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2016-3168
CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2016-3168 20916 HOMESTEAD RD CUPERTINO, CA 95014-030 (326 09 052) S M I CONSTRUCTION INC SAN LEANDRO, CA 94577-4321 OWNER'S NAME: OAKMONT INVESTMENT GROUP LLC DATE ISSUED: 03/21/2017 \, OWNER'S PHONE: 510-676-0882 PHONE NO: (510) 351-3288 LICENSED ONT ACTOR' DECLARATION BUII,DING PERNHT INFO: License Class 5 Lic. #831166 Contractor $ M I CONSTRUCTION INCDate 01/31/2018 X_ BLDG —ELECT _ PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — MECH — RESIDENTIAL X COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: I hereby affirm under penalty of perjury one of the following two declarations: UNIT A; T.I.- RESTAURANT (2098 S.F.) - TASTE GOOD i. I have and will maintain a certificate of consent to self-insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 3 z. 1 have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this `permit is issued. Sq. Ft Floor Area: Valuation: $160000.00 APPLICANT CERTIFICATION 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 326 09 052 A (Tenant Improvements),B (Tenant Improvements) representatives of this city to enter on the above mentioned property for inspection purposes. (We) agre dsave indemnify and keep harmless the City of Cupertino against Iiabil'tieg,ludgments, costs, and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said Ciconsequence of the granting this permit. WITHIlV 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant ds and will comply with all ll non-point source regulations peri ertin , Municipal Code, Section 9.18. 180 DAYS F OM LAST C +-H'H'QSPECTION. i Signature Date 0.3/21/2017 Issu -- Date: 03/21/2017 OWNER-BUTT DE DECL R TION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) z. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 03/21/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. I have and will maintain a Certificate of Consent to self-insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements undq; pter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 2 3.d 25534. I will permit is issued. maintain compliance with the Cupertino MunicipaKode, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I stoyc/or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment r dem�"ces which emit hazardous air contaminants as defined by the Bay Area dality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertin M 'c►pa ode, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sec ' s 505, 3, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent:= APPLICANT CERTIFICATION Date: 03/21/2017 1 certify that I have read this application and state that the above information is C STR4 rCTI01d LENDING correct, i agree to comply with all city and county ordinances and state laws I hereby affirm that there is a constriliction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 03/21/2017 Professional 4 11 CONSTRLf_CTM"ERMIT APPLICATION COMMUNITY DE. i DEPARTMENT! BUILDING DIVISION 10300 TORRE AVr..I;aLc� ., CUPERTINO, CA 95014-3255 (408) 777-3228 --FAX (458) 777-3333 • rbuildiinn7qar7.cupertino.org �l mTl T .\r I=D 'ITnXTI'PT I rI DM1TQlr%XTInPT7PRRPT) nPTf:TNA1 PFRMTT# PROJECT ADDRESS 20916 Homestead Rd #A APN # 326-09-052 OWNER NAME Baoyuan Zhao PHONE 510-676-0882 E-MAIL STREET ADDRESS 76 S Abel St. CITY, STATE, ZIPMII Itas, Ca 95035 FAX CONTACT NAME Raymond Situ PHONE 510-688-6261 E-MAIL STREET ADDRESS 319 Vicente Street CITY, STATE, ZIP San Francisco, Ca 94127 FAX ❑ OWNER' ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT VFNGINFER 0 DEVELOPER ❑ TEN{{{ANT CONTRACTOR LICENSE NUMBER 15 Z LICENSE TYPE BUS. LIC # �/I V I COMPANY NAME E-MAIL FAX O �� l� STREET ADDRES / ,/ , , CITY, STATE, ZIP PHONE v AA A ' ARCHITECT/ENGINEER NAME '' LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK -- --- ---- --�...__- - ,�. --- -- _- -- Tenant Improvement Project on Existing restaurant; *Build 2 ADA Restrooms, new kitchen, new dinning room remodeling; *Build new partition wall, new plumbing, new electrical lighting. EXISTING USE PROPOSED USE CONSTR. TYPE 1 # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) Restaurant Restaurant V -B 1 EXISTGgoq NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA gnqa— BATHROOM KITCHEN REMODEL AREA REMODEL AREA OTHER REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH [I ATTACH # DWELLING UNITS: IS A SECOND UNIT []YES BEING ADDED? E] NO SECONDSTORV []YES ADDITION? ❑ NO PRE -.APPLICATION ❑YES IF YES, PROVIDE COPY OF IS 'I'll L? AN ❑ YES 'RECEIV B BY, :„ � � �; � TOT4 VALUATION: PLANNING ADPL# []NO PLANNING APPROVAL LETTER EI HOME? [I N0 pyy - 4 By my signature below, I certify to each of the followin am e property owner or authorized agent o act on the property owner's behalf. have read this application and the information I have provided* o t I 1 le read th escription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildin ons ction. Ithor' a esentatives of Cupertino to enter the above-ide iffed prope for inspection purposes. Signature of ApplicanVAgent: Date: l SUPPLEMENTAL INF TI REQUIRED PI ANCHECK'r .:.; ": ROUTINGsi>P' 0 oVER COUNTER ' _ :. : © RV1LD1NgPLAN AEVIEw . New SFD or Multifamily dwelli gs: Apply for demolition permit for _ existing building(s). Demolition p mit is required prior to issuance of building "- ` permit for new building. 