITY OF DhkMOND BAR-- DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765PRESS (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarca.gov JOB SITE ADDRESS I l ^4—k ` V 1 , A APN LOT TRACT OWNER M -Wt ? ADDRESS 13_10 VM/Let Vk4T-,A'Dq_ CITYNA-li- o 9QW_ZIFR671-7&C +EL. APPLICANT014,SCy 00/5�V,,AJTEELL..nl LA— `IoaaV CONTRACTOR CASCO t [�Jti1 • '� `�1 �R S ADDRESS _(Ip Sat ICN it f; t G c,J �-1 CITY [J?Ah,� ZIP012(0 TEL Liq' / pt `l.� ARCH/ENG/ G� IVI•�Aw c DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 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 checkmark(s), I have placed next to the applicable item(s) [Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair, any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9) Commencing with Section 7000 of Division 3 of the Business and Professions Code] or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). U 1, as owner of the property, or my employees with wages as their sole compensation, will do U all of or U portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale. If however, the building or 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.). U I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law.), U I am exempt from licensure 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 improvements covered by this permit,l cannot legally sell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. 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 the following Web site: http/www.loginfo.ca.gov/calaw.html. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. LICENSE CLASS: LIC. NO.: DATE: CONTRACTOR: WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain 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 Worker's Compensation Insurance Carrier and Policy Number are: CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100) OR LESS). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation Laws of California. And agree that if I should become subject to the Worker's Compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. DATE: APPLICANT: WARNING: Failure to secure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of the compensation, damages as provided for in section 3708 of the labor code, interest, and attorney's fees. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is� n$tmction Lending Agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). r/^ 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 relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. l -;F>&-rA,--r7 PERMI EE N PRINT) :! 9 )IIINfURE OFTMWIWEE DATE LWA APPLICATION DATE: s� ' �O P/C# PR llo ISSUE DATE: S' 14 1) t= PERMIT# : *\'P— (oma 1 TYPE CONST. OCC GROUP: r/ Scope of Work n ✓�/ %`r�� F G �u�✓l pl�--n no �s w L � f✓ wn� ��� Giro # DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport W Patio/Deck w LL Pool/Spa ZRe -Roof Commercial In In Valuation: Adj. Area: QUANTITY DESCRIPTION FEE U U W J W co z in J a Z_U Q x U CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMTP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES S 1 p COMMENTS: P/C: PAID BY:M� VALIDATION: RECEIPT # — PAID BY: J ZCLVALIDATION: 'v'1 WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy CITY OF DIAIVIOIklb BAR INSPECTION RECORD INSPECTIONrA•. 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. of OCCUPANCY COMMENTS: ,.INSPECTION. DATE -,INSPECTOR TRACT AND LEDGER SWITCH GEAR COMMERCIAL HOOD T -BAR INTERCEPTER HOT MOP/SHOWERPAN SEPTIC/CESSPOOL HERS REPORT RECEIVED DEMOLITION ROOF DRAINS ROUGH CONDUIT POOUSPA ROUGH PLUMBING ROUGH ELECTRICAL ROUGH MECHANICAL GAS TEST PRE GUNITE POOL PRE DECK BONDING P -TRAP FENCE / GATE/ ALARM FINAL POOL WALLS: WALL FOOTING/STEEL WALL STEEL 15T( )2 ND( ) LIFT WALL BOND BEAM WALL DRAIN/ 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 r CITY OF DI,%,MOND BAR ITF I .1 I I DEPARTMENT OFCOM MUNITY & DEV ELOPMENT SERVICES Iljn 21810 Copley Drive, Diamond Bar, CA 91765 PRESS 909 839-7020 Fax: 90 ( ) ( 9) 861-3117 Budding Inspection Hotline (909) 839-7027 FIRMLY BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarca.gov JOB SITE ADDRESS 13,7(0 (0 Z144�Q //1Jrf9 #�J APN LOT TRACT OWNER 11ft90T ADDRESS4iJ7 T CITY _r%{/���J wA /SQL zip .1 TEL. APPLICANT �jLo Veg l" TEL. CONTRACTOR [A1Lv CD/Y;K1'Z- t ADDRESS CITY ZIP TEL. ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 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 checkmark(s), I have placed next to the applicable items) [Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair, any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9) Commencing with Section 7000 of Division 3 of the Business and Professions Code] or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). U I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or U portions of the work, and the structure is not intended or offered for sale (Section 7044. Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale. If however, the building or 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.). U I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts forthe projects with a licensed Contractor pursuant to the Contractors' State License Law.). U I am exempt from licensure under the Contractor's State License law for the following reason(s): Date: Sign: By my signature below 1 acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit,l cannot legally sell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Cade is available upon request when this application is submitted or at the following Web site: http/www.leginfo.ca.gov/calaw.htmi. