B-2017-1601 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: I CONTRACTOR: PERMIT NO:B-2017-1601
6191 BOLLINGER RD CUPERTINO,CA 95014-4630(375 41 007) HUSSEY BROS INC
SANTA CLARA,CA
95054
I
OWNER'S NAME:-WEST VALLEY,PRESBYTERIAN CHURCH DATE ISSUED:09/19/2017
1
OWNER'S PHONE:4081483-0103 PHONE NO:(408)733-6360
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-20 Lic.#675669 r X BLDG _ELECT _PLUMB
Contractor HUSSEY BROS INC Date 08/31/2019
X MECH_RESIDENTIAL X COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
WEST VALLEY PRES.CHURCH-INSTALL 4 CONDENSERS TO
I hereby affirm under pe ally of perjury one of the following two declarations: EXISTING FURNACES
1. 1 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 o i the work for which this permit is issued.
I1 I have and will maintain Worker's Compensation Insurance,as provided for by
'4.
" Section 3700 of the Labor Code,for the performance of the work for which this
I
permit is issued. Sq.Ft Floor Area: Valuation:$37000.00
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 375 41 007
representatives of this city to enter upon the above mentioned property for ' ,
inspectibn purposes. (We)agree to save indemnify and keep harmless the
City of Cupertino against liabil ie judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said Ci ' `et
equence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applic- unde` ds and will comply with all non-point
source regulati.• .er th-up- .nicipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.9jnature = V 7_ Date 9/19/2017 Issued by:Abby Ayende
0. . Date:09/19/2017
I hereby affirm that I and exempt fro e Contractor's License Law for one of the RE-ROOFS:
following,two reasons: I 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 alPnew materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,I Business&Professions Code)
2. 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:9/19/2017
I hereby affirm,under pelnalty 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 willlmaintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Health&Safety Code,Section 25532(a)should I store or handle hazardous
a. Ii certify that inf the performance of the work for which this permit is issued,I
material. Additionally,should I use e. ipmen .r devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Ba\r&,, .'tr Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupe'tin.k unicipal Code,Chapter 9.12 and
I exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sec t n I 25533,and 25534.
1' Labor Code,I must forthwith comply with such provisions or this permit shall .
be deemed revoked. • ,� er or authorized agent: •\__
' APPLICANT CERTIFICATION iiDate:9/19/2017 Ek Y
I certify that I have read this application and state that the above information is I>,. R I I►1 ►1�]Ji.
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construct'. lend ng agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued( • '97,Civ C.) j
to enter upon the abovei 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 4penses which may accrue against said City in Lender's Address ,
consequence of the grating 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. I understand my plans shall be used as public records.
Signature Date 9/19/2017 Licensed
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
V 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255-
/ 41.1,
(408) 777-3228 • building@cupertino.org PEMIT#B- Zv tiTI - Ito O I
CUPERTINO REV# DEF#
• ❑ NEW CONSTRUCTION. ADDITION ❑ALTERATION ❑T.I. ❑MEP ❑RE-ROOF ❑SWIMMING POOL/SPA .
PROJECT ADDRESS Al q 1
31`/7// l/f r „' APN 8
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ONYER NAMEPHONE E-MAIL ^
IN es V0 ((ey (��S • hGyr,4 11 r- Yr--oi j w Jel j { ® SbCdla1'G .
STRIEET ADDR SS n /p CITY,STATES ZIP / GAJ /
CO R' ❑O UILDEC� �A t n” l l/1' \ N (AA ^ / y
OMPANY NAME ' LICENSE NUMBER LICENSE TYPE
Ku)sey 5 giSSe 67S' b �Q � Z�
STREET ADDRESS b (/� �t e CITY,STAT, �A C -1 �' 6A ^ ��� 1 I
E-MAIL I ° % V PHONE /` BUS.LIC#
❑ACH�ECT ❑OWNER ❑Ol1NERAGENT/OCONTRACTORAGENT❑ENGINEER❑DEVELOPER❑TENANT
CONTACT NAMEE-MAIL,
C Gam', 2r f I C 2 1) J 0 4.. k/Sge y �oa--6 , - ,--\
S ETA RESS C TATE, PHO E ,
�'��},yj�� D1),(n �� •C c 6 , .�� -- 733-63bo
DECRIPTON V I
-n s it cA).-21 0V45e,--)- 4 67/5 -C Y e.t c -s r
❑SINGLE-FAMILY/DUPLEX ❑MULTI-FAMILY 0 INDUSTRIAL COMMERCIAL I
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO S STORIES# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
REMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED
BATHROOM SF SF SF SF 0 DETACHED
ISPRINKLERS 0 NO NG D YES
EICHLER YES0 SECOND STORY ADDITION DYES
FIRENO 0 NO
DWELLING SECOND DWELLING ❑YES 0 ATTACHED 0 DETACHED OTHER
UNITS# UNIT ADDITON: 0 NO S F
POOLS! 0 FIBERGLASS ❑VINYL-LINED 0 GUNITE 0 PREFABRICATED
POOL-SF SPA-SF I SPA ATTACHED❑YES 0 NO I TOTAL-SF
D TO ON:
Commercial or Multi-Family Buildings with Public SwimmingPools requires Department of Environmental Heath approval al / , '
,00,,
•
, .
