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B-2016-1413CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-141.3 19469 STEVENS CREEK BLVD CUPERTINO, CA 95014 (316 20 112) NAVIN PO BOX 1365, HERMOSA BEACH, CA 90254 OWNER'S NAME: Mr Mike Rohde ( MAIN STREET CUPERTINO AGGREGATOR DATE ISSUED: 09/12/2016 LLC) OWNER'S PHONE: 650-344-1500 PHONE N0: 707-31-2276 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class 11 Lic. #101125 Contractor MAVIN Date 01/31/2018 X BLDG —ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — MECH _ RESIDENTIAL X COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: PANINO GIUSTO - BUILD OUT COMMERCIAL T.I (1583 sq ft). I hereby affirm under penalty of perjury one of the following two declarations: r. 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. 2Z, 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. Sq. Ft Floor Area: Valuation: $299750.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 31620 112 A (Tenant Improvements),M (Tenant Improvcments),M representatives of this city to enter upon the above mentioned property for (Tenant Improvements),A (Tenant Improvements),A inspection purposes. (We) agree to save indemnify and keep harmless the (Tenant Improvements),A (Tenant Improvements),A City of Cupertino against liabilities, judgments, costs, and expenses which (Tenant Improvements),A (Tenant Improvements),A may accrue against said City in consequence of the granting of this permit. (Tenant Improvements),A (Tenant Improvements),A Additionally, the applicant understands and will comply with all non -point (Tenant Improvements),A (Tenant Improvements) source regulations p r the Cu ertino Municipal Code, Section 9.18. Sigriature Date 9/12/2016 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR OMTNER- 180 DAYS FROM LAST CALLED INSPECTION. I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I Issued by: AbbyAyende 1. 1, as owner of the property, or my employees with wages as their sole Date: 09/12/2016 compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) RE -ROOFS: 2. I, as owner of the property, am exclusively contracting with licensed All roofs shall be inspected prior to .any roofing material being installed If a roof is contractors to construct the project (Sec.7044, Business & Professions Code). installed without first obtaining an inspection, I agree to remove all new materials for I hereby affirm under penalty of perjury one of the following three declarations: inspection. 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 Signature of Applicant: performance of the work for which this permit is issued. Date: 9/12/2016 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER permit is issued. 3. I certify that in the performance of the work for which this permit is issued, I HAZARDOUS MATERIALS DISCLOSURE shall not employ any person in any manner so as to become subject to the I have read the hazardous materials requirements under Chapter 6.95 of the Worker's Compensation laws of California. If, atter making this certificate of California Health & Safety Code, Sections 25505, 25533, and 25534. I will exemption, I become subject to the Worker's Compensation provisions of the maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Labor Code, I must forthwith comply with such provisions or this permit shall Health & Safety Code, Section 25532(a) should I store or handle hazardous be deemed revoked. material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I APPLICANT CERTIFICATION will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and certify that I have read this application and state that the above information is the Health& Safety C±SctflonsLV50251, 533, and 25534. correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city O,wner or authorized age t: to enter upon the above mentioned property for inspection purposes. (We) agree , to save indemnify and keep harmless the City of Cupertino against liabilities, Date: 9/12/2016 judgments, costs, and expenses which may accrue against said City in AGENCY consequence of the granting of this permit. Additionally, the applicant understands I hereby affirm that there is a construction lending agency for the performance and will comply with all non -point source regulations per the Cupertino Municipal of work's for which this permit is issued (Sec. 3097, Civ C.) Code, Section 9.18. Lender's Name Lender's Address Signature Date 9/12/2016 CUPERTINO n WRW rnM.gTBI Ir-PTn-W CONSTRUCTION PERMIT :APPLICATION COMMUNITY DEVELOPMENT DEPAPTa` . NT - BUILDING DIVISION 10300 TORRE AVENUE - CUPE.RTINC, [A 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - building cupertino org I I nr11.1rnxr V(.r.....,,.....�z, I—' M ---- ._–_–__.-- ?'_Ifo_ t4�3 -------- �� wyt,�lV1�/ U�C�1[..LCC1J VriILllHVfl1...Yb1(IVIlI i� PROJJECTADDRESS i�//� APNN 316-20-112 316-20-1E 1 OWNERNAM `A-jS VVPHONE // .1 .V5Z M J STREET <31 JJE 1i IT L41 CI l FAX 16q CONTACT NAMEAi a J� PHO1V916 -r/90 6100 t STREET ADDRESS Z�.' `-Ir.i ,�y� %, 0! t C[1Y,STATE, j f t /'ry� l/ I F AA�� % /Q vI 1167,R) (l ❑ OWNER ❑. OWNER -BUILDER ❑ OWNER.AGENT ❑ CONTRACTOR ❑ CONTRACTORA GENT X ARCHITECT ❑ ENGINEER CI DEVELOPER ❑ TENANT CONTRALTO_ "Mw *7Y1/1A LICENSENUMBE110+21o. LICENSETYPEf�, BUS. LIC# E MA COMPANY NAME COWJY04 A �Jpe STREET ADDRESSMa- m1a oo C%T , T � C+ Q �� ---L- ARCHITECT/ENGINE/ ),�y,� !c�-iyGR�J.�-� LTCENSENUMBER Jr"" BUS. LIC# I • J E /7! !�/l •: F/p 451 • PHIZ(* SCTO T RE 1 210CIT t`&1* iWte 44 790i m j �� "��' DESCRIPTION OF WORK �^� - EXISTINP USE - PROPOSED USECON TR, TYFE # sTORTEs -! USE TYPE OCC. SQ.FT. VALUATION ($) EXISTGr[�j AREA NEW FLOOR AREA r� DEMO AREA TOTAL NETAREA qra BATHROOM REMODELAREA KITCHEN REMODELAREA OTHER REMODELAREA „ PORCH AREA DECKAREA TOTAL DECIVPORCH ARE GARAGE ARBA: ❑ DETACH []ATTACH I 9 DWELLING UNITS; ISA SECOND UNIT []YES EEING ADDED? ❑NO SRCONnSTORY []YES ADDITION? []NO PRE -APPLICATION ❑YES IP YES, PROVIDE COPY OF PLANNINGAPPLi1 []NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑YES EICHLERHOML+? 13 NO RECEIVED BY: -' T TALVALUATION: 21724,.y 1* 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. 1 have read this application and the information I have provided i rrect. I Have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building co Is Tc ' n. I th rize representatives Of i npertino to enter the above-identifr"ed property for inspection purposes. SignatureofApplicant/Agent Date: f�CJ SUPPLEMENTAL INFORMATIO IRE E U17 Q PLAN CI3ECK TYPE. ROUTING SLIP OVER-THE-COUNTER BUIE DIlYG PLAN REVIEW New SFD or Multifamily dwellings: Apply f d volition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ' E.�TRESS PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part ofthis project. STANDARb PUBLIC WORKS LARGE "ja FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to i4IA3{7R . SANIPARY SEWER DISTRICT ' submittal of Building Permit application, T ENVIROI�'11IENTAI, iiEALTII. i' BldgAp,p 2011. doe revised 06121111 ftr Vis• CALGREEN NON-RESIDENTIAL CHECKLIST MANDATORY ITEMS COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 building(okupertino.orrc PURPOSE: The non-residential provisions of the 2013 CalGreen Code outline planning, design and development methods that include environmentally responsible site selection, building design, building siting and development to protect, restore and enhance the environmental quality of the site and respect the integrity of adjacent properties; establishes the means of conserving water used indoors, outdoors and in wastewater conveyance; outlines means of achieving material conservation and resource efficiency; and outlines means of reducing the quantity of air contaminants. Project Name: Panino Giusto Restaurant Project address: 19469 Stevens Creek Blvd. Project Description: Commercial Restaurant Tenant Improvements Instructions: 1. The Owner or the Owner's agent shall employ a licensed professional experienced with the 2013 California Green Building Standards Codes to verify and assure that all required work described herein is properly planned and implemented in the project. 2. The licensed professional, in collaboration with the owner and the design professional shall initial Column 2 of this checklist, sign and date Section 1 - Design Verification at the end of this checklist and have the checklist printed on the approved plans for the project. 3. Prior to final inspection by the Building Department, the licensed professional shall complete Column 3 and sign and date Section 2 - Implementation Verification at the end of this checklist and submit the completed form to the Building Inspector. Column 2 1 Column 3 MANDATORY FEATURE OR MEASURE Project Verification Requirements The project meets all the requirements of Divisions 5.101 through 5.508. 1 ❑X I ❑ 5.106.1 Storm water pollution prevention. For projects of one acre or less, develop a Storm Water Pollution Prevention Plan (SWPPP) that has been designed, specific to its site, conforming to the State Storm water NPDES Construction Permit or local ordinance, whichever is stricter, as is required for ❑ projects over one acre. The plan should cover prevention of soil loss by storm water run-off and/or wind erosion, of sedimentation and/or of dust/particulate matter air pollution. Page 1 of 9 CalGreen Non -Res Checklist.doc revised 01/23/14 5.106.4 Bicycle parking. Comply with Sections 5.106.4.1 and 5.106.4.2; or meet local ordinance, whichever is stricter. ❑ ❑ 5.106.4.1.1 Short -Term bicycle parking. If the qualified project is anticipated to generate visitor traffic, provide permanently anchored bicycle racks within 200 feet of the visitors' entrance, readily visible to passers-by, Q for 5 percent of visitor motorized vehicle parking spaces being added, with a minimum of one two -.bike capacity rack. 5.106.4.1.2 Long -Term bicycle parking. For qualified buildings with over 10 tenant -occupants, provide secure bicycle parking for 5 percent of tenant vehicle parking spaces being added, with a minimum of one space. 5.106 5.2 Designated parking. Provide designated parking for any combination of low -emitting, fuel-efficient and carpool/van pool vehicles as shown in Table 5.106.5.2. 5.106.8 Light pollution reduction. Outdoor lighting systems shall be designed and installed to comply with the following; 1. The minimum requirements in the California Energy Code for lighting zones 1 — 4 as defined in Chapter 10 of the California Administrative Code; and ❑ ❑ 2. Backlight, Uplight and Glare (BUG) ratings as defined in IES TM -15-11; and 3. Allowable BUG rating not exceeding those shown in Table 5.106.8, or ❑ ❑ Comply with a local ordinance lawfully enacted pursuant to Section 101.7, whichever is more stringent. 5.106.10 Grading and paving. The site shall be planned and developed to keep surface water away from buildings. Construction plans shall indicate how site grading or a drainage system will manage all surface water flows. Division 5.201.1 Scope. The California Energy Commission will continue to adopt mandatory building standards. 0 1-F( Division- EFFICIENCY AND CONSERVATION 5.303.1 Meters. Separate meters shall be installed for the uses described in Sections 503.1.1 and 503.1.2. I 5.303.1.1 New building or additions in excess of 50,000 square feet. Separate submeters shall be installed as follows: 1. For each individual leased, rented or other tenant space within the ❑ building projected to consume more than 100 gal/day. 2. Where separate submeters are unfeasible, for water supplied to the following systems: a_ Makeup water for cooling towers where flow through is greater ❑' ❑ than 500 gpm. b. Makeup water for evaporative coolers greater than 6 gpm. c. Steam and hot-water boilers with energy input > 500,000 Btu/h. Page 2 of 9 CalGreen Non -Res Checklist.doc revised 01/23114 A5.303.1.2 Excess consumption. A separate submeter shall be provided for any tenant within a new building or within an addition that is projected to consume > 1,000 gal/day. ❑ 5.303.2 Water reduction. Plumbing fixtures shall meet the maximum flow rate values shown in Table 5.303.2.3. Exception: Building that demonstrate 20 -percent overall water use reduction. 5.303.2.1 Areas of addition or alteration. For those occupancies within the authority of the California Building Standards Commission, as specified in Section 103, the provisions of Section 5.303.2 and Section 5.303.3 shall ❑X apply to new fixtures in additions or areas of alterations to the buildings. 5.303.4 Wastewater reduction. Each building shall reduce by 20 percent wastewater by one of the following methods: 1. The installation of water -conserving fixtures or X❑ 2. Utilizing non -potable water systems. ❑ ❑ 5.303.6 Standards for plumbing fixtures and fittings. Plumbing fixtures and fittings shall be installed in accordance with the California Plumbing Code f (CPC), and shall meet the applicable standards referenced in CPC Table ❑ i 1401.1 and CalGreen Chapter 6. OM itvE Outdoor WEer Use ❑ ❑ 5.304.1 Water budget. A water budget shall be developed for landscape irrigation use. 5.304.2 Outdoor potable water use. For new water service or for addition or alteration requiring upgraded water service for landscaped areas of at least ❑ El sq.ft. but not more than 5,000 sq.ft., separate submeters or metering devices shall be installed for outdoor potable water use. 5.304.3 Irrigation design. In new nonresidential construction or building addition or alteration with at least 1,000 but not more than 2,500 sq.ft. of cumulative landscaped area, install irrigation controllers and sensors which include the following criteria, and meet manufacturer's recommendations. ❑ ❑ 5.304.3.1 Irrigation controllers. Automatic irrigation system controllers installed at the time of final inspection shall comply with the following: 1. Controllers shall be weather- or soil moisture -based controllers that automatically adjust irrigation in response to changes in plants' needs as ❑ ❑ weather conditions change. 2. Weather -based controllers without integral rain sensors or communication systems that account for local rainfall shall have a separate wired or wireless rain sensor which connects or communicates ❑ ❑ with the controller(s). Soil moisture -based controllers are not required to have rain sensor input. 