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. LICENSE CLASS: LIC. NO.: EXP. DATE: CONTRACTOR: WORKER'S COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain 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 Worker's Compensation Insurance Carrier and Policy Number are: CARRIER POLICY NUMBER (IRIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $100 OR LESS). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation Laws of California. And agree that if I should become subject to the Worker's Compensation provisions of Section 3700 of the Labor Cade, I shall forthwith comply with those provisions. DATE: APPLICANT: WARNING: Failure to secure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of the compensation, damages as provided for in section 3708 of the labor code, interest, and attorney's 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 permit is issued (Sec. 3097, Civ. 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 relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. PERMITTEE NAME (PRINT) SIGNATURE OF PERMITTEE DATE APPLICATION DATE: -2y -16 P/C# /pa ISSUE DATE: v PERMIT# : TYPE CONST. OCC GROUP: Q Scope of Work If DWEL. UNITS # STORIES # BEDROOMS DESCRIPTION SQ. Ff. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport U) Patio/Deck W LL PooVSpa ZRe -Roof i Commercial Z) M Valuation: Adj. Area:, QUANTITY DESCRIPTION FEE U U w w z m J d ZU_ 6 x U CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: 0 MECHANICAL: 66 INSPECTION FEE: ISSUANCE: SMTP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: • S6 P/C: PAID BY: RECEIPT k PAID BY: 69WVALIDATION: VALIDATION: WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy CITY OF DIAMOND BAR INSPECTION RECORD COMMENTS: STATE OF CALIFORNIA LIGHTING CONTROL ACCEPTANCE DOCUMENT CEC-NRCA-LTI-02-A (Revised 05115) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-LTI-02-A Lighting Control Acceptance Document (Page 1 of 5) Project Name: REGUS DIAMOND BAR Enforrement Agency: CITY OF DIAMOND BAR Permit Number. PR16-0118 Project Address:1370 VALLEY VISTA DR., SUITE # 200 City: DIAMOND BAR Zip Code: 91765 Note: For more than 3 spaces attach additional sets of pages 2 I Enforcement Agency Use: Checked by/Date through 5, as required. 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). 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 (only if used to claim a Power Adjustment 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 01 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 02 Occupancy Sensor Construction Inspection—confirm for all listed in Section B NI 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 May 2015 STATE OF CALIFORNIA LIGHTING CONTROL ACCEPTANCE DOCUMENT CEC-NRCA-LTI-02-A (Revised 05/15) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-LTI-02-A Lighting Control Acceptance Document (Page 2 of 5) Project Name: REGUS DIAMOND BAR Enforcement Agency: CITY Ol: DIAMOND BAR Permit Number. PR16-0118 Project Address: 1370 VALLEY VISTA DR., SUITE # 200 City: DIAMOND BAR zip Code: 91765 B. Functional Testing of Lighting Controls Representative Spaces Selected For every space in the building, conduct functional tests I through V 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) Y /N Tested space/ room name: ENTIRE JOB Space Type (office, corridor, etc) OFFICES ® 01 b The occupant sensor does not trigger a false "on" from movement in an area adjacent Untested areas/rooms Y / N Y / N Tested space/ room name: Space Type (office, corridor, etc) ❑ 02 Step 2: Simulate an occupied condition Untested areas/rooms Status indicator or annunciator operates correctly 0/ N Tested space/ room name: Space Type (office, corridor, etc) ❑ 03 Lights controlled by occupancy sensors turn on immediately upon an occupied Untested areas/rooms Functional Tests Tested Space Number Confirm compliance (Y/N) for all control system types (I-V) present in each space: 01. Automatic Time Switch Controls 1 2 3 Step 1: Simulate occupied condition a. All light4lt tetoed on and off by their respective area control switch Y / N Y / N Y / N b' Verify the swit I hting in the ceiling -height partitioned area in which exp Y N / Y N / Y N / the switch is located IC Step 2: Simulate unoccupied condition 411 a All lighting, including emergency and egress lighting, re1pt lighting may Y / N 1� Y / N Y / N remain on per Section 130.1(c)1 and 130.1(a)1. Manual override switch allows only the lights in the selected ceiling heig T T b. partitioned space where the override switch is located and remain on no longer than N Y / N Y / N 2 hours (unless serving public areas and override switch is captive key type). Step 3: System returned to initial operating conditions I Y / N I Y / N Y / N 02. Occupancy Sensors 1 2 3 Step 1: Simulate an unoccupied condition a' Lights controlled by occupancy sensors turn off within a maximum of 30 minutes 0 N Y/ /N Y /N from start of an unoccupied condition per Standard Section 110.9(b) b The occupant sensor does not trigger a false "on" from movement in an area adjacent @/ N Y / N Y / N to the controlled space or from HVAC operation Step 2: Simulate an occupied condition a. Status indicator or annunciator operates correctly 0/ N Y / N Y / N Lights controlled by occupancy sensors turn on immediately upon an occupied b. condition OR sensor indicates space is "occupied" and lights may be turned on 0/ N Y / N Y / N manually Step 3: System returned to initial operating conditions N Y / N Y / N CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA LIGHTING CONTROL ACCEPTANCE DOCUMENT " CEC-NRCA-LTI-02-A (Revised 05/15) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-LTI-02-A Lighting Control Acceptance Document (Page 3 of 5) Project Name: REGUS DIAMOND BAR Enforcement Agency: CITY OF DIAMOND BAR Permit Number. PR16-0118 Project Address: 1370 VALLEY VISTA DR., SUI'T'E a 200 city: DIAMOND BAR Zip Code: 91765 03. Partial Off Occupancy Sensor 1 2 1 3 Step 1: Simulate an unoc9NIvfondition a Lights go to partial off itw maximum of 30 minutes from start of an Y / N Y / N Y / N unoccupied condition per Stan e n 110.9(a) 'on" rom movement in an area adjacent The occupant sensor does not t%aisl 1 b to the controlled space or from4atI ry book stacks or warehouse aisle, activity beyond the stack tiv e t e ' ting in the aisle or Y / N Y / N Y / N stack. er Step 2. Simulate an unoccupied condition In the partial off state, lighting shall consume no more % of Ina i jjg}lting power, or: r1�j'� 1 /ICY Both stages (automatic on and manual on) lights turn o i um o s' Y / N Y / N minutes from start of an unoccupied condition per Standard Sectiori`i 0 • No more than 60% of installed lighting power for metal ha " r b The occupant sensor does not trigger a false "on" from movement in an area adjacent Y / N tkTY / N Y / N C. pressure sodium lighting in warehouses. p. • No more than 60% of installed lighting power for corridors and stairwells �121,<' -Y/Td' / N Y / N which the installed lighting power is 80 percent 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 Step 2: Simulate an occupied condition a The occupant sensing controls shall turn lights fully ON in each separately controlled Y / N Y / N Y / N areas, Immediately upon an occupied condition 04. Partial On Occupancy Sensors 1 1 1 2 1 3 Step 1. -Simulate an oc pied condition. Verify partial on operation. a' Immediately upo c u d condition, the first stage activates between 30 to 70% Y /N Y /N Y /N of the lighting au atical > After the first st u nual al an occupant to activate the b. alternate set of lights, a tl the ig )D,Ad manually deactivate Y / N Y / N Y / N all of the lights.nAr V(,' Step 2. Simulate an unoccupied condition a Both stages (automatic on and manual on) lights turn o i um o s' Y / N Y / N minutes from start of an unoccupied condition per Standard Sectiori`i 0 b The occupant sensor does not trigger a false "on" from movement in an area adjacent Y / N tkTY / N Y / N to the controlled space or from HVAC operation CA Building Energy Efficiency Standards- 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA LIGHTING CONTROL ACCEPTANCE DOCUMENT CEC-NRCA-LTI-02-A (Revised 05/15) CALIFORNIA ENERGY COMMISSION 0 CERTIFICATE OF ACCEPTANCE NRCA-LTI-02-A Lighting Control Acceptance Document (Page 4 of 5) Project Name: RL'GUS DIAMOND BAR Enforcement Agency: CITY OF DIAMOND BAR Permit Number. PR16-0118 Project Address: 1370 VALLEY VISTA DR., SUITE # 200 city: DIAMOND BAR zip code: 91765 05. Additional test for Occupancy Sensors Serving Small Zones in Office Spaces larger F 2 3 than 250 Square Feet, to Qualify for a Power Adjustment Factor (PAF) 1 FAIL FAIL 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 II. a. Area served by controlled lighting (square feet) II Occupancy Sensor (On Off Control) (all answers must be Y). PASS b Enter PAF corresponding to controlled area from line (a) above (<125sf for PAF=0.4, N/A stacks, corridors, stairwells in nonresidential buildings must also be accompanied by 126-250sf for PAF=0.3, 251-500sf for PAF=0.2). passing Test I or Test IL Enter PAF claimed for occupant sensor control in this space from the Certificate of IV Partial On Occupant Sensor for PAF (all answers must be Y). N/A C. Compliance V Occupant Sensor serving small zones for PAF (all answers must be Y). Also must pass N/A d The PAF corresponding to the controlled area (line b), is less than or equal to the PAF Y / N Y / N Y / N claimed in the compliance documentation (line c) e Sensors shall not trigger in response to movement in adjacent walkways or Y / N Y / N Y / N workspaces. f All steps are conducted in Functional Test 2 "Occupancy Sensor (On Off Control)" and Y / N Y / N Y / N all answers are Yes (Y) C. Testing Results PASS / PASS / PASS / FAIL FAIL FAIL I Automatic Time Switch Controls (all answers must be Y). N/A II Occupancy Sensor (On Off Control) (all answers must be Y). PASS III Partial Off Occupancy Sensor (all answers must be Y). For warehouses, library book stacks, corridors, stairwells in nonresidential buildings must also be accompanied by N/A passing Test I or Test IL IV Partial On Occupant Sensor for PAF (all answers must be Y). N/A V Occupant Sensor serving small zones for PAF (all answers must be Y). Also must pass N/A Test II D. Evaluation PASS: All applicable Construction Inspection responses are complete and all applicable Equipment Testing Requirements ® responses are positive (Y - yes) CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA LIGHTING CONTROL ACCEPTANCE DOCUMENT CEC-NRCA-LTI-02-A (Revised 05/151 i CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-LTI-02-A Lighting Control Acceptance Document (Page 5 of 5) Project Name: REGUS DIAMOND BAR Enfonxment Agency: CITY OF DIAMOND BAR Permit Number. PR16-0118 Project Address: 1370 VALLEY VISTA DR., SUITE # 200 City: DIAMOND BAR Zip Code: 91765 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. j Documentation Author Name: Documentation Author Signatu , ' G Documentation