RE-ROOFI EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES E WOOD SHINGLES❑TILE OTHER(SPECIFY)
REMOVE/REPLACE 0 NO IF NO PLYWOOD ❑' ❑3/8" PLYWOOD TYPE: PITCH: ROOF CLASS
0 YES I #OF LAYERS THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER •12 .A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER
*Provide a signed copy of the Cupertino's Tear-Off Policy SF #of SQUARES
By my signature below I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I
have read this application and the information I h$e provided is correct. I have read the Description of Work and verify it is accurate. I agree
to comply with all applicable local ordinances . v ate laws relating to building construction. I authorize representatives of Cupertino to
enter the above-identified property for insp• :fig urposes. I acknowledge and authorize all information contained on this application form
to be made available for public,record. 9 /
b______4 .
Signature of Applicant/Agent: . Date: /
SUPPLEMENTAL INFORMATION REQUI•E171111k •
*New SFD/Second Dwelling Units/Multifamily ► elli :s:A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide a completed Hazar.ous Materials Disclosure form if.any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal,of Building Permit application.
*HOA-Provide a letter of approval from the Home Owner's Association
BldgApp_2017.doc revised 08/01/17
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MECHANICAL SYSTEMS • ,!:,41;
CEC-4IRCCAMCFI41-011Reiised 01/16) CALIFORNIA-ENERGYCOMMISSION:
CERTIFICATE.QP.COMPLIANCE
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A.MECHANICAL COMPLIANCE DOCUMENTS 0.voRK$HtEt (ehikbaxif worksheet it included) , . ...
For dealledihstructions-on the use of Mkt fict all EieegyEffitiencytdifritirds'etiiinpfianceforms refer to the 2016 Nontesidential Manual
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0 ,,; ..10 : s:1ado4.0c44.04-Elpprt 2 of )•,, E Certificate Of Compliance,geqvii.64:AcqpptanO`Tesfi(MCH.4-132Atal44).Required On all 41,1?.*IttfaNc,
0. .-,P4fteciAndiXf14E(Part.:',3'cif.8)i ' Acceptance (MCHLI1 Atel8;,A).-:Reqsiited'impfansvhero,00*able;,
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1041:Wet Equipment, Summary is requirediorall'subniittak'With'-thilletWatet. hot water or condenser water
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(-3- : 0.,, , •-l4gCC-,MCH...-0742,(Part:Itg,2) . eoworcotj$prnotoh',of Fans Required plans:where.ap.pilcalete_. , . ... . . .. . .
CO •44ii:COViCH-07;E,(Part::2Of 2) .POwerterisurnotiOn Of FM1 .,beclifalibri Reititlirednii planSiitiliefeeOnlicable
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fot.0, cceptangq.cgsts 06t4.ply'and list all that renuires'a0Cceptanct kost„All-eqiiipniegOf the same type that requiresAesti.liSttheeti yipinept deseciptiortan4thertuber.0
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The:c94#2,A0or who installedthe aquipment-Wrespbrisibiettieithet conduct the aecent4i*teittherriseliiesprilayea'qualified-entity run the test foi-:theif hastherethan'One:•PerstiniTesnoriA0ilit„V;
lei the acceptance tes:iiii ,each person shall sign and submit the Certificate of Acceptanwappjcab!e tothe. ortion of the.,disnStrii0tion;orkiStellatienfOr whiCh-theyaref.responsi hie,
• ErifortementAgency:
Planthecli The- NliCt.MCH,.-61--tcomOliance.:docuinentis,netcorisidered aftoinplete-d--document'and.O'ncittO.heiiccoted by the,buildhvdepartaientveless'ihe,currect.'boxes,arethecked:'
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Test.peStriptioni .,. MC04:124',' MCH 03-A -..,MCH;'.04-A, MtH•b$4A, MCf1,0LA f .met1:07-A • NIC1+P8'..A ':',..MCH,09.‘A . ivitf0,1.0..A: NICH,13;LA,:.
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Verification ''; Units ' Outdoor Air Unitary • Ducts , ContrOiS - (pcv) ,v4v: ..Leakage Test Temp Reset Flow Control sfig-os;cphyo.
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-;cA auilding-Energy'Effidency-Standards-2016'hionretidential,portiplienee: .0:444,1Y203*,
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MECHANICAL SYSTE S
GEC=NRGC-MCH-t71-E:{Revised-oitt6}. . 4 . .
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C MECHANICAL HVAC ACCEPTANCE FORMS(check iaox for required comphiance-documentsj.
Test'1' tforrect By1... ,,
Designer:
This compliance,document'is.to.i eFused:byr tihe designer antl.attacliadito the' ons.Listed below are:all the.acce tance'testsfor HVAC stems:`The,designer`,is=re ulred to dhecl<th ..a licable.boxes
for all�acceptance tesfis Y at apply:and list l;equip�nentthat`-requires:ate at err"��:tance test:All equipment oftbe,same p.e thatre. "iresa•test list tt e e uipmennt description:and:tb�euumber'af
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The contractorWho installed the e ui merit€s res on ibleto either conduct the•acce e' es` _ ._ t has res o's 'it
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for the,acceptance teting;each person shall signand su€�rilitthe Certificateof>Acceptance:a licabfe to;he: ortion efthe<constructiori o6nstallation`for*hich,the yere:re.Or sibi.e
knforcementAgency.:
Plancheck The NRCC-i+ CH 01 E compliance 0640 document is riot considered:a=completed,document.and.is not to be:accepted:b ttkenbuildin department unless the.correct bones:are checked,
inspector-Eiefore occupancy.permit"ls-granted all•"nevaiy installed process'systems n ut be tested to ensure proper operations: _
Test Deser€ptlonMCN 12 A MCN=33-,A` • :It CI+.14-A. MCl1;-t51 MCH-16A Mai-1474 'MCH-1S-A.
guternaticFaulti
Fault Detection" Oeteetion&' • Distributed Thermal Energy Supply;Air ,Condenser.
