15010143CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10373 TORRE AVE
CONTRACTOR: CIVIC CENTER PERMIT NO: 15010143
PROFESSIONAL GROUP
OWNER'S NAME: CIVIC CENTER PROFESSIONAL GROUP
10373 TORRE AVE UNIT G DATE ISSUED: 10/29/2015
OWNER'S PHONE: 4082573031
CUPERTINO, CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
STE H-FOR DENTAL OFFICE-ENCLOSING EXISTING PATIO
License Class Lie, #
INTO ADDITIONAL TENANT SPACE (100 SQ FT).
Contractor Date
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.
I hereby affirm under penalty of perjury one of the following two declarations:
1. l have and will maintain a certificate of consent to self-insure for Worker's
Sq. Ft Floor Area:
Valuation: $20000
Compensation, as provided for by Section 3700 of the Labor Code, for the
APN Number: 36940020.10373
Occupancy Type:
performance of the work for which this permit is issued.
2. I 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.
PERMIT EXPIRES IF WORK IS NOT STARTED
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
correct. I agree to comply with all city and county ordinances and state laws relating180
D L LLED INSPECTION.
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
A—
indemnify and keep harmless the City of Cupertino against liabilities, judg
C® 5
y: Date:
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply with
all non-point source regulations per the Cupertino Municipal Code, Section 9.18.
RE-ROOFS:
Signature Date
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1. I, as owner of the property, or my employees with wages as their sole
HAZARDOUS MATERIALS DISCLOSURE
compensation, will do the work, and the structure is not intended or offered for
_ ale (Sec.7044, Business & Professions Code)
owner of the property, am exclusively contracting with licensed contractors to
I have read the hazardous materials requirements under Chapter 6.95 of the
construct the project (Sec.7044, Business & Professions Code).
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
I hereby affirm under penalty of perjury one of the following three declarations:
Safety Code, Section 25532(a) should I store or handle hazardous material.
1. 1 have and will maintain a Certificate of Consent to self-insure for Worker's
Additionally, should I use equipment or devices which emit hazardous air
Compensation, as provided for by Section 3700 of the Labor Code, for the
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
performance of the work for which this permit is issued.
Health & Safety Code, Sections 25505, 25533, and 25534.
2. I 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
wne r an or' ed agee. t
t
.permit is issued.
Date:
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
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
I hereby affirm that there is a construction lending agency for the performance of work's
become subject to the Worker's Compensation provisions of the Labor Code, I
for which this permit is issued (Sec. 3097, Civ C.)
must forthwith comply with such provisions or this permit shall be deemed
Lender's Name
revoked.
Lender's Address
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
ARCHITECT'S DECLARATION
correct. I agree to comply with all city and county ordinances and state laws relating
I understand my plans shall be used as public records.
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
Licensed Professional
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply with
all non-point source re lations per the Cupertino Municipal Code, Section 9.18.
to Date 1
�1 49/ Y3
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 FAX (408) 777-3333 - buildingacupertino.orq
CUPERTINO I
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PROJECT ADDRESSAPN R _40
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT !KT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NA 714-13eIrnT
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LICENSE NUMBER
LICENSE TYPE
BUS. LIC 9
COMPANY NAME ++,,.� �^q �j-y7y��. ,
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DESCRIPTION OF WORK
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EXISTING USE -
PROPOSED USE CONSTRPE
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TYPE
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SQ.FT.
VALUATION($)
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EXIST( ?��/J,.ep
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AREA ' I
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BATHROOM
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REMODEL AREA
DELAREA
�ARITA_GARAGE
PORCH AREA
DECK AREA
TOTAL DECK RCI
.AREA: DETACH
❑ ATTACH
4 DWELLING UNITS:
IS A SECOND UNIT ❑ YES
- BEING ADDED?
SECOND STORY ❑ YES
ADDITION? Wo
iVO
PRE -APPLICATION' []YES IF YES, PROVIDE COPY --OF
IS THE BLDG AN ❑YES
RE.CEIVED,BY pM''�
-�.,.,_ ,�.
-- =
TALV.ALUATION:
PLANNING APPL 0 r_1 NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act o t roperty owner's behalf. I have read this
and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
application
ordinances and state laws relating to bui l gco true ` I&tho ze rg resentatives of Cupertino to enter the above -identified property for inspection purposes.
�/ !�? ! 6i
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED'
Rte,,,,
PYANC73ECI- YP,E,
New SFD Multifamily dwellings: Apply for demolition permit for
p
ad
J],' s t GPLAN RE�IEiV '
or
existing building(s). Demolition permit is required prior to issuance of building
ox T> corTl.xER
Permit for new building.>
603
xxs5s w
LAT,mP Alt xEYIEw
_ Commercial Bldas: Provide a completed Hazardous Materials Disclosure
Materials being as of this
t h
❑ sTANDXxD s+�
r
srt'
pTIBI rcolt>zs
form if any Hazardous are used part project.
D I;4RGEi
IRE DEPT i* a
Copy of Planning Approval Letter or Meeting with Planning prior to
4
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❑ - SAlYIT�R3' SE\i'ERAISTHICT.
_
submittal of Building Permit application.
1lIAAJOFt
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BTdgApp_2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: -Torre Ave DATE: 0112612015 REVIEWED BY: Sean
APN: BP#: h *VALUATION: $20,000
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY PENTAMATION 1 GENCOM
USE: Commercial Building PERMIT TYPE:
WORK Enclosin existing patio into additional tenants ace 100 sq ft).
SCOPE
11c=c,t. Plan Cpec:,
3 71hanb. Plara C heeA Flec..Plan {, nsck
;
F
x Plwrb, Perndf Fee: I lc,c. Perirat r'� e:
vfi>cir. c t rui 1�>tz:
0"Ijsex 'W'dt. 1r. p, Other Pluirb In.S V. L J 01/ter I'k- °. Itssn.
III....�JJJ i'hini7 hn ;, Fee,: 1 °lec. Insp.Fee:
1c:ch 'n�'1t_ Fee:t
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fare, Sanitary Sewer District, School
District, etc.. These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l in o.
FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS
N $0 00 21 hours Plan Check, Hourly
Plan Check Fee: Hourly Only.
U. Yes
Suppl. PC Fee: (j)Reg. 0 OT
0.0
hrs
$0.00
$286.00
ISTPLNCK
PME Plan Check:
$0.00
Permit Fee: Hourly Only?
® Yes Q No
$0.00
Suppl. Insp. Feer Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:.
$0.00
consiruction Tax:
'Mi ini, trat;ve Fe'e:
Work Without Permit? 0 Yeses No
$0.00
Advanced Planning Fee_ $0.00 C� hours Inspections
1,jx l lac} , tarn/ �1;r.,ri Fc�eS: $715.00 ISTINSP Inspection, Hourly
Strong Motion Fee: 1BSE151vrrco $5.6 0 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUI?TALS
BT : $6.60 $1,001.00 _ 611
R 0
IlE: I $1,007.60
Revised: 01/06/2015
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: 15010143
10373 TORRE AVE CUPERTINO CA 95014 (369 40 020)
(COBE
CONSTRUCTION INC)
CAMPBELL, CA 95008
OWNER'S NAME: CIVIC CENTER PROFESSIONAL GROUP
DATE ISSUED: 10/29/2015
OWNER'S PHONE: 408-257-3031
PHONE NO: 408-371-3400
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class a Lie. #1335122
Contractor ( COBE CONSTRUCTION INC ) Date 02/26/2016
—BLDG _ELECT _PLUMB
MECH RESIDENTIAL _ 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:
STE H-FOR DENTAL OFFICE-ENCLOSING EXISTING PATIO
I hereby affirm under penalty of perjury one of the following two declarations:
INTO ADDITIONAL TENANT SPACE (100 SQ FT).
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 of the work for which this permit is issued.
�. I 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.
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
7/28/15 PERMIT APPLICATION EXTENDED TILL 10/25/15.
ordinances and state laws relating to building construction, and hereby
Sq. Ft Floor Area:
Valuation: $20000.00
authorize representatives of this city to enter upon the above mentioned
property for inspection purposes. (We) agree to save indemnify and keep
harmless the City of Cupertino against liabilities, judgments, costs, and
APN Number:
Occupancy Type:
expenses which may accrue against said City in consequence of the
369 40 020
369
granting of this permit. Additionally, the applicant understands and will
comply with all non-point source regulations per the Cupertino Municipal
Code, Section 9.18.
PERMIT EXPIRES IF WORK IS NOT STARTED
�--
Signature---�'�"� Date 02/26/2016
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
s
ARATION
180 DAYS FROM LAST CALLED INSPECTION.
OWNER-BUILDER DF
I hereby affirm that I am exempt from the Contractor's License Law for one of the
Issued by: MELISSA NAME
following two reasons:
Date: 02/26/2016
1. I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered
RE-ROOFS:
for sale (Sec.7044, Business & Professions Code)
All roofs shall be inspected prior to any roofing material being installed. If a roof is
2. I, as owner of the property, am exclusively contracting with licensed
installed without first obtaining an inspection, I agree to remove all new materials for
contractors to construct the project (Sec.7044, Business & Professions Code).
inspection.
I hereby affirm under penalty of perjury one of the following three declarations:
t. I have and will maintain a Certificate of Consent to self-insure for Worker's
Signature of Applicant:
Compensation, as provided for by Section 3700 of the Labor Code, for the
Date: 02/26/2016
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation Insurance, as provided for
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
by Section 3700 of the Labor Code, for the performance of the work for which
this permit is issued.