Author Company Name: Ironwood Electr*c Date Signed: 07-06-2016 Address: 1239 N Tustun aye CEA/ATT Certification Identification (If applicable): TO -A814216 City/State/Zip: 921907 Phone: 64-9553 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 a I le with the building permit(s) issued for the building. Field Technician Name: Field Technician Signature: Marco Martinez c Field Technician Company Name: Position with Company (Titl Ironwood Electri i Address: 1239 N. Tustin Aye. ATT Certification Identification (if applicable): TC -A814216 City/State/Zip: Phone: Date Signed: 07-06-2016 Anaheim Ca 92807 (951)264-9553 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the 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 a licable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the docu nta on the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Responsible Acc erson Signature: Marco Martone7 6 Responsible Acceptance Person Company Name: Position with Co any Title): Address: 1 n aye CSLB License: c-10 617971 City/State/Zip: Phone: Date Signed: 07-06-2016 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA ENERGY MANAGEMENT CONTROL SYSTEM OR LIGHTING CONTROL SYSTEM 10 CEC-NRCI-LTI-02-E (Revised 05115) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF INSTALLATION NRCI-LTI-02-E Energy Management Control System or Lighting Control System (Page 1 of 6) Project Name: REGUS DIAMOND BAR Enforcement Agency: I CITY OF DIAMOND BAR Permit Number. PR16-0118 Project Address: 1370 VALLEY VISTA DR., SUITE # 200 Cm: DIAMOND BAR LP code 91765 GENERAL INFORMATION DATE OF BUILDING PERMIT PERMIT# 03-14-2016 PR16-0118 BUILDING TYPE ® Nonresidential ❑ High -Rise Res (Common Area) ❑ Hotel/Motel (Common Area) PHASE OF ❑ New Construction ❑ Addition IR Alteration ❑ Unconditioned CONSTRUCTION SCOPE OF RESPONSIBILITY Enter the date of approval by enforcement agency of the Certificate of Compliance that provides Date: 03-03-2016 the specifications for the energy efficiency measures for the scope of responsibility for this Installation Certificate. Requirements in the Standards: §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? ❑ 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. ❑ 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. ❑ The EMCS has been separately tested for each respective lighting control system for which it is installed to function as. In B. 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). CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA ENERGY MANAGEMENT CONTROL SYSTEM OR LIGHTING CONTROL SYSTEM CFC_NRCI_I TI_n9_F tp—i—d n5H51 CAI IFr1RNIA FNFRr:V MRAMM—RIMI CERTIFICATE OF INSTALLATION NRCI-LTI-02-E Energy Management Control System or Lighting Control System (Page 2 of 6) Project Name: RF,GUS DIAMOND BAR Enforcement Agency: CITY OF DIAMOND BAR Perrnit Number: PR16-0118 Project Address: 1370 VALLEY VISTA DR., SUITE # 200 Cfty: DIAMOND BAR Zip Code: 91765 PART 2 Lighting Control Functional requirements: Check all that apply when verifying the installation of an EMCS or Lighting Control System. ® A. All lighting controls and equipment have been installed in accordance with the manufacturer's instructions. ® B. The manufacturer has provided instructions for calibration. ® C. If indicator lights are integral to any components, such indicator lights consumes no more than 1 watt of power per indicator light. M D. Components that are regulated by the Title 20 Appliance Efficiency Regulations have been certified to the Energy Commission. ❑ 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: ❑ 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 iii. Incorporates an automatic holiday shutoff feature that turns off all connected loads for at least 24 hours and then resumes normally scheduled operation. ❑ 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. ❑ 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. ❑ F. The FMCS or Lighting Control System functions as one or more of the Daylighting Controls listed below: CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA ENERGY MANAGEMENT CONTROL SYSTEM OR LIGHTING CONTROL SYSTEM 4k CEC-NRCI-LTI-02-E Revised 05/15 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF INSTALLATION NRCI-LTI-02-E Energy Management Control System or Lighting Control System (Page 3 of 6) Project Name: s Q1A+—VP EnforcementAgency: u F DIA+terp Permit Number: – ails Project Address:' V%H.i�.y V L,;.ri' pr Su lTb% I-crb City: I .D �A� lip Code: q ❑ 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. ❑ 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 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA ENERGY MANAGEMENT CONTROL SYSTEM OR LIGHTING CONTROL SYSTEM r Cr Jdorl_I Ti_n2r 1D- ; ­A A nrmrx CAI IF(1RNIA FNFRQY MMMIRRION CERTIFICATE OF INSTALLATION NRCI-LTI-02-E Energy Management Control System or Lighting Control System (Page 4 of 6) Project Name: REGUS DIAMOND BAR Enforcement Agency: CITY Or DIAMOND BAR Permit Number. PR16-0118 Project Address: 1370 VALLEY VISTA DR., SUITE # 200 Cm DIAMOND BAR LP code 91765 7. The EMCS or Lighting Control System functions as one or more of the Occupant Sensing Controls Checked Below: ® a. Occupant Sensors meeting all applicable requirements for Occupant Sensor Control devices in the Title 20 Appliance Efficiency Regulations ❑ 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: L Does not turn on lighting automatically and does not incorporate DIP switches, or other manual means, for conversion between manual and automatic functionality; ii. 