5.407.1 Weather protection. Provide aweather-resistant exterior wall and foundation envelope as required by California Building Code Section 1403.2 ❑ ❑ and California Energy Code Section 150, manufacturer's installation instructions or local ordinance, whichever is more stringent. Page 3 of 9 CalGreen Non Res Checklist.doc revised 01123114 5.407.2 Moisture control. Employ moisture control measures by the following methods; 5.407.2.1 Sprinklers. Prevent irrigation spray on structures. rl 5.407.2.2 Entries and openings. Design exterior entries and/or openings to prevent water intrusion into buildings. 5.407.2.2.1 Exterior door protection.Primary exterior entries shall be covered to prevent water intrusion by using nonabsorbent floor and wall finishes within at least 2 ft around and perpendicular to such openings plus at least one of the following: 1. An installed awning at least 4 ft in depth. 2. The door is protected by a roof overhang at least 4 ft in depth. 3. The door is recessed at least 4 ft. 4. Other methods which provide equivalent protection. 5.407.2.2.2 Flashing. Install flashings integrated with a drainage plane. ❑ Construcfi�n Wastei Reduetron�tDispndR �ec�rcl�ng $ � N a ..� .� F � 5.408.1 Construction waste management. Recycle and/or salvage for reuse a minimum of 50 percent of the nonhazardous construction and demolitionCl� e2qil! waste in accordance with Section 5.408.1.1, 5.408.1.2, or 5.408.1.3; or meet a� fG local construction and demolition waste management ordinance, whichever is more stringent. 5.408.1.1 Construction waste management plan. Submit plan per this section to enforcement authority. LME 5.408.1.2 Waste management company. Utilize a waste management company that can provide verifiable documentation that the percentage of 0 construction and demolition waste material diverted from the landfill complies with CalGreen Section 5.408. 5.408.1.3 Waste stream reduction alternative. The combined weight of new construction disposal that does not exceed two pounds per square foot of building area may be deemed to meet the 50 percent minimum requirement as approved by the enforcing agency. 5.408.1.4 Documentation. Provide documentation of the waste KA management plan that meets the requirements listed in Section 5.408.1.1 through 5.408.1.3. 5.408.3 Excavated soil and land clearing debris. 100 percent of trees, 6r stumps, rocks and associated vegetation and soils resulting primarily from land clearing shall be reused or recycled. Building Maintenance and Qperation �� § �° ��' °�_ � .L ;�6n' ,�cRw.¢., &` , nd,�a...�f b-�ai ... . ad;�✓. a'''�s �``,'K �.=", a i,.. 5.410.1 Recycling by loccupants. Provide readily accessible areas that serve the entire building and are identified for the depositing, storage and collection ❑X p� y of nonhazardous materials for recycling. u— ' 5.410.2 Commissioning. For new buildings 10,000 square feet and over, building commissioning for all building systems covered by T24, Part 6, process systems and renewable energy systems shall be included in the design and construction processes of the building project. Commissioning requirements shall include items listed in Section 5.410.2. 11 Page 4 of 9 7 `�4� �11 �e Non -Res Checklist.doc revised 01123114 5.410.2.1 Owner's Project Requirements (OPR). Documented before the design phase of the project begins the OPR shall include items listed in Section ❑ ❑ 5.410.4. 5.410.2.2 Basis of Design (BOD).. A written explanation of how the design of the building systems meets the OPR shall be completed at the design phase of the building project and updated periodically to cover the systems ❑ ❑ listed in Section 5.410.2.2. 5.410.2.3 Commissioning plan. A commissioning plan describing how the project will be commissioned shall be started during the design phase of the building ❑ ❑ project and shall include items listed in Section 5.410.2.3. 5.410.2.4 Functional performance testing. Functional performance testing shall demonstrate the correct installation and operation of each 0 component, system and system -to -system interface in accordance with the ❑ri approved plans and specifications. 5.410.2.5 Documentation and training. A Systems manual and systems operations training are required. ❑ ❑ 5.410.2.5.1 Systems manual. The systems manual shall be delivered to the building owner or representative and facilities operator and shall ❑ ❑ include the items listed in Section 5.410.2.5.1. 5.410.2.5.2 Systems operations training. The training of the appropriate maintenance; staff for each equipment type and/or system El shall include items listed in Section 5.410.2.5.2. 5.410.2.6 Commissioning report. A complete report of commissioning process activities undertaken through the design, construction and ❑ reporting recommendations for post -construction phases of the building project shall be completed and provided to the owner or representative. 5.410.4 Testing and adjusting. Testing and adjusting of systems shall be required for buildings less than 10,000 square feet or new systems to serve an addition or alteration subject to Section 303.1. 5.410.4.2 Systems. Develop a written plan of procedures for testing and adjusting systems. Systems to be included for testing and adjusting shall include, as applicable to the project, the systems listed in Section ❑ 5.410.3.2. 5.410.4.3 Procedures. Perform testing and adjusting procedures in accordance with industry best practices and applicable national standards on each system. 5.410.4.3.1 HVAC balancing. Before a new space -conditioning system serving a building or space is operated for normal use, the system should be balanced in accordance with the procedures defined by ❑X01 national standards listed in Section 5.410.3.3.1. 5.410.4.4 Reporting. After completion of testing, adjusting and balancing, provide a final report of testing signed by the individual responsible for ❑ performing these services. 5.410.4.5 Operation and maintenance manual. Provide the building owner with detailed operating and maintenance instructions and copies of 0 guaranties/warranties for each system prior to final inspection. 5.410.4.5.1 Inspections and reports. Include a copy of all inspection verifications and reports required by the enforcing agency. Page 5 of 9 CalGreen Non -Res Cheeklist.doe revised 01123114 5.503.1 Install only a direct -vent sealed -combustion gas or sealed wood - burning fireplace or a sealed woodstove and refer to residential requirements in the California Energy Code, Title 24, Part 6, Subchapter 7, Section 150. 5.503.1.1 Woodstoves. Woodstoves shall comply with US EPA Phase II emission limits. ED 5.504.3 Covering of duct openings and protection of mechanical equipment during construction. At the time of rough installation or during storage on the construction site and until final startup of the heating and cooling equipment, all duct and other related air distribution component Q openings shall be covered with tape, plastic, sheet metal or other methods acceptable to the enforcing agency to reduce the amount of dust or debris which may collect in the system. 5.504.4 Finish material pollutant control. Finish materials shall comply with Sections 5.504.4.1 through 5.504.4.4. 5.504.4.1 Adhesives, sealants, caulks. Adhesives and sealants used on the project shall meet the requirements of the following standards. 1. Adhesives, adhesive bonding primers, adhesive primers, sealants, sealant primers and caulks shall comply with local or regional air pollution control or air quality management district rules where applicable or IN SCAQMD Rule 1168 VOC limits, as shown in Tables 5.504.4.1 and 5.504.4.2. 2. Aerosol adhesives and smaller unit sizes of adhesives and sealant or caulking compounds (in units o€product, less packaging, which do not weigh more than one pound and do not consist of more than 16 fluid ounces) shall comply with statewide VOC standards and other 0 requirements, including prohibitions on use of certain toxic compounds, of California Code of Regulations, Title 17, commencing with Section 94507. 5.504.4.3 Paints and coatings. Architectural paints and coatings shall comply with Table 5.504.4.3 unless more stringent local limits apply. 0 5.504.4.3.1 Aerosol paints and coatings. Aerosol paints and coatings shall meet the Product -Weighted MIR Limits for ROC in Section 94522(a)(3) and other requirements, including prohibitions on use of certain toxic compounds and ozone depleting substances (CCR, Title 17,I Section 94520 et seq). 5.504.4.3.2 Verification. Verification of compliance with this section shall be provided at the request of the enforcing agency. QX 5.504.4.4 Carpet systems. All carpet installed in the building interior shall meet the testing and product requirements of at least one of the standards listed in Section 5.504.4.4. 5.504.4.4.1 Carpet cushion. All carpet cushion installed in the building interior shall meet the requirements of the Carpet and Rug Institute i El Green Label program. 5.504.4.4.2 Carpet adhesive. All carpet adhesive shall meet the requirements of Table 5.504.4.1. ❑ Q Page 6 of 9 r CalGreen Non -Res Checklist. doc revised 01123114 A 5.504.4.5 Composite wood products. Hardwood plywood, particleboard and medium density fiberboard composite wood products used on the interior or exterior of the building shall meet the requirements for ❑X formaldehyde as specified in Table 5.504.4.5. 5.504.4.5.3 Documentation. Verification of compliance with this section shall be provided as requested by the enforcing agency. Documentation shall include at least one of the following standards listed in Section 5.504.5.3. 5.504.4.6 Resilient flooring systems. For 80 percent of floor area receiving resilient flooring, installed resilient flooring shall meet at least one of the following standards listed in Section 5.504.4.6. ❑ ❑ 5.504.5.3 Filters. In mechanically ventilated buildings, provide regularly occupied areas of the building with air filtration media for outside and return air prior to occupancy that provides at least a MERV of 8. 5.504.7 Environmental tobacco smoke (ETS) control. Prohibit smoking within 25 feet of building entries, outdoor air intakes and operable windows where outdoor areas are provided for smoking and in buildings; or as enforced by ordinances, regulations or policies of any city, county, city and county, California Community College, campus of the California State University or campus of the University of California, whichever are more stringent. iSInc)oor�Nlorstu and Radon Conirol 1"- Aik... _ 5.505.1 Indoor moisture control. Buildings shall meet or exceed the provisions of California Building Code, CCR, Title 24, Part 2, Sections 1203 ❑ ❑ and Chapter 14.1. �� "� qr Quality:aricl Exhaust3RiT �t 5.506.1 Outside air delivery. For mechanically or naturally ventilated spaces in buildings, meet the minimum requirements of Section 121 of the California Energy Code, CCR, Title 24, Part 6 Chapter rte{ and 4 of CCR, Title 8 or the applicable local code, whichever is more stringent.' 5.506.2 Carbon dioxide (CO2) monitoring. For buildings equipped with 0 demand control ventilation, CO2 sensors and ventilation controls shall be specified and installed in accordance with the requirements of the latest edition of the California Energy Code, CCR, Title 24, Part 6, Section 121(c).' EnnaamRa ental Comfo, 5.507.4 Acoustical control. Employ building assemblies and components with STC values determined in accordance with ASTM E 90 and ASTM E 413. ❑ 5.507.4.1 Exterior noise transmission. Wall and floor -ceiling assemblies making up the building envelope shall; have an STC of at least 50 and exterior windows shall have a minimu STC of 30 for any of the building El locations listed in Items 1 through 3 i Section 5.507.5.1. 5.507.4.2 Interior sound. Wall and floor -ceiling assemblies separating tenant spaces and tenant spaces and public places shall have an STC of ❑ ❑ at least 40. Page 7 of 9 CalGreen Non -Res Checklist.doc revised 01123114 5.508.1 Ozone depletion and greenhouse gas reductions. Installations of HVAC, refrigeration and fire suppression equipment shall comply with Sections 5.508.1.1 and 5.508.1.2. 5.508.1.1 Chlorofluorocarbons (CFCs). Install HVAC and refrigeration equipment that does not contain CFCs. 5.508.1.2 Halons. Install fire suppression equipment that does not contain Halons. QX Page & of 9 CalGreen Non -Res Checklist.doc revised 01/23/14 u CAL REEK SIGNATURE DECLARATIONS °'• Project Name: Panino Gi asto Restaurant Rr ect Address: 19469 Stevens Creek Blvd. Project Description: Commercial Restaurant Tenant Improvements SECTION -1 —DESIGN VERIFICATION Complete all lines of Section 1 - "Design Verification" and submit the completed checklist (Columns 1 and 2) with the plans and building permit application to the Building Department. The owner and design professional responsible for compliance with CalGreen Standards have revised the plans and certify that the. items checked above are hereby incorporated into the project plans and will be implemented into the project in accordance with the requirements set forth in the 2013 California Green Building Standards Code as adopted by the,City of.Cupertino F ner's Si nature Dafe Owner's Marne (Please Print) ; Design Pro fessi nays Signature Date Design Professional's Name (Please Prin Signature of License Professional responsible for C� reen compliance Date Name of License Professional, responsible for Cal reen compliance (Please Print) Phone Email Address €or License Professional responsible for CalGreen compliance SECTION, 2 — IM " ENTATION VERIFICATION Complete, sign and submit the competed checklist, including column 3, together with all originaLsignatures on Section 2 to the Building Department prior to Building Department final inspection. have�j ' the work n , have received sufficient documentation to verify and certify that,the project identified above was constructedi ac o dance w this Green Building Checklist and in accordance with the requirements of the 2013 California Gre n Bu' di t r o as adopted by the City of Cupertino. Signature of License Professional r lspo sible for CalGreen compliance Date Name,ofticense Professional responsible,for CalGreen compliance (Please Print) Phone-` ay te� Emall,Ad, es's for License Professional responsible for CalGreen compliance Page 9 of 9 CalGreen Non Res Checklist doe nevis d 01123114 NATE OFCAU ORNIA ,� �� INDOOR LIGHTING — LIGHTING CONTROLS CECNRCC•Lrf•a2E Revid�6fi4 _ - _... CALIF R C ,, rnnricrrarsrt�rnnArrinrrre — __ .