HAZARDOUS MATERIALS DISCLOSURE
a. 1 certify that in the performance of the work for which this permit is issued, I
I have read the hazardous materials requirements under Chapter of the
shall not employ any person in any manner so as to become subject to the
California Health &Safety Code, Sections 25505, 25533, and 25534.34. I will
Worker's Compensation laws of California. If, after making this certificate of
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
exemption, I become subject to the Worker's Compensation provisions of the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
Labor Code, I must forthwith comply with such provisions or this permit shall
material. Additionally, should I use equipment or devices which emit hazardous
be deemed revoked.
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
APPLICANT CERTIFICATION
the Health & Safety Code, Sections 25505, 25533, and 25534.
1 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
Owner or authorized agent:
relating to building construction, and hereby authorize representatives of this city
to enter upon the above mentioned property for inspection purposes. (We) agree
Date: 02/26/2016
to save indemnify and keep harmless the City of Cupertino against liabilities,
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
judgments, costs, and expenses which may accrue against said City in
of work's for which this permit is issued (Sec. 3097, Civ C.)
consequence of the granting of this permit. Additionally, the applicant
understands and will comply with all non-point source regulations per the
Lender's Name
Cupertino Municipal Code, Section 9.18.
Lender's Address
Signature Date 02/26/2016
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Ton-e.Avenue
Cupertino, CA 05014-3255
lelLplione: X408-777-3228
Far: 408-777-3333
*Our municipal code requires all businesses working in the city to have a City of Cupert— hio business license.
NO BUILDING FINAL, OR FINAL OCCUPANCY INSPECTION(S) WILL, BE SCHEDULED UNTIL, THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPE:RTINO
BUSINESS LICENSE...
I ani not using any subcontractors:
Signature
Please check applicable subcontractors and complete the following information:
.Date
V
SUBCONTRACTOR
BUSINESS NAMEBUSINESS
LICENSE ##�
Cabinets cry: Millwork
Cement Finishing
Electrical
--.__
� U/YeA 6�a
.... .... _.__.._...
Excavation
-_........___..___.___.._..._
.Fencing
...^.._...
'Flooring/ Carpeting
Linoleum /Wood
Glass / Glazing
Heating
Insulation
ff� 6W7
Landscaping
____......�._—..
Lathing
HMasonry
Painting / Wallpaper
...._........ .
Paving
Plastering
Plumbing
Septic Tank-
`�� � ry ---
,
__.._.sem
44Roofing
........_...__......_....__....,..
Sheet Metal
- __._....__..__.. _ ...._.._
' "--
-..—_.___......_
Sheet Rock
—
.._ ---
Tile_
....--._........_
17
4-- caner / —Contractor Signature ---- ---.-.---.__._..
ate
�K�
i�
t;
CUPERTINO
OWNER -BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 - build! noaecupertino. oro
Dear Property Owner(s):
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at:
I ES _:......APN. C BPS
36 Z — `�o -azd mor q
wNER N Mi _
0WN_EER� D z
- bno
DESCRIPTION OF WORK: ccivV
We are providing you with an Ownet-Builder Acknowledgment and Information Verification Form to make you aware of
your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We
will not issue a building permit until you have read, initialed your understanding of each provision, signed, and
returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless
you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
(DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.)
t 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -
Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material
personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by
an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not
provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my
insurance coverage for injuries to workers on my property.
2. 1 understand, building permits are not required to be signed by property owners unless they are responsible for
/�ttruction and are not hiring a licensed Contractor to assume this responsibility.
3. 1 understand as an "Owner -Builder" I am the responsible party of record on the -permit. I understand that I may
rotect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her
na a instead of my own.
4. I understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
f� 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the
total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be
/ c Idered an "employer" under state and federal law.
1 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and
federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to
unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject
me to serious financial risk.
/7.tential
1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family
structures cannot legally build them with the intent to offer them for sale, unless all work is performed by
licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work
is performed under contract with a licensed general building Contractor.
6. I understand as an Owner -Builder if 1 sell the property for which this permit is issued, I may be held liable for
any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction
defects in the workmanship or materials.
OwnerBuilderForm 2010.doc revised 04/14/10
ff-9. 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal
Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments,
and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State
License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed
A0.
co
1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I
a t e party legally and financially responsible for proposed construction activity at the site address listed above.
hL11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide
yall applicable laws and requirements that govern Owner -Builders as well as employers.
12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
information l have -provided on this form. License contractors are regulated bylaws designed to protect.the.public. If
you contract with someone who does not have a license, the Contractors' State License Board may be unable to
assist you with any financial loss you may sustain as a result of a complaint. -Your only remedy against unlicensed
Contractors maybe in civil court. it is also important for you -to understand that if an unlicensed Contractor or
employee of that individual or firm is injured .while working on your property, you may held liable for damages. If -
you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not
those Contractors are properly licensed and the status of their workers' compensation insurance coverage.
CONSTRUCTION LENDING AGENCY
(DIRECTIONS: Please complete the following construction lending agency information.)
I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued
(Sec 3097 Civ.)
Lender Name: Lender Address:
Before a building permit can be issued, this form must be completed and signed by the property owner and
returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license,
form notarization, or other verification acceptable toth ity may be required to be presented when the permit is issued
to verify the property owners sLqn2tjre.If 14,
Property Owner's Signature: Date -; 7,J9 -Zr
-
-------------------------------------------------------------------------------------------------------------------------------------------
--
(NOTE: The following Authorization Form is required to be completed by the property ov✓neronly when designating an
agent of the property owner to apply for a construction permit for the Owner -Builder).
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby
authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an
Owner -Builder Permit for my project. p
Scope of Construction Project (or Description of Work).Z� IY1 dTl Pllc'�Q52c� �1C�
Project Location or Address: )0_373 lc_ r-, alr, # Cu tan-0 (3+ ��r
Name of Authorized Agent: Pd (m W"' (n l n (9 MaDW Tel No .408
Address of Authorized Agent:103 83 Tar -e (auc O --A C�ppr
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the
above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other
verification acceptable to the city may be required to e presen when the permit is issued to verify the property owner's
signature. /
Property Owner's Signature: Date:
OwnerBuilderForm_2010.doc revised 04/14/10
2/26/16
10383 Torre Ave Suite I
Cupertino, CA, 95014
Cupertino Dental Group
To Whom it may concern,
We pulled a permit in October as owner builder by mistake and at this time we would like to
change it to Contractor with Cobe Construction. This dental practice uses both Suite I and H.
Alex Pagonis DDS
Cupertino Dental Group
408-257-3031
Please call if any concerns.
FILE
New 2x12 DF #2 ledger
oD 3
2 16d at every stud ' 7 -6 -
New
class A roofing tile roof lJ
to match (e); install over 30# felt
Additional R-30 Insulation in rafters.
Maintain 1" min airspace per CBC 1203.2
Attic vents above insulation
Min. 96 sq. inches -
(E) Parapet
New 8" plywood w/
8d @ 4" o.c. edge, 12" o.c. field Profile of (e) roof
New 2x12 DF #2 Rafters @16" o.c.
with solid blocking at mid -span
New 6" HVAC duct
2x6 DF#2 ceiling joists @ 16" o.c. w/ R8 Insulation
with blocking at mid -span
and (5) 16d @ every rafter
New 6" HVAC duct w/ R-8 insulation- j -- Existing HVAC system
2x6 ledger w/ joist J
Continuous screen attic vents hangers and (2)
Match (e); min. 96 sq in. - 16d @ every stud Existing Space
00
New R-30 fiberglas batt Lay -in ceiling
insulation in new ceiling (e) bearing wall with shear panel
New R-15 fiberglas batt New office
insulation in new walls
Revised East-West Section
s
BUILDING ENERGY ANALYSIS REPORT
PROJECT:
Cupertino Dental Group CFIVED
I03%3. ---Torre Aver# APR 17 2015
Cupertino, CA 95014
L -
Project Designer:
Paul H. Fick Architect
550 Calero Ave
San Jose, CA 95123
408-281-4400
Report Prepared by:
Nicholas L Bignardi NR08-12-3847
FRI Energy Consultants, LLC sUBMITTAL
21 N. Harrison Ave, Suite 210 ##2
Campbell, CA 95008
408-866-1620
Job Number:
0150290
4/1D5/2COPYQFFscE
The EnergyPro computer program has been used to perform the calculations summarized in this compliance report. This program has approval and is
authorized by the California Energy Commission for use with both the Residential and Nonresidential 2013 Building Energy Efficiency Standards.
This program developed by EnergySoft, LLC — www.energysoft.com.
