Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
B-2017-0254
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0254 10815 N WOLFE RD STE 103 CUPERTINO, CA 95014 (316 05 056) EXPRESS SET S JORDAN, UT 84095 OWNER'S NAME: CUPERTINO VILLAGE LP DATE ISSUED: 06/09/2017 OWNER'S PHONE: 801-878-3574 I I PHONE NO: (801) 815-7078 fa01DQ&141ZKI]i ItY7LKttlil Y1x RAIRAW 030 License Class 5 Lic. #903143 Contractor EXPRESS SET FIXTURES Date 09/30/2017 I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. hereby affirm under penalty of perjury one of the following two declarations: 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 y performance of the work for which this permit is issued. 2 % I have and will maintain Worker's Compensation Insurance, as provided for by C/ Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue agar said City in consequence of the granting of this permit. Additionally, the ap licant understands and will comply with all non -point source regulations R;er the Cupertino Munjq:ipal Code, Section 9.18. Date 7/25/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following_ two reasons: 1. I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 1. I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. s. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 7/25/2017 BUILDING PERMIT INFO - BLDG —ELECT —PLUMB MECH _ RESIDENTIAL X COMMERCIAL JOB DESCRIPTION T -MOBILE - SUITE 103, T.I. - RETAIL (2402 S.F ) REV #1- REVISE WALL PER FIELD CONDITIONS - ISSUED 7/25/2017 Sq. Ft Floor Area: Valuation: $80000.00 APN Number- Occupancy Type: 316 05 056 1 A (Tenant hnprovements),M (Tenant Improvements) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by ABBY AYENDE Date: 06/09/2017 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, Lagree to remove all new materials for inspection. Signature of Applicant: Date: 7/25/2017 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use a 'pment or devices which emit hazardous air contaminants as defined by the ay ea Air Quality Management District I will maintain compliance with th Cup rtino Municipal Code, Chapter 9.12 and the Health & Safety CVde, S, ctions 25505, 25533, and 2553 r or authorized 7/25/2017 I hereby affirm that there is a coi of work's for which this permit is Lender's Name Lender's Address A lending agency for the performance (Sec. 3097, Civ C.) ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional "jACHIEVEMENT ENGINEERING lCORP Date July 5, 2017 Proiect No 3033 Chief Building Official City of Cupertino Subject: Dear Sir Structural Steel Welding For T -Mobile 10815 N Wolfe Road, Suite 103, Cupertino, CA 95014 Permit #- B-2017-9265 Based on owner representative's request we visited the job site on June 27 and 28, 2017 and observed the completed structural steel welding for the framing for new opening in the roof level per following detail - (4) L4X4X1/4" are welded to existing trusses using 3/16" fillet weld per detail 4/S1 0 dated 02/10/2017 - (4) 1_2=1/4 are welded to (4) L4X4X1/4" using 3/16" fillet weld per detail 4/S1 0 dated 02/10/20'17 - Certified welder was M Saldivar In general work was in compliance with approved plans sheet S1 0 details 3 and 4 dated 02/10/17 Inspection was performed periodically and on call basis as requested by the owner's representative We claim no responsibility or liability for damages from improper use of the results or findings We do not undertake the guarantee of construction nor do we relieve the contractor of his primary responsibility to produce a completed project in accordance with plans and specifications Our findings refer to locations that were inspected by Achievement Engineering representative If you have any questions or need any additional information, please feel free to call us at your convenience Sincerely Yours, Farshad Safaian, P.E State of California Licensed Civil Engineer A.T Address: 2455 Autumnval.e Drive, Unit E, San Jose, CA 95131 -Tel: (408) 217-9174, Fax: (408) 217-9632 www.achieveng.com Form R-11 P`,�VIRONMENTA4 �gT MESA3, Inc. www.MESA3•.com \G F Improving facility performance, efficiency, safety and compliance since 1985 3 � s San Jose (HQ) Sacramento 1945 Las Plumas Ave. 7501-T Foothills Blvd. y San Jose, GA 95133 Roseville, CA 95747 fi P P) 408-928-3000 P) 916-803-0268 9y�}srSANO gQ:�us�� F 408-928-3003 ) F) 916483-6246 Test + Balance Report # 7675 Rev.O Tenant Improvements T -Mobile 10815 N. Wolfe Road, Ste. 103 Cupertino, CA Architect: Not Listed Mechanical Engineer: CSHQAU L ig General Contractor: Not Listed Mechanical Contractor: Air Craft, lnc?7 Certification All systems have been tested and balanced in accordance with the project plans and specifications and to the optimum performance capabilities of the equipment. Testing; and balancing has been performed in accordance with the standards published by the Associated Air Balance Council and the results of these tests published herein. Guarantee • If for any reason MESA3 has failed to comply with either the above certification or the contract document requirements, except for quipment malfunction, inadequacy or improper design, MESA3 shall re -perform the services as required to bring the report into compliance.. to extra charges for these services shall be made. The services covered in this report are guaranteed for a period of ONE YEAR following to date of the report. This guaranty shall be null & void should any person change, modify, readjust, or alter the described systems in any canner without our prior acknowledgment with the exception of normal maintenance. • Also, included within this report is an additional AASC National Performance Guaranty issued by the Associated Air Balance Council. toersonnet Kecorct Project Manager: PaulMocny Project Engineer: Paul Mocny Tests Performed. By: PreD/QC By: Dean Ferreira Justin Knepp Report Approval: 7/26/2017 Paul Mocny, TBE #12-01-87 Rate AABC Certified Test and Balance Engineer AMk Independent Certified and endent Certified *6 � iSii 5001:2098 r Independent Ceriiiled Test & BalanceAgency CommissioningAulh U