Equipment Requiring Testing or &Diagnostics. Diagnostics for :Energy-Storage: Storage(TES) Temperature ' :Water Reset
'Verification • #-nf Urltts far DXUnits Air&'ane. C X AC Systems, Systems' Reset Controls Controls' ECMS
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CA B`iiilding'Energy Efficiency Standards-2616 Nonresidential Compliarac+e 44044040
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ECI AJCAL SYSTEM$' �
CECNRCC-MACH-9ELReviscd b1116). CALIFORNIAENERGY,COMMISSION '
••l'CERTIFICATE O COMPLIANCE' NRCC:MCN-01-E
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• DOCUMENTATION AUTHORS DECLARATION ST+4LEiVIENT``
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thatCertific to of C9mpl ince documentation Isla curate and°crsritpiete.
tatiat:At hotName: , .` C}osurnehtationAuth tilatitre, -^
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RPSPU.1.SIBLE PEfsQN',S DECLARATION STATEMENT" 1
I certify the follow►rtg under penalty of perjury,un ier'the.laws of the Stateof California
1., The information provided of this Certif icate of Compliance"is truetand correct.
1 ell n r 0 :,.,
2, urn gibie.u de ivisiah,3 of the.;BBusiness and Professions CoCeito;accept.resporisitailtty tot the building;design orsystean;design identified ori this Certificate.of Compliance(responsible
designer)..
3. The energy featurec,and performance speciftcatiorls,materials,co orients andy anufactured devices for;the';buiidiin =desi 'n`or.s:stem desig n identified,on th s,Certiftcate of Com.liance
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conform to tlie'requirerrteaats of Title;24,,Parti and frart 6•ofthe California Cade of Regulations:;
4, 'The building,design features o,r-system design features:identified`on this Certif�icate;of.,Com l atice arre�consistent-W tth the lnformatt n rovided on other, livable.co liartce$ocurnents
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worksheets,calculations,pians and,specificationssubmitted to the enforcement;agencyfor approval Wrxtttrthts building permit-iippttcatfon,,
.S... I will.ensure that a=completed signed`copy.of thrs erttficate.of,Compliance shall;be-made available:witivthe buildin ermit(s issue? :for the :u td ri.:and ade available to f.tie°enforcement
agency for all applicable•inspections.I Linde tstandtiiat`a coa>�pleted,signed cppy of this=,Certificate°of.Com tiance'is•re uIred to be,included with�the docu entatiun th""l}la 1 erprovides tc the,
build ng:ownerat occupancy„_ .. :
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Responsible Designe&Name: Rwytonsihie Desiignersi>tna ure
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1,40;4(1)
•.110.*; '
.4:: pr-atii-de.Rguipireottagskg-AM):j iolOa041:-sYstfo740c1:10910:t,0.%qtiglk:.1310.4 WAY ieie40:q4OPProPri0..fe0irliVe:utrits,
with cOnmotrttqdirepteiltsi.tp4-ije,4Milpfc/fogOth#fi
I, PravidcreferenCes0laoS)(140,Drawing Sheet Numbers)ana/prspecifieritionS(incitidintfectioaairarcipornher.ondieley'ar4'
paragraphs)*hot.each requirement is Enter iflki/Aftll'tire'rerlairenIcatkria.t opolkokto,tho*terms,
3 Me,referenced plans and specifications musiinciiip ,t.cii.01-.0efoupwinolpfp,rin4tioptllotopilfta4;...ep atpinCritparninot
tapaiikritle.:24.47.iintroqopoolcy0,400,meno;00,0004400000.0thent:tificiet)cies. Whora'.fliultOle*.ffki00
i.040101170.0.too.:pppile00.0:041,41.1:7,'(:iftetpoiff00.:„;10cliide,all, Wheridpplidhciitandardi.apply0494:4,140*wheret
equipment 0.2ti4oirecii.to bower!."periTitie'2a1461.,ef seq.;
4, Identify whereiheyeatilation requirements are daturnentealor ench-cer40yyxtysteffi;,'4104„de tef.ofonegs,tompthxentral
unit schearilis:.and'searientes aloPgratIPP:(Jane or morO*0004.tinoturelyli,ghtilOte,,:tidentify.w4eri:thii.is documelifer14p:i .
theplans ohetspecificcitiO4%•.Multiple zone central airsystet*mostalsa provide a 114C4t0347, compliance document
'.,,,,, if ppoarrnorepaces:has 40004.0iiift01.1d*ntilcition.lilentify wherifri.specifiea"iriclatling tilg,",sovor#?etvOtions and the •
'.
sequence of OPCtiatiaa... ,,.
'.. t. If oat or more space has;occuparrisensor Jventilation contratiOrentilwiiereig,is4peCifiedinelucling'thcsensar specifications and ;..
.i
the seflOcr...c .9.TPgfelv9P •
7,„ If thie,:systoyi is`Qpgitientily,00.SeaticriecS for the SYStemstartlitopi4pdinalstart;sediack 64011.004 olgt*typ(if required);
fariiia:00-0.15.1001iti#,Che.,4PocilkatiorifPiehe,thermosiats.analitnedackilif applicable) .