EnergyPro 6.5 by EnergySoft User Number: 1315 ID: 0150290 1
9
TABLE OF CONTENTS
Cover Page
1
Table of Contents
2
Form ENV -01 -E Envelope Component Approach
3
Form ENV -02-E Fenestration Worksheet
7
Form ENV -MM Envelope Mandatory Measures
9
Form LTI-01-E Indoor Lighting
10
Form LTI-02-E Lighting Controls
15
Form LTI-03-E Indoor Lighting Power Allowance
18
Form MCH -01-E Mechanical Systems
21
Form MCH -02-E HVAC System Requirements
24
Form MCH -03-E Mechanical Ventilation and Reheat
26
Form MCH -04-E Required Acceptance Tests
28
STATE OF CALIFORNIA
ENVELOPE COMPONENT APPROACH
CEC-NRCC-ENV-01-E (Revised 06/14) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-ENV-01-E
Envelope Component Approach (Page 1 of 4)
Project Name: Cupertino Dental Group Date Prepared: 4/15/2015
A. GENERAL INFORMATION
1
Project Location:
6 Compliance Method:
m Component ❑ Unconditioned (file
5
10383 Torre Ave Suite I
7
Affidavit)
2
CA City and Zip Code: Cupertino, 95014
7 Building Front Orientation (deg or cardinal):
180 deg
3
Climate Zone: 4
8 Permitted Scope of Work 1 ❑ New Construction IZI Addition ❑ Alteration
4
Total Conditioned Floor 105
9 Building Type(s)
❑ Nonresidential ❑ High -Rise Residential ❑ Hotel/Motel Guest Room
Proposed
U -Factor
Area:
Comments
1
5
❑ Schools (Public School) ❑ Relocatable Public School Bldg. 13 Conditioned Spaces ❑ Unconditioned Spaces
2x4 @ 16
❑ Skylight Area for Large Enclosed Space > 5000 ftz (If checked include the NRCC-ENV-04-E with submittal)
B. ENVELOPE DETAILS — Framed
1
2
3
4
5
6
7
8
9
10
11
Tag/ID
Assembly Type
Frame
Material
Frame
Depth
Frame
Spacing
Appendix JA4
Reference
Cavity
R -value
Continuous
Insulation
R -value
Proposed
U -Factor
Required U -Factor From
Tables, B, C, D
Comments
1
Wall
Wood
2x4 @ 16
4.3.1-D22
15
0.0
0.059
0.059
R-13 Wall
2
Roof
Wood
2x4 @ 24
4.2.1-A20
30
0.0
0.031
0.039
R-30 Roof Attic
C. ENVELOPE DETAILS — Non -framed
1
2
3
4
5
6
7
8
9
10
Tag/ID
Assembly Type
Assembly Materials
Thickness
(inches)
Interior or
Core
Insulation
R -value
Continuous
Insulation
R -value
Appendix JA4
Reference
Proposed
U -Factor
Required U -Factor from
Tables, B, C, D
Comments
Required U -Factor from
Tables, B, C, D
Comments
D. ENVELOPE DETAILS — Mass
1
2
3
4
5
6
7
8
9
10
11
Tag/ID
Mass
Type
Density
(Ib/ft3)
Mass
Thickness
(inches)
Furring Strip
Thickness
(inches)
Interior
Insulation
R -value
Exterior
Insulation
R -value
Appendix JA4
Reference
Proposed
Insulation
U -factor
Required U -Factor from
Tables, B, C, D
Comments
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014
STATE OF CALIFORNIA
ENVELOPE COMPONENT APPROACH
r��)
CEC-NRCC-ENV-01-E (Revised 06/14) UAW-UKNIA ENEHUY GUMMIJJIUN
CERTIFICATE OF COMPLIANCE NRCC-ENV-01-E
Envelope Component Approach (Page 2 of 4)
Project Name: Cupertino Dental Group Date Prepared: 4/15/2015
E. ROOFING PRODUCTS (COOL ROOF)
1
2
3
4
5 6 7
8 9 10
11
Mass Roof
Whole Building
Air Leakage Testing
Comments
Proposed
Minimum Required
Aged Solar
Thermal
SRI
Aged Solar
Thermal
SRI
25 Ib ft2
CRRC Product
or greater
Roof Pitch
ID Number
Product Type
Reflectance
Emittance
(Optional)
Reflectance
Emittance
(optional)
Comments
❑
5/12
❑1
0.20
0.75
0.20
0.75
R-30 Roof Attic
❑
❑1
❑
❑'
❑ An aged solar reflectance less than 0.63 is allowed provided the maximum roof / ceiling LI -factor in TABLE 140.3 is not exceeded
❑ High-rise residential buildings and Hotels and Motels with low -sloped roofs in Climate Zones 1 through 8, 12 and 16 are exempted from aged Solar
Reflectance and emittance requirements.
❑ High-rise residential buildings and Hotels and Motels with steep -sloped roofs in Climate Zones 1 and 16 are exempt from aged Solar Reflectance and
emittance requirements.
❑ The roof area covered by building integrated photovoltaic panels and building integrated solar thermal panels are exempt from aged Solar Reflectance
and emittance requirements
To apply Liquid Field Applied Coatings, the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage recommended
by the coatings manufacturer and meet minimum performance requirements listed in §110.8(i)4. Select the applicable coating:
❑ Aluminum -Pigmented Asphalt Roof Coating
❑ Cement -Based Roof Coating
❑ Other
NOTES:
1. Check the box if the aged Solar reflectance was not available in the Cool Roof Rating Council's Rated Product Directory, Then use the equation in Section 110.8(i)2 where the Initial Reflectance
value from the some directory and use the equation (0.2+B(p;,i;rio1 — 0.2) to obtain a calculated aged value. Where p is the Initial Solar Reflectance and a is either set to 0. 65for Field -Applied
Coatings or it is set to 0. 70for all other roofing products other than Field -Applied Coating.
2. Calculate the SRI Value by using the SRI -Worksheet at (TBD) and enter the resulting value in the SRI Column above and attach a copy for the SRI -Worksheet NRCC-ENV-03-E to the to this form.
F. Air Barrier
1
2
3
4
5
Tag/ID
Air Barrier
Material Type
Air Barrier
Assembly Type
Whole Building
Air Leakage Testing
Comments
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014
pp -
STATE OF CALIFORNIA
ENVELOPE COMPONENT APPROACH
rn-J4
CEC-NRCC-ENV-01-E (Revised 06/14) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-ENV-01-E
Envelope Component Approach (Page 3 of 4)
Project Name: Cupertino Dental Group Date Prepared: 4/15/2015
G. FENESTRATION PROPOSED AREAS AND EFFICIENCIES
1
2
3
4
5
6
7
8
9
10
11
12
Tag/ID
Fenestration Type
Area
Orientation
N, S, W, E
or Roof
# of
Panes
Max
U -Factor
Overhang
Max
(R)SHGC
Min
VT
Label
Conditions
Status
Comments
H. ENVELOPE MANDATORY MEASURES
Indicate location on building plans of Mandatory Envelope Measures Note Block: ENV -MM
INSTRUCTIONS TO APPLICANT ENVELOPE COMPLIANCE & WORKSHEETS (check box if worksheet are included)
For detailed instructions on the use of this and all Energy Efficiency Standards compliance forms, please refer to the Nonresidential Compliance Manual.
0 NRCC-ENV-01-E Certificate of Compliance. Required on plans for all submittals.
❑ NRCC-ENV-04-E Use when minimum skylight requirements for large enclosed spaces are required in climate zones 2 through 15. Optional on plans.
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance
June 2014
STATE OF CALIFORNIA
ENVELOPE COMPONENT APPROACH
CEC-NRCC-ENV-01-E (Revised 06/14) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-ENV-01-E
Envelope Component Approach (Page 4 of 4)
Project Name: Cupertino Dental Group Date Prepared: 4/15/2015
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certificate of Compliance documentation is accurate and complete. in
Documentation Author Name: Nicholas L Blgnardl NR08-12-3847
Documentation Author Signature:
Company FRI Energy Consultants, LLC
Signature Date: 4/15/2015
Address: 21 N. Harrison Ave, Suite 210
CEA/ HERS Certification Identification (if applicable):
City/state/zip: Campbell, CA 95008
Phone: 408-866-1620
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 Compliance is true and correct.
2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible
designer).
3. The energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance
conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations.
4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents,
worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application.
5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be 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 Compliance is required to be included with the documentation the builder provides to the
building owner at occupancy.
Responsible Designer Name: Paul Fick
Responsible Designer Signature:
Company: Paul H. Fick Architect
Date Signed:
Address: 550 Calero Ave
License:
City/State/Zip: San Jose, CA 95123
Phone` 408-281-4400
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014
STATE OF CALIFORNIA
FENESTRATION WORKSHEET
CEC-NRCC-ENV-02-E (Revised 06/14)
CALIFC
ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-ENV-02-E
Fenestration Worksheet (Page 1 of 3)
Project Name: Cupertino Dental Group Date Prepared: 4/15/2015
A. WINDOWS DETAILS Worksheet §140.3(a)5B and C
NOTE: Newly installed fenestration shall have a certified NFRC Label Certificate or use the CEC default tables found in Table 116-A and
Table 1168. Site -built fenestration less than 1,000 ft2, or more than or equal to 1, 000 ft2 see Reference Nonresidential Appendix NA6.
1
2
3
4 5 1 6 1 7 8 1 9
10 1 11 1 12 13 14
Tag/I
D
Window Type
(e.g., Window -1
Area
Fenestration
D. Enter Proposed West Window Area
10 ft2 Proposed West Window Area
Note: If the PROPOSED WEST WINDOW AREA is greater than the MAXIMUM STANDARD WEST AREA then the envelope component
approach may not be used.
Overhang
U -Factor
SHGC
VT
Dimensions
F. Linear Display Perimeter
0
Calculated
C o
—
a Q
a o
—
a Q
C o
—
a Q
H
V
HIV
(R)SHGC
Proposed
Max
(R)SHGC
Allowed
B. WEST WINDOW AREA CALCULATION See §140.3(a)5A in the Energy Standards
A. Gross West Exterior Wall Area
81
ft2 x 0.40 =
33 ft2 40% of Gross West Facing Exterior Wall Area; or
B. West Display Linear Perimeter
0
FT x 6 ft =
0 ft2 West Display Perimeter Area
C. Enter Larger of A or B
33 ft2 Maximum Standard West Area
D. Enter Proposed West Window Area
10 ft2 Proposed West Window Area
Note: If the PROPOSED WEST WINDOW AREA is greater than the MAXIMUM STANDARD WEST AREA then the envelope component
approach may not be used.