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. ❑ 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; ii. 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. 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. CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA ENERGY MANAGEMENT CONTROL SYSTEM OR LIGHTING CONTROL SYSTEM CF('_MRCI-1 TI -n9 -F tp—i—i nrimri CCI WrIPMIA FMFRGV CrIIUG/NSSIr)?d CERTIFICATE OF INSTALLATION NRCI-LTI-02-E Energy, Management Control System or Lighting Control System (Page 5 of 6) Project Name: REGUS DIAMOND BAR Enforcement Agency: I CITY OF DIAMOND BAR Permit Number: PR16-0118 Project Address: 1370 VALLEY VISTA DR., SUITE # 200 cin: DIAMOND BAR LPcode:91765 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 ID A. Section 130.1(a) Area Controls. ® B. Section 130.1(b) Multi -Level Lighting Controls ❑ C. Section 130.1(c) Shut -OFF Controls ❑ D. Section 130.1(d) Automatic Daylighting Controls. ❑ E. Section 130.1 (e) Demand Responsive Controls. ® F. Section 130.5 (d) Circuit Controls for 120 -Volt Receptacles. If installed to qualify for a Power Adjustment Factor, submit this Installation Certificate in addition to the PAF Installation Certificate. ❑ G. To qualify for the PAF for a Partial -ON Occupant Sensing Control in TABLE 140.6-A ❑ 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 ❑ I. To qualify for the PAF for a Manual Dimming System PAF or a Multiscene Programmable Dimming System PAF in TABLE 140.6-A ❑ J. To qualify for the PAF for a Demand Responsive Control in TABLE 140.6-A ❑ K. To qualify for the PAF for Combined Manual Dimming plus Partial -ON Occupant Sensing Control in TABLE 140.6-A 04 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA ENERGY MANAGEMENT CONTROL SYSTEM OR LIGHTING CONTROL SYSTEM 10 CEC-NRCI-LTI-02-E (Revised 05/15) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF INSTALLATION NRCI-LTI-02-E Energy Management Control System or Lighting Control System (Page 6 of 6) Project Name: REGUS DIAMOND BAR Enforcement Agency: CITY OP DIAMOND BAR Permit Number: PR16-01 l8 Project Address: 1370 VALLEY VISTA DR., SUITE # 200 cty: DIAMOND BAR LP Code: 91765 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Marco Martonez 6 Documentation Author Company Name: Ironwood Electric Inc - Date Signed: 07-06-2016 Address: 1239 N Tusfin Ave CEA Certification Identification (If applicab /J/9N // �Y �J ! L� f0 City/State/Zip: Anaheqm Ca 92807 Phone: 1(951)264-9553 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/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 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 inspe 'pns. I understand that a re completed signed copy of this Certificate of Installation is required to be included with the document on builder provides to the building owner at occupancy. Responsible Builder/Installer Name: Marco Mgirtanez Responsible Builder/Installer Signature: VK/Fu Company Name: (Installing Subcontractor or General Contractor or Position With Company (Title): Builder/Owner) Ironwood Electric Inc. Aft/Service Tech Address: sten Ave, CSLB License: C10-617971 City/State/Zip: Anaheom Ca 92807 Phone (9511264-9553 Date Signed: 07-06-2016 1 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA INDOOR LIGHTING CEC-NRCI-LTI-01-E (Revised 05/15) CALIFORNIA ENERGY COMMISSION :& CERTIFICATE OF INSTALLATION NRCI-LTI-01-E Indoor Lighting (Page 1 of 2) Project Name: REGUS DIAMOND BAR Enforcement Agency: CITY OF DIAMOND BAR Permit Number. PR16-0118 Project Address: 1370 VALLEY VISTA DR., SUITE # 200 City: DIAMOND BAR Zip Cnde:91765 GENERAL INFORMATION DATE OF BUILDING PERMIT PERMIT # 03-14-2016 PR 16-0118 BUILDING TYPE © Nonresidential ❑ High -Rise Res (Common Area) ❑ Hotel/Motel (Common Area) PHASE OF ❑ New Construction 11Addition ® Alteration ElUnconditioned CONSTRUCTION SCOPE OF RESPONSIBILITY Enter the date of approval by enforcement agency of the Certificate of Compliance that provides Date: 03-03-2016 the specifications for the energy efficiency measures for the scope of responsibility for this Installation Certificate. In the table 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. I the Enforcement ELECTRICAL PLAN I E3.0 I 03-03-2016 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 STATE OF CALIFORNIA INDOOR LIGHTING CFC-NRCI-LTI-01-F /Revised 05/151 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF INSTALLATION NRCI-LTI-01-E Indoor Lighting (Page 2 of 2) Project Name: REGUS DIAMOND BAR Enforcement Agency: CITY OF DIAMOND BAR Permit Number. PR16-0118 Pmject Address: 1370 VALLEY VISTA DR., SUITE # 200 cit': DIAMOND BAR Zip code: 91765 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT r 1. 1 certify that this Certificate of Installation documentation is accurate and complete. f Documentation Author Name: Documentation Author Sign Marco Mart"nez6 (t Documentation Author Company Name: Date Signed: 07-06-2016 Address: 1239 N Tusten Ave. CEA Certification Identification (If ap ,a e . tc/ e/- // �Cy �J ! LJ (O City/State/Zip: Anahewm Ca 92807 Phone: .(951)264-9553 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. lam 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/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 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 applicableif ections. I understand that a completed signed copy of this Certificate of Installation is required to be included with the docu ntzi on the builder provides to the building owner at occupancy. Responsible Builder/Installer Name: Responsible Builder/Installer Signature: 6 CU Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Position With Company (Title): Address: 1239 N Tuston Ave- CSLB License: C10-617 71 City/State/Zip: Anahe"m Ca 92807 Phone .