8,.. identify where the cooling anedeadbarracriffloyiO4eggig40041 for this sYS'terrr,,.iii:Oa t10,g,.iefe Mace to the i.
specification of the acne controls Provide city ciF047.000000,000.0.1t.,,
.9'4: .Etit.er',AVA if there hQ.0,040kligatirWif dic.*5teril has efeetikticadpgInclicaie.which excepfionto.'214q4:(p)gppg0.4.,:;
.. , ....
• 10, Ilaattieakae,sepliri a.iiiiettestind-. 0,,taiTd.,:,cr•MH:,.04,4'...cPn70.1tance dogat:101r oust lik,'„coholitted,
.... ,. . . .. . . ,
, .. .
-Gkeut ,
.........: ....: .. .. .„...... .. ....:,.. „ . ,..... .: ,. .
iding.Eritrey OrkfeticiiStandArd*, p1p Nqprp"sici ei?tia I.cotfitv..4070.: Jitty 2014
.j: , •.,
WitAt'PRYA:WET SYSTEM RaQUIR5MeNTS
1
CEO:4NCC„...46:kiiiEiiiksimitib)(' ' -- . - • . . . .. . cAtotifit4*,-6htkdy,:cairoliatiot4..':
CERTIFICATE OF N)3Cp.f,Acti401•4E'i •
... ... .,. ._
(•HVAc'Dryik Wet Sy •i4r.tt'Requittmerits• 10.0g 44 '.
.......... . , . .. ., . .. . .... , . . : .
tsobt:11.,,, •- -r• -` 1:44teffPaTif,
,r
0'Atli 100 11:1 f To g$'and$Viteitu:';Oes4ription '4-)11/4 .Systems .„ .
:J•
MANDATORY MEASURES T-24SectionsReference to theRequr
emertiln,The,ContractIaruments.
:.-.. . .
heating Itilit•Wat4t14Plinerit'Effil,encY t3:01:...1.;-.. ,, : 1;:.„ ..,-,N.i.1\:.:,......,, :. .,,, N A.)t
Cooling Chilled Condenser •'.1.1::(XT;14a4(iy
. .._.,.....,.
..$
..,FACJjiji.1*.rifEffi0:066!::.
. .
:-Ppgrfrict....elps40)-cukciologlow.§ 1.-.1(LZ( )..:1;,: \\) A ' 'ijA---- --''....
....
,,to.(44etivitii.§t**,-44..*4-. 40y61$.,' :
. . ,,... . . .
".:.oppruppdttostf ircuit.Cooling Towers '14.44,1.40,q” i
\,)
004014Tri4111004,1gYcksf. t's) i- , .
N.)A
,
...=c01.1000•4004.(cso? . . .:,. .. .... ... .. . :,
„, . . .„ . „ , . . ... •
Open 4ridttOsotftlt,6465411hgtimet .. 110.:-2(e)'3
T.Ii*Mi,014i*''iiii:04.o-piogootkot:
,syriort.andtiog6dtircalitodth:o'rbrs
.,..
PY5041WAl60# .
Doan andClciect:',CircUit',..Coolihg Towers titi.,i( ).-5
„...
(Etilii6n't'biiitt..Eilitiiiifors1,•:, . . .
. . ,..
. ...
, . ...... .
•
Pipe Insulation 116.3 -- - . (\J i3 ..... ,..,.•..„
PRESCRIPTIVE'mtmoitt$,
tiAti
tatilfrigtower'tarttorlirols; ,
, :iAfi,j;40i4(ti)$1 ' '0 :)'. ::, allo- ... c),):(0, 0: No .. . 0`.Y„..4 allo
....., .. .
Cooling Tower flow Controls
, 1.40.1,4(h)3 , I:\? , .r.N.i
'.:entrift4gal,61-1..':Oiptiogimwer54:- 3..4p,40-04, - - tca-' :-'::::- ' tO : Ai
Air4tiiole0Chillor:otitation
1404y ' '.: 1‘,.) . •,, fk.) Al
Variable Flow 140 4(k)
thilleratiO.,:gbiler',IssilAttol; '. 140 4(k) ,..,... . , , ..,.,..:.i I-1 ' _ iv
01iv'4ni.r.iHkiM100%:,c011010.14. 140 4(k) • • ''' 14 . ..., ;: .1,. 1'1/4/..
Wit4fliciratiti.tiVatves: : 440,400 ' 1,,, ; 10..- iv--
......
YSAklitt719V;Vil;,,134W10Tfitts§. :14P 1.404(k) ',.. .. ' , ..1 ... C,,. -,. ',... ay. ., /4/
,..
PR Sensor Location 140 4(k) ....,
...
lJ
I , ,
.abtp :,,
'E ! i ,,grovicire'egtitptnerifiag .(6-, -ti:11,i'a.J).or system description(qg,,OilittThpp)*$:lttjvraprotq:•:'Iypftsple'y-p,tp-:tysttr.xpimp0n.
tt44.kOOktftc".ccitl.. oroptitgo.ftflp,,-::
:2,,, .174-60410'.eoloi*o...00•40 pfpn•F11,;"...*.„prooti ,shoorpftyrob,074:0:pd/61-'ipe:iffiotipn$(incigdmgS.e.ctibancore(azirriber:cinct::relevant -,
parogiciphi)ivih*Ceaai.i'eq6liemeni'tispeifigd.,J.Eater'!Wil!`if the requfrerneit it'neii*Iillicable to this system
..,... *ti.iixef:grencedplOns,ond:spedPcai-iems,rnust inclode.:,tilfolif4011<b*gti7i9tiPP04.0. 41#401044-0:.0.;e44,13-004004.111.4
topiitityi Title 24 rof.Opuoi eflOgg'4.7.grOtike,:i*i.),4;and gctiiit'if004.1'00001:00officiefiao.'whote:rivittbie*fficleiirk;
.. . ,-•' . ,.„. .. .
reggireidthts:;oiroppijcpmo fr.4...'full-i:304.04.1:.00,04)20L.04. a.11.For:'ch#1.00::00:(4.04g.gt-pqn-stanaarri,gffict.e*it5,provide
., .....„,. _. .... .. ,. . , .. -.,
,•' :
the ka...4:vaik,..E.oeetlillea,c,,00...hpre,.iiiiheihethe,:ificifrrteles.ore-.PathA,or Path Et,
, ..