C. WINDOW AREA CALCULATION for all other orientations other than West - See §140.3(a)5A in the Energy Standards
E. Gross Exterior Wall Area
164
ft2 x 0.40 =
66 ft' 40% of Gross Exterior Wall Area or
F. Linear Display Perimeter
0
FT x 6 ft =
0 ft2 Display Perimeter Area
G. Enter The Larger of E or F
66 ft2 Maximum Standard Area
H. Enter Proposed Window Area
0 ft2 Proposed Window Area
Note: If the PROPOSED WINDOW AREA is greater than the MAXIMUM STANDARD AREA then the envelope component approach may
D. SKYLIGHT AREA CALCULATION See §143(a)6A in the Energy Standards
ACTUAL GROSS
ROOF AREA
STANDARD
ALLOWED
A IF Atrium/Skylight Height is <_ 55 ft; or
105
ft2 X 0.05 =
5 ft2
B. IF Atrium/Skylight Height is > 55 ft
ft2 X 0.10 =
ft2
C. Proposed Skylight Area (from plans)
0 ft2
D. Skylight SSR %' 2 = Proposed Skylight Area Divided by Actual Gross
0.0
1. If the SKYLIGHT SSR % is less than or equal to 5% then choose the appropriate column in Table 140.3-B and C and row in Table 140.3-D.
2. If the SKYLIGHT SSR % is greater than 5% then the Envelope Component Approach may not be used.
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014
STATE OF CALIFORNIA
FENESTRATION WORKSHEET
CEC-NRCC-ENV-02-E (Revised 06/14)
CALIFCjt_® I
ENERGY COMMISSION _
CERTIFICATE OF COMPLIANCE NRCC-ENV-02-E
Fenestration Worksheet (Page 3 of 3)
Project Name: Cupertino Dental Group °ate Prepare°: 4/15/2015
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name: Nicholas L Blgnardl NR08-12-3847
Documentation Author Signature:
Company FRI Energy Consultants, LLC
signature Date: 4/15/2015
Address: 21 N. Harrison Ave, Suite 210
CEA/ HERS Certification Identification (if applicable):
City/state/zip: Campbell, CA 95008
Phone: 408-866-1620
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 Compliance is true and correct.
2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified
on this Certificate of Compliance (responsible designer).
3. The energy features and performance specifications, materials, components, and manufactured devices for the building design or system
design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of
Regulations.
4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information
provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement
agency for approval with this building permit application.
5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be 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 Compliance is required to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name:
Responsible Designer Signature:
Company: Paul H. Fick Architect
Date Signed:
Address: 550 Calero Ave
License:
City/state/zip: San Jose, CA 95123
Phone: 408-281-4400
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014
ENVELOPE MANDATORY MEASURES: NONRESIDENTIAL ENV -MM
Project Name
Date
Cupertino Dental Group
4/15/2015
DESCRIPTION
Building Envelope Measures:
Installed insulating material shall have been certified by the manufacturer to comply with the California Quality
§110.8(a):
Standards for insulating material, Title 20 Chapter 4, Article 3.
All Insulating Materials shall be installed in compliance with the flame spread rating and smoke density requirements of
§110.8(c):
Sections 2602 and 707 of Title 24, Part 2.
The opaque portions of framed demising walls in nonresidential buildings shall have insulation with an installed R -value
§110.8(f): of no less than R-13 between framing members.
All Exterior Joints and openings in the building that are observable sources of air leakage shall be caulked, gasketed,
§110.7(a):
weatherstripped or otherwise sealed.
Manufactured fenestration products and exterior doors shall have air infiltration rates not exceeding 0.3 cfm/ft.z of
§110.6(a): window area, 0.3 cfm/ft.Z of door area for residential doors, 0.3 cfm/ft.Z of door area for nonresidential single doors
(swinging and sliding), and 1.0 cfm/ft.z for nonresidential double doors (swinging).
§110.6(a): Fenestration U -factor shall be rated in accordance with NFRC 100, or the applicable default U -factor.
Fenestration SHGC shall be rated in accordance with NFRC 200, or NFRC 100 for site -built fenestration, or the
§110.6(a) :
applicable default SHGC.
Site Constructed Doors, Windows and Skylights shall be caulked between the unit and the building, and shall be
§110.6(b):
weatherstripped (except for unframed glass doors and fire doors).
Ener Pro 6.5 by Ener Soft User Number: 1315 RunCode: 2015-04-15721:40:54 ID: 0150290 Page 9 of 30
STATE OF CALIFORNIA
INDOOR LIGHTING
r�,r
CEC-NRCC-LTI-01-E Revised 06/14 UALIFUKNIA tNtKUY UUMMIbbIUN
CERTIFICATE OF COMPLIANCE — USER INSTRUCTIONS NRCC-LTI-01-E
Indoor Lighting (Page 1 of 5)
Project Name: Cupertino Dental Group Date Prepared: 4/15/2015
Climate Zone:
4
Conditioned Floor Area : 105
YES NO FORM
TITLE
YES NRCC-LIT-01-E
Certificate of Compliance. All Pages required on plans for all submittals.
Unconditioned Floor Area : 0
Lighting Controls, Certificate of Compliance, and PAF Calculation. All Pages required on plans for all submittals.
General Information
Indoor Lighting Power Allowance
NO NRCC-LIT-04-E
j Tailored Method Worksheets
NQ NRCC-LIT-05 E
Line Voltage Track Lighting Worksheets
Building Type:
❑ Schools
El Nonresidential
❑ Relocatable Public Schools
❑
❑
High -Rise Residential
Conditioned Spaces
❑
❑
Hotel/Motel
Unconditioned Spaces
Phase of Construction:
❑ New Construction
❑
Addition
❑
Alteration
Method of Compliance:
❑ Complete Building
❑
Area Category
❑
Tailored
LIGHTING COMPLIANCE DOCUMENTS (select yes for each document included)
For detailed instructions on the use of this and all Energy Efficiency Standards compliance documents, refer to the Nonresidential Manual published by the California Energy Commission.
YES NO FORM
TITLE
YES NRCC-LIT-01-E
Certificate of Compliance. All Pages required on plans for all submittals.
YES NRCC-LIT-02-E
Lighting Controls, Certificate of Compliance, and PAF Calculation. All Pages required on plans for all submittals.
YES NRCC-LIT-03-E
Indoor Lighting Power Allowance
NO NRCC-LIT-04-E
j Tailored Method Worksheets
NQ NRCC-LIT-05 E
Line Voltage Track Lighting Worksheets
Summary of Allowed Lighting Power
Conditioned and Unconditioned space Lighting must not be combined for compliance
Indoor Lighting Power for Conditioned Spaces Indoor Lighting Power for Unconditioned Spaces
Watts I Watts
Installed Lighting 96
1. NRCC-LTI-01-E, page 4 +
PORTABLE ONLY FOR OFFICES
2. NRCC-LTI-01-E, page 3 +
Minus Lighting Control Credits
3' 0
NRCC-LTI-02-E, page 2
4 Adjusted Installed Lighting Power _ 96
(row 1 plus row 2 minus row 3)
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance
Installed Lighting
NRCC-LTI-01-E, page 4 1 + 0
Minus Lighting Control Credits 0
_ NRCC-LTI-02-E, page 2
Adjusted Installed Lighting Power
(row 1 minus row 3) 0
June 2014
STATE OF CALIFORNIA
INDOOR LIGHTING
CEC-NRCC-LTI-01-E (Revised 06/
CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE — USER INSTRUCTIONS NRCC-LTI-01-E
Indoor Lighting (Page 2 of 5)
Project Name: Cupertino Dental Group Date Prepared: 4/15/2015
5.
Complies ONLY if Installed <_ Allowed
Complies ONLY if Installed <_ Allowed
NO
Form/Title
Allowed Lighting Power
Allowed Lighting Power
NRCI-LTI-01-E - Must be submitted for all buildings
6.
Conditioned NRCC-LTI-03-E, page 1
105
Unconditioned NRCC-LTI-03-E, page 1
0
Declaration of Required Installation Certificates — Declare by selecting yes for all Installation Certificates that will be submitted. (Retain copies and verify forms are
completed and signed.)
YES
NO
Form/Title
NRCA-LTI-02-A - Must be submitted for occupancy sensors and automatic time switch controls.
NRCI-LTI-01-E - Must be submitted for all buildings
❑ Field Inspector
NRCA-LTI-03-A - Must be submitted for automatic daylight controls.
NRCI-LTI-02-E - Must be submitted for a lighting control system, or for an Energy Management Control System (EMCS),
❑ Field Inspector
NRCA-LTI-04-A - Must be submitted for demand responsive lighting controls.
to be recognized for compliance.
•/
NRCI-LTI-03-E - Must be submitted for a line -voltage track lighting integral current limiter, or for a supplementary
❑ Field Inspector
overcurrent protection panel used to energize only line -voltage track lighting, to be recognized for compliance.
NRCI-LTI-04-E - Must be submitted for two interlocked systems serving an auditorium, a convention center, a
❑ Field Inspector
conference room, a multipurpose room, or a theater to be recognized for compliance.
NRCI-LTI-05-E - Must be submitted for a Power Adjustment Factor (PAF) to be recognized for compliance.