®.__m IIIVVV The NRCC Ti -02-E shall be used to document all mandatnry and nrp nrintivp-liphtinornntrnlc that nrp nnnGenhh. t., the —m - Mandatory Blighting Control Declaration Statements (indicate if the measure applies by checking yes or no below.) - YES NO Control Requirements X Lighting shall be controlled by self-contained lighting control devices which are certified to the Energy Commission according Lathe Title 20 Appliance Efficiency Regulations in accordance withsection 1117.9_ Lightingshall be controlled by a lighting control a system or energy management control system in accordance with §110.9_ An Installation, Certificate X sha11 be submitted in accordance with Section 130.4(6). X One or more 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 besubmitted in accordance with Section 130,4(b).. ATrack Lighting Supplementary Overcurrent Protection Panel shall be installed in ar-rordance with Section 110.9 and Section 130.0. Additionally, an X Installation Certificate shall be installed in accordance with Section 130.4(b). All lighting controls and equipment shall comply with the applicable requirements In §11M9 and shall be installed in accordance with the manufacturer's X instructions in accordance with Section 130.1, X All luminaires shall be #urialonaily controlled with manually switched ON and OFF !tghting controls in accordance with Section General lighting shall be separately controlled from all other lighting systems in an area. Floor and nvall display, window display, case display; ornamental, X 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 spec ai effects- liighting shall each be separately controlled; in accordancewith Sertioh 130,1(a)4. The general lighting of any enclosed area loo square feet or larger, with a Connected lighting load that exceeds 0.5 watts per square foot shall meet the X multi-level lighting control requirements in accordance with Section 130.1(la). X All installed ltidoarlighting shall beequipped with controls thatrrieetthe applicable 5hut-CiFFcontrol requi merits nSection1.30.1(c); X Lighting in all Daylit Zones shall be controlled in accordance with the requirements in Section 130.1(d) and dayliE zones are shown on the plans. Lighting power in buildings larger than 10,00Dsquare feet shall be capable of beingautomatically reduced in response to a Demand Responsive Signal in X accordance with Section 130.1(e)• Before an octupancy permit is granted for a newly constructed building or area, or anew fighting system serving a building, area, or site is operated for X normal use; indoor lighting controls sersring'the building, area; or site shall be certified as rneetingithe Acceptance Requirements for Cade Compliahce'in accordance with Section 130.4.(a).Tha controls i equiredle meet the Acceptance Requirements include automatic daylight controls, automatic shut -OFF controls, and demand responsive controls. CA Building Energy Efficienty Standards -,2013 Norimsideralal CumAilance June 2Gl4 STATEOFCALIFORNIA INDOOR LIGHTING —LIGHTING CONTROLS, CF0ARCC-L7rz W2.M 1— commiss ON* CERTIFICATE OF COMPLIANCE NRCCL7I_6i_E_ I Indoor ughfing- U . ghtingControls (Page of 3) PANINO GIUSTO 5-24-16 A. separate document most be filled out for conditioned and Unconditioned Spaces. This page is used only for the folloving: M CONDITIONEDSPACES 0 UNCONDITIONED SPACES MANDATORY AND PRESCRIPTIVE INDOOR LIGHTING CONTROL SCHEDULE, PAF CALCULATION, and FIELD INSPECTION CHECKLIST PAF Credit Calculation Al ", t�; n Standards Complying'WIth S- Ughting Control Schedule (V all that apply, orenter'Vif Exempted) 5 * ?ff, R A S C D E F 6 H I J K L M N D. Type/ Description of lighting Control (i.e.: occupancysensor, R Location in Building automatic time switch, Of W W Qmmer, adtomatle daylight, units a E a etc:.:) I I ALL AREAS DIMMER SWITCH 6 X RM 204 LIGHTING CONTROL PANEL Z L_ X 0 13 TIME CLOCK 0 STORAGE,RESTROOM 'MOTION SENSORS/DIMMER 3 X X 0 Cl SIGNS,DINING AREA PHOTO SENSOR 8 X 0 13 M FUT _Q Control credit PAGE TOTAL (Sum of Column M):. IF MULTIPLE PAGES ARE USED, ENTER SUM T(TFAt OF control credit for all pages HERE (Sum of all Column M)., Enter Control Credit total into NRCC-L71-01-E; PzgL, 1. §130.1(o) = Manual area controls; §13ao1b] =Muldlevel; §130.lfc) =Auto Shut -Off; §230.1fdl =Mandatoryftlfght° §1.16.1(q) = Demandilesgonsive, §140.6(d) Additional lighting controls installed toeorn a PAF; §140.6(dl =Prescriptive Secondarysiffelit Daylight Controls. 2. Check Table 140.6-Ajbr correct Factor. PAashall not be traded between conditioned and unconditioned spa;es. As a condition to earn a PAF aniristallation Certificate i� also required to befilladoU4 signed, and submitted CA Building Energy Efficiency Standards -'2013 Nonresidential C-Dinpliance June 2014 Indoor -- LIGHTING CONTROLS GIUSTO DOCUMENTATIONAMOR'S DECLARATION STATEMENT _1, 1 certify that this Certificate of Com fiance docurnentation is accurate and ciimpieta. tSosumeniati�nRyhwNa�rir: -... - - DacwaenraunnAu;-her5lyraturar KHOSROW NOURMOHAMMADI [ompampo: ABSOLUTE CONSULTING ENGINEERS 5i8nd:vre€3ates 8-3-16 3839 BIRCH STREET c£AttiEase€ntr a; on de ec,rca.lentn�apkcire3; NEWPORT BEACH, CA 92660 r+r,>sr (949) 852-8700 RESPONSIBLE PERSONS DECLARAMONSTATEMENT I certify the following under penalty, of perjury, under the laws of the state of California 1.'Me information provided on this Cartiffmte of Compliance istrue and correct 2. I am eligible under Division Sof the Susinessand ProfessionsCode to accept responsibilfty for the building design orsystem design identilled on this Certificate of Compliance (responsible designer} 3. The energy featuresandperformance spedficatonc. materials, components, and manufactured deviteR for the building design or system design identified on this Certificate.of Compliance conform to the requirements of'Title 24, Part 1 anis Part5oftbe California Code of Regulations. 4, The kidding design features or svAern design featutesidentifred on this Certificate of Compliance are consistent with the Informationprovided on other applicable Lompliance documents, worksheets, calculations plans and specificationssubmitterf to the enforcementagency for approval ;vith this building permit application. S. I willensure'tbata completed signed Copy ofthis Certificate of Compliance shall be trade available with the building permit(s) issuedfor the building, and made available to -the ahtarcementagencyforall applicable inspectiont. landerstand that acompletedsignadcopy ofthis Certificate eComplianceisrequiredtobel ed with the documentation the builder provides to the building owner atrrecupancy. Rt-spon�ib6e;QcstE^fer Name:. - Resparsitite 6e7�}ter5tgnaiurc: CRAIG MIERS, AIA .company- CRAIG MIERS + GEORGE SCOTT ARCHITECTS, LLP ua:o-s'gne�i: - �;(� 12;�-'!a - A�i&as' 1624 SANTA CLARA DRIVE, SUITE 230 ti`m'e` C15485 - vts aze u: ROSEVILLE. CA 95661 Phone. (916) 780-0100 CA Building Energy Efficiency Standards - 2013 llanreMdential Compliance June 2014 STATE of CALIFORNIA. ENERGY MANAGEMENT CONTROL SYSTEM OR LIGHTING CONTROL SYSTEM IvRCI-L Energy Management Control System or Lighting Control GUSTO GENERAL' INFORMATION DATE OF BUILDING PERMIT PERMIT# BUILDING TYPE 0' Nonresidential ❑High -Rise Res 1[ammanArea) ❑ Hotel/Motel (Common Area) PHASE OF CONSTRUCTION New Construction ❑ Addition ® Alteration ❑ Unconditioned SCOPE -OF RESPONSIBILITY Enter the date of approval by enforcement agency of the Certificate of Compliance that provides Date; thespecifications for the energy efficiency measures for the scope of responsibility for this Installation ,Certilkate. Requirements in the Standards; §130.4(b) Before an Energy Management Control System (FMCS), or Lighting Control System can be recognized for compliance with the lighting control requirements in Part 6 of Title 24, the person who is eligible under Division 3 of the Business and Professions Code to accept responsibility forthe construction or installation of features; materials,. components, or manufactured devices shall sign and submit this Installation Certificate. If any of the requirements in this Installation Certificate fail the Energy Management Control System or lighting Control System installation requirements, these options for controlling lighting shall not be recognized forcompliance with the Building Energy Efficiency Standards. Check all that apply.- PART pply.PART 1 What type of Lighting Control System has been instalied? A. Energy Management Control System (ENCS) - Is a computerized control system designed to regulate the energy. consumption of a building by controllingthe operation of energy consuming systems, such asthe heating,. ventilation and airconditioning (HVAC), Lighting, and water heating; systems, and iscapable of monitoring environmental and systern loads, and adjusting HVAC operations in orderto optimize energy usage and respond to demandresponse signals. 0 The Energy Management Control System has been installed to function as a lighting control required by -Part 6 and functionally meets all applicable. requirements for each application for which it is. installed, in accordance with Sections 110.9, 130.0 through 130.5, 140.6 through 150.0, and 150.2; and complies with Reference Nonresidential Appendix NA7-7;2_ 0 The EMCS has been separately, tested for each respective lighting control system for which it isinstalled to function as. 11 B. Lighting Contrail System Requirestwo or more componentsto be installed in the building to provide all of thefunctionality required to. make up a fullyfunctional and compliant lighting control. 0 The installed Lighting Control System.complies with the requirements checked below; and Oil'compc the system considered together as installed meet all applicable requirements for the application for CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance July -STATE OF CALIFORNIA ENERGY MANAGEMENT CONTROL SYSTEM OR LIGHTING CONTROL SYSTEM CEC-NRCI-M-n?-F (RwuicrarMWIAl _. CERTIFICATE OF INSTALLATION NRCI-LTI-02-E. EnergyManagement Control System or Lighting Control (Page 2 of 5) System Prefect Nam e; PANINO GIUSTO EnfomementAgency. - - Permit Number Project Addrem 19409 STEVEN CREEK BLVD. City' CUPERnNO, CA LPcode:. they are installed as required in Sections 130.0 through -130.5 Sections 140.6through 140.8, Section 141.13, and Section 150.0(k). PART 2 Lighting Control Functional requirements: Check all that apply when verifying the installation of an EMC S or Lighting Control Systeme. 0 , A. All lighting controls and`equipment have been installed in accordance with the manufacturer's instructions. 0 13. The manufacturer has provided instructions for calibration_. C. if indicator lights are integral to any components, such indicator.lights consumes no more than 1 watt of power per indicator light. 0 D. Components that are regulated: by the Title "20 Appliance Efficiency Regulations leave been certified to the Energy Commission. E. The FMCS or Lighting Control System functions as one or more of the Time-Switch'Lighting Controls checked below, and complies with all of the following requirements; 0 1. Automatic Time -Switch Controls meeting all requirements, for Automatic Time Switch Control devices in the Title 20Applibnce Efficiency Regulations, includingthe requirements below; a. Residential automatic time -switch controls have program backup' capabilities that prevent the loss of the device's schedule for at least 7 days, and the device's date and time for at least 72 hours if power is interrupted. `b. Commercial automatictime-switch controls meet the following requirements: 1. Has program backup capabilities that prevent the loss of the device's schedule for at least 7 days, and the device's date and time for atleast72.hours If,power is interrupted; ii. is capable of'provid;ing manual override to each connected load and shall resume normally scheduled operation after manual override is initiated within 2 hours for each connected load; and iii. Incorporates an automatic holiday shutoff feature thatturns off all connected loads for at least 24 hours and then resumes normally scheduled operation. ❑ 2. Astronomical Time -Switch Controls meeting all requirements forAstronornical TiMe-Switch Control devices in the Title 20 Appliance Efficiency Regulations, including the requirements below - a. Meets the requirements of an automatic time -switch control; b. Has sunrise and sunset prediction accuracywithin plus -or -minus 15 minutes and timekeeping accuracy within 5 minutes per year; c. Is:capable of displaying date, currenttime, sunrise time, sunset time, and switching times for each step during programming; d. Has an automatic daylight savings time adjustment; and e. Has the abilityto independently offset the on and off for each "channel by at [east 99 minutes before and after sunrise or sunset. 0 3. Multi -Level Astronomical" Time -Switch Controls, in addition to meeting all of the requirements for, Astronomical Time -Switch Controls, includes at least 2 separately programmable stepsper zone. CA Building Energy Efficiency Standards 2013 Nonresidential Compliance July 2014 STATE OF CALIFORNIA , ENERGY MANAGEMENT CONTROL SYSTEM OR LIGHTING CONTROL SYSTEM' CEC-NF C1-LTI-02-E (RaAnPdn7/i41 rnt rGnanna cncory rr n CERTIFICATE OF INSTALLATION NRCI-tTI-02-E Energy Management Control System or Lighting Control (Page, of 6) System Prplect Name PANINO GIUSTO Enforcement Agency, Permit Number: Project Address: 19409 STEVEN CREEK BLVD. City:- CUPERTINO, CA Zip Code. Q F The EMCS or Lighting Control System functions as one or more of the Daylighting Controls listed below. 