Certified QualitySystem Cleanroom Performance Testing, , W Air, Water, Sound. Vibration �a � AABC CommissioningGrow ° � ' Q � � Certification & Monitoring � P Cert , g CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 +CUPERTIhIQ (408) 777-3228 • FAX (408) 777-3333 • buiiding(I_cupertino.org NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/ TI REVISION / DEFERRED ORIGINAL PERMIT # 61-20(7 —16 1 f` PROJECT ADSSS APN # 112a I r OWNER NAME - PHONE E-MAIL ' STREET ADDRESS g� CITY ' STAT IP �r - FAX 10 19 Y CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP I FAX El OWNER 1771 OWNER -BUILDER ❑. OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICEIq I� 15FI � LICENSE TYPE BUS. LIC # COMPANY NE -MAIL . iQ FAX Ya! SL Wr_5 °Zet�v[ %its STREET ADDRESS i CI Y, STAT , IP - PHONE I�-e ✓ a t ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC COMPANY NAME E-MAIL FAX STREET ADDRESS - CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR. TYPE I # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM -- KITCHEN OTHER REMODEL AREA REMODEL AREA. REMODEL AREA PORCH AREA I DECK AREA. I TOTAL DECK/PORCH AREA I GARAGE AREA: n DETATTACHACH # DWELLING UNITS: ISA SECOND UNIT ❑YES SECONDSTORY L]YES BEING ADDED? ❑NO ADDITION? []NO PRE -APPLICATION ❑ YES. IF YES, PROVIDE COPY OF IS THE BLDG AN [:]YES "RECEIVED $Y _ ,�f TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO By my signature below, I certify to each of e f owing: I am the property owner or authorized agent to act on t e property owner's behalf. I have read this application and the information I have p vide s correct. I have read the Description of Work and verify it is accurate. I agre to comply with all applicable local ordinances and state laws relating to ilding 'onstruction. I authorize representatives of Cupertino to enter the above-identifi d propertyfor inspection purposes. - - Signature of Applicant/Agent: Date: f SUPPLEME AL I&FORMATION REQUIRED „_,_„ PLANCHEIKTYPE,u -?, R4UTI1?�SLiP, ....,.`� • .=; New SFD or Multifamily dwellings: Apply for demolition permit for ❑ avER THE COHNTER flE C7 BI7ILDINGPLANAEVSER k _ existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ E rxEss ❑ >rLALNNI GPLANRESIEYY Commercial Bldgs: Provide a completed Hazardous Materials Disclosure C1 sTANDARn ❑ ruBLIctiYOR.s form if any Hazardous Materials are being used as part of this project. ❑ I AxGE � � �� DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ � _ submittal of Building Permit application. M�roR sANrT AR3; sEw>;x DISTRIC'� BldgApp_2011.doe revised 062'1/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0254 10815 N WOLFE RD STE 103 CUPERTINO, CA 95014 (316 05 056) EXPRESS SET FIXTURES S JORDAN, UT 84095 OWNER'S NAME: CUPERTINO VILLAGE LP DATE ISSUED: 06/09/2017 OWNER'S PHONE: 415-656-6605 PHONE NO: (801) 815-7078 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class a Lic. #903143 Contractor EXPRESS SET FIXTURES Date 09/30/2017 X BLDG —ELECT —PLUMB MECH RESIDENTIAL X COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: T -MOBILE - SUITE 103; T.I. - RETAIL (2402 S.F.) I hereby affirm under penalty of perjury one of the following two declarations: 1. I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 Sq. Ft Floor Area: Valuation: $80000.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 316 05 056 A (Tenant Improvements),M (Tenant Improvements) representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant understands and will comply with all non -point source regulations per the upertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 06-9-2017 Issued by: Kim Dunbar OWNER -BUILDER DECLARATION Date: 06/09/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is t. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 06-9-2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER t. I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the s. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections2 5, 25533, and 254. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: 06-9-2017 7CTIONL I certify that I have read this application and state that the above information is CONSTRt ING AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 06-9-2017 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE. CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildintaOcupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION X ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 10815 N. WOLFE RD. 103 AP"# 2)1 �1- 65 - wsy OWNER NAME KIMCO (attn: Grace Anicete) PHONE (415) 656-6605 E-MAIL ganicete@kimcoreaity.com sTREETADDREss 15 SOUTHGATE AVE. CITY, STATE, ZIP DALY CITY, CA 94015 1 PAx CONTACT NAME TIM SIEVERS PHONE 208-343-4635 E-MAIL tim.sievers csh a.com STREET ADDRESS 200 BROAD ST. CITY. STATE, zip pry702 BOISE,ID CI �7 OJ FAX 208-343-1858 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT © CONTRACTOR ❑ CONTRACTOR AGENT N ARCHITECT ❑ ENGINEER 11 DEVELOPER 11 TENANT CONTRACTOR N E LICENSE NUMB LICENSE TYPE` • � BUS. LIC # COMPANY NAME EX PYZ L' -j lj 5� % FI X TN R E 55.,,-r,45; E-MAIL FAX ! 0$(p w 5,,4T4 Tofto&o pl:f 0 Ste lol uTm qc 15" STREET ADDRESS CITY, STATE, ZIP PHONES 6 I_ ARCHITECTIENGINEERNAME JIM OTRADOSKY LICENSE NUMBER n-25q�� BUS,LICC# in process�(J lr J aid 2/9117 COMPANY NAME CSHQA E-MAIL 'im.otradosky@cshqa.com FAX 208-343-1858 STREETADDRESS 200 BROAD ST. CITY, STATE, ZIP BOISE,ID 83702 PHONE 208-343-4635 DESCRIPTION OF WORK INTERIOR ALTERATION: REMODEL OF EXISTING TENANT SPACE. NEW INTERIOR FINISHES, LIGHTING, AND STORE FIXTURES. NO CHANGES TO SITE OR TO RIGHT-OF-WAY. EXISTING USE Mercantile PROPOSED USE CONSTR.TYPE Mercantile Unchanged #!TORTES Single USE TYPE OCC, SQ.FT. VALUATIONEXIST($) AREA AREA 2,124 A"bn OR `�nchan ed AREA NIA TOTAL NET AREA 2,124 mercentile unchanged rn 2,124 80,000 BATHROOM KITCHEN OTHER REMODELAREA REMODEL AREA REMODELAREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: EIDETACH I Q ATTACH I # DWELLING UNITS: IS A SECOND UNIT YES SECOND STORY [IYES TURING ADDED? NNO ADDITION? NNO PRE -APPLICATION []YRS IF YES, PROVIDE COPY OF PLANNING APDL # []NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EfC1ILE ® NO RE -. -_ .