❑ Field Inspector
NRCI-LTI-06-E - Must be submitted for additional wattage installed in a video conferencing studio to be recognized for
❑ Field Inspector
compliance.
Declaration of Required Certificates of Acceptance — Declare by checking all of the Certificates of Acceptance that will be submitted. (Retain copies and verify forms are
completed and signed.)
YES
NO
Form/Title
NRCA-LTI-02-A - Must be submitted for occupancy sensors and automatic time switch controls.
❑ Field Inspector
NRCA-LTI-03-A - Must be submitted for automatic daylight controls.
❑ Field Inspector
NRCA-LTI-04-A - Must be submitted for demand responsive lighting controls.
❑ Field Inspector 71
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014
STATE OF CALIFORNIA
INDOOR LIGHTING
'EC
-NRCC-LTI-01-E (Revised 06/14) CALIFORNIA ENERGY COMMISSION "°°mv011`
CERTIFICATE OF COMPLIANCE — USER INSTRUCTIONS NRCC-LTI-01-E
Indoor Lighting (Page 3 of 5)
Project Name: Cupertino Dental Group Date Prepared: 4/15/2015
A separate Lighting Schedule Must Be Filled Out for Conditioned and Unconditioned Spaces. Installed Lighting Power listed on this Lighting Schedule is only for:
® CONDITIONED SPACE ❑ UNCONDITIONED SPACE
A. INDOOR LIGHTING SCHEDULE and FIELD INSPECTION ENERGY CHECKLIST
❑ The actual indoor lighting power listed on this page and on the next page includes all installed permanent and planned portable lighting systems.
❑ When Complete Building Method is used for compliance, list each different type of luminaire on separate lines.
❑ When Area Category Method or Tailored Method is used for compliance, list each different type of luminaire by each different function area on separate lines
❑ Also include track lighting in schedule, and submit the track lighting compliance form (NRCC-LTI-05-E) when line -voltage track lighting is installed.
B. Installed Portable Luminaires in Offices — Exception to Section 140.6(a)
❑ This section shall be filled out ONLY for portable luminaires in offices (As defined in §100.1). All other planned portable luminaires shall be documented on next page of
this compliance form.
❑ This section is used to determine if greater than 0.3 watts of portable lighting is planned for any office
❑ Fill out a separate line for each different office. Small offices that are typical (having the same general and portable lighting) may be grouped together. This allowance
shall not be traded between offices having different lighting systems.
Office Portable Luminaire
Office Installed Portable Luminaire Watts Per Square
Office Location
Field
Schedule
Foot
Inspector
A
B
C
D
E
F
G
H
I
J
Installed
Z
c
portable
0 L
0
Watts
If F <_ 0.3,
Identify Office area in which
35. 3
0-
luminaire
� v
'^ �
per
enter zero;
E x G
these portable luminaires are
T,
v
Complete Luminaire Description
L".
watts in this
0 rD
square
installed
(i.e., LED, under cabinet, furniture mounted
Watts per
°
office
K :
STATE OF CALIFORNIA
INDOOR LIGHTING
CEC-NRCC-1-TI-01-E (Revised 06/14) UALIF-UHNIA LNLHUY UUMMIJJIUN "
CERTIFICATE OF COMPLIANCE — USER INSTRUCTIONS NRCC-LTI-01-E
Indoor Lighting (Page 4 of 5)
Project Name: Cupertino Dental Group Date Prepared: 4/15/2015
A separate Lighting Schedule Must Be Filled Out for Conditioned and Unconditioned Spaces. Installed Lighting Power listed on this Lighting Schedule is only for:
IZI CONDITIONED SPACE ❑ UNCONDITIONED SPACE
C. INDOOR LIGHTING SCHEDULE and FIELD INSPECTION ENERGY CHECKLIST
Luminaire Schedule
Installed Watts
Location
Field Inspector 1
A
B
C
D
E
F
G
H
How wattage was
determined
d
o
o ro
Complete Luminaire Description
30
^°
3 z
s
E E
(i.e, 3 lamp fluorescent troffer,
3 O
Z d
w a
o dQ
°' a
x
Primary Function area in which
z —
F32T8, one dimmable electronic ballast)
`�
-
00 ;
—'
(D
rD
M� C-
°
these luminaires are installed
Pass
Fail
2 Lamp 4 ft T8
48.0
®
❑
2
96
Office <= 250 sqft
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
INSTALLED WATTS PAGE TOTAL:
96
Enter sum total of all pages into
NRCC-LTI-01-E; Page 2
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014
STATE OF CALIFORNIA
INDOOR LIGHTING
CEC-NRCC-LTI-01-E (Revised 06/14) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE — USER INSTRUCTIONS NRCC-LTI-01-E
Indoor Lighting (Page 5 of 5)
Project Name: Cupertino Dental Group Date Prepared: 4/15/2015
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certificate of Compliance documentation is accurate and complete. of
Documentation Author Name: Nicholas L Blgnardl NR08-12-3847
Documentation Author Signature::
Company FRI Energy Consultants, LLC
Signature Date: 4/15/2015
Address: 21 N. Harrison Ave, Suite 210
CEA/ HERS Certification Identification (if applicable):
City/State/Zip: Campbell, CA 95008
phone: 408-866-1620
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 Compliance is true and correct.
2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance
(responsible designer).
3. The energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of
Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations.
4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance
documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application.
5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be 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 Compliance is required to be included with the documentation the
builder provides to the building owner at occupancy.
Responsible Designer Name: Paul Fick
Responsible Designer Signature:
Company: Paul H. Fick Architect
Date Signed:
Address: 550 Calero Ave
License:
City/State/Zip: San Jose, CA 95123
Phone: 408-281-4400
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014
STATE OF CALIFORNIA
INDOOR LIGHTING — LIGHTING CONTROLS
CEC-NRCC-LTI-02-E (Revised 06/14) L;ALIFUKNIA LNLKIiY GUMMItNUN
CERTIFICATE OF COMPLIANCE NRCC-LTI-02-E
Indoor Lighting - Lighting Controls (Page 1 of 3)
Project Name: Cupertino Dental Group Date Prepared: 4/15/2015
The NRCC-LTI-02-E shall be used to document all mandatory and prescriptive lighting controls that are applicable to the project.
Mandatory Lighting Control Declaration Statements (Indicate if the measure applies by checking yes or no below.)
YES
NO
Control Requirements
JLighting
shall be controlled by self-contained lighting control devices which are certified to the Energy Commission according to the Title 20 Appliance
Efficiency Regulations in accordance with Section 110.9.
J
Lighting shall be controlled by a lighting control a system or energy management control system in accordance with §110.9. An Installation Certificate
shall be submitted in accordance with Section 130.4(b).
JOne
or more Track Lighting Integral Current Limiters shall be installed which have been certified to the Energy Commission in accordance with §110.9 and
§130.0. Additionally, an Installation Certificate shall be submitted in accordance with Section 130.4(b).
A Track Lighting Supplementary Overcurrent Protection Panel shall be installed in accordance with Section 110.9 and Section 130.0. Additionally, an
Installation Certificate shall be installed in accordance with Section 130.4(b).
J
All lighting controls and equipment shall comply with the applicable requirements in §110.9 and shall be installed in accordance with the manufacturer's
instructions in accordance with Section 130.1.
All luminaires shall be functionally controlled with manually switched ON and OFF lighting controls in accordance with Section 130.1(a).
General lighting shall be separately controlled from all other lighting systems in an area. Floor and wall display, window display, case display, ornamental,
and special effects lighting shall each be separately controlled on circuits that are 20 amps or less. When track lighting is used, general, display,
ornamental, and special effects lighting shall each be separately controlled; in accordance with Section 130.1(a)4.
•/
The general lighting of any enclosed area 100 square feet or larger, with a connected lighting load that exceeds 0.5 watts per square foot shall meet the
multi-level lighting control requirements in accordance with Section 130.1(b).
J
All installed indoor lighting shall be equipped with controls that meet the applicable Shut -OFF control requirements in Section 130.1(c).
JLighting
in all Daylit Zones shall be controlled in accordance with the requirements in Section 130.1(d) and daylit zones are shown on the plans.
JLighting
power in buildings larger than 10,000 square feet shall be capable of being automatically reduced in response to a Demand Responsive Signal in
accordance with Section 130.1(e).
Before an occupancy permit is granted for a newly constructed building or area, or a new lighting system serving a building, area, or site is operated for
Jnormal
use, indoor lighting controls serving the building, area, or site shall be certified as meeting the Acceptance Requirements for Code Compliance in
accordance with Section 130.4.(a). The controls required to meet the Acceptance Requirements include automatic daylight controls, automatic shut -OFF
controls, and demand responsive controls.
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014
STATE OF CALIFORNIA
INDOOR LIGHTING — LIGHTING CONTROLS
Ai
CEC-NRCC-LTI-02-E (Revised 06/14) CALIFORNIA ENERGY COMMISSION ''wMw"
CERTIFICATE OF COMPLIANCE NRCC-LTI-02-E
Indoor Lighting - Lighting Controls (Page 2 of 3)
Project Name: Cupertino Dental Group Date Prepared: 4/15/2015
A separate document must be filled out for Conditioned and Unconditioned Spaces. This page is used only for the following:
0 CONDITIONED SPACES ❑ UNCONDITIONED SPACES
MANDATORY AND PRESCRIPTIVE INDOOR LIGHTING CONTROL SCHEDULE, PAF CALCULATION, and FIELD INSPECTION CHECKLIST
PAF Credit Calculation Z
n
(D
N D
_D
!D
a
1
o
r
's (D
n
N rD
fD
Standards Complying With
° v,
v
to
x r.