1 rii ss; CI ANrONGPLAN RE.VIEw Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 0ST,kNDAxn ":.." _ © �PUBLiG.wURxs _ fornt if any Hazardous Materials are being used as part of this project. DEPT- ; _ Copy of Planning Approval Letter or Meeting with Planning prior to ©saNlrAxSEWER nisrxici: submittal of Building Permit application. E ENymONMENTAL HEALTH- . BldgApp_201 1. doe revised 06/21/11 Fl IUD Air Balance Report Santa Clara DEH#: SR0852169 Permit Number B-2016-3168 For Taste Good Restaurant 20916 Homestead Road, #A Cupertino, CA Prepared By Oct 10, 2017 Raymond Situ, P E. STONE ENGINEERING INC. 319 Vicente Street San Francisco, CA 94127 1 I HVAC AIR BALANCE TEST PROJECT NUMBER: B-2016-3168 DATE: 10/10/2017 PROJECT NAME: Taste Good Restaurant PROJECT LOCATION: 20916 Homestead Road, #, Cupertino, CA AC-2(Roof Top Package Unit) COOLING PERFORMANCE HEATING PERFORMANCE SLIPPY FAN DATA MANUFAC. EQ. VOLT./ NOM. TOT. /MODEL TOT.SEN EER/ TOT. TOT. AFUE MIN.OSA AIR E.S.P. MOTOR MOTOR TAG. PH/HZ CAP. CAP, INPUT OUTPUT FLOW (W.G. NO. S.(MBH) IEER (%) (CFM) (BHP) (HP) (TON) (MBH) (MBH) (MBH) (CFM) ) ' AC-2 Day/Night 208/1/60 4 45 45 11 60 50 81.0% 1600 1600 0.6 0.79 1 48TCLA05 I FORMULA USED: Q=A x V(Effective Area x Average Velocity) 8 READINGS PER DIFFUSER (FPM) #1 + + Diffuser: 14"x14" #2 4 4 Diffuser: 14"x14" 650 600 Duct.: 10"Dia. 650 750 Duct: 10"Dia. 4--- 600 650 —► Area(sg ft, 0.55 4— 650 450 -► Area(sq ft, 0.55 4— 500 600 --p. Avg.FPM 594 f__ 550 500 --► Avg.FPM 606 450 700 CFM: 327 650 650 CFM: 333 + + j 4, #3 4 4 Diffuser: 24"x24" #4 4 4 Diffuser: 24"x24" 650 700 Duct: 10"Dia. 500 550 Duct: 8"Dia. -4, — 600 550 —► Area(sg ft, 0.55 450 600 —► Area(sg ft, 0.35 4— 600 650 -0. Avg.FPM 638 4— 550 650 --0 Avg.FPM 556 700 650 CFM: 351 600 550 CFM: 195 + + + + #5 4 4 Diffuser: 24"x24" #6 4 4 Diffuser: 12"x6" 550 400 Duct: 8"Dia. 300 250 Duct: .4-- 600 550 --* Area(sq ft, 0.35 4— 300 300 —0. Area(sq ft, 0.5 .4--A 500 500 --0. Avg.FPM 519 4— 300 350 —► Avg.FPM 309 550 500 CFM: 182 320 350 CFM: 154 + Total Air Volume(CFM)Supplied by Ceiling Diffusers: 1541 CFM 6 READINGS PER REGISTER (FPM) 4/ j Register: 20"x24" 680 750 Duct: 18"Dia. — 750 800 1-- Area(sq ft, 1.8 800 850 4--- Avg.FPM 772 4 4 CFM: 1389 Total Air Volume(CFM)Exhausted by Register(s): 1389 CFM ' Comments/ *There is positive 152 CFM air volume supplied by AC 2. Recommendatio *The air balance is within 90%criteria for unit AC-2. *The AC-1 unit shall be serviced regularly to maintain the optimum performance. Prepared by: Raymond Situ, P.E.. 510-688-6261 Stone Engineering&Associates raysitu@yahoo.com 4 I HVAC AIR BALANCE TEST PROJECT NUMBER: B-2016-3168 DATE: 10/10/2017 PROJECT NAME: Taste Good Restaurant PROJECT LOCATION: 20916 Homestead Road, #, Cupertino, CA AC-1(Roof Top Package Unit) COOLING PERFORMANCE HEATING PERFORMANCE SUPPY FAN DATA MANUFAC. EQ. /MODEL VOLT./ 'NOM. TOT. TOT;SEN EER/ TOT. TOT. AFUE MIN.OSA AIR E.S.P. MOTOR MOTOR TAG. NO. PH/HZ CAP. CAP. S.(MBH) IEER INPUT OUTPUT (%) (CFM) FLOW (W.G. (B ) ( ,) (TON) (MBH) (MBH) (MBH) (CFM) ) AC-1 Day/Night 208/1/60 4 45 45 11 60 50 81.0% 1600 1600 0.6 039 1 48TCLA05 FORMULA USED: Q=A x V(Effective Area x Average Velocity) 8 READINGS PER DIFFUSER (FPM) #1 4 f Diffuser: 24"x24" #2 4 4 Diffuser: 24"x24" 560 600 Duct: 10"Dia. 650 700 Duct: 10"Dia. .4— 600 650 —► Area(sq ft, 0.55 41-- 650 450 —► Area(sq ft,. 0.55 4— 500 450 —► Avg.FPM 589 -4—.. 550 500 --0- Avg.FPM 600 650700 CFM: 324 650 650 CFM: 330 + + 4' l #3 4 4 Diffuser: 24"x24" #4 4 4 Diffuser: 24"x24" 650 700 Duct: 10"Dia. 650 550 Duct: 10"Dia. 4--- 550 600 * Area(sq ft, 0.55 4— 450 600 —► Area(sq ft, 0.55 600 550 -_ Avg.FPM 619 4— 550 650 —► Avg.FPM 606 650 650 CFM: 340 700 700 CFM: 333 #5 4 + Diffuser: 24"x24" 550 400 Duct: 8"Dia. 600 450 —► Area ft, 0.35 .4_A 450 500 --0. Avg.FPM 500 550 500 CFM: 175 + + Total Air Volume(CFM)Supplied by Ceiling Diffusers: 1503 CFM 6 READINGS PER REGISTER (FPM) + + Register: 20"x24" 650 750 Duct: 18"Dia. --► 750 800 4— Area(sq ft, 1.8 750 850 4— Avg.FPM 758 4 4 CFM: 1365 Total Air Volume(CFM)Exhausted by Register(s): 1365 CFM Comments/ *There is positive 138 CFM air volume supplied by AC-1. Recommendatio *The air balance is within 91%criteria for unit AC-1. *The AC-1unit shall be serviced regularly to maintain the optimum performance. Prepared by: Raymond Situ, P.E. 510-688-6261 Stone Engineering&Associates 3 EXHAUST HOOD 1 FILTER CALCULATION PROJECT NUMBER: SR0852169 DATE: 10/10/2017 PROJECT NAME: Taste Good Restaurant PROJECT LOCATION: 20916 Homestead Road, #A, Cupertino, CA (2015c16") (16"x16") Number of