' -
4 ,iikdifii if tooling towers,:havapropellerfthas.if towers use.cmiritivatians'doegofAvwbi6h. gopopti-l$-,q..g.4.:..
. , .
5..,-; ildir-cp6leq.chiller&areused,docament•tivhick0(OPSOP bo...Y0:,.ii:c*.h'osorto0001Witth...14,9:*/)trnellfik.010r#'14011,04.0".ijit
capacity theOYI: :Oil-obieii:0010.01n the chilled Water plant
6,. -,,id eeifip.!,t.6k xistence of 006-W1i-fed 01CI..P.0.67Ewheti open or ClOSaa'araitt cooling towers are,speciflett:to:.6e:thiStiiiied;.
',.•.' , . attig.4e-Ontor#719/A ,
. „... . ...... . , .... ...... .:..,.,.,:.:.. .
. .. . . . ... . .,.... . . ” - . :. -- - "--•
Okatiii0it enetgsigtietoW-g*ford ,.-203.;6N9oreid60,4igptiligiancg ianitaty2016
, .
A
.1 HVAC'SYSTEMQi ENTS g ,
CECMRC( MCH 02 E'(Revisod 01110) >CALIFORNIA-ENERGY CQMMISSION "
CERTIFICATEF.COMPLIANCEIRCC MCH..t3 -b
• HVAC.Wet System Requirements (Page 3 of 3)
Rrh ecti arnei '
1 ilat6 Pieiiaed:
3 ' OOCUMENTA'UON;AUTh1OR S DECI BATIOI'I STATEMENT .:,., ., ,..... ..
t:
I certifythat this Certificate ofCOmpliance d•oc•u•ment•ation,is a•ccurate and complete
J Dceurnentatin4�:Uf,Ttur Na, ff _ •
�. ..I -. --^ J.a n. .,,. nocutnentat ori s�uclsar$r$t�t�'' ... .
Gampany. Signature,0ate. •
iiilres,
�"'�� �7( • • �AjtlEk�Cetttfic�fitrnlclentrEjcahQn(r€�rPlrGalate�,�
ChyS[ate/ ! Poona
'RESPONSIBIIOtASO $DECLARATION STATEMENT'
E certify ttlefoiloya ng unfit*. nal ',o
Pe 1Y' #per)ury,under the iaws of the.State fit.afifornia;
1 The iinformat an provided on this Certificate of Compliance is true and correcii
'22. I arn'eligibble:under Division 3 ofthe I3usss and:Professions Code tq;accept'responsiibiliity for the.Iiililcdtng.design orWstem des gh,
identified°on.this Certificate of Compliance{responsible designer);;
`4,-„, The energy;featuresarid performance specifications,matetialsr corriparients,ands ma)iurfactu ed devices for the:;buildirer esiRn.or systei i.
design identified on-this Certificate:of Compliance:conform td the=tequirements of Title 24,Part1 and Part S•of the Calif irnia,.Code;of
•ftegulatibns,;
4 'The buildingdesign feat'iires or:system design features iientified on this Certificate of Comphsanee`are'consistentwitf 3 the information
provided nn.other applicable:compliance documents,worksheafs,calculations,plans specifications submitted'to the enfiorcenierit.
.
agency for approval with this building permit tpp1icatior.)
S' ).,:volt ensure that,a completed 4giled,copy of f'Sts:Certificate•of:Compiiahtce.Shal!be nidi 'avJable,with the bui ding permitf s)'lssved forth e• '
.;0000;and made available to the enforcement;ag •
ency far ail a'pplicable;inspections !undeisiand that a completed signed copy;of this:
Certificate of;Com�6 nce is required to lie incliii#eo.Vtii,the documentation`the•build r pravld;s.totl etittiidingi Wi1ll`at occupancy .,
#�
,qespnnsibia�a�signetMnrite;, ��" ftes an$ibisD0gneY3rgna urea
tornpany c .j} /n i/ ... �1 Date signed,✓' fit, q
AddreaK: I
` `L COQ ' 4 e G' c?`
kic ride«
1st-keno= r 1').4.'-9'.t.''..
hone
..= : c-, -r Q.- , , `t :[!h .` ,, "1 °3 -- 0
GA:Euiidirig toogy;gsticii~ncy,5tandards 2015 Algrlresidential:Compliance January 2026:.
irtitAt. t..itt t 0; ItY I -.0 tolttOt.KittitVilltrilkeittbi
. .
dtb-NRdd.iiiidH;tii-cikeirista.n.01/.16i , ,. ..„ -CALIFORNIA ENERGY-COMMISSION:
IKR
qFICT ., 11.1,?,,LAANgf:
fIK-C40c}17,02- -,.Q,P.4) . . ..... . . , , ... , : , ... .... .