�$g -- ' -:" : TOTAL VALUATION: -HOME? 80, 000 By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on tle property owner's behalf. I have read this application and the information i have provided is correct//f 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 constructi . I authorize representatives of Cupertino to enter the above-identifiedroperty for inspection purposes. Signature of Applicant/Agent: •-- Date: O"— �l l 717 SUPPLEME AL INFORMATION REQUIRED PLANCIIEC&fiYPB .._._..._ _ __ ROUtYNGSYih _ __ KD.YFRTRFIK 3 9R-:- New SFD or Multifamily dwellings: Apply for demolition permit for--------- gggg [ AUILIIIN� pLAh ItEVIEw existing building(s). Demolition permit is required prior to issuance of building - permit for new building.1xP1tESS 17 PIiNNING PI A� REYIIF2S , __ _ _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure �. %tNDav �p[tsLlc��oxxS form if any Hazardous Materials are being used as part of this project. ❑ LAYtCE .., Y❑�HtF DFP' .. - Copy of Planning Approval Letter or Meeting with Planning prior to p Sr11yLTARY SElYER p ntA Submittal of Building Permit application. i?CSTAICT P' _ ENY. RON61E1!ITAL.HE:4Ly iY BldgApp_201 Ldoe revised 06/21/11 Test + Balance Report # 7675 Rev.Q �s Tenant Improvements T -Mobile rE t-6a1��-cr;h+�n.or-f�r2te-o_m��-hda,E 10815 N. Wolfe Road', Ste. 103 San Jose 408.928-3009 Sacramento 916-003.0268.. 24hr Emergency 408-928-3000 x150 tirfWMESA3.com _ 'Cupertino, 1711 ryA Table of Contents S eeifila Cover 1 TOC 2 2 Comments RTU -1 SF RTU -1 EEF 5 5 RTU -1 Air Dist. EF -1 7 11 AABC Performance Guaranty 11 Report Abbreviations 13 Test Procedure Notice 14 Test Equipment Detail 15 T -Mobile HVAC Plan - Dw : 7674 -BALANCE -1 Rev.0 2417-07-26 Attached Page 2 of 15 Test + Balance'Report # 7675 Rev.0 Tenant Improvements Te T -Mobile San Jose 406.928.30W SactamenW 918.86&0268 10815 N. Wolfe Road, Ste. 103 241hr EmerqOnCy 408.928-3" xJ50 m".MESA3.com Cupertino, CA Report Comments 1.00 BACKGROUND 1.01 This test and balance project was initiated because of ongoing improvements to the tenant space at T -Mobile in Cupertino, CA. 1.02 These Systems consist of (1) rooftop AC unit and (1) exhaust fan, 2.00 PROPOSED SCOPE 2.01 Perform.HVAC Testing & Balancing services per plans and project specifications. 3.00 FORMAT NOTES 3.01 Each test sheet documents the design balance criteria (example +/-10% of Design) W3.02 Air distribution test sheets results have auto -format color coding to assist in quick and efficient evaluation. PASS or = Within listed specification FAIL or % = Below listed specification = Above listed specification 3.03 Unit test sheets have calculated brake horsepower. Design and specified BHP listed is for . the fan or pump only, not including drive losses. Calculated motor BHP is total BHP including drive losses. 3.04 For record, in order to have the most accurate data contained within each cell of the report, all formulas and calculations include all of the decimal places even if not displayed. (i.e.: The "Precision as Displayed" is not turned on). 4.00 PROCEDURE CLARIFICATIONS 4.01 FLOWHOOD USE a) Application: For critical environment systems (e.g.: labs, hospitals, cleenrooms) all of the FlowHood . readings are corrected for air temperature & atmospheric pressure and backpressure compensated to achieve the highest accuracy available. For non-critical environments (e.g.: offices) performing the additional backpressure compensation readings are not warranted and therefore not performed. b) Limitations: FlowHood test equipment has a calibrated range from 25 to 2,500 cfm supply and 25 to 1,500 cfm exhaust. Physical airflows below 25 cfm may be displayed as zero by the FlowHood even if airflow is present. As such, if the hood displays a value of zero cfm, this will be reported by MESA3 as "<25 cfm". c) For VAV systems, if other registers were able to be acceptably measured (>25 cfm) in minimum airflow mode, then the minimum airflow for any "<25" cfm was calculated based on the register reducing by the same average percentage as the others for use in determining VAV total flow. Continued on following page... Page 3 of 15 Test + Balance Report # 7675 Rev.0 3 Tenant Improvements T -Mobile 7E -salr tll:11101-cuu ,ss;� Va date 10815 N, U1it2lfe Rt7 d, S$E3. 1 Q3 Sart Jose 408.9283C0(F Sacramanio 9l&803.0266 24fu Emergency408•928.3000x164 WOMESAImm Cupertino, CA Report Comments 4.02 OUTS16E AIR T€STING a) When direct outside air measurement is practical, MESA3 will show the test results, along with any permanently installed airflow measuring station display value, on the air distribution sheet for the system. b) Whenever direct outside air measurement is not practical, MESA3 will use the following procedure to measure minimum outside air . All test results and calculations will be documented on a special outside air/economizer worksheet, along with any permanently installed airflow measuring station display value. - After proportional balance of the supply system is completed, determine the supply duct static pressure vs. supply total cfm relationship, - After, proportional balance of any ducted return inlets is completed, determine the return duct static pressure vs. return cfm relationship by temporarily sealing off the OSA inlet screen with plastic to achieve full return mode and recording SA & RA reference duct statics. Then calculate the current supply and return airflows (which at this point are equal) to determine the return duct static pressure vs. return cfm relationship. - Remove OSA temporary plastic cover and adjust minimum outside airflow using the 5A & RA duct reference static pressures to calculate the current SA & RA cfm quantities with the difference being the current outside cfm airflow rate. While in full outside mode; record supply duct reference SP and determine impact to SA cfm. Should there be an economizer exhaust fan (power exhaust fan, relief fan) installed, then measure the return/exhaust