Filters: 10 Size of Filters: 1.73 FPM per Filter: 287 Filter Type: Baffle Filter 17.3 Total sq.ft.: 17.3 FORMULA USED: AVERAGE FPM/FILTER x EFFECTIVE AREA(in square feet) 9 readings per filter 240 250 250 246 Avg.FPM 320 300 330 323 Avg.FPM 250 240 250 320 330 330 250 240 240 330 320 330 260 260 260 259 Avg.FPM 320 310 320 319 Avg.FPM 250 250 260 320 330 320 260 260 270 300 330 320 290 280 290 298 Avg.FPM 300 300 280 294 Avg.FPM 300 300 300 300 320 280 300 300 320 280 300 290 300 320 310 312 Avg.FPM 250 260 260 254 Avg.FPM 300 330 320 250 260 260 300 300 330 240 260 250 320 330 300 318 Avg.FPM 250 250 260 248 Avg.FPM 310 320 330 240 250 250 330 320 300 240 240 250 Avg.FPM Avg.FPM _ I Total CFM Exhausted through the Filter Bank: 4967 CFM Prepared by: Raymond Situ P.E. 510-351-3288 SMI Construction Inc. HOOD 1 EVALUATION WORK SHEET AND CHECK LIST GUIDE Use a separate work sheet for each hood or segment of hood as needed. PROJECT NUMBER: SR0852169 DATE: 10/10/2017 PROJECT NAME: Taste Good Restaurant PROJECT LOCATION: 20916 Homestead Road, #A, Cupertino, CA 1. TYPE OF EQUIPMENT UNDER HOOD(S). List number of pieces of segment:-to determine the correct formula to be used.(Q=100A) A. Solid fuel burning(Char broiler): B. High Temp.(Grills,ranges,etc.) 2 Fryers, 1 Range Oven C. Low Temp.(Oven,steamer,stock pots): 1 Stock Pot, 1 BBQ Oven, 1 Steamer. a. Bas on#1 above which formula will be used for calculation?: ETL Listed,Captive Aire Hood ND5424 Type I,Listed Hood,formula will be used for calculatio 300 CFM/LF 2. KITCHEN EXHAUST DESIGN CALCULATION. Hood 1 Size 14 ft.Length 4.5 ft.Width Usually taken from plans dimensions. Size 1 Size 2 Total A. Net Filter Area(ea.Filter): 1.73 sq.ft. B. Total Number of filters: 10 10 EA all C. Net Filter Area(all Filters): 17.30 17.30 sq.ft. (2A times 2B equals 2C) (20"x16") (16"x16") D. Calculation with formula to be used: 4200 Total CFM E. Duct 1 Size: 36 in.L 10 in.W 2.50 sq.ft. Total: 2.50 sq.ft. Duct 2 Size: in.L in.W F. Duct Velocity:: 2300 FPM G. Make up air Velocity: 481 FPM H. Type of Diffuser: Ceiling Mounted I. Diffuser Size: 20"x20" Number: 4 Opening: 10.8 openings sq.ft. J. Total CFM Supplied: 10382 CFM K. Are there any blanks installed? N/A L. Where is duct located in relation of the horizontal run of hood? Center M. What is the filter rating of each filter? 250-350 FPM/LF 3. PERFORMANCE EVALUATION Use data recorded on field work sheet A. What is the average FPM: 287 per filter B. Net Filter Area: 1.73 X FPM= 497 CFM C. CFM time number of filters: 10 =Total CFM 4967 CFM D. What is duct size: 36"x10" E. Does#3C match#2D: 18% stronger than design value. F. Does#2M match#3A: Yes. G. Comments/Recommendations: This Hood CFM met the design requirment. Prepared by:Raymond Situ P.E. 510-351-3288 SMI Construction Inc. EXHAUST HOOD 2 FILTER CALCULATION PROJECT NUMBER: SR0852169 DATE: 10/1012017 PROJECT NAME: Taste Good Restaurant PROJECT LOCATION: 20916 Homestead Road, #A, Cupertino, CA (20,5c16') (16"x16") Number of Filters: 10 Size of Filters: 1.73 FPM per Filter: 286 Filter Type: Baffle Filter 17.3 Total sq.ft.: 17.3 FORMULA USED: AVERAGE FPM/FILTER x EFFECTIVE AREA(in square feet) 9 readings per filter 250 250 250 248 Avg.FPM 320 330 330 324 Avg.FPM 250 240 250 320 330 330 250 250 240 330 300 330 260 250 260 259 Avg.FPM 320 310 320 321 Avg.FPM 250 250 260 320 330 320 260 260 280 300 320 350 270 290 290 284 Avg.FPM 280 280 320 294 Avg.FPM 280 300 290 310 300 300 280 280 280 290 280 290 300 300 320 310 Avg.FPM 260 250 240 254 Avg.FPM 300 310 320 250 260 250 330 310 300 260 260 260 320 300 320 316 Avg.FPM 260 250 250 247 Avg.FPM 310 320 300 240 250 250 330 320 320 230 250 240 Avg.FPM Avg.FPM Total CFM Exhausted through the Filter Bank: 4944 CFM Prepared by: Raymond Situ P.E. 510-351-3288 SMI Construction Inc. HOOD 2 EVALUATION WORKSHEET AND CHECK LIST GUIDE Use a separate work sheet for each hood or segment of hood as needed. PROJECT NUMBER: SR0852169 DATE: 10/10/2017 PROJECT NAME: Taste Good Restaurant PROJECT LOCATION: 20916 Homestead Road, #A, Cupertino, CA 1. TYPE OF EQUIPMENT UNDER HOOD(S). List number of pieces of segment:-to determine the correct formula to be used.(Q=100A) A. Solid fuel burning(Char broiler): B. High Temp.(Grills,ranges,etc.) 1 Wok Range(7 Burners) C. Low Temp.(Oven,steamer,stock pots) a. Bas on#1 above which formula will be used for calculation?: ETL Listed,Captive Aire Hood ND5424 Type I,Listed Hood,formula will be used for calculatio 300 CFM/LF 2. KITCHEN EXHAUST DESIGN CALCULATION. Hood 1 Size 14' ft Length 4.5 ft.Width Usually taken from plans dimensions. Size 1 Size 2 Total A. Net Filter Area(ea.Filter): 1.75 sq.ft. B. Total Number of filters: 10 10 EA all C. Net Filter Area(all Filters): 17.50 17.50 sq.ft. (2A times 2B equals 2C) (20"x16") (16"X16") D. Calculation with formula to be used: 4200 Total CFM E. Duct 1 Size: 36 in.L 10 in.W 2.50 sq.ft. Total: 2.50 sq.ft. Duct 2 Size: in.L in.W F. Duct Velocity: 2250 FPM G. Make up air Velocity: 447 FPM H. Type of Diffuser: Ceiling Mounted I. Diffuser Size: 24"x24" Number: 4 Opening: 10.8 openings sq.ft. J. Total CFM Supplied: 10382 CFM K. Are there any blanks installed? N/A L. Where is duct located in relation of the horizontal run of hood? Center M. What is the filter rating of each filter? 