HVAC Dry System Requirements Page I.of 3)
1 , ,.... . -... ....
P.itiOct mr06. ,--1 ..- 1 /-",
. (.' lc-% q .'_ •-'-A 1 ' 4:d - — '
' • , - . • e- • ,..' .if",, kiY • ' ' ' D*P.teOred* . .
„ ..
' ' ':. ' * 9 j te" ta.:0(1
..,....,,..,,. .
Tags. System . : 1 ,‹ 4.." '. Li 1 ' 1
A.. EijuiilmriiandlbescriptiOnt OtySVsteitit''.
_, ... ... . ._ .
IVIAISirAttiOV:MEASURES 14440004' Rg.00cO•to.thelf/OfyliVolgat$in the Contract boattnehtt
, ,. . .. ...,...,.„
140atingttitifinqrtftfficiricy4 ,' n.11.Q4:0P:I.IO...4eIn
,... ,... ..,
.t: ...:
ffi
t6ofiri3O ..-Oitipinorit tnientiO ,
'14o4,or1:10:;.2(P)
. . . ..... ., .. ,. .. . : .' . ,..... . .. ..
-.1Y:?‘C'9!•!,IP.Pt,PWYf)ern'44t.0-0- .110..:2pil;-1.1:0214.....'
Ft4rnateStandbyloss.tbnirgi 110i,*0 ki A' ' - '. ' - - - • • - '' '
,. . ,
.,
1 -'1•4*i;040.:AHui. l.:1.040); ......:,.',..,—.N.a .
i: R0 . ., ......., ..
ventitaion- , 120 (b) -•. ' ,'i•,',:,',„s4A.1-'.'"'''' -: .,'::. ' ,...',L....:.,, ' . ,
•,',. ,.,,. De6146:41,CcintibtVerittlation .'
. ..: .
•,
Occupant:.P.0.4017 V4004011 coinroi „.,,.. ...
:.12;0.1(c)5iVAg(e)$',.
.-!Shottiff andResittontrols- 120 2(e)
n.ifJutci00t.i044.ild ggt40-.t'pot.nodtgaittpl 124,2(0,
lsolbiitidttine$J. -120 2(g)
A0t01'.4tie.Dmailti'Shd Controls 120 2(h)
.,.'
Economizer DD :120 2(i)
... .
Duct Insulation "-1.20A
....,
Iffititt.tRitit(VEICAEA$tittg§ ._.. ,. . .. , . . . . ...... .
. ... .. ,. . ...... . , ..
Equipment isizattin or'rfor,rifint'a,,Aqi.tn ' 180,4(a ge*) . . .. ,
''. . 0 Yes: lc),No i I, ,0L'Sie4 70'Nii, 0..1.0 '0-:,,Ydn;
S
. ,
.. .....-.-.. .... .,...._..... ,, . . .. ., . , , . ' ,- ...-
i.ipAr,Fan Prsture'.Control
...$1.-iniiltaii0f4HeafiEboi:-
'
Economizer , 140 4(e)
'
, ..., ..
,• ., , - ..,:....: . - . ,
Fleatatid Coal.AirSitppfylteet ::146,,41(f).
giOttic.RPSIFL:44 4*.ffe,OtirlIg 140,4(g) .,., ,., . . . ky,.•,. ,.., ., i ,,.- „ ,,,,.„,
-• .
Duct Lekagealing,andtest.iikgP;; 140 4(f)
-” ' • " - .,.. . ,,.. .
Notes:
* Pr014e'equinmenftOgis,?egi.,A8.41;1to INtniti-sotlin„44criptiOrtio.,.g,sjooleptia wAy,tokgoacil"ppprcrrldfg.,:Multii,le units .:.,
With common teltglie enten0E.ctin:',.hc„,groupecltdgefiret
,..;?; etowqg,we000:4pio0$(1.;:t.:,..tkoiki.tig,she.gt..NOlber„#.onti/pr'vecificatierns‘.(iiieltidiiV,Age:09#044f07040,40r a00tottikofg.
paragraphs)Where.eiith rie:qUitement.iispeCifieth Enter f'iv/Ai!#ffie.(qtlyirprOlti*p.pt0040'0:iiiq?.tri.:111fs'sy#0.01,
3.: the referenced."plans and specifications must include all of the following .64.4:46200.ft:04 tag,•equipment nptrithat
•, .
capacity,Title 24'•'rfiliiirnirPfificI0,0,..requirements,0:000ttqiilitil:0,'.04(rifirnortt efficiencies;:Where multiple efficiency
oqiiiii*otocire applicable(e q fa...11,,4iliq;AaTt6 load)Include nil, identifyWhere'enaplihnte'..itandardS,oppiyal4iI„ where
• , - •. „ ... ....
0401Aittcntis‘retitrfirottto pelistod.:peklitte 20.160.1•etzew
...: 4, :irtentyrsfy wherethe ventilation requirements ore'dpcurneote4Igt,0.,90 1040111,..W4csYsT04-:.•?figl4.40t0:eirn-ce4,",tibotkeeptrat
• - .unit ichediries.undsequentes'nt spaces i*nti#Ntrillk.tiehtilh,te4Identify.wherei'thl=s4stiocumenter414
the,1#411441/1.4.,430/fi:tAtipopoltiotp.,:4pe. eritteli.,coi.. .0,Ais.-inusi qlSo,providea.M04-03i-E'compliance document
5, Ii*...010,*filore4104:01W4eriOnd,000.Nledventilriti6n..litentifiwhere it Istspecifierifnchtding'thOz''*0. 0.i.,.:00cifittoreosb:„.0.0 the.