1_ 'Automatic Daylight Controls meet all requirements for Automatic Daylight Control devicesinthe Title 20 Appliance Efficiency Regulations, includingthefoilowiing a. is capable of reducing the power consumption in response to measured daylight either directly or by sending and receiving signals; b. If the system includes a dimmer, complies with the Dimmer Control device requirements in the Title 20 Appliance Efficiency Regulations. c. Automatically return to its most recent time delay settings within 60 minutes when put in calibration mode; d, Has a set point control that easily distinguishes settings to within 10 percent offull scale adjustment; e. Has a light sensor that has a linear response within 5 percent accuracy over the range of illuminance measured by the light sensor; f. Has a light sensorthat is physically separated from where the calibration adjustments aremade,, or is capable of being calibrated in a mannerthat the person initiatingthe calibration is remote from the sensor during calibration to avoid influencing calibration accuracy; and g. Complies with the Title 20 requirements for photo controls. if the system contains a photo control'. component.. D 2. Photo Controls meet all requirements forPhoto Control devices in the Title 20 Appliance Efficiency Regulations, including the following that it does not have a mechanical' device that permits disabling of the control. 13 G. The EMGS or Lighting Control System functions as a Dimmer and meets all requirements fora Dimmer Control device in the Title 20 Appliance Efficiency Regulations, including the following 1. Is capable of reducing_ power consumption by a minimum of 65 percent when the dimmer is at its lowest level; 2. Includes an off position which produces a zero lumen output; and 3. Does not consume more than 1 watt per lighting dimmer switch leg when in the off position. 4. Dimmer controls that can directly control lamps provide electrical outputs to lamps for reduced flicker operation through the dimming range so that the light output has an amplitude modulation of less than. 30 percent for frequencies less than 200 Hz without causing premature lamp failure. 5. R designed for use in three way circuits is capable of turning lights off, and to the level set bythe dimmer'ifthe lights are off. 13 H. The EMCS or Lighting Control System meets the following requirements; 1. Is :capable of automatically turning. off controlled lights inthe area no more than 3t}, minutes afterthe. area has been vacated; 2. Allows all lights to be manually turned off regardless of the status of occupancy; and 3. Has a visible status signal that indicates that the device is operating properly, or that it has failed.or malfunctioned. Thewisible status signal may have: an override switch that turns off the signal, 4. All occupant sensing devices that utilize ultrasonic radiation for detection of occupants meet the Ultrasound Maximum Decibel Values in the Title 20 Appliance Efficiency Regulations CA Building Energy Efficiency standards 2013 Nonresidential Compliance July 2014 STATE OF CALIFORNIA �. ENERGY MANAGEMENT CONTROL SYSTEM OR LIGHTING CONTROL .SYSTEM r;rr_NRr_I_I TU11%r-M—i—A n7Hd\ rnc CERTIFICATE OF INSTALLATION NRCI-LTi-02-E Energy Management Control System or Lighting Control System (Page 4 of 6) Pro eye Nam e: PANINO" GIUSTO - -. _.... _ EnfnrcementAgency: -Permit Number: _. ProjectAddress:. 19408 STEVEN CREEK BLVD. G1tyo CUPERTiNO, CA Zip Cnde: 5. All occupant sensing devices that utilize microwave "radiation for detection of occupants meet the radiation requirements in the Title 20 Appliance Efficiency Regulations 6. Occupant sensing; devices incorporating dimming comply -with the requirementsfor dimmer controls in the Title 20 Appliance Efficiency Regulations 7. The EiVICS or Lighting Control System functions as one or more ofthe Occupant Sensing Controls Checked 'Below: 13 a. Occupant Sensors meeting all applicable requirements for Occupant Sensor Control devices in the Title 20 Appliance Efficiency Regulations b. Motion Sensors meeting all applicable requirements for Motion Sensor Controls devices in the Title 20Appliance Efficiency Regulations, including that motion sensors are rated for outdoor use. 13 c. Vacancy Sensors meeting all applicable requirements for Vacancy Sensor Controls devices in the Title 20Appliance Efficiency Regulations, includingthefollowing: i. Does not turn on lighting automatically and does not incorporate DIP switches, or other manual means, for conversion between manual and automatic functionality; ii. Has a grace period of no more than 30 seconds and no less than 15 secondsto turn on lighting automatically after the sensor has timed Out; and iii.- Does not have an override switch that disables the sensor. 13 d. Partial ON Sensors meeting all applicable requirements for partial on sensing devices in the Title 20 Appliance Efficiency Regulations, including the following: L Has two poles each with automatic -off functionality; ii. Has one pole that is manual -on and does not incorporate DIP switches, or othermanual' means, for conversion between manual and automatic functionality; and iii. Has one pole that is automatic -on and is not be capable of conversion by the user to manual -on fu ctionality. CI e., Partial-OFFSenso s meet all applicable requirementsfor partial off sensing devices in the Title 20 Appliance Efficiency Regulations, including the following- L Has'two poles; ii. Has one pole that is manuakon and: manual oft; and ill. Has one pole that is automatic -on and automatic -off and is not capable of conversion by the`userto manual -on only functionality. ❑ f. `Occupant Scnsing Control systems consist of a combination of single or Multi-level Occupant, Motion, or VacancySensor Controls, and all components installed to complywith manuakon requirements are not capable of conversion by the user from `manual -on to automatic -on functionality. PART 3 Requirements for which the control is being installed to complied with:. Identify all requirements in the Standards for which the EIVIGS or Lighting Control System is installed to function as and. complies with; Check aN'that are applicable 13 A. Section 130.1(a) Area Controls. B. Section 130.1(b) Multi -Level Lighting Controls M C. Section 130.1 (c) Shut -OFF Controls D. Section 130.1 (d) Automatic Daylighting Controls, E. Section 130-1 (e) Demand Responsive Controls. F. Section 130.5 (d) Circuit Controls for 120 -Volt Receptacles. CA Building Energy Efficiency Standards 2013 Nonresidential Compliance Ju1y2014 LIGHTING COMPEIANc£DOCIIMENTs{seiyesforeathdocumentintiodfdl far detailed instructions aui the use of this and ail EnergyEfflciency steandards complionce dneumentsreferto tiae ivanresidentr'oi AAttnunfFuh7 shedby the Callf arnia fmrgy Commission yea NO FORM TITLE _.. - X NROC-LIT-0I-E Gertif+caieofcompliance, All Pages requiredonElansforalisutunitt s X NRCGiII62-E LighiingCailtrcals,Certgrkateorcompliance, and PAFCaleulallon. All Pagesrequlmdonglansforallsnhmittals, X NKCAIT--03-€ indoor L'ightingPowerAlldwance _ X NftCC-117-04-E Tailored Method Worksheets X NRCC-LIT-054E. 6ne VoltageTracktthting WoA-sheets Summary of Allowed Lighting Bower Conditioned and Unconditioned spare Lighting msastnot becombined for compliance Indoor Lighting Power for Conditioned Spaces Indoor Lighting Power forUnconditionedspaces Watts IWatts Installed Lighting Installed Lighting' 1, NRCCLTI-01 E. Rae 4 1,100.0 NRCC-LTI til, -E, Pap 4 1 2. PORTABLEONLYFOR OFFICES � 0 NRC[ LTI-01-E, a e3 . 3. Minus LlghtingControl[redits - U Minus Lighting Credits NRC[ RCC -12-E; a e 2' NRCC-11I-02-E, e 2 ¢ Adjusted installed Lighting Power _ _ 1,100.0 Adjusted Installed Lighting Power (row 1 plus row 2 rrainus mw 3) (row i minus row 3) o ,CA Building Energy Effidenq standards -2013 Nonresidential Compliance June 2014. Declaration of Required Installation Certificates- Declare by selecting yes for all Installation Certificates that will besub raoitted. ( Retain copies and verify forms are Complies ONLY of lnsfalled 5 Allowed Complies ONLY if Installed SAllowed S E5 NO Form/Title - - Allowed Lighting Fowey Allowed Lighting Polder 0 Field Inspector X Conditioned �iRCC LT1�33 l ; page 2.171.0 Unconditioned NRCC-al-03-E, page 1 Declaration of Required Installation Certificates- Declare by selecting yes for all Installation Certificates that will besub raoitted. ( Retain copies and verify forms are completed and signed.) S E5 NO Form/Title - - X NRCI-LTl-01-E- Must be submitted for all buildings 0 Field Inspector X NRCI-LTI-ill-E-MusCbesubmitted for a lighting control system, or for an Energy. Management Control System (EMCa) 13 Field Inspector to be recognized for compliance. NRCKTl-03-E - Must.be submitted fora line-rroltage trach lighting Integral current limiter, or for a supplementary X 0 Field Inspector oven ui rent protection panel used to energize only line -voltage -track lighting to be recognized for compliance.. NRR-LTf-04-E - Must be submitted fsrtwo interlocked systems serving an auditorium, a convention center, a 1J Field Inspector X conference room,, a multipurpose room, or a theater to be necognized'for compliance. X NRCl-LTl-05-E - Must ate submitted fora Power Adjustment Factor (PAF) to he recognized for compliance. f Field Inspector X NRCI-LTI-05-E - Musk be submitted foradditlonal wattage installed in a video conferencing studio to he recognized for L7 Field Inspector compliance. by completed and signed.) YES I NO 171 X NBCAATI-02-A-M4—rtbesubmitted for occupancy sensors -arid automati-tii7 —VitchcoriSrols. Fie]dinsnec#or X NRCA-LTI.03-R - Must be submitted for automatic daylight contrails: M Field rnsnprrnr demand responsive CA BuMing Energy£fifidency SCaapdards, -2013 NonregidenMI Curnpliance June2014 are A separate Lighting Schedule Must Be filled Out far Conditioned and Unconditioned Spaces, installer/ Lighting !sower listed on this lighting schedule is onlyfar; M CONDITIONER SPACE [3 UNCONDITIONED SPACE C. INDOOR LIGHTING SCHEDULE and FIELD INSPECTION ENERGY CHECKLIST i uminalre Schedule Installed Watts Locatinn i � td1nspe�ror' A B C p £ g, H How wattage was determined 0 CarzapteteLuminaire Descaigtinss Q 0 Q 3 a 1m-, 3Iamp f]" aresc€nttrotter, d a a Q a. 3 x Primary Function2rea in w Bich A F3278,one dimmable electronic ballast) 7M s = o^ d .� ; theseluminaires are installed Pass Fail A 4' DOWN LIGHTS 11 18 198 DINING,SERMNG,RESTROOM 0 a B _ 4' PENDANT LIGHTS 20 lKl I 22 440 DINING ❑ M C 14" DUAL HEAD DOWN LIGHTS 21 ❑ - 6 126 SERVING ❑ ❑ D 8' PENDANT LIGHTS 20 lel ❑ 5 100 SERVING 13 E WALL SCONCE 20' Q 3 60 DINING,RESTROOM,STORAGE 13 a F,FE 2x4 RECESSED LIGHTS 32 21 0 3 96 KITCHEN 0 0 G LED ROPE LIGHTS 60 ❑ — 60 DINING 0 0 K SURFACE MOUNTED DOWN LIGHT 20 20 STORAGE ❑ E3 ❑ ❑ - ❑ ❑ INSTALLED WATTS PAGE TOTAL: r EnteBurn total of all pages into 1.100.0 NRCC-LTI 01-E; Page 2 CARuiMirlgEpergyEfriciencyStandards- 2(inNonresidentialCompliance June 20 4 DOCUMEWAXION AUTHOR'S DECLARATION STATEMENT 1, IcertifythartblsCertificate ofCanpftaneedocumentationisnscuaateand completer nalumomtitEprAuthartJaitw� _ Dacwrlmta:ian re: Airh., 5igm'z .. KHOSROW NOURMOHAMMADf CoroganY.. - 3igrmtat, Date. ABSOLUTE CONSULTING ENGINEERS 8-3-16 ad=Iress:" - 3839 BIRCH STREET c�IH€gsi<r+rtiiicafanidendflcauoro.eaaltca6ie3: atalstaILM . NEWPORT BEACH,. CA 92660 (949) 852-8700 RESPONSIBLE PERSON'SDECIARATIONSTATEMEttIf Icertify the folluw1rigunder penalty mfperjurY: under the lawsmftbeStatesfCalifomia 1. The information provided on this Cer[ificateofComptianceistrue and correct. 2. t arsi-eligible under pivisian 3 ofthe Business and Professions to ar pLresps nsi it tyfar the building design orsystern desitpa identified orthisCeiti€icate of Compliance (responsible designer). 3. The energyfeetutes and performance specifications, materials, components, and manufactured devicesforthe building design orsystem design identified mnthisicert'ifirate of Compliance conform to the requirements of Title 24, Parti and Part f of the California Code of Regulations, 4. The buililingdesign features or system design features identified an this Certificate ofCompliaripe are consistent with the informat;ioaprovided ori otherappficable compliance documents worksheets, calculations, plans and specifications submitted to the enforcementagencyforapptmvatwith this building Permit application. 5. 1 wilt ensure thata completed signed copy of thFs Certificate of iompfiance shall be made available with the building permits) issued for the building, and ri-,ade available tothe enfortementagency for all applicable inspections. l understand theta completed signed copy ofthis Certificate of Compliance is require dq be included v✓ith the documentation the builder providestothebuilding owner atoccupancy. i i fleSnCrKa7tays[akr ei2m CRAIG MIERS,.:. AIA - agsRar�FibieoRSigru`sign�,ure -. -... _.. CRAIG MIERS + GEORGE SCOTT ARCHITECTS, LLP 'tes+ariea: ed l 1624 SANTA CLARA DRIVE, SUITE 230 u`" °i C15485 ci:�lstatslZlir< ROSEVILLE. CA 95661,- Plunei (916) 780-0100 CA Building Energy TMciePW Standar45-2013 Nonresidential Compliance June 2024 STATE OFCALIFORNtA INDOOR LIGHTING POWER ALLOWANCE ALLOWED LiGH`f NG POWER A separate page must be filed'cut for Conditioned and Unconditioned Spaces. This page is only for; ® CONDITIONED spaces l3 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 Metha d or a combination of Area Category and Tailored Method for compItance, use onlythetotal irar column (b) as thetotal allowed building watt (a) (b) 1. Complete Building Method Allowed Watts. Documented in section B of NRCC-LTJ-03-E (below on this page) 2. Area Category Method Allowed Watts. Documented in section C-1 of NRCC-LT 03-F (below an this page) 2,171.0 3. Tailored Method Allowed Watts. pocurrtented in section A of NRCC-LTI-04;E r TOTAL ALLOWED BUILDII G WATTS. Ener number into correct cell on NRCC-LTI-01, Page 2 Row 1 2.171.0 11 Chock here if building contains 4th conditioned and unconditioned areas. B. COMPLETE r rs C D WAITSCOMPLETE I ALLOWED TYPE OF BUILDING (From §140.6 Table 140.£-8) PER (ft)7t SLOG. AREA = WATTS Total Watts. Enter Total Watts into section A, rove 1 C -1 AREA CATEGORY MET OD TOTAL LIGHTING POWER ALLOWANCES (C-2 Plus C-3) Watts. Total from section G2 e. 2,171.0 — - --- - — -- -- ----_ --- --- -_ _ — — -- . 7 . Total from section C-3' . 0 Total Watts. Enter Total Watts intasection A, row 2 (Above on this page) 2,171.0 €A Building Energy Efficiency Standards 12013 Nonresidential Compliance lune2024: DOWER ALLOWANCE Indoor lighting , pQWer AjI%vajjc,. A separate page must be filled out for Conditioned and Unconiltioned Spaces. This page is onlyfort C11 CONDITIONED spaces, 13 UNCONDITIONED spaces C -2 AREA CATEGORY METHOD GENERAL LIGHTING POWER ALLOWANCE Cl bo not include portable lighting for offices. Portable lighting foe -offices shall be documented only in section j3 of mRcc-vn-oj.,F-, E3 Separately list lighting for each primary function area as defined in §10o.1 of the standards. A AREA CATEGORY (Front §3,40.6 Table 140;6-C IAtATTS PER (ftp} 1.1 x C AREA 552! 