duct reference static and used to calculate the return airflow to verify that the economizer exhaust fan can handle the same airflow as the maximum return airflow so as to maintain a similar building pressure impact from the unit under test. - Document any final ducted return inlet airflows in both min OA and Max OA modes. c) MESA3 does not use the following procedures to measure minimum outside air for the statedreasons:. - MESA3 does not measure minimum outside air using the temperature method due to having a small difference between the return and outside air temperatures. Also, most systems do not allow for 100% mixing of air before entering coils or flowing across the supply fan motor. - MESA3 does not calculate the minimum outside air by subtracting the RA grille total from the SA grille total because of the ductwork leakage uncertainty. Page 4 of 15 s� 3esi-Balance-Cerw[y-[rionixbr-Galinrate-•Canmigsioo-tfaGdaie San JCSO 408.928-3000 Sacramento 911rW3.0258 24r Emergency 408-928.3000x180 vmvr MESA3.com- Supply Fan Fan: RTU -1 Test + Balance Report # 7675 Rev.0 Tenant improvements T -Mobile 10815 N. Wolfe 'Road, Ste. 103: Cupertino, CA Doc: TAB -A01 -SF Rev 1, 4070222 QMESA31997-2014 F(ow Vogeimbelactpye S c - aj - - -Test Description ". t7esign .., Plans Submit, Date 7/20117 Testy By TestSO Date 13y Test E Date By :" Test Sq#f 113 295, OF ` 1 7 7120/17 113,295, OF 1387 I As -Left Flt Spd. (Min OSA) Test# 2 As -Left Lo Spd. (Min OSA) `rest# Manufacturer Daiken Fan Model Number DCGO902103VXXXAA Type or Size Gas -Packs a Unit Manufacturer Qty Mtrs : US Motor 1 HERPM-hi RPM -lo 2.00 1740 11160 Motor Frame I Phase SF 56HZ 3 1. Volts 208 208 FLA 6.0 Model or Size JP.Diam. 1VL40 4.75" 4 Motor Sheave Bore or Bushing - Adj. % of Max Mid Fan Model or Size IP.Diam. 7„C Sheave Bore or Bushing 1.00" Number Belts Belt Size 1 AX -51 Centerline % of Max Adj. 18114150% Volume Type Position 2 -Speed High 2 -Speed Lown Control Set Point I indicated Actual Tested RPM Motor 1,749 1,166 Fan 790 528 Air Dist. Total SAcfm % des. 3,015 2,981 99% 1,970 Fan Air Flows SAcfm % des. 3,000 3,115 104%Q No Test RAcfm 2,390 No Test QAcfm % des. 600 790 132%Q 604 101 /a Discharge SP ESP TSP 0.51 0.51 0.22 0.22 Suction SP ESP TSP 0.17 0.72 0.08 .0.31 Total Resistance ESP TSP 1.20 0.68 1.23 0.30 0.53 Clean Media Filter & DX coil 0-55 0.23 AP's Tested' T1-T2 T1-T3 T2-T3 .', '. 209 209 208 209 209 208 Volts Voltage Corrected FLA 5.98 5.98 Tested T1 T T3 4.9 4.3 4.7 2.7 2.6 2.8 Amps BHP CFLA Calc. 1.90 1.55 9.90 Volts Ams kW VFD BHP Kwh Calo. 1.90 None None No Load Amps (if overloaded) Note Test # Comment Date By 1 1 Fan operates at high speedonly when second stage heating or cooling is required. 7/21117 OF All other conditions are at low speed. MESA3 set minimum OSA to be at design during low speed operation. Page 5 of 15 Test + Balance Report # 7675 Rev.0 Tenant Improvements T-Mobile .1 np.1 L fest'Balance-Certify-h4onitor-CaGbraL-Cwnsssion-Validate 100.15 N. Wolfe Road, Ste. 103 San Jose 408.928-ZM Sacramento 0116-803-0268 24hr Emergency 408-928-3000x150 1uaW-MESA3.com Cupertino, CA. Economizer Exhaust Fan Pan: RTU -1 Page 6 of 15 3 rFb San Jose 408-928-3= Sacramento W6.803-0268 24hr Errmqgency 408-928-3000 xM ',WMMESA3,rorn Air Distribution System/ Area: RTU -1 Test + Balance Report # 7675 Rev.0 , Tenant Improvements T -Mobile 10815 N. Wolfe Road, Ste. 103 Cupertino, CA Doc: TAB -A11 -Air Dist Rev 1.6-110429 QMESA3 1998-2012 FloWspea- 10% Register °, _T_ Desigh Date By Test Eq# bate: By Test Eci# 7120/17 DF 113 7120/17 DF 113 l.t3: Raor Type size E Ak FPM Test*J I As -Found (Min OSA Low SP) T est# 1 2 As -Left (Min OSA High Spd.) Nbtel Codi % OoTt] SPNP FkvcFKj CFk, LA a y F 6polsi-tv+ -11� CF t Anaiys Storage CD 12x12 270 100% 280 104% 60% 266 99% 2 Hall CD 24x24 270 100% 219 81%_ 60% 289 107% 3 Store CD 24x24 275 100% 225 82% 60% 265 06% 4 Store CD 24x24 275 100% 117 143% 100%1 1 295 107%1 5 Store CD 24x24 275 100% 216 79% 60%1 1 286 104% 6 Store CD 2424 275 10000 222 811% 50% 252 92% 7 Store CD 2424 275 100% 105 38% 100% 285 104% Store CD 2424 1 275 100% 178 1-65% 70% 250 911% 9 Store CD 2424 1 275 275 100% 297 108% 50% 248 90% 10 'Store CD 2424 100%1 195 71% 50% 275 11000/0 11 Storel CD 2424 A275 275 100% 1 230 84% 50% 270 98% Supply Outlet Total on noted Speed 3,015 2,284 76% 2,981 99% Duct Traverse 30x15 2.6721 1128 No Test 1,166 3,115 .1031% SA Tray. Total 3,015 1 3,115 103% Calc SA Leakage Max at 6%= 181 134 PASS I 3 12 CRG - 2 13 CRG 12.0 0.785 344 270 1 No Test 351 276 2 14 Open 22"0 2.640 No Spec I No Test 801 2,114 2 1 ,Return Inlet Total No Spee I 2,390l Page 7 of 15 um c raa Test + Balance Report # 7675 Rev.0 Tenant Improvements 1p�"atbMranu'a 1. T -Mobile 10815 N. Wolfe Road, Ste. 103 SanJos� 608.928-3300 Sacramento 916-803-0288 r.I iG'rtfno,. /©►,. 24hr Emergency 498-92&3001! x150 www.MESA3ca .m Air Distribution System/ area: RTU -1 Doc: TAB -A71 -Air Dist Rev 1.6-110429 OMESA31998-2072 it Spo+0% Flow&pec'= 1Q°la Register F}es'tgn Date ay Test E01 Date By Test 1!q# 7120/17 DF 113 7/20117 DF 113 size! FPM Test* 1 As -Found (Min OSA Low SP) Testf€' 2 As -Left (Min OSA High Spd.) " Note 1:10. Roo. Type or .4. Ak or ' U'i~ItAi : rutrxf 'I aP %OP- SPlt1P FP{1tCFk# CFAIn: maws -I ot�eiT �PniP FgNSC€[� ". CFM " firlal�` CcSde r Page 8 of 15 OA Open 26x1'6 2.297 261 600 No Test 14% 344 790 132% 5 (3.15x) EA - No Test No Test Test# All Ail All All Comment RA design calculated by subtracting Min OSA from SA Calculated SA leakage by subtracting the grille total from the SA traverse.. Fan operates at high speed on second stage heating and cooling modes only. All other conditions are low speed. , Single position minimum outside air controller. Set for low speed fan operation at design min. Date 7/20117 7/20117 7120117 7121/17 B DF DF DF DF r Page 8 of 15 Test + Balance Report # 7675 Rev.0 ti s Tenant Improvements 4a:nr T -Mobile 10815 N. Wolfe Road, Ste. 103 Sten Jose 4M9M3000 Sa rnento$t6.803-0268 Cupertino, �� 24hr Emerg&ncy40&928-'30Wxi50 wv.