250-350 FPM/LF 3. PERFORMANCE EVALUATION Use data recorded on Yield work sheet A. What is the average FPM: 286 per filter B. Net Filter Area: 1.75 X FPM= 500 CFM C. CFM time number of filters: 10 = Total CFM 5001 CFM D. What is duct size: 36"x10" E. Does#3C match#2D: 19% stronger than design value. F. Does#2M match#3A: Yes. G. Comments/Recommendations This Hood CFM met the design requirment. Prepared by:Raymond Situ P.E. 510-351-3288 SMI Construction Inc. /` // ,yc / rF /7 MAKE-UP AIR CALCULTATION PROJECT NUMBER: SR0852169 DATE: 10/10/2017 PROJECT NAME: Taste Good Restaurant PROJECT LOCATION: 20916 Homestead Road, #A, Cupertino, CA Hood 1 Hood 2 Total sq.ft. Number of Diffuser: 4 4 Size of Diffusers: 2.7 2.7 Sub-total sq.ft.: 10.8 10.8 21.6 sq.ft. FPM per Diffuser: 481 Type of Diffuser: Ceiling FORMULA USED: AVERAGE FPM/DIFFUSER x OPENING AREA(in square feet) 4 READINGS PER DIFFUSER * + 450 500 Avg.FPM 500 538 Avg.FPM 4- 500 —> 4--- 550 4- 550 4--- 550 —► 500 550 + * 4 550 538 Avg.FPM 500 513 Avg.FPM 4- 600 —► 4- 550 ----0- 4- --►4-- 500 4- 500 --- - 500 500 500 463 Avg.FPM 500 475 Avg.FPM 4--- 450 —► 1---- 450 --► f-- 450 — 4.-- 450 —► 450 500 * * 4 + 4 4 500 495 Avg.FPM 350 325 Avg.FPM 4- 500 —o. f— 300 ----► f-- 500 — f-- 350 --► 480 300 + + * + Total CFM Supplied by Make-Up Air: 10382 CFM Total CFM Exhausted by Hood 1: 4967 9968 CFM Difference: 4% Total CFM Exhausted by Hood 2: 5001 CFM Prepared by: Raymond Situ, P.E. 510-351-3288 SMI Construction Inc. 1 CERTIFICATE of INSTALLATION (Part 1 of 2) N Ktl-M -01-E PROJECT NAME: DATE: Taste Good Restaurant 10/10/2017 PROJECT ADDRESS: 20916 Homestead Road,#A Cupertino, CAeheckeifh mate Enforcemen genty Use , GENERAL INFORMATION DATE OF BUILDING PERMIT PERMIT# g_2016-3168 BUILDING TYPE Q Nonresidential 0 High-Rise Residential 0 Hotel/Motel Guest Room PHASE OFUnconditioned CONSTRUCTION 0 New Construction 0 Addition L1 Alteration If more than one person has responsibility for building construction, each person shall prepare and sign an Installation Certificate document applicable to the portion of construction for which they are responsible;alternatively,the person with chief responsibility for construction shall prepare and sign the Installation Certificate document(s)for the entire construction. DECLARATION STATEMENT • I certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction,or an authorized representative of the person responsible for construction(responsible person). • I certify that the installed features,materials,components,or manufactured devices identified on this certificate(the installation) conforms to all applicable codes and regulations,and the installation is consistent with the plans and specifications approved by the enforcement agency. • I reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the Certificate of Compliance that apply to the installation have been met. • I will ensure that a completed,signed copy of this Installation Certificate 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 Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. Company Name: Micro Air Mech.1714 Quimby Rd.San Jose,CA 95122 Responsible Person's Name: Responsible Person's Signature: 7/ Tony Hyunh TOTU - TYGt- Lic.# Date Signed: Position With Company: U 741339 10/10/2017 Manager SCOPE OF RESPONSIBILITY Enter 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 table below identify all applicable construction documents that specify the requirements for the scope of responsibility for this Installation Certificate. Date Approved By Document Title or Description Applicable Sheets or Pages,Tables,Schedules,etc. the Enforcement M T-24 Plan M-0 2013 Nonresidential Compliance Forms February 2013 CERTIFICATE of INSTALLATION (Part 2 of 2) NRCI-MCH-01-E In the table below identify all applicable construction documents that sped 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 Bnfareement ,. ncy 2013 Nonresidential Compliance Forms February 2013 0 5.1 { <;yy� L73...,,,,72Fes.• di STATE OF CALIFORNIA -1 10'04,1'1 �, COMMERCIAL KITCHEN EXHAUST SYSTEM ACCEPTANCE cAUFORNINERCmI=C-01141VkFSION -�- CEC-NRCA-PRC-o2-F Revised 05/15 NI ION C 02 F CERTIFICATE OF ACCEPTANCE (Page 1 of F Commercial Kitchen Exhaust System Acceptance Permit NumbeF ) Enforcement Agency: B-2016-3168Nu : Project Namei Taste Good Restaurant - - - - - - - - � Zip Code: City: CA Project Address: 20916 Homestead Rd,#A Cupertino _ Note:Submit one Certificate of Acceptance for each system EnforcemeotAgencyUw Checked og/gte that must demonstrate compliance. , Intent: I Verify that airside economizers function properly 1 A.Construction Inspection 1.Supporting documentation needed to perform test includes: a. 2013 Building Energy Efficiency Standards Nonresidential Compliance Manual(NA7.5.4 Air Economizer Controls Acceptance At-A-Glance). b. 2013 Building Energy Efficiency Standards. 