6351 1701 63 D ALLOWED WATTS 607.2 bocation in Building Peimaey Function Area per Table 140.6-C DINING AREA CLINICAL CARE AREA SERVING AREA LABORATORY 1.6 1,016.0 KITCHEN CORRIDOR 1.6 272.0 RESTROOM CORRIDOR 0.6 37.8 L -STORAGE CORRIDOR 0.7 340; 238.0 TOTALS 1 1, Enter suMtbt2iAreaCateg(iTy'all6wfRdw-itts into section C-1 of NRCC-LTI-03-E (this compliance 2,171.0 2,171.0 WATTS CA Building Fnere 1clencv Stanoards-2013 Nunresidential Compliance JUne2014 yEff Xt separate page must be Filled out for Conditioned and Unconditioned Spaces. Thispage is only fora 13 CONDMONEDspaces 13 UNCONDITIONED spaces e 3 AREA CATEGORY METHOD Additional lighting Wattage Allowance (from Table 140.5-C Footnotes) A B C p E F G Primary Function Sq Ft or linearft Additional watts Allowed Wattage Allowance JBXQ Description(s) and Quantity ofSpecal LummaireTypesineachPrimary FuricticinArea Total Design wafts ALLOWED WAM smalwof D-orr TOTALS— Enter into TOTAL AREA CATEGQRYMETHOD AI)D1T10NALALLDAIALACES—Seek on Gl 1. Use llrsear feet only for addittoraal allowance for white board nr chalk board. All other additional Area category allowances shail use watts persquore ftspt. 7. Additional watts aro available only when allowed according to the footnotes on bottom affable 146-0, which include; Specializedtask work; Ornamental lighting; Precision commercial and industrial work; Per linear foot of white board or chalk board; Accent, display and feature lighting; and Videoconferencing Studio lighting.. 3. Lumma(re classification and wattage shall be determined in accordance with §130.0(c) ofthe Standards, CA Building Energy Efficiency Standards -2033 Nonresidential Compliance Junu 2024 POWER #LLOWAN-CE - Indoor NINO GIUSTO a.Wprop: - 5-24-16 -. DOCUMENTATION AUTHOR'S DECLARATIONSTATEMEfiI7 3. I certify that this Certificate Of Compliance documentation is accurate and comp]ete DOW ren;annnAuttwr,vamc KHOSROW NOURMOHAMMADI aonumenra,IonAuharssnaues. ecmnany: _ , ABSOLUTE CONSULTING ENGINEERS Slang xeaa'e 8-3-16 Aidre�sp - - _ �qj HERS L'erdfle�5on tQ[n.l icafi6nli€app71ra6tR}o _ - 3839 BIRCH STREET. ccy/sateJ': NEWPORT BEACH, CA 92660 phonm _ - (949) 852-8700 RESPONSIBI PER5fiJ ia'S FSI;iwtARA7fON 53+4TEM£NY _ _ - - I certify the following under penalty of perjury, under the laws of the State of Californian 2. The information provided on this Certificate of compliance istrueand correct, 2. '1 am eligible under Division 3 ofthe Business and Prafessicins Code to accept responsibility for the building designorsystem design identified on this Certificate of Compliance: (responsible designer), 3. The energyfeatures and performance-spedrications materials.?omponents, and manufactured devicesfor the buildingdesign orsystem design identified an th s Certificate of Compliance conform to the requirements of Tide 24, Partl and Part Gofthe Califomi'a Code of Regulations, 4. The huildingdesignfeatures orsystem design features identified onthis rtifjcateofComplianceareconsistenYwjththeinformationprovidedonatherapplirabiecomplaance documents,+worksheets, calculations, plans an d specifications submitted to the enforcement agency for approval with this bullding permitapplication. S. f will ensure thata completed signed copy ref this Certificate of Compliance shall be made available with the building permit(s) issu or -the building, and made availabletothe enforcement agency for all applicable irspectlorts, I understand that a completed signed copy of this Certificate of Compliance is qu dtobeincludedwith the documentation the builder provides to the buildingowner at occupancy aespans11,1eae54 rNamer CRAIG MIERS, AIA RopenstbleDesigner senazum- C°mP"r` CRAIG MIERS t GEORGE SCOTT ARCHITECTS, LLP aa`esswd: Adruess: ®� Memo;1624 SANTA CLARA DRIVE, SUITE 230 C15485 CdrylStatel'Jna Aiwrm: - '; ROSEVILLE CA 95661 916 780-0100 CA Building Energy Efficiency Standards -2D13 Nonresidential Compliance lune 2014. STATE OF QAfLIFORNIA► INDOOR LIGHTING CEG-I3IRGI-LTI-0i-E ReWsed07s14) CERTIFICATE OF INSTALLATION Indoor Lighting "G PANINO GIUSTOnfcxcemt e�cr: Permitu nb�r.' goes glare 19409 STEVEN CREEK BLVD. CUPER11N0, GA BUILDING TYPENonresidential El High -Rise Flea [Common Area}, ❑ Hotel/Motel (Common Area) tH-M iOF CONSTRUCTION 0 New Construction ❑ Addition ® Alteration ❑ Uncc+nditionetd SCOPE OF RESPONSIBILITY _ Enter the date of approval try ertfareement agency of the Certificate of Carp pliance that provides gate; the specifications for the energy of ftciencymeasires far the scrape of responsibility for this Installation Certificate. In the tabu below identify all applicable construction documents that specify the regutremen is for the supe of responsibility reported by this Installation Certificate (continued). D3 teApproved By Document Title or Description Applicable Sheets or Pages, Tables, Schedules, etc. I tee Enforcement INDOOR LIGHTING E-1, E-2, E-3 NRCC—LTI-01-E INDOOR LIGHTING—LIGHTING CONTROLS E NRCC—LTI-02—E —1, E-2. E-3 INDOOR LIGHTING—POWER ALLOWANCE E-1, E-2, E-4 NRCG—LTI-03—E CA Building Energy Efficiency Standards- 2,013 Nonresidential Compliance July 2014 STATE OF CALIFORNIA INDOOR LIGHTING 10— 1-4 . CERTIFICATE OF INSTALLATION aHLirurcrvt�etu�rcG;YGC3�dI�lt55I4[�f `._. QoP,tlmenladonAuthor{V-ame: KHOSROW N,QURMOHAMMADI NRCI-LTI701-E Indoor Lighting (Page � �# zj Prpl�cEpiam ; PANINO GIUSTO ... -. Enl�rtemeatAc:n�cy: -. - .... -. Permett+t:� ber t'rdcstAddre.^. 19409 STEVEN CREEK BLVD..: ... MY; CUPERTIHQ CA DOCUMENTATION At1THOR'S I)ECLARATION STATEMENT I certify that thIsCertificate of Installation documentation is accurate and complete. QoP,tlmenladonAuthor{V-ame: KHOSROW N,QURMOHAMMADI L1vcutit93ltaTion Author Si$tiatur ..... Date signed. Documentation Author t umpany Ngpe: ABSOLUTE CONSULTING ENGINEERS 8-3-16 Address: 3839 BIRCH STREET t t of tits 4ertificat urient,ficaiigntragptica&iej; City{State%Zip: NEWPORT BEACH, CA 926601°t'e' (949) 852-8700 RESPONSIBLE PERSON'S DECLARATION 5TATMIFNT I certify the following under penalty of perjury, under the lags of the state of California. 1. The information provided on this Certificate of Installation is true and correct, 2. 1 am eligible under Division 3 of the Business and Professions Cotte in the applitable eiaSsifieatiairi t6aceept responsibility farthe System design, cQnStructipn, or installation of features, materials,components, or manufactured devices for the scope of work identified on this Certificate of Installation and attest to the.declarations in this statement (responsible builder/installer). otherwise lam an authorized representative of the responsible builder/installer. S. The constructed or installed features, materials, components or manufactured' devices (the installation) identified on this_ Certificate of Installation conforms to alt applicable codes and regulations, and the installation conforms to the requirements given on the plans and specifications approved by the enforcement agency, 4. 1 reviewed a copy of -the, Certificate of Compliance approved by the enforcement agencyfhat identifies the specific requirements for the scope of construction or installation identified on this Certificate of Installation,. and I have ensured that the requirements that apply to the construction or installaVor! have been met. I will ensure that a completed signed copy ofthis'Certificate of Installation shall be posted, or made available tAtith the building permit(s) issued for the building, and made available to the: enforcement agency'for all applicable inspections, l understand that a completed signed copy ofthis Certificate of Installation is required to be included withthe dectimentationthe builder pravidesto the building owner at occupan❑y. Responsible Builderlinsialler Mame: Responsible Builderf Installer CmnpanyMauie_(IInstallingSuhtontraoornrGeneralContractoror auilderfom.er)1iA4'1'Pei VIL'0x$ :WCa-figL- a position With Cotnpany( iq allpleA 1A Address; 0. O�� 1365 tsCG tieense: - 10111-5 citrifstate/rup, }'tlrl/�Mo3i�-_00VC1-? CA 100ZS�! ffii ted: , Phone F. 3/®—k030 3 �y /6—/3-%e CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance July 2014 ,1 STATE OFCALIFORNIA DEMAND RESPONSIVE LIGHTING CONTROL ACCEPTANCE CERTIFICATE OF.ACCEPTANCE iVRCA-tf€-04 A Demand Responsive Lighting Control Acceptance Dcicument ` (Page 1 of Fr) itplattmc: PANINO GIUSTO 6acementfi�escr taemth rrr ercyeatsadres€ 19409 STEVEN CREEK BLVD. ; CUPERTINO. CA I Zip Bode: Atate, Submit one Cert1r0te afRcreptancefor each systemthat' Enforcement Agency Use., Checked by/Date mist demonstrate compliance. Demand Responsive Lighting Control Intent: Test the reduction in lighting power due to the demand responsive lighting control as per Sections 130.1(e)and 130.5(e). NA7,6.9 Acceptance tests for Demand Responsive Lighting Controls in accordance with Section 130.1(e 1 Instrumentation to perform test includes, but not limited to: a. Nand -held amperage and voltage meter' b. Power meter c. Light meter 2 Construction inspection Verify the demand responsive control is capable of receiving a demand Iresponse signal directly or indirectly through another device and that it complies with the requirements in Section Demand responsive controls and equipment shall be capable of receiving and automatically 130.5(e) responding to at least one standards based messaging protocol which enables demand response -- after receiving a demand response signal. DEMAND RESPONSESIGNAL is a signal sent bythe 1=1 utility, independent System Operator {IS—J Definition or designated curtailment service provider or aggregator, to a customer, indicating a price or a request to. modify electricity consumption, for a Iimited time period. p If the demand response signal is received from another device (such as an EM+CS), that system must itself be capable of receiving a demand response signal from a utility meter or other -external source. NA7 6.3.2 Functional Test 1 Use eitherMethod 1(illuminance measurement) or Method 2 (pourer input measurement) to perform the functional test, 'rest building -wide reduction in lighting powerto at least 35°lo below the maximum total lighting power, as calculated 0 2 on an area -weighted basis (measured in illuminance or power). However, any single space must' not reduce the combined illuminance from daylight and electric light to less than 50',6 of the design illuminance. 3 For buildings with up to. seven (7) enclosed spaces requiring demand responsive lighting controls, all spaces shall be tested. For buildings with more than seven (7) enclosed spaces requiring demand responsive lighting controls, sampling may be done on additional spaces with similar lighting systems.. if the first enclosed space with a demand responsive ri 4 lighting control in the sample group passes the acceptance test, the remaining building spaces in the sample group also pass. If the first enclosed space with a demand responsive lighting contr©l in the sample.group fails the acceptance test the rest of the enclosed spaces in that group must be tested. Cl 5 If any tested demand responsive lighting control system falls it shall be repaired, replaced or adjusted until it passes the test. CA Build log Energy Efficiency Standards - 2013 Non residential Compliance June 2014 STATE OF CALiFORNI . DEMAND RESPONSIVE LIGATING CONTROL ACCEPTANCE DOCUMENT C9(_'WRCA.1Ti_itd..A;—A...4nAHA CERTIFICATE OF ACCEPTANCE c su ervKtutf3 t:NhK4+T i;OMPJil3SJOIN ". _ NRCA-LTI-04,-A pemand Responsive Lighting Control Acceptance Document (Page 2 of B) a�ectr*m PANINO GiUSTOfnrtpr sett r5g2r cy e mte3rnr. +bi cctadess: 1$409 STEVEN CREEK BLVD. CUPERTINO, CA a Lader Cry Building Energy Efficiency Standards -2013 NsnresidentialComplianco June 2014 Method 1A Illuminance Measurement. - in each space, select one location for illuminance measurement. The chosen location must not be in a primary or A.. secondary skylit or sidelit area, and when placed at the location, the illuminance meter must not have a direct ew of a vi window orskylight. if this is not possible, perform the test at a time and location at which daylight illuminance provides less than half of the design illuminance, Mark each location to ensure that the illuminance meter can be accurately located. Step 1.: Full output test Space number 1 2 4. _ 7 Using the manual switches{dimmers in each space, set the lighting system to design full a. output. Note that the lighting in areas with photocontrols or occupancy/vacancy sensors may be: at less than full output, or may be off. Take one illuminance measurement ata: b, representative location In each space, using at) fc fc fe fc fc fc fic illuminance meter. C. Simulate a demand response condition using the demand responsive control. Take one illuminance measurement atthesame d. locations as above, with the electric lighting fc fc fc fc fc " fc fc system in the demand response condition. e. Turn off the electric lighting and measure the da Ing at the same location (if present) fc fc fe fc ft fc fc Calculate the reduction in illuminance in the f demand response condition, compared with the design full output condition. (((thee b - line ae)- In � n Q ° Q ' t a l (line d — line e)) Aline b - line ell g. Note the area of cacti controlled space sf sf sf sf sf sf sf The area -weighted reduction must be at least 0.25 (151) but must not reduce the combined x gly -l- (M x g2) + (13 x g3) h. illuminance from electric light and daylight to f9i + 92 + 93 � less than 50% of the design illuminance in any individual space. The demand response signal must not reduce I. the power input of any individual circuit by Y / iN Y / N Y/ lel Y/ N Y/ til Y / NY / N more than 5T/o. step Z: Minimum output test Using the manual switches/dimmers in each space, set the lighting system to minimum a. output (taut riot Doff). Note that the lighting in areas with photocontrols or occupancy/vacancy 1c, sensors may beat more than minimum output, or may be off. b. Take one illuminance measurement at each location, using an illuminance meter. fc fc fc fc fG fc fc Simulate a demand response condition using the demand responsive control. Take one illuminance measurement at each d location with the electric lighting system in the fc fic fc fc fc fc fc demand response condition. Cry Building Energy Efficiency Standards -2013 NsnresidentialComplianco June 2014 STATE OF CALIFORNIA DEMAND RESPONSIVE LIGHTING CONTROL ACCEPTANCE DOCUMENT CEGNRCA.LTI-04-AtRvKAS aid MAN ____.._ __.