�•
Lighting Control Schedule
(✓ all that apply, or enter 'E' if Exempted)
C- o
n
v o
(D
o
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
Type/ Description of Lighting
Control (i.e.: occupancy sensor,
#
N
N
t4;'
`4'
F-
A
i4;
Location in Building
automatic time switch,
of
o
0
0
0
cu
0
P
o
v
_
dimmer, automatic daylight,
Units
N
Z'
o
m
�..�
�...
N
.�
etc... )
DIMMER
❑ ❑
❑ ❑
❑ ❑
Control Credit PAGE TOTAL (Sum of Column M):
0
IF MULTIPLE PAGES ARE USED, ENTER SUM TOTAL OF Control Credit for all pages HERE (Sum of all Column M):
0
Enter Control Credit total
into NRCC-LTI-01-E; Page
1.
1. §130.1(a) =Manual area controls; §130.0(b) = Multi Level; §130.1(c) =Auto Shut -Off; §130.1(d) =Mandatory Daylight; §130.1(e) =Demand Responsive, §140.6(d) =
Additional lighting controls installed to earn a PAF, • §140.6(d) = Prescriptive Secondary Sidelit Daylight Controls.
2. Check Table 140.6-A for correct Factor. PAFs shall not be traded between conditioned and unconditioned spaces. As a condition to earn a PAF, an Installation Certificate is
also required to be filled out signed, and submitted.
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014
STATE OF CALIFORNIA
INDOOR LIGHTING — LIGHTING CONTROLS
CEC-NRCC-LTI-02-E (Revised 06/14) l HLIr VRIVIH GIVCRV T l VNIIVIIJJIVIV
CERTIFICATE OF COMPLIANCE NRCC-LTI-02-E
Indoor Lighting - Lighting Controls (Page 3 of 3)
Project Name: Cupertino Dental Group Date Prepared: 4/15/2015
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name: Nicholas L Bignardi NR08-12-3847
Documentation Author Signature:
Company: FRI Energy Consultants, LLC
signature Date: 4/15/2015
Address: 21 N. Harrison Ave, Suite 210
CEA/ HERS Certification Identification (if applicable):
City/State/Zip: Campbell, CA 95008
Phone` 408-866-1620
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 Compliance is true and correct.
2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance
(responsible designer).
3. The energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of
Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations.
4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance
documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application.
5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be 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 Compliance is required to be included with the documentation the
builder provides to the building owner at occupancy.
Responsible Designer Name: Paul Fick
Responsible Designer Signature:
Company: Paul H. Fick Architect
Date Signed:
Address: 550 Calero Ave
License:
City/State/Zip: San Jose, CA 95123
Phone: 408-281-4400
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014
STATE OF CALIFORNIA
INDOOR LIGHTING POWER ALLOWANCE
:EC-NRCC-LTI-03-E (Revised 06/14) GALIFURNIA ENEHUY UUMMI55IUN
CERTIFICATE OF COMPLIANCE NRCC-LTI-03-E
Certificate of Compliance - Indoor Lighting Power Allowance (Page 1 of 4)
Project Name: Cupertino Dental Group Date Prepared: 4/15/2015
ALLOWED LIGHTING POWER
A separate page must be filled out for Conditioned and Unconditioned Spaces. This page is only for:
0 CONDITIONED spaces ❑ UNCONDITIONED spaces
A. SUMMARY TOTALS OF LIGHTING POWER ALLOWANCES
❑ If using Complete Building Method for compliance, use only the total in column (a) as total allowed building watts.
❑ If using Area Category Method, Tailored Method, or a combination of Area Category and Tailored Method for compliance, use only the total in column (b) as the total
allowed building watts
(a) (b)
1. Complete Building Method Allowed Watts. Documented in section B of NRCC-LTI-03-E (below on this page)
2. Area Category Method Allowed Watts. Documented in section C-1 of NRCC-LTI-03-E (below on this page) 105
3. Tailored Method Allowed Watts. Documented in section A of NRCC-LTI-04-E 0
TOTAL ALLOWED BUILDING WATTS. Enter number into correct cell on NRCC-LTI-01, Page 2, Row 1 105
I❑ Check here if building contains both conditioned and unconditioned areas.
B. COMPLETE BUILDING METHOD LIGHTING POWER ALLOWANCE
A
B
105
C
0
D
TYPE OF BUILDING (From §140.6 Table 140.6-B)
WATTS
PER (ft)
X
COMPLETE
BLDG. AREA
=
ALLOWED
WATTS
Total Area:
Total Watts. Enter Total Watts into section A, row 1 (Above on this page)
C -1 AREA CATEGORY METHOD TOTAL LIGHTING POWER ALLOWANCES (C-2 plus C-3)
Watts
Total from section C-2
105
Total from section C-3
0
Total Watts. Enter Total Watts into section A, row 2 (Above on this page)
105
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014
STATE OF CALIFORNIA
INDOOR LIGHTING POWER ALLOWANCE
'EC -03 (Revised 06/14) UAW-UKNIA ENERGY UUMMISSIUN
CERTIFICATE OF COMPLIANCE NRCC-LTI-03-E
Certificate of Compliance - Indoor Lighting Power Allowance (Page 2 of 4)
Project Name: Cupertino Dental Group Date Prepared: 4/15/2015
A separate page must be filled out for Conditioned and Unconditioned Spaces. This page is only for:
m CONDITIONED spaces ❑ UNCONDITIONED spaces
C -2 AREA CATEGORY METHOD GENERAL LIGHTING POWER ALLOWANCE
❑ Do not include portable lighting for offices. Portable lighting for offices shall be documented only in section B of NRCC-LTI-01-E.
❑ Separately list lighting for each primary function area as defined in §100.1 of the Standards.
A B C D
AREA CATEGORY (From §140.6 Table 140.6-C) WATTS ALLOWED
Location in Building Primary Function Area per Table 140.6-C PER (ft) X AREA (ft2) = WATTS
Cupertino Dental Group Office <= 250 sqft 1.00 105 105
TOTALS 1 105
Enter sum total Area Category allowed watts into section C-1 of NRCC-LTI-03-E (this compliance form)
105
WATTS
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014
STATE OF CALIFORNIA
INDOOR LIGHTING POWER ALLOWANCE
RAN
CEC-NRCC-LTI-03-E (Revised 06/14) GALIrUKNIA ENEHUY GUMMIJJIUN
CERTIFICATE OF COMPLIANCE NRCC-LTI-03-E
Certificate of Compliance - Indoor Lighting Power Allowance (Page 4 of 4)
Project Name: Cupertino Dental Group Date Prepared: 4/15/2015
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name: Nicholas L Bignardi NR08-12-3847
Documentation Author signature:
Company: FRI Energy Consultants, LLC
Signature Date: 4/15/2015
Address: 21 N. Harrison Ave, Suite 210
CEA/HERS Certification Identification (if applicable):
City/state/zip: Campbell, CA 95008
Phone` 408-866-1620
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 Compliance is true and correct.
2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance
(responsible designer).
3. The energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of
Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations.
4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance
documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application.
5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be 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 Compliance is required to be included with the documentation the
builder provides to the building owner at occupancy.
Responsible Designer Name: Paul Fick
Responsible Designer Signature:
Company: Paul H. Fick Architect
Date Signed:
Address: 550 Calero Ave
License:
City/State/Zip: San Jose, CA 95123
Phone: 408-281-4400
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014
STATE OF CALIFORNIA
MECHANICAL SYSTEMS
u :l%
CEC-NRCC-MCH-01-E (Revised 06/14) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-MCH-01-E
Mechanical Systems (Page 1 of 3)
Project Name: Cupertino Dental Group Date Prepared: 4/15/2015
MECHANICAL COMPLIANCE FORMS & WORKSHEETS (check box if worksheet is included)
For detailed instructions on the use of this and all Energy Efficiency Standards compliance forms, refer to the 2013 Nonresidential Manual
Note: The Enforcement Agency may require all forms to be incorporated onto the building plans.
YES
NO
Form/Worksheet #
Title
El
❑
NRCC-MCH-01-E (Part 1 of 3)
Certificate of Compliance, Declaration. Required on plans for all submittals.
El
❑
NRCC-MCH-01-E (Part 2 of 3)
Certificate of Compliance, Required Acceptance Tests (MCH -02A to 11A). Required on plans for all submittals.
❑
❑
NRCC-MCH-01-E (Part 3 of 3)
Certificate of Compliance, Required Acceptance Tests (MCH -12A to 18A). Required on plans where applicable.
®
❑
NRCC-MCH-02-E (Part 1 of 2)
Mechanical Dry Equipment Summary is required for all submittals with Central Air Systems. It is optional on plans.
21
❑
NRCC-MCH-02-E (Part 2 of 2)
Mechanical Wet Equipment Summary is required for all submittals with chilled water, hot water or condenser water
systems. It is optional on plans.
El
❑
NRCC-MCH-03-E
Mechanical Ventilation and Reheat is required for all submittals with multiple zone heating and cooling systems. It is
optional on plans.
MECHANICAL HVAC ACCEPTANCE FORMS (check box for required forms)
Designer:
This form is to be used by the designer and attached to the plans. Listed below are all the acceptance tests for HVAC systems. The designer is required to check the applicable boxes for all
acceptance tests that apply and list all equipment that requires an acceptance test. All equipment of the some type that requires a test, list the equipment description and the number of systems.