%YMESR3.com. Air Distribution System/ Area: RTU -1 Doc: TAE-A11-Alr Dist Rev 7.6-1/0429 bME8A31988-2072 - , pIowSp— iD% �1avd3P��� 'EDYa Register Design Date By . Test E'q# "Date: By Test Eq# . 7/24/17 DF 113 7/21117 DF 113 ,1:D Roo' Type size' or : Model a Ak ' FPtvl or pp Cfltl)- fest# 3 As -Left (Min OSA Low Spd.) Test # 4- As Left (100% EA) Nate Code °� Open SPftIP F�rnrcFua CFM t�naiys' ®!ape►t SPlvPrrcFr :` GFM� Atasaj+si 1 storage CD 12x12 270 60% 174 No Test 2 Hall CD 24x24 270' 60% 193 No Test 3 Store CD 2424 275 60% 175 No Test 4 Storel CD 2424 275 100% 197 No Test 5 Store CD 24x24 275 60% 188 No Test 6 Store CD 24x24 275 50%fl 165 No Test 7 Store CD 24x24 275 100% 191 No Test 8 Store CD 24x24 275 70% 167 No Test 9 Store CD 24x24 275 50% 161 No Test .10 Store CD 24x24 275 50% 182' No Test 1' 1 Store CD 2424 275 50% 1177 1No Test Supply Outlet Total 3,015 1,970 No Test Duct Traverse 13x28, 2.672 1128 No Test No Test SA Tray. Total 3,015 Calc SA Leakage I Max at 6%4= 181 12 CRG _ _ 2 13 CRG 12"0 0.785 344 270 No Test 321 252 93%d 2 14 Open 22"01 2.640 No Spec No Test 748 1,975. 2 Retum Inlet Total No Spec 2,227 1 Page 9 of 15 :MS,sFb$ Test+ Balance Report# 7675 Rev.0 Tenant Improvements AAS T -Mobile Test-92fance-cat 6t Alan itor-Catbra ta- Conn '-6c -VaUate 10815 F V Wolfe Ell F e i" oadt Ste. 103 San Jose 408-928.3000 Sacramento 9.16803-0288 . 24hi 6m-memy 40&923-30DO x150 wmo,1ESA3.com _ Cupertino, CA Air Distribution System/ area;. RTU -1 Doe: TAE-Ail-NrDistRev 1.6-1104ig QMEsA3 1998-20121'PtowSpe t tq°lo Flow spa i7afa, Sy Test' Eq# tlette BY :. Test F-0 Register Oestgn 7/20117 OF 113 7121117 OF 113 � FPM° � � - U. Roo Tyrie or' �iit or CFM test 3 As -Left (Min OSA Low Sod.) Test ## 4- As Left (100% EA) Note ModeG P °lo=Open $PNP FPM�cPM CFM,. Arta ` °I €Soeri .,PNP t a�am.Ftu Fna n �h,rr� r , r Page 10 of 15 OA Open 26x16 12.297 261 600 14Q10 263 604 101 °lo No Test (3.15x) EA No Test No Test - estTest# Test Comment ate Py All RA design calculated by subtracting Min OSA from SA y 7/20117 OF All Calculated SA leakage by subtracting the grille total from the SA traverse. 7120/17. OF All Fan operates at high speed on second stage heating and cooling modes only. All other conditions 7/20/17 "' OF are low speed. All Single position minimum outside air controller. Set for low speed fan operation at design min. 7/21117 OF Page 10 of 15 v . : Test + Balance Report # 7675 Rev.0 Y r Tenant Improvements 4A�u s4 Tom+=Mobile Test-Balance-Celt(y-R9ontar-Calibata-Commssion-Validate 10815 N. Wolfe Road, Ste. 103 San JOSS 408.9283000 Saonnwnto 916.803-0268 Cupertino,2rtrr Emer4encY aDS-928-3006x190 .,1,MEM,mm CA Page 11 of 15 'AABC N'ational Perfo"nance Guarant Pursuant to the agreement between MESAS, Inc. AAMC Certified Testing & Balancing Agency and _..,____�__,��_.��w����.._ Air Craft, Inc. Client All systems shall be tested and balanced in accordance with ; the project plans anc specifications and to t he optimum performance capabilities of the equipment. Testing and balancing, shall be clone in accordance with the standards published by the Associated Air Balance Council. if the Agency listed above fails to comply with the specifications ,ter any reason other than termination of business by the AABC agency or equipment malfunction or inadequacy which - prevents proper ,balancing of the systems, AABC will investigate and, if warrantee, will provide supervisory personnel to assist the member Agency to perform work in accordance with AABC Standards. This supervision will be provided at no additional cost to the building owner: This Guaranty is valid for one year from the date of submission of a test and balance report, provided the Agency is a current member of AABC, and may only be invoked in writing by the building owner, architect or engineer of record. The Guaranty is limited to the terms and conditions as stated herein. MESAS ##7675 Rev.0 T -Mobile Tenant Improvements 2017-07 Project Name = _ Address10815 N. Wolfe Road, Ste.: 103 Cupertino, CA Steven Hardy, P.E. Name of Engineer CSHQ4 Engineering Finn Email Address steven.hardy@cshga.com , Address 200 Broad St. Boise, IQ IMF AA13+C` 7/25/2017 Dale Associated Air 12-01-87 u TBE # N 1518 K Street, N.W. Paul Mocny Washington, D.C. 20005 BY 202-737-0202 * Fax 202-838-4833 AABC Certified TBE info@aabc.com = Awwaabc.com ^i%'�yyVt64 catKS&1 4 �`3Rau3rc�arA�a-' San Jose 408-8283000 Sam 24hr Emergency 40&,32&3Wo x150 Report Abbreviations Test + Balance Report # 7675 Rev.0 Tenant Improvements T -Mobile 10815 N. Wolfe Road, Ste. 103 Cupertino, CA yy`36 Wall Supply Grille AC/H Air Changes per Hour AFF Above Finished Floor ASHRRAE American Society of Heating, Refrigeration Belt & Gossett - Triple Duty Valve & Air-conditioning Engineers DNA Data Not Available DNL Data Not Listed Flo For Information Only I/o Information Only LOA Lack Of Access NA Not Applicable NEBB National Environmental Balancing Bureau Ni Not installed NIC Not in Contract NM Not Measured NR No Requirement NVL No Valid Location for testing HVAC Air Balancing- Ak Area Coefficient B.TRAV Branch Traverse CD Ceiling Diffuser CEF Ceiling Exhaust Fan CEG Ceiling Exhaust Grille CER Ceiling Exhaust Register (w/ OBD) CH Canopy Hood CRG Ceiling Return Grille CSR Ceiling Supply Register (w/ OBD) CRR Ceiling Return Register (w/ OBD) DD Dual Duct Terminal Unit DH Ducted NEPA ESP External Static Pressure FEG Floor Exhaust Grille FER Floor Exhaust Register (w/ OBD) FFU Fan Filter Unit FH Laboratory Fume Hood FPH Fan Powered NEPA FRG Floor Return Grille FRR Floor Return Register (wl OBD) FSR Floor Supply Register (w/ OBD) LCD Linear Ceiling Diffuser LSD Linear Slot Diffuser LWE Low Wail Exhaust LWR Low Wall Return LWS Linear Wall; Supply M.TRAV Main Traverse OA / OSA Outside Air' OBD Opposed Blade Damper OPEN Open Duct PD Pressure Dependent PI Pressure independent POU Point -of -Use POUF Point -o€ -Use Filter RA Return Air SA Supply Air SD Single Duct Terminal Unit St. Pt. Set Point : TAF Terminal Air' Filter TRAY Traverse TSP Total Static Pressure VFD Variable Frequency Drive NEG Wall Exhaust Grille