— , CERTIFICATE of ACCEPTANCE 1.4ALIrUKIVIA tP hKQT ULMMd55iG�N NRCA-LTI-04-A Demand Responsive Lighting Control Acceptance Document (gage 3 of 3Y p'QCttl3Ytp: - - PANINO GUSTOPMmAddresv 'c''42hIA t,.s ACy: t961llY Ni - t��rit 19409 STEVEN CREEK BLVD. CUPERTINO, CA YIN «erode; CA Building Energy Efficiency Standards -2013 Nonresidential Compliance lune 2014 1n each space, the illuminance in the demand e, response condition rust net be less than the illuminance in the minimum output condition or YIN YIN Y/ N Y/ N Y/ Y/ N Y f N SMIQ of the design illurnirlance whichever is less, EXCEPTION: In daylit spaces, the illuminance in the demand response condition maybe below the minimum output setting, but in the demand response condition the combined illuminance from daylight and electric light must be at least 50% of the design illuminance. CA Building Energy Efficiency Standards -2013 Nonresidential Compliance lune 2014 STATE OFCALIFOP IA 4 DEMAND RESPONSIVE LIGHTING CONTROL ACCEPTANCE DOCUMENT M—NRCA LTE-04-AfRavicarl TF iAl -- CERTIFICATE OF ACCEPTANCE VriLli'V.i'SiV1Y5 C4VCKV 7 t.tfiI11N113i7{V1'a. ,;'�°-"".n`�"•:. B NRCA-LTI-04-A Remand Responsive Lighting Control Acceptance Document (Fuge 4 of 6) T'rti 4 N*."u PANINO GUSTO r 0f 4 etr4 ft Apney p m;t tduri 3�r: 19409 STEVEN GREEK BLVD. Cit}: CUPER nNO. CA Step 1. Full output test V, "Oft! CA .Suilding Energy Efficiency Standards - 2013 Nonresidential Compliance lune 2014 Methoir 2. Power input Measurement. B At the lighting circuit panel, select at least one lighting circuit that serves spaces required to meet Section 13€ .1(h) o measure the reduction in electrical current. Alternatively, employ the power monitoring capabilities of the DR controls .! !tern to monitor the circuits in the tests below. The testis process is constant with either approach. Circuit nu mber Step 1. Full output test 5 Using the manual switches/dimmers in each space, set the lighting system to full output. a. Note that the lighting in areas with photocontrols or occupancy/vacancy sensors may be at less than full output, or may be off. b Take one electric power measurement for each selected circuit.. VA VA tfA. VA VA VA Simulate a demand response condition using c" the demand responsive control. Take one electric power measurement at each d. circuit location with the electric lighting systern VA VA VA, VA VA VA VA in the demand response condition. Calculate the reduction in lighting power in the e. demand response condition, compared with the l % ', % % % % full output condition [(b-d)/b] . Note the area of each controlled space Sf sf sf sf sf sf sf 1g. 1cuCate the area -weighted average reduction in electric power in the demand response 1-(E(elxfl)+(e2*f2)+(e3xf3) .,J/[fl+f2+f3..,)} condition, compared with the full output Y/ N cvndition.The area -weighted reduction must be at least 15% The demand response signal must not reduce h. the power inputrefanyindividualcircuit by Y/N Y/f~t Y/N Y/N Y/N Y/N Y/N more than 50'x. Step 2: Minimum output test _ Using the manual switches/dimmers in each space, set the lighting system to minimum output (taut not off). Nate that the lighting in e" areas with photocontrols or occupancy vacancy sensors may beat morethan minimum output, or mav be off: b. Take one +electric power measurement for each VA VA VA VA VA VA VA selected circuit location, Simulatea demand response condition casing c. the demand res onsive control, Take one electric power measurement at each d, circuit With the electric lighting system in the VA VA VA VA VA VA VA demand response condition, CA .Suilding Energy Efficiency Standards - 2013 Nonresidential Compliance lune 2014 m STATE OF CAUORNIA u DEMAND RESPONSIVE LIGHTING CONTROL ACCEPTANCE DOCUMENT - GEGT1R!"AJ TLrt&& M—4—A Mnfia1 . " CERTIFICATE OF ACCEPTANCE :�w.}rvexty}F5 �1+1Ct4177 VVMRIi33liL7Pt. "'"'' ,y/ N NRCA-LTI-OA-A Demand RespongiVe Lighting Control Acceptance Document (Page 5 of 6) lrcypniaarte PANINO GIUSTO rts�cea»ert cy Y/ P910iichuMbe? Pr*aAdim—s; 19409 STEVEN CREEK BLVD. `S CUPERTINO, CA PASS: All applicable Construction Inspection responses are complete and all applicable Equipment Testing Requirements responses are positive lY-yes) • In each space, the electric power input in'the demand response condition must not be less than the powaernputtin the minimum light output condition or 50% of the design illuminance power input condition, whichever is less. ,y/ N Y/ N y/ N Y/ N YIN fN y/ N Y/ EXCEPTION: Circuits that supply power to the daylit portion of enclosed spaces as long as lighting in non-daylit portions of the space are not reduced below the lesser of 501/ power input leve or the minimum light output condition.. C. Evaluation r PASS: All applicable Construction Inspection responses are complete and all applicable Equipment Testing Requirements responses are positive lY-yes) CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance lune 2014 STATSOFOAUFMNIA DEMAND RESPONSIVE LIGHTING CONTROL ACCEPTANCE DOCUMENT CEf—tdRCA,LTl-DL'-A (Rmisarl rMiAl . _.vrx.ir--vnsxin cfxcTiLx.7.GVM1Y11.J31lJiV. '". CERTIFICATE O ACCEPTANCE NRCA-LTI-04-A Demand Responsive lighting Control Acceptance Docurnent (Page 6 of ) PANINO GIUSTQ Ag2ney.. j'4: reit Nur#`ope; .._. QraizciAcf esu 19409 STEVEN CREEK BLVD. city' CUPERTINO, CA zfpcode DOCUMENTATION AUTHOR'S DECLARATION STATEMENT it I certl(V that this Certificate of acceptance documentation is accurate and complete. DocumentationAitthorNames KHOSROW NOURMOHAMMADI Uocumentadon{auther5lgnature< lsocumentationAuthorCompanyNamec ABSOLUTE CONSULTING ENGINEERS DatcSigned $-3-16 Addrew 3839 BIRCH STREET CEA/HEttsjrti`rrrtilkatNorrWentirication(Ifoppitcaisle)s city/state/zip: NEWPORT BEACH,. CA 92660 phone: {949 } $52-8700 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the iaws of the State ofCalife rnia: 1, The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person WI'6 performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified do this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency; and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7.. 4. 1 have confirmed that the Certiflcate(s) of installation for the construction or installation identified: on this Certificate of Acceptance has been completed and signed by the responsible builder%instailer and has been posted or made available with the building permit(s) issued for the building, FIeld'fechnician Name; Field T rota ina' FieldT--h l--ian�CvpanyName- PVC, Pas anti ny tej Addr�T 0 G®x /3 Coa ...city ATTCeniti ation identification (lr applicalale): Statlj2ipc 6 �,4 � / CA �67� ph 1 ---Date X16 — 873 --- I ()LIZ /6 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 ase the Field Technician, orthe field Technician is acting on my behalf as my employee or my went and t have reviewed the information: provided on this Certificate of Acceptance, 2. 1 am eligible under Division 3 of the Business and professions Code in the applicable classification to accept responsibility for the system design, construction or installation offeatures, materials, coin ponents, or manufactured devices for the scope of work identified oil this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person,.), 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7, 4. I have confirmed that the Certificates} of installation for the Construction or installation. identified on this Certificate ofAcceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posited, or made available with the building permits} issued for the building, and made available to the enforcement agency for aft applicable inspections, I understand that a signed copy of this Certificate of Acceptance is required to be Included with the documentation the builder rovides to the building owner at occupancy, Responsible Acceptance -Person tame. Responsi6 nature; ikesporisibla AccepuincePersor CompanyNama: /'44V/n/ 3Ui4-Vt��C . INC. Rasiii it[iCninpa tie}: �a2 "-A � e f3 % � C'5L& License:: i `J % G cry/5taiefZip: &b i��mbS�i &F-19-Ckl CAq02� ?hone: 3/® - 97a - 332— Daze 5i�ned: [o /13 i( CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance .lune 2014 477 STATE OF CALIFORNIA. 7 LIGHTING, CONTROL ACCEPTANCE DOCUMENT - nn A —_ nom,... CERTIFICATE OF ACCEPTANCE Automatic Time Switch Controls Construction Inspection—confirm for all listed in Section 8 NBCA -LTi -02-A Lighting Control Acceptance Document (Page 1 of 5) ProjectName. PANINO GIUSTO EnforcementAgency. Pem9tNumber. ProjectAddrew, 19409 STEVEN CREEK BLVD. cltrCUPERTINO, CA z code: Note. For more than 3 spaces attach additional sets of pages Z Enforcement Agency Use: Checked by/Date through 5, as required. Automatic Shut-off Controls: Automatic Time Switch Control and Occupant Sensor Intent: -Lights are turned off or set to a lower level when not needed per Section 110.9(a) & 130.1(c). Guidance This acceptance test form must be filled out for all newly -installed lighting control systems of the following types: 1. Automatic Time Switch Controls II. Occupancy Sensors 111. 1 Partial -OFF occupancy sensors IV. Partial -ON occupancy sensors (only if used to claim a Power Adiustment Facto V. Occupancy Sensors serving small zones in large open plan offices (only if used to claim a Power Adjustment Factor) For automatic claylighting controls use acceptancertest form NRCA-LTI-03-A; for demand responsive lighting controls, use acceptance test form NBCA-LTI-04-A. The tests On this certificate are required by Section 140.6(a)2 and 130A(a) of the Building Energy Efficiency Standards 2013. The tests themselves are described in Sections 140.6(a)2 and in Reference Appendix NA7.6. A. Construction Inspection Fill out.$ection A to cover spaces I through 3 that are functionally tested under Section B. Make as many copies of pages 2-5 as are required to test all spaces 1n the building, and attach to page 1. Instruments needed to perform tests include, but are not limited to: hand-held amperage meter,power meter, or I! , ght meter Automatic Time Switch Controls Construction Inspection—confirm for all listed in Section 8 a. All automatic time switch controls are programmed for (check all): Weekdays El Weekend Holidays b. Document for the owner automatic time switch programming (check all): Weekdays settings Weekendsettings Holidays settings ci Set-up settings Preference program setting [I Verify the correct ti me and date is properly set in the time switch E] Verify the battery is installed and energized E] Override time limit is no more than 2 hours Occupant Sensors and Automatic Time Switch Controls have been certified to the Energy Commission in accordance with the applicable provision in Section 110.9 of the Standards, and model numbers for all such controls are listed on the Commission database as Certified Appliance and Control Devices Occupancy Sensor Construction inspection—confirm for all listed in Section 13 D Occupancy sensors are not located within four feet of any HVAC diffuser Ultrasonic occupancy sensors do not emit audible sound 5 feet from source CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 STATE OF CALIFORNIA LIGHTING CONTROL ACCEPTANCE DOCUMENT CERTIFICATE OF ACCEPTANCE -r>•rr..ff vnfafn cfycn+ar a.._cJMMiDOIVIV- NBCA-LTI-02-A Lighting Control Acceptance Document (Page 2,of5) ProjectName:. PANINQ GUSTO EnforcementAgenq. - -Permit Number:: Pioject$ddress: 19409 STEVEN CREEK ®LVD. city: CUPERTINO. CA Zip Code: B. Functional Testing of Lighting Controls Representative, Spaces Selected For every space in the building, conduct functional tests i through V below if applicable. If there are several geometrically similar spaces that use the same lighting controls, test only one space and list in the cells below which "untested spaces" are represented by thattested space. EXCEPTION: For buildings with up to seven (7) occupancy sensors, all occupancy sensors shall be tested. (NA7.6.2.3) Y/N Y/N from start of an unoccupied condition per Standard Section 110.9(b) Tested space/ room name: Space Type (office, corridor, etc) 0 1 The occupant sensor does not trigger a false "on" from movement in an area Y J N Y / N Untested areas/rooms adjacent to the controlled space or from HVAC operation Tested space/ room name: Space Type (office, corridor, etc) 2 Step 2: Simulate an occupied condition a. Untested areas/rooms Y / N Y' / N Tested space/ room name: Space Type (office, corridor, etc) Ll 3 Untested areas/rooms condition OR sensor indicates space Is "occupied" and lights may be turned on Functional Tests Tested Space Number Confirm compliance (Y/N) for all control system types (I' -V) present in each space: 1. AutomaticTime Switch Controls 1 2 3 Step 1: Simulate occupied condition a. All lights can be turned on and off by their respective area control switch Y / N Y / N Y / N b Verify the switch only operates lighting in the ceiling -height partitioned area in Y / N Y / N Y / N which the switch is located: Step 2: Simulate unoccupied condition a. All lighting, including emergency and egress lighting, turns off. Exempt lighting may Y / N Y / N Y / N remain on per Section 130.1(c)1 and 130.1(a)1. Manual override switch allows only the lights in the selected ceiling height. b. partitioned space where the override switch is located and r main on no longer Y / N Y / N Y / N than 2 hours (unless serving public areas and override switc is captive key type). Step 3: System returned to initial operating conditions I Y / N Y / N Y / N 2. Occupancy Sensors 1 2 3 Step 1: Simulate an unoccupied condition a. Lights controlled by occupancy sensors turnoff within a maximum of 30 minutes Y/N Y/N Y/N from start of an unoccupied condition per Standard Section 110.9(b) b The occupant sensor does not trigger a false "on" from movement in an area Y J N Y / N Y / N adjacent to the controlled space or from HVAC operation Step 2: Simulate an occupied condition a. Status indicator or annunciator operates correctly Y / N Y' / N Y / N Lights controlled by occupancy sensorsturn on immediately upon an occupied b. condition OR sensor indicates space Is "occupied" and lights may be turned on Y / N Y / N Y / N manually - Step 3: System returned to initial operating conditions Y 14\1 Y / N Y / N CA Building Energia Efficiency Standards - 2013 Nonresidential compliance June 2014 STATE OF CALIFORNIA LIGHTING CONTROL ACCEPTANCE DOCUMENT CFr_NPrJ4_1 'n-nl-A M—A-4 nAMAI CERTIFICATE OF ACCEPTANCE 'IF WMNIA =1MCM0 T %,UM1V1MZ11V1N NRCA-LTIw02-A Lighting Control Acceptance Document (Page 3 of 5) ProjectName: PANINO GIUSTO EnfwcernentAgency. PurritNumber. — ProjectAddress. 