Installing Contractor:
The contractor who installed the equipment is responsible to either conduct the acceptance test them self or have a qualified entity run the test for them. If more than one person has
responsibility for the acceptance testing, each person shall sign and submit the Certificate of Acceptance applicable to the portion of the construction or installation for which they are responsible.
Enforcement Agency:
Plancheck — The NRCC-MCH-01-E form is not considered a completed form and is not to be accepted by the building department unless the correct boxes are checked.
Inspector - Before occupancy permit is granted all newly installed process systems must be tested to ensure proper operations.
Test Description
MCH -02A
MCH -03A
MCH -04A
MCH -05A
MCH -06A
MCH -07A
MCH -08A
MCH -09A
MCH -10A
MCH -11A
Equipment
# of
Outdoor
Single Zone
Air
Economizer
Demand
Supply Fan
Valve Leakage
Supply Water
Hydronic
Automatic
Requiring Testing
units
Air
Unitary
Distribution
Controls
Control
VAV
Test
Temp. Reset
System
Demand Shed
or Verification
Ducts
Ventilation
Variable Flow
Control
(DCV)
Control
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014
STATE OF CALIFORNIA
MECHANICAL SYSTEMS
CEC-NRCC-MCH-01-E (Revised 06/14) CALIFORNIA ENERGY COMMISSION ^""wR,
CERTIFICATE OF COMPLIANCE NRCC-MCH-01-E
Mechanical Systems (Page 2 of 3)
Project Name: Cupertino Dental Group Date Prepared: 4/15/2015
MECHANICAL HVAC ACCEPTANCE FORMS (check box for required forms)
Designer:
This form is to be used by the designer and attached to the plans. Listed below are all the acceptance tests for HVAC systems.
The designer is required to check the applicable boxes for all
acceptance tests that apply and list all equipment that requires an acceptance test. All equipment of the some type that requires a test, list the equipment description and the number of systems.
Installing Contractor:
The contractor who installed the equipment is responsible to either conduct the acceptance test them self or have a qualified
entity run the test for them.
If more than one person has
responsibility for the acceptance testing, each person shall sign and submit the Certificate of Acceptance applicable to the portion of the construction or installation for which they are responsible.
The following tests require a
Enforcement Agency:
Plancheck — The NRCC-MCH-01-E form is not considered a completed form and is not to be accepted by the building department unless the correct boxes are checked.
Inspector - Before occupancy permit is granted all newly installed process systems must be tested to ensure proper operations.
Test Description
MCH -12A
MCH -13A
MCH -14A
MCH -15A
MCH -16A
MCH -17A
MCH -18A
Equipment
# of
Fault Detection &
Automatic Fault
Distributed Energy
Thermal Energy
Supply Air
Condenser
Water
ECMS
Requiring Testing
units
Diagnostics for DX
Detection &
Storage DX AC
Storage (TES)
Temperature Reset
Reset Controls
or Verification
Units
Diagnostics for Air &
Systems
Systems
Controls
Zone
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014
STATE OF CALIFORNIA
MECHANICAL SYSTEMS
CEC-NRCC-MCH-01-E (Revised 06/14) CALIFORNIA ENERGY COMMISSION �"
CERTIFICATE OF COMPLIANCE NRCC-MCH-01-E
Mechanical Systems (Page 3 of 3)
Project Name: Cupertino Dental Group Date Prepared: 4/15/2015
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name: NIChOIaS L Blgnardl NR08-12-3847
Documentation Author Signature: ,c
`, ..
Company FRI Energy Consultants, LLC
Signature Date: 4/15/2015
Address: 21 N. Harrison Ave, Suite 210
CEA/ HERS Certification Identification (if applicable):
City/State/zip: Campbell, CA 95008
Phone: 408-866-1620
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 Compliance is true and correct.
2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible
designer).
3. The energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance
conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations.
4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents,
worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application.
5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be 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 Compliance is required to be included with the documentation the builder provides to the
building owner at occupancy.
Responsible Designer Name: Paul Fick
Responsible Designer Signature:
Company: Paul H. Fick Architect
Date Signed:
Address: 550 Calero Ave
License:
City/State/Zip: San Jose, CA 95123
Phone: 408-281-4400
CA Building Energy Efficiency Standards- 2013 Nonresidential Compliance June 2014
STATE OF CALIFORNIA
HVAC SYSTEM REQUIREMENTS
:;EG-NRGG-MGH-024E (RewSetl 06/14) CALIFORNIA ENERGY COMMISSION --
CERTIFICATE OF COMPLIANCE NRCC-MCH-02-E
HVAC Dry System Requirements (Page 1 of 3)
Project Name: Cupertino Dental Group Date Prepared: 4/15/2015
Equipment Tags and System Description'
System 1
MANDATORY MEASURES
Heating Equipment Efficiency3
Cooling Equipment Efficiency3
HVAC or Heat Pump Thermostats
Furnace Standby Loss Control
Low leakage AHUs
Ventilation
Demand Control Ventilations
Occupant Sensor Ventilation Control6
Shutoff and Reset Controls'
Outdoor Air and Exhaust Damper Control
Isolation Zones
Automatic Demand Shed Controls
Economizer FDD
Duct Insulation
PRESCRIPTIVE MEASURES
T-24 Sections
Reference to the Requirements in the Contract DocumentS2
110.1 or 110.2(a)
Page 6
110.1 or 110.2(a)
Page 6
110.2(b), 110.2(c)
Page 6
110.2(d)
Page 6
110.2(f)
Page 6
120.1(b)
Page 6
120.1(c)4
Page 6
120.1(c)5, 120.2(e)3
Page 6
120.2(e)
Page 6
120.2(f)
Page 6
120.2(g)
Page 6
120.2(h)
Page 6
120.2(i)
Page 6
120.4
Page 6
Equipment is sized in conformance with 140.4(a & b) y
140.4(a&b)
Supply Fan Pressure Control 140.4(c) Page 6
Simultaneous Heat/Cool8 140.4(d) Page 6
Economizer 140.4(e) Page 6
Heat and Cool Air Supply Reset 140.4(f) Page 6
Electric Resistance Heating9 140.4(g) Page 6
Duct Leakage Sealing and Testing.'D 140.4(1) Page 6
Notes:
1. Provide equipment tags (e.g. AHU 1 to 10) and system description (e.g. Single Duct VAV reheat) as appropriate. Multiple units
with common requirements can be grouped together.
2. Provide references to plans (i.e. Drawing Sheet Numbers) and/or specifications (including Section name/number and relevant
paragraphs) where each requirement is specified. Enter "N/A" if the requirement is not applicable to this system.
3. The referenced plans and specifications must include all of the following information: equipment tag, equipment nominal
capacity, Title 24 minimum efficiency requirements, and actual rated equipment efficiencies. Where multiple efficiency
requirements are applicable (e.g. full- and part -load) include all. Where appliance standards apply (110.1), identify where
equipment is required to be listed per Title 201601 et seq.
4. Identify where the ventilation requirements are documented for each central HVAC system. Include references to both central
unit schedules and sequences of operation. If one or more space is naturally ventilated identify where this is documented in the
plans and specifications. Multiple zone central air systems must also provide a MCH -03-E form.
5. If one or more space has demand controlled ventilation identify where it is specified including the sensor specifications and the
sequence of operation.
6. If one or more space has occupant sensor ventilation control identify where it is specified including the sensor specifications and
the sequence of operation
7. If the system is DDC identify the sequences for the system start/stop, optimal start setback (if required) and setup (if required).
For all systems identify the specification for the thermostats and time clocks (if applicable).
8. Identify where the heating, cooling and deadbond airflows are scheduled for this system. Include a reference to the
specification of the zone controls. Provide a MCH -03-E form.
9. Enter N/A if there is no electric heating. If the system has electric heating indicate which exception to 140.4(g) applies.
10. If duct leakage sealing and testing is required, a MCH -04-A form must be submitted.
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014
STATE OF CALIFORNIA
HVAC SYSTEM REQUIREMENTS
CEC-NRCC-MCH-02-E (Revised 06113) CALIFORNIA ENERGY COMMISSION -
CERTIFICATE OF COMPLIANCE NRCC-MCH-02-E
HVAC Wet System Requirements (Page 3 of 3)
Project Name: Cupertino Dental Group Date Prepared: 4/15/2015
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name: Nicholas L Blgnard'I NR08-12-3847
Documentation Author Signature:
Company FRI Energy Consultants, LLC
signature Date: 4/15/2015
Address: 21 N. Harrison Ave, Suite 210
CEA/ HERS Certification Identification (if applicable):
City/State/Zip: Campbell, CA 95008
Phone` 408-866-1620
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 Compliance is true and correct.
2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design
identified on this Certificate of Compliance (responsible designer).
3. The energy features and performance specifications, materials, components, and manufactured devices for the building design or system
design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of
Regulations.
4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information
provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement
agency for approval with this building permit application.