2.Instrumentation to perform test includes: a. Space differential pressure sensor Calibration Date: (must be within last year) b. Recording Analog Manometer with Pitot Tube and VelGrid Calibration Date: (must be within last year) 3. Installation:(all of the following boxes should be checked) ID Exhaust and make-up air systems and installed and fully functional. Demand Ventilation Control systems(if installed)are fullyfunctional and have been set up and calibrated by the ® installing contactor For Kitchens with>5,000 cfm of Type I and Type II kitchen hood exhaust,All Type I hoods meet the requirements of ® Table 140.9-A . I Results B. Functional Testing The following acceptance test applies to systems with and without demand control ventilation exhaust systems.These tests shall be conducted at full load conditions for each hood. Step 1:Setup: >;p/N a. Operate all sources of outdoor air providing replacement air for the hoods Operate all sources of recirculated air providing conditioning for the space in which the hoods are 6/N b. located lis/N c. Operate all appliances under the hoods at operating temperatures Step 2:Verify the following: a. Verify that the thermal plume and smoke is completely captured and contained within each hood at full load conditions by observing smoke or steam produced by actual cooking operation and/or by visually seeding the thermal plume using devices such as smoke candles or smoke puffers.Smoke bombs shall not be used(note:smoke bombs typically create a large volume of effluent from a point source and do 6/N not necessarily confirm whether the cooking effluent is being captured).For some appliances(e.g., broilers,griddles,fryers),actual cooking at the normal production rate is a reliable method of generating smoke).Other appliances that typically generate hot moist air without smoke(e.g.,ovens,steamers) need seeding of the thermal plume with artificial smoke to verify capture and containment. b. Verify that space pressurization is appropriate(e.g.kitchen is slightly negative relative to adjacent spaces 6/N and all doors open/close properly). / c. Verify that each Type 1 hood has an exhaust rate that is at or below the maximum allowed. 0/N NA ;` May 2015 CA Building Energy Efficiency Standards-2013 Nonresidential Compliance _ _ r COMMERCIAL KITCHEN EXHAUST SYSTEM ACCEPTANCE CEC-NRCA-PRC-02-F(Revised 05/15) . CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-PRC-02-F Commercial Kitchen Exhaust System Acceptance (Page 3 of 3) Project Name: Enforcement Agency: Permit Number: Taste Good Project Address: City: Zip Code: 20916 Homestead Rd,#A Cupertino CA DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. I certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Raymond Situ Documentation Author Company Name: Date Signed: SMI Construction Inc. 10/10/17 Address: CEA/HERS/ATT Certification Identification(If applicable): 595 Montague Ave. City/State/Zip: Phone: San Leandro,CA 94577. 510-351-3288 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury,under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. I am the person who performed the acceptance verification reported on this Certificate of Acceptance(Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency,and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. I have confirmed that the Certificate(s)of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Ton Hynh Field Technician Signature: Field Technician Company Name: Position with Company(Title): Micro Air Mech. Manager Address: CEA/HERS/ATT Certification Identification(If applicable): 1714 Quimby Rd. City/State/Zip: Phone: Date Signed: San Jose,CA 95122 408-724-7205 10/10/2017 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury,under the laws of the State of California: 1. I am the Field Technician,or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 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). i 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: Responsible Acceptance Person Signature: Raymond Situ Responsible Acceptance Person Company Name: Position with Company(Title): SMI Construction Inc. Project Engineer Address: CSLB License:B83116 595 Montague Ave. City/State/Zip: Phone: Date Signed: San Leandro.CA 94577 510-688-6261 10/10/17 CA Building Energy Efficiency Standards-2013 Nonresidential Compliance May 2015 POWER ADJUSTMENT FACTORS mo 7_N �► ._ . CEC-NRCI-LTI-05-E(Revised 12/15) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF INSTALLATION NRCI-LTI-05-E Power Adjustment Factors (Page 1 of 5) Project Name:–as te Good Restaurant Enforcement Agency: Permit.Number:B-2016-3168 Project Address:20916Homestead Rd,#A Cupertino ertin0 Zip Code:CA . GENERAL INFORMATION DATE OF BUILDING PERMIT PERMIT# B-2016-3168 3/20/2017 