(951)264-9 53 Date Signed: 07-06-2016 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 -7 STATE OF CALIFORNIA AUTOMATIC DAYLIGHTING CONTROL ACCEPTANCE DOCUMENT CEC-NRCA-LTI-03-A /Revised 05/151 CAI IMPNIA FNFR(.'V Cr1MMMRInN CERTIFICATE OF ACCEPTANCE NRCA-LTI-03-A Automatic Daylighting Control Acceptance Document (Page 1 of 11) Project Name: REGUS DIAMOND BAR Enfonxmem Agency: CITY OF DIAMOND BAR Permit Number. PRI6-0118 Project Address: 1370 VALLEY VISTA DR., SUITE # 200 City: DIAMOND BAR zip Code: 91765 Note: Submit one Certificate of Acceptance for each system that Enforcement Agency Use: Checked by/Date must demonstrate compliance. Check boxes for all pages of this NRCA-LTI-03-A completed and included in this submittal A 03-A 02. System Information • Zone Type: Skylit (Sky), Primary Sidelit (PS), or Secondary Sidelit (SS) Construction Inspection. This page required for all submittals. Control Type: Continuous Dimming with more than 10 light levels (C), Stepped Dimming (SD), Switching (SW) Pag & Design Footcandles: (enter number or "Unknown") ❑ NRCA-LTI-O - nous dimming control functional performance test watt -meter or amp -meter measurement Page 3 & 4 N RCA-LTI-03-A • Page 5 & 6 Stepped It i a ped Dimming functional performance test —watt -meter or amp -meter measurement NRCA-LTI-03-A Continuous dimming c nal performance test— light meter power measurement, and default look -up • Page 7 & 8 table of fraction of rat po coon of rated light output. NRCA-LTI-03-A Stepped Switching/ Step in fun mance test —based on light output Page 10 & 11 k—o"n_ " V1 )h— A. Construction Inspection NA -7.6.1.1 1,1 01. Drawing of Daylit Zone(s) must be shown on plans or attached to this m. Select on o the following: ❑ Shown on plans page Ws ❑ Daylit zones(s) drawn in on as -built plans (attached) page Ws `-,O1V Check box below if sampling method is used in accordance with NA7.6.1.2. If checked, attach a page with names of other controls in sample (only for buildings with > 5 daylight control systems, sample group glazing same orientation) Control System System Name N/A A Plans Page Number Check if Tested Control is Representative of Sample ❑ Aoolicable Control Svstem B ❑ C ❑ A B C 02. System Information Zone Type: Skylit (Sky), Primary Sidelit (PS), or Secondary Sidelit (SS) Control Type: Continuous Dimming with more than 10 light levels (C), Stepped Dimming (SD), Switching (SW) / Design Footcandles: (enter number or "Unknown") CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance May 2015 -CfM - t fn the3table'tieiow, identify all appbcabie construci►onrdocuments that specify the features, materials; components; _ mbnufaaetfeuar(eeodndteinvuiceed)s ostlrcesults requiredrfor the scoeoibyfrths, IsfNa�oppans s„oiagii Certfn? Applicable Sheets or, PmespTables , Date Approved"by Document Title or D'escnptlgn • Schedules, etc.. Enforcemeritl genc•'yi r t. I ` ,OZ WWZ— --- mom— — —I --- - - b GA R'i11i11na�Fno�ov�Fffieionrv�Ctandaf.(iG �f1AiQ!Nnnraci�l JIHI t',Vr l�iL'Ir�VKNIFi+, MECHANICAL OMMISSIONr __CALIFORNI&ENERGY C__ Instructws fo'r MCHQl _ Secton�A;�General`�Infoemation; - ' +;Ql !Eriter,the;d`ate on _the�building permit, - A2L lhfelhe4aopropnate buildJng type from the pulldown}list iQ3 Enter the appropratephase of construction_ from :thelpull downJai'st Section B Seope,ofResporisibJlJty . D1 Enter the�date the=enforcement.agencyappcoyed;theyce'riLficate oftcomplLance' (NRCC; NIGH XX)'t_hat used'asatle kiaslstof tf'e speclficatlons used totdemonstr, tVkomplJance 02 .Enter the,,constr uetlon,document;that specJfies the Jnstall_`eed,feature, ma_tenal,;eomponent, manufactured device` orsystem performancesaiagnostic'resWtsor eomplJances speclfled;.on.the ci rffi cateiof eompliar►Ge., 03 4540a,,,this row:shMib- flled!uctions(fd %ow,8 02 04?, Asineeded, thls wisWhbe{filled!;accordiri94 theliM ruetionObrirow;0U2' p5'. s;needfhe msfructJgnsjfor row B;Q3 Note mo"re rows;shalltl e�added'i�Whervr i — ded N RC1 MCH.01 CERTIFICATE, OFiINSTALLATION' , Fag 3 r p &MC,�w11 ~ ff PrcleB Address ` a ;r'?_. v „� "y; wt, --tib Gty Y - 2lp cbdc Instructws fo'r MCHQl _ Secton�A;�General`�Infoemation; - ' +;Ql !Eriter,the;d`ate on _the�building permit, - A2L lhfelhe4aopropnate buildJng type from the pulldown}list iQ3 Enter the appropratephase of construction_ from :thelpull downJai'st Section B Seope,ofResporisibJlJty . D1 Enter the�date the=enforcement.agencyappcoyed;theyce'riLficate oftcomplLance' (NRCC; NIGH XX)'t_hat used'asatle kiaslstof tf'e speclficatlons used totdemonstr, tVkomplJance 02 .Enter the,,constr uetlon,document;that specJfies the Jnstall_`eed,feature, ma_tenal,;eomponent, manufactured device` orsystem performancesaiagnostic'resWtsor eomplJances speclfled;.on.the ci rffi cateiof eompliar►Ge., 03 4540a,,,this row:shMib- flled!uctions(fd %ow,8 02 04?, Asineeded, thls wisWhbe{filled!;accordiri94 theliM ruetionObrirow;0U2' p5'. s;needfhe msfructJgnsjfor row B;Q3 Note mo"re rows;shalltl e�added'i�Whervr i — ded MECHANICAL 'CAIF-OF CEC-NR61-MCH-0i'-E,(Ri6avited'12/15)' t�TlFfC-A,,T7��,.C-),F'tN.St-AL�-A,,f 104 k rp tificat CEA/ HE C rt1ficatio-mid p rqjf �;jpllcable ;: Address -.. P,hbne t RESPONSIBLE PERSON'S DECLARATION 'STATEMENT ;Ststebfl.clarlfornW) PIM p correct: H'ls� ruean&Ccift -'d ioruthistUrti, ,t* cateO Compliance f,.