5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be 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 Compliance is required to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name: Paul Fick
Responsible Designer Signature:
Company: Paul H. Fick Architect
Date Signed:
Address: 550 Calero Ave
License:
City/State/Zip: San Jose, CA 95123
Phone: 408-281-4400
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014
STATE OF CALIFORNIA
MECHANICAL VENTILATION AND REHEAT
CEC-NRCC-MCH-03-E (Revised 06/14) GALIFUHNIA tNLF(GY GUMMISSIUN
CERTIFICATE OF COMPLIANCE NRCC-MCH-03-E
Mechanical Ventilation & Reheat (Page 1 of 2)
Project Name: Cupertino Dental Group Date Prepared: 4/15/2015
ACTUAL DESIGN INFO (FROM EQUIPMENT
SCHEDULES, ETC)
AREA BASIS
OCCUPANCY BASIS
MINIMUM
VAV Reheated Primary Air
CFM
VAV Deadband
Primary Air CFM
A
B
C
D
E
F
G
H
I
1
K
L
M
N
0
P
Q
R
S
T
N
D O
< m
vi
x ,<„
D
L1
O
O rn
Gl
T Gl
D z
D
D o
z o vm,
O
O O v
D z
Z 3
O D
<<
m o
D v,
Ll
T G1
D _a
v T
D
n
\
Z
.._. 0
On
D z
r r Z
O �'
"'r{ z
n
O
Z
�' p O
D p
2
m
O
3
r
3
D
D
3
Z
3
D
z
D
Z
3
v
O
m
T
3
v
z
m
s
W
Z
3
T
D
�<
O
r�
C
y m
x D
-nrO T O
3— O <
O Z
z
_""
n
O
r
rn
A
Z o 3
O ao D
T Z O D<
300 0
n w O
o R
Z>
O
T D
3 x
_
p C
O x p
O m
2
n
O
—
J
N
Z O
O\
T Z p
o (")
D
Z d
w
D ru
T p p
n Z
v 0
Z O
n
O
m
to
Cuperi
105
0.15
16
1.1
15.0
16
16
Y
Total
16
Yellow shaded cells require user input. Remaining cells are protected and automatic
B.
The largest amount of primary air supplied by the terminal unit when it's operating in the cooling mode.
C.
The smallest amount of primary air supplied by the terminal unit in the deadband mode.
D.
The largest amount of primary air supplied by the terminal unit when it's operating in the heating mode.
E.
A terminal unit can be controlled with DDC controls, or non -DDC controls. Each control category has different reheat limitations in code.
F.
Transfer Air must be provided where Required Ventilation Airflow (Column M) is greater than the Design Primary Deadband Airflow (Column C).
H.
Minimum ventilation rate per Section §120.1. Table 120.1-A.
J.
Based on number of fixed seats where applicable or the greater of the expected number of occupants and 50% of the CBC occupant load for egress purposes for spaces without fixed seating.
M.
Required Ventilation Airflow (Req'd Ventilation Airflow) is the larger of the ventilation rates calculated on an AREA BASIS or OCCUPANCY BASIS (Column I or L)
N.
This column identifies whether or not the Design Primary Deadband Airflow complies or not. It compares the value in column M to the value in column C and column F.
O.
Design Primary Cooling Airflow * 0.50 for DDC, Design Primary Cooling Airflow * 0.30 for Non -DDC. If the Design Primary Cooling Airflow is less than 300 cfm, then this is not applicable.
P.
Maximum of Column M and Column 0. If the Design Primary Cooling Airflow is 300 cfm or less, then this is not applicable.
Q.
This column identifies whether or not the Design Primary Reheat Airflow at the zone level, complies or not. It compares the value in column P to the value in column D.
R.
Design Primary Cooling Airflow * 0.20 for DDC. Not applicable for Non -DDC zones or zones where Design.Primary Cooling Airflow is is 300 cfm or less.
S.
Maximum of Column M and Column R. Not applicable if the Design Primary Cooling Airflow is 300 cfm or less.
T.
This column identifies whether or not the Design Primary Deadband Airflow at the zone level, complies or not. It compares the value in column S to the value in column C.
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014
STATE OF CALIFORNIA
MECHANICAL VENTILATION AND REHEAT
CEC-NRCC-MCH-03-E (Revised 06/14) CALIFORNIA ENERGY COMMISSION -
CERTIFICATE OF COMPLIANCE NRCC-MCH-03-E
Mechanical Ventilation & Reheat (Page 2 of 2)
Project Name: Cupertino Dental Group Date Prepared: 4/15/2015
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name: NIChOIaS L BlgnarCll NROB-1 Z-384%
Documentation Author signature:' _y
Company: FRI Energy Consultants, LLC
signacureDate: 4/15/2015
Address: 21 N. Harrison Ave, Suite 210
CEA/ HERS Certification Identification (if applicable):
City/state/zip: Campbell, CA 95008
Phone: 408-866-1620
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 Compliance is true and correct.
2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible
designer).
3. The energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance
conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations.
4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents,
worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application.
5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be 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 Compliance is required to be included with the documentation the builder provides to the
building owner at occupancy.
Responsible Designer Name: Paul Fick
Responsible Designer Signature:
Company: Paul H. Fick Architect
Date signed:
Address: 550 Calero Ave
License:
City/State/Zip: San Jose, CA 95123
Phone. 408-281-4400
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014
STATE OF CALIFORNIA
REQUIRED ACCEPTANCE TESTS
F-11),
(Revised 06/14) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-MCH-04-E
Required Acceptance Tests (Page 1 of 3)
Project Name: Cupertino Dental Group Date Prepared: 4/15/2015
MECHANICAL COMPLIANCE FORMS & WORKSHEETS (indicate if worksheet is included)
For detailed instructions on the use of this and all Energy Efficiency Standards compliance forms, refer to the 2013 Nonresidential Manual Note: The Enforcement Agency may
require all forms to be incorporated onto the building plans. Forms NRCC-MCH-04-E and NRCC-MECH-05-E are alternative forms to NRCC-MCH-01-E, NRCC-MCH-02-E and NRCC-
MCH-03-E for projects using only single zone packaged HVAC systems.
YES
NO
Form
Title
NRCC-MCH-04-E (1 of 2)
Certificate of Compliance. Required on plans when used.
NRCC-MCH-04-E (2 of 2)
Mechanical Acceptance Tests. Required on plans when used.
NRCC-MCH-05-E (1 of 2)
HVAC Prescriptive Requirements. It is required on plans when used.
NRCC-MCH-05-E (2 of 2)
Mechanical SWH Equipment Summary is required for all submittals with service water heating, pools or spas. It is
required on plans where applicable.
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014
STATE OF CALIFORNIA
REQUIRED ACCEPTANCE TESTS
rrl�
CEC-NRCC-MCH-04-E (Revised 06/14) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-MCH-04-E
Required Acceptance Tests (Page 2 of 3)
Project Name: Cupertino Dental Group Date Prepared: 4/15/2015
Designer:
This form is to be used by the designer and attached to the plans. Listed below are all the acceptance tests for mechanical systems. The designer is required to check the
applicable boxes by all acceptance tests that apply and list all equipment that requires an acceptance test. If all equipment of a certain type requires a test, list the equipment
description and the number of systems. The NA number designates the Section in the Appendix of the Nonresidential Reference Appendices Manual that describes the test.
Since this form will be part of the plans, completion of this section will allow the responsible party to budget for the scope of work appropriately.
Enforcement Agency:
Systems Acceptance. Before occupancy permit is granted for a newly constructed building or space, or a new space -conditioning system serving a building or space is operated
for normal use, all control devices serving the building or space shall be certified as meeting the Acceptance Requirements for Code Compliance.
Systems Acceptance. Before occupancy permit is granted. All newly installed HVAC equipment must be tested using the Acceptance Requirements..
The NRCC-MCH-04-E form is not considered a completed form and is not to be accepted by the building department unless the correct boxes are checked. The equipment
requiring testing, person performing the test (Example: HVAC installer, TAB contractor, controls contractor, PE in charge of project) and what Acceptance test must be
conducted. The following checked -off forms are required for ALL newly installed and replaced equipment. In addition a Certificate of Acceptance forms shall be submitted to
the building department that certifies plans, specifications, installation certificates, and operating and maintenance information meet the requirements of Section 10-103(b)
and Title 24 Part 6. The building inspector must receive the properly filled out and signed forms before the building can receive final occupancy.
Test Description
MCH -02-A
MCH -03-A
MCH -04-A
MCH -05-A
MCH -06-A
MCH -07-A
MCH -11-A
MCH -12-A
MCH -14-A
MCH -18-A
Test Performed By:
Equipment
# of
Outdoor
Single Zone
Air
Economizer
Demand
Supply
Automatic
FDD for
Distribute
Energy
Requiring
units
Air
Unitary
Distribution
Controls
Control
Fan VAV
Demand
Packaged
d Energy
Managem
Testing or
Ducts
Ventilation
Shed
DX Units
Storage
ent
Verification
(DCV)
Control
DX AC
Control
Systems
System
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014
STATE OF CALIFORNIA
REQUIRED ACCEPTANCE TESTS
R 11
CEC-NRCC-MCH-04-E (Revised 06/14) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE NRCC-MCH-04-E
Required Acceptance Tests (Page 3 of 3)
Project Name: Cupertino Dental Group Date Prepared: 4/15/2015
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name: Nicholas L Blgnardl NR08-12-3847
Documentation Author Signature:
Company: FRI Energy Consultants, LLC
Signature Date: 4/15/2015
Address: 21 N. Harrison Ave, Suite 210
CEA/ HERS Certification Identification (if applicable):
City/State/Zip: Campbell, CA 95008
Phone_ 408-866-1620
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 Compliance is true and correct.
2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible
designer).
3. The energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance
conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations.
4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents,
worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application.
5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be 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 Compliance is required to be included with the documentation the builder provides to the
building owner at occupancy.
Responsible Designer Name: Paul Fick
Responsible Designer Signature:
Company: Paul H. Fick Architect
Date Signed:
Address: 550 Calero Ave
License:
City/State/Zip: San Jose, CA 95123
Phone` 408-281-4400
CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014