4ectirteitO,ipf.Opelciticvl6 .
yoili,or more space hastrccupanf sensor ven61 a ti4 gPlArP1.140(itifi::*1)00:ft.154P-acifreetrtiOlilipg the.,serlsorsPecifkatiOns.and;
che.:sequeticg:cfpperatlop
7.-- "if thelostenrisDOCidentify the' Sentieridespi the systentstartAtop,optima!?;:sfartisetibock flift-erttfirgtiignci.setup Of.:tetAilte4
, .., ...... .. . ..... . . . ., .
Fbi!.:-Oil,Wite*idehtifi'the,ipecifierillonfOithe theitnostats:ohlitimeelqc4lifi4ppg0-41i.
g. Identify where the.,hettinztoolingtenifiieodbrind.'nftf4)W$Ore-01q40.ifik"thiS S'itStent,.friCkitte,'0 reference to the
... ,. . . ,
specification of the zoneeortrp14;,Provide rtMckf'i),4r5:4-#.nplifiritf. iff0400.iff, .. .. . .,.
9:„. fotetN/Affthtft fS..ho efeeStkijghting:.if the.system her electric he4tinTinditate whicrtexceptiontn: 49,4(gtappliO4,:-,
10 ,..ifauttie#k00400010 aneteitlidis'required,,,a*C14,:.6241:4•cpwiiiOntedik•colvfont:030A,.lie,,,50,4i,nittet,
„...,. ,
.., ... . .... .. . . ... .....„... :, . . ..
. , , . .., .... . .„. . .
cA:BundflottiovrEt.fitfencystaltdard .,,qp1:.q,Nopr4iciov0.!p0-00rico• 140.0*:V 2016•
• ..., ..,.
,. .HVAC:DRY,a,WET SYSTEM REQUIREOAENTS
.tt0',Nri.pd....roci442,-.E.Iktriise.dr.6.1/i4 .... cAtiF-15RMA-EktikilV.ditiiAiisititi :-"44.g"'"'::•:
,.„.,
CERTIFICATEOF-COMOLIANCE . :-ktiet•Atieli4014:,
1.. HVAt1Yrkti.Vti6tSyitem,Adquir6iitei4 .:- .. ..„. . ....,.;. ......... . ... , . ......_... .
tp,og,4: :.af;$1
, . Pra,0444.4ite :.' el . tor \ . Iii d .,p.:4• !,,0.00:,;-- ' •. • 96-1/.(4, i
v.<
4 ,. ......... , :„.• , . , : _ . . 4 . .
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0,.'.E4064iiOfit,TiOiiiid Sitst*::00tiirliiticifilkfilit'*isfeths: 3Y-2;14,y) Li
..:,
,, _ . , ..... . • . . .
•iviANPAIPRY'MEAttiRes: .. .1.1.4.5.ectionq: f.ItOferencg,,,iiithe,kegfitiemenislifihe!toniract octcyn4rite.
•::'
17toitriiit.Ff0WateigOlorrtorif:.Efficift-4,3 110 1
c0ii)i61(1100-404 tofiii6'.0$0:w0t01;.,1;0.;,1;#14.94),„ . itv.A• . .
Etitii*Orii::fffielOtitie,
. . .. . . _ : .• . , .. • , „ ,:. . , „ <,...„, ..,
.!'...Q.Ren'Apd-tfpgcl',.qrculy,cqoptig..T9,00 116:2(0* Mg• .
conductivityPii.if..444.. i-04*4-..iiik-'
011en.,and,Clostetircuff Coaling Towers .'' ..14;g1.0.4-
tv.10fm,c0-4)1i49otil6d9c.letit
. ,
' .
Concentration OM ' •
'1600.4atioiof.Circuit Cooling 1.;:owo, . ,- ci.;.':t-(0t -
. FloiAi'moto,,*1-6,040fog;0:44# _
„.. _,
Open and:ticiseditcLiittoolfhg•Tiawers 1102(6)4.,.. , ,' NA. .
.•0841.t.i..0C.WNailt.j. ..
.
. .
Open argt.0owtttirctilttoolihetawets ' litil(eyS - . , - > . , ..•
• -
',Efficipot'DriftVimifiatiar$ • ,„ .
' . .
....... -,... . . ., ' -
fli*I4014040.:,.. :: i20.:8'. ' ' '' ''",v./1 ' ' . :: ' • • , l',..
OttOtkinV..t.Mt4$06-0.,
1:40;'40.1)1,140 4(h)5 : ''..0 Nt-, a No." ,;. 0 Yes:'• ''',0"06'•: - 0"Y,,4"'0,446
Cooling tower Farr Confrors, •
;
.
Cooling Tower Controls
140 4(h)3 \,.)
. .‘, . ..,.:.-._ '.'. 2.::' ' 1
, . . . . . . ,._
0<ootrik$P1, oty:t':*pl:itf.g4:0Were'.
14Q4(4)*
Ai r‘7,C691. d.Ch 1110'01.t.ttOtiOn.5. i46.4):' ' '' IV
, ' ,.-.....- ,:, • , -- ,
..
Y614,1.40. 0 00.b080t0fil*(tri! 149.,4(k)-
, •.._... „. ., .. .