BUILDING TYPE Q Nonresidential ❑ High-Rise Res(Common Area) 0 Hotel/Motel(Common Area) PHASE OF ❑ Alteration CONSTRUCTION 0 New Construction 0 Addition 0 Unconditioned SCOPE OF RESPONSIBILITY Enter 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: Power Adjustment Factor(PAF) §130.4(b)-Before a Power Adjustment Factor will be allowed for compliance with Section 140.6 of 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. §140.6(a)2-Reduction of wattage through controls. In calculating actual indoor Lighting Power Density,the installed watts of a luminaire providing general lighting in an area listed in TABLE 140.6-A may be reduced by the product of(i)the number of watts controlled as described in TABLE 140.6-A,times(ii)the applicable Power Adjustment Factor(PAF),if all of the conditions[in this Certificate of Installation are met]: If any of the requirements in this Installation Certificate fail,the installation shall not be eligible for using the PAF. Check all that apply: PART 1 Certificate of Compliance Correctly Filled Out 0 In addition to this Certificate of Installation,the PAF has been correctly document on page 2 of NRCC-LTI-02—E of the Certificate of Compliance submitted to the building department. PART 2 Type of PAF A. This installation qualifies for the following PAFs: El 1.This installation qualifies for the PAF for a Partial-ON Occupant Sensing Control in TABLE 140.6-A because it meets all of the following requirements: ❑ a. The Partial-ON Occupant Sensing Control is use in only the following space types: Q i. An area<_250 square feet enclosed by floor-to-ceiling partitions ❑ ii. A classroom of any size • iii. A conference room of any size ❑ iv. A waiting room of any size ❑ b. The PAF used is 0.20 O c. The control automatically deactivates all of the lighting power in the area within 30 minutes after the room has been vacated;and • d. The first stage automatically activates between 30-70 percent of the lighting power in the area • e. The lighting control is a: El i. Switching system,or CA Building Energy Efficiency Standards-2013 Nonresidential Compliance December 2015 POWER ADJUSTMENT FACTORS *ZS x., CEC-NRCI-LTI-05-E(Revised 12/15) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF INSTALLATION NRCI-LTI-05-E Power Adjustment Factors (Page 2 of 5) Project Name: Taste Good Restaurant Enforcement Agency: Permit Number: B-2016-3168 Project Address: 20916 Homestead Rd,#A city` Cupertino Zip Code: CA 0 ii. Dimming system;and • f. The second stage manually activates the alternate set of lights;and • g. This manual-ON function is not capable of conversion from manual-ON to automatic-ON functionality via manual switches or dip switches;and ❑ h. Switches are located in accordance with Section 130.1(a) O i. Occupants can manually do all of the following regardless of the sensor status: Activate the alternate set of lights;and 0, Activate 100 percent of the lighting power;and E Deactivate all of the lights. E 2 This installation qualifies 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,because the following requirements have been met: El a. The occupant sensing controls are in large open plan offices that are greater than 250 square feet and: i. One sensor is controlling an area that is no larger than 125 square feet,and the PAF used in 0.40 ▪ ii. One sensor is controlling an area that is from 126 to 250 square feet,and the PAF used in 0.30 • iii. One sensor is controlling an area that is from 251 to 500 square feet,and the PAF used in 0.20 • b. This PAF is only being applied only to office areas which contain workstations;and ❑ c. Controlled luminaires are only those which provide general lighting directly above the controlled area,or furniture mounted luminaires that comply with Section 140.6(a)2 and provide general lighting directly above the controlled area;and • d. Qualifying luminaires have been controlled by occupant sensing controls that meet all of the following requirements,as applicable: ▪ i. Infra-red sensors have been equipped by the manufacturer,or fitted in the field by the installer,with lenses or shrouds to prevent them from being triggered by movement outside of the controlled area. • ii. Ultrasonic sensors have been tuned to reduce their sensitivity to prevent them from being triggered by movements outside of the controlled area. • iii. All other sensors have been installed and adjusted as necessary to prevent them from being triggered by movements outside of the controlled area. ID 3 This installation qualifies for the PAF for a Manual Dimming System or a Multiscene Programmable Dimming System in TABLE 140.6-A because: o a. The lighting is controlled with a control that can be manually operated by the user;and El b. The space is only of the following type: • i. Hotel/motel O ii. Restaurant • iii. Auditorium • iv. Theater ❑ c. The type of control and PAF used is one of the following: • i. A Dimming System with manual dimming and the PAF used is 0.10 CA Building