NER Waif Exhaust Register (w/ OBD) Test + Balance Report # 7675 Rev.0 Tenant Improvements T -Mobile 10815 N. Wolfe Road, Ste. 103 Cupertino, CA yy`36 Wall Supply Grille WSR Wall Supply Register (w/ OBD) HVAC Water Balancina- BG-CS Bell & Gossett - Circuit Setter BG-TDV Belt & Gossett - Triple Duty Valve BG -CB Bell & Gossett - Circuit Balance Valve TA-CBV Tour & Anderson - Circuit Balance Valve Annu Annubar flow measuring station Cteanroom Performance Testing (Certification) BBC Bio. Safety Cabinet (Class -11) DOP Dioctyi Phthalate EMI Electromagnetic Interference IES (LEST) institute of Environmental Sciences & Technology NSF National Sanitation Foundation Particle Non-viable or -viable particulate PSL Polystyrene Latex spheres PAO Polyalphaolefin ISA Breathing Air ,BSC Building Systems Commissioning BSCA Building Systems Commissioning Administrator CDA Clean Dry Air CO Carbon Monoxide CO2 Carbon Dioxide CX Commissioning MEP Mechanicat-Electrical-Plumbing-Piping NO Nitric Oxide NO2 Nitrogen Dioxide PPM Parts Per Million SO2 Sulfur Dioxide Component Gal Calibration of a single portion of the measurement chain Page 13 of 15 of events, typically includes recording of transmitter signal. Loop Cal Calibration of the entire measurement chain of events, typically includes recording of indicated values. Component & Loop Cat Simultaneous calibration of both a single portion of the measurement chain and the entire chain,tYp� " icali y includes recording of transmitter signal and indicated values. Calibration Part ID number referring to the individual calibration number and total number of sequential calibrations which are or could be performed jointly to an individual instrument as part of an overall calibration plan- [.e.: 3 -Point Component Cal with adjustment (1 of 2), followed by t- Point Loop Cal with no adjustment (2 of 2) j. Standard instrument used as reference during calibration procedure. NIST National institute of Standards and Technology .Facilit�r cGCP current Good Clinical Practices cGLP current Good Laboratory Practices cGMP current Good Manufacturing Practices ISPE International Society for Pharmaceutical Engineering iQ Installation Qualification OQ Operational Qualification Page 13 of 15 Test + Balance Report # 7675 Rev.0 Tenant Improvements ��v+nAo.xi�4P�� T -Mobile � {sin -c ry. Ea�.c�=gatecpm "v. �e 10815 N. Wolfe Road, Ste. 103 San Jose 4M928.3 Sacramcn{a 9i6.803•Q2E8 24hr Em@rgency408-928-3000x950 uwwPAESR3,com Cupertino, CA Test Procedure Notice 1. INDUSTRY PROCEDURES The following information "is applicable if any of the test documents contained within this report indicate that the services were performed in accordance with an industry standard, procedure, recommended practice or guideline. 1.1. Copies of industry documents may be purchased from the publishing association or group. Feel free to contact MESAS for the address and phone numbers of any association of interest, 1.2. Abbreviations for issuing agencies, which MESAS frequently reference are as follows. 1.2.1. NEBB-TAB National Environmental Balancing Bureau Testing, Adjusting and Balancing Standards 1.2.2. NEBB-BSC National Environmental Balancing Bureau Building System Commissioning Standards 1.2.3. NEBB-CPT National Environmental Balancing Bureau Cleanroom Performance Testing Standards 1.2.4. IE$T-RP-CC Institute of Environmental Sciences Recommended Practice - Contamination Control 1.2.5. NSF49 National Sanitation Foundation - Class 11 Biosafety Cabinetry 1.2.6. ASHRAE American Society of Heating, Refrigeration and Air Conditioning Engineers guidelines 1.2.7. SMACNA Sheet Metal and Air Conditioning Contractors National Association 2, PROJECT SOP's The following information is applicable if any of the test documents contained within this report indicate that the services were performed in accordance with a "Project SOP" or "Project Procedure". 2.1. If formal "project specific" procedures were developed by MESAS for use in MESA3`s execution of services associated with this project, even if these procedures were disseminated during the course of the project or have been included in this final ,report, MESA3 retains the copyright ownership to all such procedures. , 2.2. If procedures were developed by MESA3 specifically for use by the Client, these documents shall bear the Client's name and only mention MESA3 under a "prepared by" caption. These documents are the property of the Client. 3. MESA3 SOP's The following information is applicable if any of the test documents contained within this report indicate that the services were performed in accordance with a MESA3 SOP (Standard Operating Procedure). 3.1. MESA3 SOP's are created by MESA3, at MESATs sole expense, for the sole purpose of being used by MESA3 employees in performing company related services and are the intellectual property of MESA3 with all rights reserved. 3.2. Due to the trade secret nature of these controlled documents, they are considered PROPRIETARY AND CONFIDENTIAL by MESA3. They shall not be copied or disclosed in any manner either in whole or in part in any way, shape; or form to any person other than to MESA3 employees for any reason whatsoever without the prior expressed written consent of the 'President of MESA3 with the exception that the copying or disclosing of the "Page 0 Confidentiality Notice" of any MESA3 SOP to either the Client or the Client's duly appointed Representative shall be allowed. 3.3. Any MESA3 client who wishes to perform a Quality Assurance (QA) Audit of a MESA3 SOP procedure referenced within this report may do so provided the following conditions are met. 3.3.1. The QA Audit shall be scheduled in advance with the President of MESA3. It can be performed at either MESATs main office or at any site of the Client's choosing within 50 miles of MESATs main office at no charge. A QA Audit performed at a site greater than 50 miles from MESATs office can be accommodated so long as the Client compensates MESA3 for reasonable travel expenses.. 