‘.0•iii14 atiif iipirdr#olati".00.,. ' ;.•.i.46:400„ ., . :f l' tiv . . .....,„... ,.•
•-:.
cli)eli-'0.0-;1tJHW;1140:401'ilf(*
;•ktitf.0'ktilkApilA./6.10.s : •440.4(k)
V$Poilti,A;t:si$4.t WIliii,q4rar5:2- 5.H.P, 146400
„ . , . ._.„..., ,• , .
Ap..50tO.1*4i4,0,', •'„'-, 41).:,4()) .... --- 110
''fiptOs.; . •
!'•
14. „Pity/de equipment tags(e;.-g,:;tkleo',4).:'orqAtetn.ciesceihili*(g,z..-cOw.:100),....0.00).0tocq.molookvglitg•Oth Offiti)0,11i
.;'.'*4fillit*tr*alc011,b4:4)toopo.,4 :golfiii.7.,..,::
2 ' •PiOVidef6kii.tieei..tapietW(46,.brg.44ficiSh00:(WOMbAi,5):otiiiiiii:, 00ilfiealtian. (Incluiling.Sgctieyrotore/fiumberonr);:feleVani
paragiqli.4,ivh'oeie.q4h:i'equii-ernefit4§,,':,spe.cifiecLinteeWA",lif:04 requiiernetieis not golicable icythis.-•oiierti
;. 'j, :•".thg.,:rifergnceciplans..0.-ndSspecifications:must include all thelolip01.4,10.0rration: cipip.i.ogrg 00,;•eti0101*fft Ornitki.l'''.
capacity,,ti.ti 24:•tfilPitTiPra'0#00P.Pkrfq(ilteitg-04;9.1.7.4CIPqat'fqr0."4'•Offirifti'Mg•fficiOWWhi>i.e.,101.t.ij;51kefficiOiitk
iiiiit 00110-4f6,,,60011e0/44(4.*.filik 00.ctiJoit400)11itiii0;VI.Aketillki;g::00i-Attloqpt.hcin4tondord4ffideiiesprovide
Oio441'110164;.tok'thillete..,plio,hote Whothefha,'.sfficie.pcies.-cirg,Pody4:•orPathtk
4 -litnillyi4cpoting fowers,havepropellet)bris.If towers u4eco•Ofttg6,1farts,V6tyment'whfth0K00on is used
•' ,.5, ; (fair coaled chillers are used,document which except onshat/e kieen used.0<comfiliii with1444(1)dnd40.00101,0401100iigfr
e4,6.004ti*Ofit-P0:00./.6100t.s....41 fOo,.031110:0*-00tPlai/t
• 6, •-Viii-f6<ftiOit't.i.e.1,1-3fici,•46700-6„ig-d Ma-t-06,,E.Wheit.atietj':.pr.cliged'ckculf roolitvtqwers.ore•vecifiedtg:beln4dIfe-di,
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:cr=c ivRcc14tct1-o2 E(Ri4iied oiii00 XiaFORR(.M ENERGY GOMMlsstol4 :
`CER FA:ATE OF COMPLIANC
.HVAC:Wet System Requrrernerrts -
IIRC: MCff:02=E
�, i i . . . (Page 3:of 3�
1<1.,1.Qpl^ K j 0419-Rrnpared.
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A.OCUMENTA'tibriAUOR,'SOECLARATION:STA1T MENT'
t certify thattfits Certificate;of tornulialsce docxnnentation is,accurate and complete. . „
• 00cu nkat /
., AAth,titt 4* yrmatrti0siAUthorPg1:04,*
z ompar S1ii6. tie bate;
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1. Address �! t
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Y 1 certify tfiefollowing wider-peccral1ty of perjury,under the laws of the5tate of tafifotniat
?. The information p,c?tided Op•'.11 s Certif cate of Compl ansa.is true;and correct
2 Tam eligible'Under DTvrsfon 3.of the Sur mess and'Professions Codeto acceptres aartsibilitty, re fothe.buiilding. cdesign or,system design
identified ori;thrs Certificate•of Compliance ire sporrstble designer};;
3 The energy features and performance speciffcatiorts„materials componeltts,and matrufactured devices for the building.design;or system'
R .a#onstified on;tht Certificate pf Gompl arise conform to..the requireritents of Tate Z4,Part 1 enrl,Part,0 cif".the Calkfornta.:(otfe.of'
:4 The buwldrng design”featsrres or'systerrr,design features tdentifled:on this Certificate: Co
• ofCompliance are tonsistOnt ihith,the•information
provieded on;other appifcablt tornptfarice.doi:umenss,worksheets,calci.14.T its pians atzd apeciRtatioris:subirttittecf to the enforcementt
agertcyffor approval with auild
ils bing pertrnt aplication
' ',S I will e.iiig*tiata complefud signed copy,•ofihis Certificate.of.Congiiaritdshefig t74cteAyaila}01e+11 1thiebuilding pertrtttis}-issued.foi•Ahei.
building,and maade available to`the enforcement agency for.alfapplicable:liispectiorzs,l understand that a completed signed cpy;of'th's
Cert ficat'e of:-CCorrr iUnce isrequirCd to pe included Wittrsthe documentation thehuii 'er prsavides:to°ttre 4rititliria oWnet;a't occupan
iesgarisibieoesimsr,Jvat»e, �y
Respdnsible ttsigr+er 5a atvte.
Com�s' IIdt3tg94Jt-;
Q L3 d t�''
C, tisen6i` k11. 1. C8
atis7StatelZip'
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t:A'$titic irig E*ieTgy Et ctdrgcVS?and t4:s,-'gc4, N tOs.igeritial Cot#,plfance Jartuary.2015