19409 STEVEN CREEK BLVD. aty: CUPERTINO, CA Zip Code; 3. Partial Off Occupancy Sensor T 3 Step k Simulate an unoccupied condition Immediately upon an occupied condition, the first stage activates between 30 to 70% Lights go to partial off state within a maximum of 30 minutes from start of an a. a. unoccupied condition per Standard Section 110.9(a) YJ N Y I N Y I N After the first stage occurs, manual switches allow an occupant to activate the The occupant sensor does, not trigger a false "on" from movement in an area b. b. adjacenttothe controlled space or -from HVAC operation. For library book stacks or YIN YIN all of the lights. warehouse aisle, activity beyond the stack or aisle shall not activate the lighting in YIN YIN YIN a. the aisle or stack. In the partial off state, lighting shall consume no more than 50% of installed lighting YIN YIN YIN b. power, or: • No more than 60% of installed lighting power for metal halide or high YIN YIN YIN C. pressure sodium lighting in warehouses. • No more than 60% of installed lighting power for corridors and stairwells in YIN YIN YIN which the installed lighting power is 80 percent or less of the value allowed u rider the Area Category. Method. Light level may be used as a proxy for lighting power when measurements are taken ep 2: Simulate an occupied condition rThe I occupant sensing controls shall turn lights fully ON in each separately controlled I . I areas, Immediately upon an occupied condition I YIN YIN YIN 4. Partial On Occupancy Sensors 3 step 1. -Simulate, an occuPie7conditlon. Verify partial on operation. Immediately upon an occupied condition, the first stage activates between 30 to 70% a. ofthelighting automatically. YIN YIN YIN After the first stage occurs, manual switches allow an occupant to activate the b. alternate set of lights, activate i00% of the lighting power, and manually deactivate YIN YIN YIN all of the lights. Step 2. Simulate an unoccupied condition a. Both stages (automatic on and manual on) lights turn off within a maximum of 30 minutes from startof an unoccupied condition per Standard Section 110.9(a) YIN YIN YIN b. The occupant sensor does not trigger a false "on" from movement in an area adjacent, to the controlled space or from HVAC operation YIN YIN YIN CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 STATE OF CALIFORNIA LIGHTING CONTROL ACCEPTANCE DOCUMENT rFf'-N1*rA-1'n-n?-A'(P'-A—d nRIIAN CERTIFICATE OF ACCEPTANCE NRCA-LTI-02-A Lighting Control Acceptance Document (Page 4 of 5) ProjectName: PANINO GIUSTO EnforcementAgencT. PerrritNumber: ProjectAddress. 19409 STEVEN CREEK BLVD. city: CUPERTINO, CA Zip Code. 5. Additional test for Occupancy Sensors Serving Small Zones in Office Spaces Larger I Testing Resins -T PASS than 250 Square Feet, to Qualify for a Power Adjustment Factor (PAF) 3 First, complete Functional Test (ahove)foreach controlleclzone Step 1. Verify area served and compare actual PAF With claimed PAF. Refer to Functional Test If, a. Area served by controlled lighting (square feet) ' 11 Occupancy Sensor (On Off Control) (all answers must be Y). ,b. Enter PAF corresponding to controlled area from line (a) above (<125sf for PAF=0.4, III Partial Off Occupancy Sensor (all answers must be Y). For warehouses, library book 126-250sf for PAF=0.3, 251-500sf for PAF=0.2). stacks, corridors, stairwells in nonresidential buildings must also be accompanied by Enter PAF claimed for occupant sensor control in this space from the Certificate of IV Partial On Occupant Sensor for PAF (all answers must be Y). Compliance ccupantSensor serving small zones for PAF (all answers must be Y). Also must pass d. The PAF corresponding to the controlled area (line b), is less than or equal to the PAF Test If claimed in the compliance documentation (line c) YIN YIN YIN Sensors shall not trigger in response to movement in adjacent walkways or e. workspaces_ Y IN YIN YIN LAll steps are conducted in Functional. Test 2 "Occupancy Sensor (On Off Control)" and Y,/ N YIN Y/N all answers are Yes (Y) C I Testing Resins PASS/ PASS PASS FAIL FAIL FAIL I Automatic Time Witch Controls (all answers must be Y). 11 Occupancy Sensor (On Off Control) (all answers must be Y). III Partial Off Occupancy Sensor (all answers must be Y). For warehouses, library book stacks, corridors, stairwells in nonresidential buildings must also be accompanied by passing Test I or Test If. IV Partial On Occupant Sensor for PAF (all answers must be Y). ccupantSensor serving small zones for PAF (all answers must be Y). Also must pass Test If D. Evaluation: PASS: All applicable Construction Inspection responses are complete and all applicable Equipment Testing Requirements responses are positive- (Y -yes) CA Building Energy Efficiency Standards - 2423 Nonresidential Compliance June 2014 STATE OF CALIFORNIA LIGHTING CONTROL ACCEPTANCE DOCUMENT f,F:r-NP,rA-i n -n,) -A ip—i—A nAMAI CERTIFICATE OF ACCEPTANCE NRCA-LTI-027-A Lighting Control Acceptance Document (Page 5 of 5) ProjectName: PANINO GIUSTO Enforcement Agency. Perrnit Number: ProjectAddress- 19409 STEVEN CREEK BLVD. City; CUPERTINO, CA Z!p Code. Documentation author's Declaration Statement 1. 11 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Namea KHOSROW NOURMOHAMMADI Documentation Author Signature; Llc'en8.. 2 Documentation Auth orcornpany Name: ABSOLUTE CONSULTING ENGINEERS Date Signed; 8-3-16 Address: 3839 BIRCH STREET CEA/HERS/ATT certification Identification iffapplicable]: City/State/Zip; NEWPORT BEACH, CA 92660 Phone: (949) 052-8700 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and. correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or Installation identified on'thiscertificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and spec ifications approved by the enforcement agency, and conforrnsto the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s), issued for the building_ Field Technician Narne; Field Field Technician ny Com Name: J,A4_V1;T L3 v f Lo L--,7�zf AJ C Position with Company Pit Addresp- A -TT certification Identification (if applicable): "ty, of A- seA-r" 6A 1.3 Phone: ----Tate I'D S73 Signed: 1"6, RESPONSIBLE PERSON'S DECLARATION STATEMENT I certifvthe following under penalty of perjury, under the laws of the State of California - 1. 1 am the Field Technician, or the Field Technician, is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices forthe scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information -provided, on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conformsto the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5- 1 will ensu re that a completed, signed copy of this Certificate of Acceptance shall he posted, or made available with the building permit(s) Issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed. copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Res Responsible Acceptance Person company Name, A,Avim GL)1i—V-9=9r 9 INC PositionmAth Comp 6 e c o tj -trzq c—ro tz Address; CSLB License: -1 Phone:-- 2,5 073 D.tesign.d P3& CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 �, • INDEPENDENT AIR BALANCE 9D I:1134 Walsh Ave. • Santa Clara, Ca 95050 • TEL: 408-327-8400 : Email: main@independentairbalance.com IndependentAirBalance-- HVAC TEST & BALANCE REPORT PROJECT: PANINO GIUSTO 19469 STEVENSCREEK BLVD CUPERTION, CA CONTRACTOR: TRILLO MECHANICAL THE RESULTS OF OUR TESTS ARE ENCLOSED. REPORT CERTIFICATION NO: 26306 REPORT CERTIFICATION DATE: Sentember 29.2016 REVIEWED AND APPROVED BY: J -0A L111 C2i� JOHN CHOO J Certified NEBB Professional The data presented in this report is a record of system measurements and final adjustments that have been obtained in accordance with the current edition of the NEBB Procedural Standards For Testing, Adjusting, and Balancing of Environmental Systems. Any variances from design quantities, which exceed NEBB tolerances, are noted in the Test -Adjust -Balance report project summary. AIR SOUND IIYDRONIC PROFESSIONALS I INDEPENDENT AIR BALANCE AIR SOUND HYDRONIC PROFESSIONALS TEL: 408-327-8400 TABLE OF CONTENTS PANINO GIUSTO 19469 STEVENSCREEK BLVD CUPERTINO, CA * * * MAU-1 AND KEF-1 FAN APPARTUS SHEET PAGE: 01 *** MAU-1 AND KEF-1 AIR DISTRIBUTION SHEET PAGE: 02 * * * KEF-1 FRONT HOOD VELOCITY EVALUATION SHEET PAGE: 03 *** KEF-1 BACK HOOD VELOCITY EVALUATION SHEET PAGE: 04 *** SANTA CLARA COUNTY HOOD SHEET ** COMPANY INFORMATION / CERTIFICATES ------ NEBB CERTIFICATIONS ------ CALIFORNIA STATE LICENSE ------ ABBREVIATION SHEET ------ INSTRUMENT CALIBRATION INDEPENDENT AIR BALANCE_ AIR SOUND HYDRONIC PROFESSIONALS TEL: 408-327-8400 FAN COIL SHEET PROJECT: PANINO GIUSTO 19469 STEVENSCREEK BLVD CUPERTINO, CA PAGE: 01 FAN IDENTIFICATION MAU-1 KEF-1 FAN LOCATION ROOF ROOF FAN MANUF CAPTIVEC AIR CAPTIVEC AIR MODEL NO. Al -G10 NM DESIGN CFM 1785 1785 ACTUAL CFM 1915 1940 MOTOR MANUF WEG WEG MOTOR HP 1 1.5 MOTOR VOLTAGE 460 460 MOTOR PHASE 3 3 MTR AMPS, NMPLATE 1.6 2.1 MTR AMPS, ACTUAL 1.2 1.6 SERVICE FACTOR 1.15 1.15 MOTOR RPM 1760 1760 MOTOR SHEAVE VL40 x 5/8" VL40 x 5/8" SHEAVE % OPEN 30% 20% FAN SHEAVE AK66 x 3/4" AK56 x l" FAN RPM, DESIGN DNL DNL FAN RPM, ACTUAL 853 931 BELT SIZE/NO OF AX41 /I AX25 /I NOTES: *1 *2 *3 *4 INDEPENDENT AIR BALANCE INC, AIR SOUND HYDRONIC PROFESSIONALS TEL: 408-327-8400 AIR DISTRIBUTION PROJECT: PANINO GIUSTO 19469 STEVENSCREEK BLVD CUPERTINO, CA PAGE: 02 ' •'MAKE-UP •p ,. ! m- AIR TOTAL � 1 : '•1 it 1 i EXHAUST AIR TOTAL *1 Set fan for total efm, measured available airflow. *2 *3 INDEPENDENT AIR BALANCE AIR. SOUND HYDRONIC PROFESSIONALS 1134 Walsh Ave., Santa Clara, CA 95050 TEL: 408-327-8400 EXHAUST HOOD PROJECT: PANINO GIUSTO 19469 STEVENSCREEK BLVD CUPERTINO, CA EQUIPTMENT IDENTIFICATION: KEF-1 FRONT PAGE: 03 TYPE OF FILTERS GREESE MODEL # NOT LISTED SIZE OF FILTERS 18" x 14" ID x 4 EFFECTIVE AREA 1.75 1 TOTAL AREA 7.00 SIZE OF FILTERS 20 " x 16" OD EFFECTIVE AREA NA I FPM PER FILTER 140 FORMULA USED: AVERAGE FPM/FILTER x EFFECTIVE AREA (insquare feet) = CFM 140 X 7.0 = 980 CFM TOTAL NINE READINGS PER FILTER #1 122 1 137 1 144 127 133 122 131 117 118 AVG. FPM = 128 #4 129 136 1 131 133 144 144 145 143 129 AVG. FPM = 137 NOTES: #2 144 _1 163 _ _155 _ 161 145 133 144 150 160 AVG. FPM = 151 #3 130 1 144 1 154 141 139 144 151 133 147 AVG. FPM = 143 COMMERCIAL COOKING VENTILATION SYSTEM SUMMARY - KEF-1 DESIGN ACTUAL TOTAL EXHAUST HOOD VOLUME 825 .980 CFM GREASE DUCT SIZE 12" x T' 0.58 0.58 SQUARE FEET VELOCITY WITHIN GREASE DUCT SYSTEM 1422 1689 FPM *1 *2 *3 INDEPENDENT AIR BALANCE AIR SOUND HYDRONIC PROFESSIONALS 1134 Walsh Ave., Santa Clara, CA 95050 TEL: 408-327-8400 EXHAUST HOOD PROJECT: PANINO GIUSTO 19469 STEVENSCREEK BLVD CUPERTINO, CA EQUIPTMENT IDENTIFICATION: KEF-1 BACK PAGE: 04 TYPE OF FILTERS GREESE I MODEL # NOT LISTED SIZE OF FILTERS 18" x 14" ID x 2 EFFECTIVE AREA 1.75 1 TOTAL AREA 3.50 SIZE OF FILTERS 20 " x 16" OD I EFFECTIVE AREA NA I FPM PER FILTER 275 FORMULA USED: AVERAGE FPM/FILTER x EFFECTIVE AREA (insquare feet) = CFM 275 x 3.5 = 960 CFM TOTAL NINE READINGS PER FILTER #1 290 1 301 1 276 250 277 288 277 1 246 277 AVG. FPM = 276 NOTES: *1 *2 *3 #2 288 1 294 1 277 248 271 288 288 258 248 AVG. FPM = 273 COMMERCIAL COOKING VENTILATION SYSTEM SUMMARY - KEF-1 DESIGN ACTUAL TOTAL EXHAUST HOOD VOLUME 960 960 CFM GREASE DUCT SIZE 12" x 10" 0.83 0.83 SQUARE FEET VELOCITY WITHIN GREASE DUCT SYSTEM 1156 1156 FPM Panino Giusto Cupertino KEF-1 FRONT HOOD HOOD EVALUATION WORK SHEET AND CHECK LIST GUIDE Use a separate aosk sheet for each hood or seemern of hmd u rmdcd. TYPE OF EQUIPMENT UNDER HOOD(S), test mrmber ofpiece preach tgwgmcat. -to dtietmme the cancer rormtda lobe used {Evmple Q- JMA) A. Solid fuel burning (Charbroiler) B. High temp. (Grills, ranges, etc.) C. Low temp. (Givens, steamers, stock pots a. Based on #I above which formula will be used for calculations? B 2. KITCHEN EXHAUST DESIGN CALCULATION tl-4Y taker from plans of dtmem,em. A. Net Filter Area (ea. Filter) 1.75 - sq ft_ B_ Total Number of filters 4 all C. Net Filter Area (all filters) 7.0 sq -ft. (2A times 2B equals 2C) D. Calculation with formula to be used AVERAGE VELOCITY x AREA = Total CFM E_ Duct Size 12" x 7" sq.ft. F. Duct velocity 1422 FPM G. Make up air Velocity 1152 FPM H. Type of Diffuser? DUCT I. Diffuser Size 12" ROUND 0.785 SQFT openings sq - ft -J.. Total CFM Supplied 905 K. Are there any blanks installed? NO L. Where are the blanks installed? NA M. Where is duct located in relation the horizontal run of hood? CENTER N. What is the filter racing of each filter`s 100 - 450 FPM 3. PERFORMANCE EVALUATION Use date recprdedonrrw=side ofworksheet. ` A. What is the average FPM? 140 per filter B. Net Filter Area 1.75 X FPM = 245 CFM C. CFM time number of filters 4 = Total CFM 980 D. What is duct Size? 12" x 7" E. Does 93C match 92D? YES F. Roes 42N match #3A? YES G. Comments/Recommendations? h:VicMp1=ck\o foo4_f:l=.ew Panino Giusto Cupertino KEF-1 BACK HOOD HOOD EVALUATION WORK. SHEET AND CHECK LIST GUIDE Use a seP=tc o* sheet for each hood of scpn=% of hood u needed, l . TYPE OF EQUIPMENT UNDER HOOD(S). Lai numbs ofp=Lc otgch egMM=t.- to det== the c,_nM fMmtda to fie uud Mxam eQ-100A) A. Solid fuel burning (Charbroiler) B. High temp. (Grills, ranges, etc.) X C. Low temp. (Ovens, steamers, stock pots) .. , a. Based on #1 above which formula will be used for calculations B 2. KITCHEN EXHAUST DESIGN CALCULATION Usually takett&om plans ofdmensoat A. Net Filter Area (ea. Filter) 1.75 sq.#I- B_ Total Number of filters 2 all C. Net Filter Area (all filters) 3.0 sq.fl. (2A times 2B equals 2C) D. Calculation with formula to be used AVERAGE VELOCITY x AREA = Total CFM E. Duct Size 12" x 10" sq fi F. Duct velocity 11 LFPM G. Make up air Velocity 1286 FPM H. Type of Diffuser? DUCT I. Diffuser Size 12" ROUND 0.785 SQFT openings sq.ft. J. Total CFM Supplied 1010 K. Are there any blanks installed? NO L. Where are the blanks installed? NA M. Where is duct located in relation the horizontal run of hood? CENTER N. What is the filter rating of each filter? 