Energy Efficiency Standards-2013 Nonresidential Compliance December 2015 POWER ADJUSTMENT FACTORS '74 N,4 CEC-NRCI-LTI-05-E(Revised 12/15) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF INSTALLATION NRCI-LTI-05-E Power Adjustment Factors (Page 3 of 5) Project Name: Taste Good Restaurant Enforcement Agency: Permit Number: B-2016-3168 Project Address: 20916 Homestead Rd,#A City: Cupertino Zip Code: CA.... • ii. A Multiscene Programmable control and the PAF used is 0.20 0 4. This installation qualifies for the PAF for a Demand Responsive Control in TABLE 140.6-A, because the installation meets all of the following requirements: i. The building is 10,000 square feet or smaller;and • ii. The PAF used is 0.05. Note that luminaires that qualify for other PAFs may also qualify for this demand responsive control PAF. ❑ iii. The controlled lighting is capable of being automatically reduced in response to a demand response signal;and ❑ iv. Lighting has been reduced in a manner consistent with uniform level of illumination requirements in TABLE 130.1-A;and O v. Spaces that are non-habitable have not been used to comply with this requirement,and • vi. Spaces with a lighting power density of less than 0.5 watts per square foot have not been counted toward the building's total lighting power. ❑✓ 5. This installation qualifies for the PAF for Combined Manual Dimming plus Partial-ON Occupant Sensing Control in TABLE 140.6-A because the installation meets all of the following requirements: El a. The Combined Control is use in only the following space types: ❑ i.An area 5 250 square feet enclosed by floor-to-ceiling partitions ❑ ii. A classroom of any size El iii. A conference room of any size • iv. A waiting room of any size 9 b. The lighting is controlled with a control that can be manually operated by the user;and • c. The dimming component is one of the following: • i. A Dimming System with manual dimming;or ❑ ii. A Multiscene Programmable control O d. The Partial-ON Occupant Sensing component automatically deactivates all of the lighting power in the area within 30 minutes after the room has been vacated;and • i. The first stage automatically activates between 30-70 percent of the lighting power in the area ii. The lighting control is a: 9 Switching system,or Ei Dimming system;and ❑ iii. The second stage manually activates the alternate set of lights;and • iv. This manual-ON function is not capable of conversion from manual-ON to automatic-ON functionality via manual switches or dip switches;and 0 v. Switches are located in accordance with Section 130.1(a) D vi. Occupants can manually do all of the following regardless of the sensor status: 9 Activate the alternate set of lights;and 9 Activate 100 percent of the lighting power;and 9 Deactivate all of the lights. • e. The PAF used is 0.25 CA Building Energy Efficiency Standards-2013 Nonresidential Compliance December 2015 POWER ADJUSTMENT FACTORS CEC-NRCI LTI-05-E(Revised 12115) CALIFORNIA ENERGY COMMISSION m, CERTIFICATE OF INSTALLATION NRCI-LTI-05-E Power Adjustment Factors (Page 4 of 5) Project Name: —aste'Good Restaurant Enforcement Agency: Permit Number. B_2016-316$ Project Address; 20916 Homestead Rd,#A ary: Cupertino Zip Code: CA PART 3 PAF Minimum Requirements Check all that apply: ❑ A. The lighting control used to earn the PAF is designed and installed in addition to all manual,and automatic lighting controls otherwise required in 130.1(a)through (e) EXCEPTION.The lighting control used to earn a PAF has been designed and installed for the sole purpose of compliance with Section 130.1(b)3,and this lighting control is designed and installed in addition to all other manual,and automatic lighting controls otherwise required in Section 130.1. O B. Installed wattage has been determined in accordance with Section 130.0(c) • C. Space types that qualify for the PAF comply with the definition for that space type in Section 100.1(b) • D. Self-contained lighting controls used to earn the PAF comply with Section 110.9 and are certified in accordance with the Appliance Efficiency Regulations,as verified on the Title 20 database of certified lighting controls • E. A lighting control system is used to earn the PAF,which complies with Section 110.9. When using a lighting control system to earn a PAF,also submit the Installation Certificate for Energy Management Control System and Lighting Control System • F. The controls are permanently installed nonresidential-rated lighting controls. (Portable lighting, portable lighting controls,and residential rated lighting controls shall not qualify for PAFs.) • G. The controlled lighting used to earn this PAF is a permanently installed general lighting system. El Furniture mounted luminaires qualify as general lighting system for the purpose of earning this PAF because the general lighting is in an office,and the furniture mounted luminaires comply with all of the following conditions: i. The furniture mounted luminaires