§e,.ihformatiorf,provi ed 2';. Y-am,elFgible _under 2�oftM� pjqjMorflOusiiie-ss,,gqd!Profg!sti6hi,,Cb-d-�,,tb.acce.pt,ti�sOOOs' iftYJ Ft ,_ . , Wntified,di. this Certificate fiis;Gertificateof"tC—q, n.O'Ijgff�c6,:(&sO 2. The' energy,46at6ds4hdlo 'acfficiikns; tat o,nponents,5n&_ma-h.f.:a-'c, ture&,'ce It 's joe'tl hdi- building fi- g d-- es-ig. ij oIirsystem design tdentlfiedonithis,,C�ftjfc_te qf,QnoliaftceiconformA therequirements ofTitle, ,PaftTjhdPjt6l6ftheCaIiaorjii Code of :kegjlatibns TThe Widng, esig nt eaturesdr �ystkkdesign'(ftu resaenfif Igo,tFiissCertificate - ..-isten t withthe information rbv"ded,onv6ther applicablejotkshedisjcalculation-sjp ahij&spec ficatiod�.SYft6d:to,the enforcement t fo�rihe 5pp 1 �ig-ekcylfori MV 'i�wiih�this�bmild.i'�g�o,'e(MiirapplitgtldnI tal , , — 1— , - - * 561�-with-t4e(buildirigp 'e li6rVc �ha-1056-fiia&aYaLlI .-grmt opy,ofthl�'C rtt icat I wily ntorii.tht a.completedsipad-t .9 -.6fifbnrio -e itned cop Is -J'ufider5tan&�hqt a �90 _y of this ct .1660. d6available'tdith tinentage'ncylo 'Zi ap _pq,; ions. ,,plicablwins -I;iCiiIdIng,,and,ma e P owner at occupancy nfi�tion�tti�!;bLiilderprovides_ ,I 0 he Resp Certificatertof Com Nance Is required toi6e Wnsibie'suimer/instame, A I isp i I B'ul Signature: bnsbe P-dbr/Installer :,NaTe. n;Ziti Oii . ndhe.ds�2013'Nor 440 W. Crowther Ave. .Placentia, CA 92870 Ph:(714) 937-5305 TEST AND BALANCE ANALYSIS REPORT Regus - #4086 1370 Valley Vista Dr., 2nd Fir. Diamond Bar, CA John Anderson, President HVAC Mechanical Air Balance Report meets TABB and NEBB Standards Contractor: H.V.A.C. Mechanical, Inc. JOB# 7276 COMPLETION DATE: June 30, 2016 Tech: Chris Miller * UNLESS OTHERWISE NOTED, INDICATED CFM IS AT STANDARD CONDITIONS. * FLOW HOOD USED ON ALL CEILING SUPPLY AND RETURN TERMINAL UNITS, AND SIDEWALL REGISTERS AND GRILLES WHERE APPLICABLE. Page 1 MASTER CODE SHEET CSD = CEILING SUPPLY DIFFUSER CEG = CEILING EXHAUST GRILLE CER = CEILING EXHAUST REGISTER CRG = CEILING RETURN GRILLE CSR = CEILING SUPPLY REGISTER CRR = CEILING RETURN REGISTER EDO = EXHAUST DUCT OPENING EAR = EXHAUST AIR REGISTER FEG = FLOOR EXHAUST GRILLE FER = FLOOR RETURN REGISTER FRG = FLOOR RETURN REGISTER FSR = FLOOR SUPPLY REGISTER RAB = RETURN AIR BAR RAG = RETURN AIR GRILLE RDO = RETURN DUCT OPENING RLD = RETURN LINEAR DIFFUSER SAB = SUPPLY AIR BAR SDO = SUPPLY DUCT OPENING SLD = SUPPLY LINEAR DIFFUSER WE = WALL EXHAUST GRILLE WE = WALL EXHAUST REGISTER WR = WALL RETURN GRILLE WR = WALL RETURN REGISTER WS = WALL SUPPLY GRILLE WS = WALL SUPPLY REGISTER GENERAL REPORTING CODES 440 W. Crowther Ave. Placentia, CA 92870 Ph:(714) 937-5305 DNA = DATE NOT AVAILABLE DNL = DATA NOT LICENSED NA = NOT ACCESIBLE NI = NOT INSTALLED NS = NOT SPECIFIED NT = NOT TESTED DUE TO ABNORMAL CONDITIONS NVL = NO VALID LOCATION FOR ACCURATE TESTING = MEASURED WITH ELOW HOOD Page 2 440 W. Crowther Ave. Placentia, CA 92870 Ph:(714) 937-5305 �-e ALNOR CERTIFICATE OF CALIBRATION TSI Incorporated, Alnor Products, 500 Cardigan Road, Shoreview, MN 55126 USA l't.LA-800-874.2811 1-651-490-2811 FAN:I-651-490-3824 www.alnor.com ENVIRONMENT CONDITION TEMPERATURE 72.7 ° r RELATIVE HUMIDITA' 27.0 %RFI BAROMETRIC PRESSURE 29.1 inHg CALIBRATION STANDARDS USED ® AS LCIFT ® IN TOLERANCE Capture Flood Calibration System 3 1 ❑ AS FOUND ❑ OUT OF "TOLERANCE C,LUMATION DATA Tolerance: t ( 345 a f reading + 7.0 rfnn ) EBT" Balometer MOUEL EBT731 SIa41AI. No. .EBT731510004 CALIBRATION STANDARDS USED ® AS LCIFT ® IN TOLERANCE Capture Flood Calibration System 3 1 ❑ AS FOUND ❑ OUT OF "TOLERANCE C,LUMATION DATA Tolerance: t ( 345 a f reading + 7.0 rfnn ) 9'EsnNc SBPI't.A' DATA MEASURED IN ft3/min RFa'111rN DAT.\ p1 F..\SUI21iU IN ft"/ruin POINTS CALIBRATION STANDARD INSTRUMENT OUTPUT ALLOWABLE RANGE CALIBRATION STANDARD INS'T'RUMENT OUTPUT ALLOWABLE KANGE 1 1869 1877 1806- 1932 1879 1843 1816- 1942 2 1477 1476 1426- 1528 1486 1463 1435- 1537 3 1180 1178 1138- 1222 1187 1185 1145-1229 4 879 878 846 -912 882 888 849 -915 5 589 590 565 -613 594 598 570 -618 6 293 289 278 -308 295 294 280 -310 7 99 98 90-108 99 98 90 - 108 TSI Incorporated does herehv certify that the above described instrument conforms to the original inanufacmrer's specifications ( not applicable m : Ls Found (1ata) and has been calibrated using standards whose accuracies are traceable to the National Institute of Standards and Tecloudoxv within the limitations of nvST'.s calibration services or have been derived from aecepted values of natural phyairal constants or han,e been derived bP the ratio ripe nfself eadihratimh techniques. The calibration ratio for this instrument is at least 1.40:1 at 100 f linin (170 m'` /hr, 47 Us) and ?.11: l fit all other points. TSI is registered to ISO -9001:2008. QualityAssurance Requirements. This report nu0- not be reprodoced, esrept in firll, on/es'.s perniission far the publication a f an approved abstract is obtained in writiog from the calibration organi.ation issuing this report. Measurement Variable Svstern 1D.Number DC Voltage 6002072 Thermometer 6003391 PrCSSUrC 6002083 Pressure 6002051 Flow 1003994 Flow F003995 Barometric Pressure 6003782 Calibration procedure used: 1000000078513 Calibrated By i083503A Page 3 Date Last Calibrated Calibration nue n:nc 01-08-15 01-08.16 10-01.14 04-01.15 11.04-14 05.04-15 11-04-14 05.04-15 06.19-13 06.19-15 06-19-13 06.19.15 06-03.14 06-03-15 Mar. 4, 2015 Calibration Date 1 440 W. Crowther Ave. Placentia, CA 92870 Ph:(714) 937-5305 L�WCertificate of Calibration Traceability/JobNo 110506.001 Prepared For.. HVAC MECHANICAL, INC. 1000 E. HOWELL AVENUE "B" P.O. No: PENDING ANAHEIM, CA 92805 Data Reqd: Yes Calibration Standards:Used ID No Model No Manufacturer Description Serial No Cal Date Cal Due A220 FMP DMC/FLOWMETRICS VELD PROBE A220 WINDT. 