100 - 450 FPM 3. PERFORMANCE EVALUATION U= datcrecaded on revasa silo ofwork sheet. A. 'What is the average FPM? 275 per filter B. Net Filter Area 1.75 X FPM = 481.25 CFM C_ CFM time number of filters 2 = Total CFM 962.5 D. What is duct Size? 12" x 10" E. Does 93C match 92D? YES F. Roes 92N match 43A! YES G. Comments/Recommendations? h:lrichtplaf cMp o €bmt.dm M Pursuant, to Chapteo of Division 3 of the Business and Professions Code and the IZLIles and Regulations. -of the Contractors State License Board, the Registrar of Cotitractors do -Is hereby issue this license to: INDEPENDENT,41R BALANCE INC 11cense Number 981416' to engage in the business or act in -the capacity of a contractor -in the (of lowing lclassificatton(s)i C20 - WARM -AIR HE&ING, V!_NTILATING AND AIR-OONDITIONING III .Ij tQPV 17A71 f nq')A� I nt'i' Witness my hand and seal this day, March 4, 2013 This license is the property of the Relpstrar of Contractors, 15 not transferrable, and shalt be returned to the Registrar upon demand when suspended, revoked, or invalidated for any reason. It becomes void if not renewed. Stephen P. Sands Registrar of Contractors ALOIT NO: $51390 121 0111110R, 06,21 r 4. -610 V(-esting7 Adjusting and.3alaac -n en t I _q W vitownental (,)Ystems This Certificate, as Nvell as IndIvidual affiliation wit4 a NEBB Certifigd, firm and associated NERB Certification starnp are REQUI",I) to provide a NEU Certified.Report. P�.rtieil)at.ioti.int4i.tNFBBQuali.t)rAsstirai),ceProgr"lI reqnixell; that the holder of this certification also be affiliated vith a INE BB Certifiedfirm. March 31, 2018 Ex. piration, Date NE11 Certifica CioVBoard, Chairman. 2.3704 NE B.3 Certificant Number Ni:.-ece—rtificatiorx Director INDEPENDENT AIR BALANCE 1134 Walsh Ave Santa Clara, CA 95051 AIR SOUND HYDRONIC PRO MSiSIONALS TEL- 408-327-8400 ACT ACTUAL AK FREE AREA FACTOR CD CEILING DIFFUSER CER CEILTNIG EXHAUST REGISTER ('FM C URIC' FEET per MINUTE CL - CENTER LINE CRR - CEILENIG RETURN REGISTER D B- - DRY BULB DI) - DIRECTDRIVE DNA - DATA NOT ACCESSIBLE DNI- - DATA NN OT LIS TE D ENT ENTERING ESP EXTERNAL STA'T'IC PRESSURE PH FLOWHOOD (MEASURES ('FJv1 DIRECTLY SO FP.M AND AK FACTORS ARE NOT REQUIRED), FP,M FFET PER MINUTF FLA FULL LOAD AMPS FLRR FLOOR RL.TI - 56 RN REGISTER F'LSR 17LOOR SUPPLY RFOISTER GPM GALLONS PFR MINUTE 14EPA HIGH EFFICIENCY PARTICULATE AIR FILTER I'LP, HORSEPOWER LVG LEAVING N -A NOTAPPLICABLE NI NOTINSTALLED N -NI NOT MEASURED LOA LACK OF ACCESS NVI, NO VALID LOCATION O.S-A. OUTSIDE AIR P.D PRESSURF DROP P.T, PITO TTRAY ERS E RA, RETURN, AIR REQ REQUIRED RPX4 REVOLUTIONS PER MINUTE RD ROUND DIFFUSER S.A. SUPPLY AIR SP SERVICI- FACIOR sJ11 STATIC PRESSURE sws SIDE WALL SUPPLY SWR SIDE WALL RETURN T,D.Fl= - TOTAL DEAD HEAD W13 - WET BULI-3 w C, - WATEk GAUGE INDEPENDENT AIR BALANCE 1134 Walsh Ave., Santa Clara, Ca 95050 AIR SOUND HYDRONIC PROFESSIONALS TEL: 408-327-8400 Tool Calibration Tool Model Number — SN — Calibration Dates ADM860C — M12737 — 07/16/2016 to 07/15/2017 Fluke52 — 93710033 — 07/16/2016 to 07/15/2017 Fluke332 — 89130969 — 07/16/2016 to 07/15/2017 Hydronic Manometer HM670 — 70741061— 07/16/2016 to 07/15/2017 Tachometer — A1370067R — 07/16/2016 to 07/15/2017 Thermometer / Hydrometer — 200-6510526 — 07/16/2016 to 07/15/2017 Fluke Type K Temp Probe— NSN — 07/16/2016 to 07/15/2017 Fluke Type K Surface Probe— NSN — 07/16/2016 to 07/15/2017 with 1 and 6 of the California Code of Regulations.'This certificate applies only to buildang mechanical requirement Title 24, Parts The documentation preparer hereby certifies that the documentation is accurate and complete. ...... j DATE - Mark Tri.11o I - — j IV The Principal Mechanical Designer hereby certifies that the proposed building design represented in this set of construction documents is consistent with the other compliance forms and worksheets, with the specifications, and with any other calculations submitted with this permit application. The proposed building has been designed to meet the mechanical requirements contained in the applicable parts of Sections 110 through 115, 120 through 124, 140 through 142, 144 and 145. Please check one: L1 I hereby affirm that I am eligible under the provisions of Division 3 of the Business and Professions Code to sign this document as the person responsible for it's preparation; and that I am licensed in the State of California as a civil engoreer or mechanical engineer, or I am a licensed architect. I affirm that I am eligible under the exemption to Division 3 of the Business and Professions Code by Section 5537.2 or 6737.3 to sign this document as the person responsible for its preparation; and that I am a licensed contractor performing this work. CI 1 affirm that I am eligible under the exemption to Division 3 of the Business and Professions Code to sign this document because it pertains to a structure or type of work described pursuant to Business and Professions Code .sections 5537, 5538, and 6737.1. {These sections of the Business an Prnfes ons Code ar Il in the Nonresidential Manual) PRINCIPAL MECHANICAL DESIGNER G� N DATE LIC. # Mark Trillo ;1 888818 MECHANICAL MANDATORY MEASURES Indicate location on plans of Note Block for Mandatory Measures I INSTRUCTIONS TO APPLICANT For Detailed instructions on the use of this and all Energy Efficiency Standards compliance forms, please refer to the Nonresidential Manual published by the California Energy Commission. MECH-1: Required on plans for all submittals. Part 2 may be incorporated in schedules on plans. MECH 2. Required for all submittals, but may be incorporated in schedules on plans. MECH-3: Required for all submittals unless required ventilation rates and airflows are shown on plans, see 4.3.4. MECH 4: Required for all prescriptive submittals. MECH-5: Optional_ Performance use only for mechanical distribution summarv. um carucuuar t.umpnenue rwms August 2001 CERTIFICATE OF COMPLIANCE (Part 2 of 2) MECH-'1 PROJECT NAME Panino Gusto SYSTEM FEATURES 10-10-W SYSTEM NAME TIME CONTROL MECHANICAL SYSTEMS ISOLATION NOTE TO FIELD TIME CONTROL HEAT AND COOL SUPPLY RESET? ZONES SIMULTANEOUS HEAT/COOL? Bid . Dept Use HIGH EFFICIENCY? Enter number of PIPE INSULATION REQUIRED? s PIPE/DUCT INSULATION PROTECTED? SETBACK CONTROL SEALED DUCTS IN CEILINGIROOF Sensor H: Heating V: VFD ISOLATION ZONES O: Other HEAT PUMP THERMOSTAT? C: Curve VENTILATION OUTDOOR ELECTRIC HEAT? O.A. CFM DAMPER FAN CONTROL B: Air Balance A: Auto A: Air Enter Design VAV MINIMUM POSITION CONTROL? G: Gravity W. Water Outdoor Air M: Outside Air SIMULTANEOUS HEAT/COOL? r CFM. Measure HEAT AND COOL SUPPLY RESET? Note: This shall D: Demand Control Control See HEAT REJECTION CONTROL N: Natural Section 144(e)3 Column H on VENTILATION s OUTDOOR DAMPER CONTROL? A ECONOMIZER TYPE A DESIGN O.A. CFM (MECH-3, COLUMN H) 500 cpm - HEATING EQUIPMENT TYPE�� est HIGH EFFICIENCY? IF YES ENTER EFF. # MAKE AND MODEL NUMBER DAY U&u—' COOLING EQUIPMENT TYPE p Gni CGi=ice{ HIGH EFFICIENCY? IF YES ENTER EFF. # MAKE AND MODEL NUMBER�� , PIPE INSULATION REQUIRED? PIPE/DUCT INSULATION PROTECTED? HEATING DUCT LOCATION R -VALUE COOLING DUCT LOCATION R VALUE VERIFIED SEALED DUCTS IN CEILING/ROOF SPACE %FAN FLOW Y:Yi es I N:No i HEAT PUMP THERMOSTAT? TIME CONTROL ELECTRIC HEAT? ISOLATION VAV MINIMUM POSITION CONTROL? HEAT AND COOL SUPPLY RESET? ZONES SIMULTANEOUS HEAT/COOL? S: Prog. Switch HIGH EFFICIENCY? Enter number of PIPE INSULATION REQUIRED? s PIPE/DUCT INSULATION PROTECTED? isolation Zones SEALED DUCTS IN CEILINGIROOF Sensor TABLE OF CODES: Enter code from table below into columns above TIME CONTROL SETBACK ISOLATION FAN CONTROL CTRL. ZONES S: Prog. Switch B: Both Enter number of I: Inlet Vanes O: Occupancy C: Cooling isolation Zones P: Variable Pitch Sensor H: Heating V: VFD M: Manual Timer O: Other C: Curve VENTILATION OUTDOOR ECONOMIZER O.A. CFM DAMPER B: Air Balance A: Auto A: Air Enter Design C: Outside Air Cert. G: Gravity W. Water Outdoor Air M: Outside Air N: Not Required CFM. Measure EC: Economizer Note: This shall D: Demand Control Control See be no less than N: Natural Section 144(e)3 Column H on MECH-3_ Nonresidential Compliance Forms August 2001 .r STATE OF CALIFORNIA CONSTANT VOLUME SINGLE ZONE UNITARY AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-MECH-3A (Revised 08/09) rAt IPnRr nA Fn1GRrry Onneee,ec,nni s CERTIFICATE OF ACCEPTANCE MECH-3A NA7.5.2 Constant Volume Sin Ie Zone Unitary Air Conditioner and Heat Pump Systems (Page 1 of 4) Project Name/Address: Panino Giusto, 19429 Stevens Creek Blvd, Cupertino,CA 95014 System Name or Identification/Tagg: Jn^'t 1�- -1 System Location or Area Served: but -1, 0i i'% Enforcement Agency: Permit Number: City of Cupertino Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. FIELD TECHNICIAN'S DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • 1 am the person who performed the acceptance requirements verification reported on this Certificate of Acceptance (Field Technician). • I certify that the construction/installation identified on this form complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. • I have confirmed that the Installation Certificate(s) for the construction/installation identified on this form has been completed and is posted or made available with the building permit(s) issued for the building. Company Name: Trillo Mechanical Fiei ieian'sam Date Signed: Position With Company (Title): RESPONSIBLE PERSON'S DECLARATION STATEMENT • I certify under penalty of perjury, under the laws ofthe State of California, that I am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this form. • I am a licensed contractor, architect, or engineer, who is eligible under Division 3 of the Business and Professions Code, in the applicable classification, to take responsibility for the scope of work specified on this document and attest to the declarations in this statement (responsible person). • I certify that the information provided on this form substantiates that the construction/installation identified on this form complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. • I have confirmed that the Installation Certificate(s) for the construction/installation identified on this form has been completed and is _ posted or made available with the building permit(s) issued for the building. • I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Company Name: Phone: Trillo Mechanical 831-636-7825 Responsible Person's Name: R-esI rso ' Mark Trillo License: Date Signed: Position With Company (Title): 888818 --I President 2008 Nonresidential Acceptance Forms August 2009 STATE OF CALIFORNIA _ CONSTANT VOLUME SINGLE ZONE UNITARY AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-MECH-3A (Revised 08/09) raa aFnanua �niGtr_v rnnenmccinn CERTIFICATE OF ACCEPTANCE MECH 3A NA7.5.2 Constant Volume Single Zone Unita Air Conditioner and Heat Pum S stems (Page 2 of 4} Project Name/Address: Panino Giusto, 19429 Stevens Creek Blvd, Cupertino,CA 95014 System Name or Identification/Tagg, T'.' System Location or Area Served: i,. Intent' Verify the individual components of a constant volume, single -zone, unitary air conditioner and heat pump system ficnction correctly, including: thermostat installation and programming, supplyfan, heating, cooling, and clamper operation perNA7.5.2 Construction Insvection 1. Instrumentation to perform test includes, but not limited to: a. None required 2. Installs ion hermostat is located within the space -conditioning zone that is served by the HVAC system. 3. Programming (check all of the following): rheostat meets the temperature adjustment and dead band requirements of 122(b) ® Occupied, unoccupied, and holiday schedules have been programmed per the facility's schedule. ❑ Pre -occupancy purge has been programmed to meet the requirements of Standards Section A. Functional Testing Requirements operating Modes Cooling_ load during unoccupied condition Cooling load during occupied condition Manual override No-load during unoccupied condition Heating load during unoccupied condition No-load during occupied condition . Heating load during occupied condition Step 1: Check and verify the following for each simulation mode required AIB C D E IF G a- Supply fan operates continually b. Supply fan turns off ~ c- Supply fan cycles on and off d- System reverts to "occupied" mode to satisfy any condition e. System turns off when manual override time period expires ❑ % Gas-fired furnace, heat pump, or electric heater stages on g- Neither heating or cooling is provided by the unit ❑> h- No heating is provided by the unit El p L No cooling is provided by the unit -a- MI -T-3 J• Compressor stages on D 1 k- Outside air damper is open to minimum position ❑ p p L Outside air damper closes completelyawl— ❑ m- System returned to initial operating conditions after all tests have been completed: ' / N B. Testing Results D EF G Indicate if Passed (P), Failed (F), or N/A (X), fill in appropriate letter MC 2008 Nonresidential Acceptance Forms August 2009 STATE OF CALIFORNIA CONSTANT VOLUME SINGLE ZONE UNITARY AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-MECH-3A (Revised 08/09) PAI !rnQ 11A Mdr-Df-v rnnnnmec,n , CERTIFICATE OF ACCEPTANCE MECH-3A NA7.5.2 Constant Volume Single Zone Unitary Air Conditioner and Heat Pump Systems (Page 3 of 4) Project Name/Address: Panin© Gusto, 19429 Stevens geek Blvd, Cupertino,CA 95014 System Name or Identification/Tag:System f Location or Area Served: LL 2008 Nonresidential Acceptance Fornis August 2009 STATE OF CALIFORNIA CONSTANT VOLUME SINGLE ZONE UNITARY AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-MECH-3A (Revised 08/09) CALIFORNIA ENERGY COMMISSION � CERTIFICATE OF ACCEPTANCE MECH3A A NA7.5.2 Constant Volume Single Zone Unita Air Conditioner and Heat Pum S stems (Pa e 4 o f Project Name/Address: Panino Giusto, 19429 Stevens Creek Blvd, Cupertino,CA 95014 System Name or Identification/Tag: System Location or Area Served: C. PASS / FAIL Evaluation (check one): p PASS: All Construction Inspection responses are complete and all applicable Testing Results responses are "Pass" (P) p FAIL: Any Construction Inspection responses are incomplete OR there is one or more "Fail" (F) responses in Testing Results section. Provide explanation below. Use and attach additional pages if necessary_ 2008 Nonresidential Acceptance Forms August 2009