have been permanently installed no later than the time of building permit inspection;and ii. The furniture mounted luminaires have been permanently hardwired;and iii. The furniture mounted lighting system has been designed to provide indirect general lighting;and iv. Before multiplying the installed watts of the furniture mounted luminaire by the applicable PAF,0.3 watts per square foot of the area illuminated by the furniture mounted luminaires has been subtracted from installed watts of the furniture mounted luminaires;and El H. At least 50 percent of the light output of the controlled luminaire is within the applicable area listed in TABLE 140.6-A.Luminaires on lighting tracks are within the applicable area in order to qualify for a PAF. ® I. Only one PAF from TABLE 140.6-A has been used for each qualifying luminaire. PAFs have not been added together unless specifically allowed in.TABLE 140.6-A. ❑ L. Only lighting wattage directly controlled in accordance with Section 140.6(a)2 has been used to reduce the calculated actual indoor Lighting Power Densities as allowed by Section 140.6(a)2. Only a portion of the wattage in a luminaire is controlled in accordance Section 140.6(a)2,and only that portion of controlled wattage has been reduced in calculating actual indoor Lighting Power Density. CA Building Energy Efficiency Standards-2013 Nonresidential Compliance December 2015 POWER ADJUSTMENT FACTORS . CEC-NRCI-LTI-05-E(Revised 12/15) CALIFORNIA ENERGY COMMISSION .r CERTIFICATE OF INSTALLATION NRCI-LTI-05-E Power Adjustment Factors (Page 5 of 5) Project Name:Taste Good Restaurant Enforcement Agency: Permit Number:B-2016-3168 Project Address:20916 Homestead Rd,#A city:Cupertino Zip Code:CA DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. I certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: M Raymond Situ Documentation Author Company Name:SMI ConstructionInc. Date Signed:10/10/2017 Address:595'Montague Ave. CEA Certification Identification(If applicable): city/state/zip:San Leandro,CA 94577 Phone:510-351-3288 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 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. I reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the specific requirements for the scopeof 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.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/Installer Name: Responsible Builder/Installer Signature: WEI 11E LI 9 Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Position With Company(Title):Electrician Address:595 Montague Ave, CSLB License:519079 City/State/Zip: San Leandro,CA 94577 Phone 510-351-3288 Date Signed:510-351-3288 Third Party Quality Control Program(TPQCP)Status: Name of TPQCP(if applicable): CA Building Energy Efficiency Standards-2013 Nonresidential Compliance December 2015 INDOOR LIGHTING to vtin 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: Enforcement Agency: Permit Number�B2016-3168 Taste Good Restaurant Project Address: City: Zip Code: CA 20916 Homestead Rd,#A _ Cupertino C GENERAL INFORMATION DATE OF BUILDING PERMIT PERMIT# BUILDING TYPE [Z Nonresidential 0 High-Rise Res(Common Area) 0 Hotel/Motel(Common Area) PHASE OF CONSTRUCTION 0 New Construction 0 Addition 10 Alteration 0 Unconditioned SCOPE OF RESPONSIBILITY Enter 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 3/20/17 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). qte Approved By Document Title or Description Applicable Sheets or Pages,Tables,Schedules,etc. the Enfarcernentxv Agency Lighting Control Plan El-E3 Power Adjustment Plan El-E3 CA Building Energy Efficiency Standards-2013 Nonresidential Compliance May 2015 .. .......... rt INDOOR LIGHTING CEC-NRCI-LTI-01-E(Revised 05/15) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF INSTALLATION NRCI-LTI-01-E Indoor Lighting (Page 2 of 2) Project Name: Enforcement Agency: Permit Number: Taste Good Restaurant Project Address: City: _. . . —_... Zip Code: DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. I certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name: Documentation Author Signat ( Raymond Situ Documentation Author Comparj SMI Construction Inc. Date Signed: 10/10/2017 Address: JIVMI CEA Certification Identification(If applicable): 595 Montague Ave. City/State/Zip: Phone: 510-351-3288 San I Randro CA 94577 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 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. 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.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/Installer Name: Responsible Builder/Installer Signature: WEI JIE LI Company Name:(Installing Subcontractor or General Contractor or Builder/Owner) Position With Company(Title): SMI Construction Inc. Electrician Address: CSLB License: 519079 595 Montague Ave e City/State/Zip: Phone Date Signed: San Leandro, CA 94577 510-351-3288 10/10/17 CA Building Energy Efficiency Standards-2013 Nonresidential Compliance May 2015