22 -Feb -2013 22 -Feb -2014 Calibration Room Environment Temperature: 71 F/21.7C Relative Humidity: 45 % Barometric Pressure: N/A This item meets published specifications. It has been calibrated using standards traceable to SI units and/or the National Institute of Standards and Technology. Alternatively, accuracies have been derived from accepted values of natural physical constants, or derived by the ratio type of self -calibration techniques. This certificate may be reproduced in full. Partial reproduction may be done only with written prior consent. All calibration activities are performed In compliance with applicable portions of ISO/IEC 17025:2005, ANSI/NCSL Z540.3-2006, ISO 10012, and/or MIL -STD -45662A. FLW Service Corporation Issued On January 22, 2014 By: 5672 Bolsa Avenue n Huntington Beach, CA 92649 _YY✓A4-- (800) 576-6308 Fax: (714) 622-2002 Frank Libertine, Technician Page 4 FORM P370-15.3 May 2013 Instrument Information Inst Descrip: BALOMETER STANDARD CAPTURE HOOD Calibration Site: OTHER As Received As Left Manufacturer: ALNOR Date Rec: 10 -Jan -2014 Model: 6465CFM Date of Cal: 22 -Jan -2014 IN TOLERANCE IN TOLERANCE Serial No: BR4586 Next Cal Due: 22 -Jan -2015 OPERATIONAL OPERATIONAL Cust IO No: BR4586 Procedure: MFG. SPECIFICATIONS FULL CAL Accuracy: z 3% F.S. Cal Result: PASS NOT ADJUSTED Remarks: REFER TO ATTACHED DATA. Calibration Standards:Used ID No Model No Manufacturer Description Serial No Cal Date Cal Due A220 FMP DMC/FLOWMETRICS VELD PROBE A220 WINDT. 22 -Feb -2013 22 -Feb -2014 Calibration Room Environment Temperature: 71 F/21.7C Relative Humidity: 45 % Barometric Pressure: N/A This item meets published specifications. It has been calibrated using standards traceable to SI units and/or the National Institute of Standards and Technology. Alternatively, accuracies have been derived from accepted values of natural physical constants, or derived by the ratio type of self -calibration techniques. This certificate may be reproduced in full. Partial reproduction may be done only with written prior consent. All calibration activities are performed In compliance with applicable portions of ISO/IEC 17025:2005, ANSI/NCSL Z540.3-2006, ISO 10012, and/or MIL -STD -45662A. FLW Service Corporation Issued On January 22, 2014 By: 5672 Bolsa Avenue n Huntington Beach, CA 92649 _YY✓A4-- (800) 576-6308 Fax: (714) 622-2002 Frank Libertine, Technician Page 4 FORM P370-15.3 May 2013 FLOW HOOD HOOD: A COLLECTOR TYPE WHICH READS IN CFM 440 W. Crowther Ave. Placentia, CA 92870 Ph:(714) 937-5305 METER: ALONOR VELOMETER WITH EIGHT RANGE SELECTIONS, THREE EACH FOR SUPPLY AND RETURN. ONE POSITION SELECTOR IS ADJUSTABLE TO CORRECT FOR ALTITUDE AND TEMPERATURE. THE OTHER TWO CALIBRATED AND SEALED TO READ OUT DIRECTLY IN CUBIC FEET PER MINUTE AT CONSTANT VOLUME STANDARD CONDITIONS. RANGE: 30-500, 100-1000, 200-2000 0-500, 200-1000, 500-2000 FLOW SENSOR: DUAL Y2" DIA. PIEZOMETER GRID SUSPENDED AT RADIUS OF AVERAGE VELOCITY. Page 5 DIFFUSER & GRILLE TEST SHEET 440 W. Crowther Ave. Placentia, CA 92870 Ph:(714) 937-5305 Page 6 SYSTEM: 2-01 REQUIRED REQUIRED ACTUAL REQUIRED ACTUAL ROOM NO. CODE SIZE (") EFF. AREA FPM CFM FPM CFM MINIMUM MINIMUM 239 1 CSD 10 225 230 240 2 CSD 12 315 330 241 3 CSD 1 12 1 1 1 315 1 1 330 242 4 CSD 10 225 225 Page 6 SYSTEM: 2-03 REQUIRED ACTUAL REQUIRED ACTUAL ROOM NO. CODE SIZE (") EFF. AREA FPM CFM FPM CFM MINIMUM MINIMUM 239 1 CSD 10 225 230 240 2 CSD 12 315 330 241 3 CSD 1 12 1 1 1 315 1 1 330 242 4 CSD 10 225 225 TOTAL 1080 1115 1 600 1610 Page 6 DIFFUSER & GRILLE TEST SHEET 440 W. Crowther Ave. Placentia, CA 92870 Ph:(714) 937-5305 SYSTEM: SYSTEM: 2-05 ACTUAL REQUIRED ACTUAL REQUIRED ACTUAL REQUIRED ACTUAL ROOM NO. CODE SIZE (") EFF. AREA FPM CFM FPM CFM MINIMUM MINIMUM 229 1 CSD 12 400 405 236 2 CSD 10 325 325 237 3 CSD 10 325 330 TOTAL I I I I 1 1050 1 1 1060 1 420 1 435 SYSTEM: 2-06 REQUIRED ACTUAL REQUIRED ACTUAL ROOM NO. ACTUAL REQUIRED ACTUAL • • • FPM CFM MINIMUM MINIMUM • . CSD 10 275 ® 206 2 CSD 10 340 335 TOTAL 615 615 250 240 Page 7 SYSTEM: 2-07 REQUIRED ROOM NO. ACTUAL REQUIRED ACTUAL • • • FPM CFM MINIMUM MINIMUM • . CSD 10 275 ® 206 2 CSD 10 340 335 TOTAL 615 615 250 240 Page 7 0• REQUIRED ACTUAL REQUIRED ACTUAL ROOM NO. CODE SIZE (") EFF. AREA FPM CFM FPM CFM MINIMUM MINIMUM 204 1 CSD 10 275 280 206 2 CSD 10 340 335 TOTAL 615 615 250 240 Page 7 DIFFUSER & GRILLE TEST SHEET 440 W. Crowther Ave. Placentia, CA 92870 Ph:(714) 937-5305 SYSTEM: 2-10 REQUIRED ACTUAL REQUIRED ACTUAL REQUIRED ACTUAL REQUIRED ACTUAL Page 8 SYSTEM: 2-12 REQUIRED REQUIRED ACTUAL REQUIRED ACTUAL Page 8 SYSTEM: 2-13 REQUIRED ACTUAL REQUIRED ACTUAL Page 8 DIFFUSER & GRILLE TEST SHEET 440 W. Crowther Ave. Placentia, CA 92870 Ph:(714) 937-5305 Page 9 SYSTEM: 2-15 REQUIRED REQUIRED ACTUAL REQUIRED ACTUAL Page 9 SYSTEM: 2-16B REQUIRED ACTUAL REQUIRED ACTUAL Page 9 DIFFUSER & GRILLE TEST SHEET 440 W. Crowther Ave. Placentia, CA 92870 Ph:(714) 937-5305 Page 10 SYSTEM: 2-17. REQUIRED REQUIRED ACTUAL ACTUAL REQUIRED ACTUAL • • • ®' • . ®��®�®®® '®----_�_�®' ®' Page 10 SYSTEM: 2-18 REQUIRED ACTUAL REQUIRED ACTUAL • • • ®' • . ®��®�®®® Page 10 SYSTEM: 2-19 REQUIRED ACTUAL REQUIRED ACTUAL • • • ®' • . ®��®�®®® Page 10