3.3.2. The personnel performing the QA Audit shall be either direct employees of the Client and be charged with QA activities for the client, or shall be employees of a goverment regulatory agency, which is performing a QA Audit of the Client's operations. 3.3.3. The QA Audit personnel shall execute a confidentiality agreement as prepared by MESA3 prior to conducting the audit. This agreement shall primarily stipulate that the QA Auditors agree not to discuss or disseminate the!contents of this MESA3 procedure in whole or in part in any way, shape or form, except that they shall be free to disclose the results and conclusions of their QA Audit with other QA employees of the client and/or to the employees of government regulatory agencies so long as they inform the recipient of the proprietary and confidential nature of the MESA3 document that has been audited. Page 14 of 15 ' Test } Balance Report # 7675 Rev.O g Tenant Improvements T -Mobile Test-&glance-CerliFt-Menior-Cat�Sacramento 916-03-0268 1 -03. 268 108155 N. Wolfe Road, Ste. 103 Son rasp aaa•s2a-a000 Sacramento Sts-ao�-Dasa 24hr Emergency 408•928m=O x150 rnr�l.r1ESA9.aum Cupertino, CA Test Equipment Detail Refer to individual tPrf Shp_ptq fnr a rnrnrA of \dtili^11 ;-4.,,..-...,..4 .... .—A -1.. _ Al7Pitca{Can DescriptionMa."cturer od tuwl itItwu Uy U IC lVlr:OMO Cid fF _ Idodat M SA3 Prigr,,� a ne EQ tit Ca Gat - GaC F �- Due ' ? -r Press, DP, Vel, Vol, & Temp Air Data Multimeter I Flowhood Shortridge ADM -860C _ Y, 2/21/16 2/3/17 ADM -860 2/1$ Rotational Speed- Chronometric Tachometer O.Zemickow 262 295 NA NA NA Electrical Digital Volt I Amp Meter Fluke 32 1387 12/20/15 12(9116 12!17 Documenting Process Calibrator Fluke 704 _ 74IS17438 _ All unused or not applicable cells either contain {�. '1 Of 1.5 "NA", "dashed 6ne(sr or are shaded gray- P d 4} J [A I t OF CHLIFUKNIA OUTDOOR AIR ACCEPTANCE CEC-NBCA-MCH-02-A (Revised 07/16) CERTIFICATE OF ACCEPTANCE CALIFORNIA ENERGY COMMISSION NRCA-MCH-02-A. Outdoor Air Acceptance '„ (Page 1 of 3) Project Name: ` T -Mobile Enforcement Agency: Permit Number: Project Address: - r 1 7�(S 10815 North Wolfe Rd Suite 103 city: Cupertino ----- ® Zip Code: System Name or Identification/Tag: - RTU -1 - System Location or Area Served: Entire Space Nate: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate comolionce_ Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH -03 (Column 14) or Mechanical Equipment Schedules. A. Construction Ins Note: MCH -02-A can be performed in conjunction with MCH -07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. Instrumentation needed to perform test includes: a. Watch Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). Method and equipment used: ADM 870c with Velagrid measuring velocity ii. Equipment calibration date (must be within one yeas): 02/17 System type (check either VAV or CAV): Q VAV ❑ CAV a. Check if Variable Air Volume (VAV) and complete the following: i. Outside airflow is either factory calibratedor field calibrated. ❑ Check if factory calibrated and attach calibration certification. ❑✓ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑✓ Other Active Control, Describe: 2-pos. Min OSA damper from 2 -speed SA fan b. Check if Constant Air Volume (CAV) and verify the following: ❑ System is designed to provide a fixed minimum OSA when the unit is on. Method of delivering outside air to the unit (check one of the following): ❑ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ftp. of the unit. ❑ 15 ft. of the unit, with the air directed substantially toward the unit. ✓❑ Return air plenum is NOT used to distribute outside air to the unit. (Le, outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) Pre -occupancy purge has been programmed for the 1 -hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑✓ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 b I A It OF UALII-URNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: - T -Mobile Project Address: 10815 North Wolfe Rd Suite 103 System Name or Idents ication/Tag: RTU -1 Enforcement Agency: City: Cupertino System Location or Area Served: Entire Space N RCA -MCH -02-A (Page 2 of 3) Zip Code: B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing CAV Step 1: Disable demand control ventilation (if applicable) Step 2: Verify unit is not in economizer mode during test (economizer disabled) El Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow a. Adjust supply air to achieve design airflow or maximum airflow at full cooling. Record VFD speed (Hz). b. Measured outdoor airflow reading (cfm) cfm C. Required q outdoor airflow (cfm) (from MCH -03; Column 14, or Mechanical Equipment Schedules). d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): cfm Ste 4: VAV testing at reduce Step g d supply airflow CAV a. Adjust supply airflow to' either the sum of the minimum zone airflows, full heating, or 305,.'of the total design airflow. Record VFD speed (Hz). b. Measured outdoor airflow reading (cfm). C. Required outdoor airflow (cfm) (from MCH -03, Column 14, "or Mechanical Equipment Schedules). d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): Step 5: Return to initial conditions (check) VAV 0✓ High Speed Hz 790 cfm 600 cfm 0.5 min VAV Low Speed Hz 604 cfm 600 cfm 0.5 min Z✓ C. Testing Calculations' & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a.. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) % 1.32 % b. %OAFA is within 10% of design Outside Air. (90%:5 %OAFA <,110%) Yes Q No Q Yes @ No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes @ No Q Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA= Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) 1.01 % b. %OARA is within 10% of design Outside Air. (90%!5 %OARA < 110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes @ No 0 Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation Q I PASS: All Construction Inspection responses are complete and, Testing Calculations & Results responses are positive CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 Sl A I L Ul- t:ALlhUKNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: T -Mobile 10815 North Wolfe Rd Suite 103 System Name orJdentiBcation/Tag: RTU -1 Agency: City: Cupertino System Location or Area Served: Entire Space NRCA-MCH-02-A (Page 3 of 3) Permit Number: Zip Code: DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Dean Ferreira Dean Ferreira �.M �om.a= Documentation Author Company Nam P Y e: MESA3' Date Signed: 2/27/17 Address: 1945 Las Plumas AV ATT Certification Identification (If applicable): B61153475TMT City/State/Zip: San Jose, CA 95133 Phone: 408.928-3000 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification.reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by'the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Dean Ferreira Field Technician Signature: q Dean Ferreira o,pu 3,�grG Field Technician Company Name: MESA3 Position with Company (Title): Field tech Address: 1945 Las Plumas Av ATT Certification Identification if applicable): 1 pP ): gg1153475TMT City/State/Zip:San lose, CA 95133 Phone: 408-928-3000 Date Signed: 2/27/27 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the field Technician,, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed_ the. information provided on this Certificate of Acceptance, 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features; materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided, on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and :conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at. occupancy. Responsible Acceptance Person Name:Responsible Rlcherson Acceptance Person Signature: a " acraa^ Jano°BfSO Rihesone � zo i zzs .__raos:s-0rso Responsible Acceptance Person Company Name: Air Craft, Inc. Position with: Company (Title): Off icer Address: 3053 Freeport Blvd., Suite 104 CSLI3 License: 1018104 City/State/Zip: Sacramento; CA 95818 Phone: (916) 318-6060 `Date signed: 6/26/17 CA Building Energy Efficiency Standards -2016 Nonresidential Compliance July 2016 5 I A It Uh UALII-URNIA AIR DISTRIBUTION DUCT LEAKAGE CEC-NRCA-MCH-04-A (Revised 01/16) CERTIFICATE OF ACCEPTANCE AIR DISTRIBUTION DUCT LEAKAGE Project Name: T -Mobile Project. Address: - 10815 N. Wolfe Rd, Suite 103 Agency: City: Cupertino Note: Submit one Certificate of Acceptance for each system that must demonstrate compliance. HERS verification required. ENERGY COMMISSION N RCA -MCH -04-A (Page 1 of 3) Permit Number: Zip Code: Enforcement Agency Use: Checked by/Date This compliance document iss u Section A then determine i sed for duct pressure test and to certify low leakage air handlers. Fill out the System Information in f s is a New Duct System (fill out Section 8), an Altered 'Space Conditioning System and/or Altered Duct System (fill out Section C), or if the compliance software requires Low Leakage Air -Handling Unit Verification (fill out Section E) A. System Information A New Duct System is when at least 75% of the duct system is new duct material, and up to 25% may consist of reused parts from 01 HVAC System Identification or Name: Air -Handler Airflow Determination Method (Tons or BTU): Cooling system Method RTU -1 02 HVAC System Location or Area Served: a) For an air conditioner or heat pump use 400 cfm per rated ton of cooling capacity of outdoor 03 Was Low Leakage Air -Handling Unit Credit Taken on MCH -01? Store and Support Yes 0 No 04 Duct System Construction Type: capacity. Calculation = (0.06 x 21.7 x kBtu)/hr ) = cfm 03 Completely New 05 Condenser Nominal Cooling Capacity (ton): Compliance Statement: Pass Pass - Pass if B03 is less than or equal to B02. 7.5 Ton 06 Heating Capacity (kBtu/h): 103 MBH B. Duct Leakage Diagnostic Test - New Duct System A New Duct System is when at least 75% of the duct system is new duct material, and up to 25% may consist of reused parts from the dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, coil, plenums, duct material) 01 Air -Handler Airflow Determination Method (Tons or BTU): Cooling system Method Calculated Target Allowable Duct Leakage Rate (cfm) a) For an air conditioner or heat pump use 400 cfm per rated ton of cooling capacity of outdoor 02 condenser or package unit. Calculation = (0.06 x 400 x Tons 9.5 ) =_L81 cfm b) For heating -only system furnaces shall be based on 21.7 cfm per kBtu/hr of rated heating output capacity. Calculation = (0.06 x 21.7 x kBtu)/hr ) = cfm 03 Actual Duct Leakage Rate from Leakage Test Measurement (cfm): 134 04 Compliance Statement: Pass Pass - Pass if B03 is less than or equal to B02. C. Duct Leakage Diagnostic Test - Altered Space Conditioning System and/or Altered Duct System Altered Space Conditioning System — is an HVAC changeout or when the air handler, condensing unit of a split system, our cooling coil or any amount of ducting added to an existing system but less than a new duct system. 01 Air -Handler Airflow Determination Method (Tons or BTU): Calculated Target Allowable Duct Leakage (cfm) a) For an air conditioner or heat pump use 400 cfm ,per rated ton of cooling capacity of outdoor 02 condenser or a package unit. Calculation = (0.15 x 400 x. Tons ) = cfm b) For heating -only system furnaces shall be based on 21.7 cfm per kBtu/hr of rated heating output capacity. Calculation ,= (0.15 x 21.7 x kBtu/hr ) = cfm 03 Actual Duct Leakage Rate',from Leakage Test Measurement (cfm) 04 Compliance Statement: Pass - Pass if CO3 is less than or'equal to CO2, or Fail but passed with Smoke — If unable to pass the leakage test a smoke test is allowed to confirm that all accessible leaks have been sealed. Enter actual leakage rate before moving to smoke. Fill out Section D Smoke Test. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 J I A It UI- UALWUMIA AIR DISTRIBUTION DUCT LEAKAGE CEC-NRCA-MCH-04-A (Revised 01116) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE' NRCA-MCH-04-A AIR DISTRIBUTION DUCT LEAKAGE (Page 2 of 3) Project Name: T -Mobile - Enforcement Agency: - - Permit Number:. Project Address: 10815 N. Wolfe Rd, Suite 103 City: - p - - - Cupertino Zip Cotler - D. Smoke Test 01 Inject smoke into a fan pressurization device that is maintaining a duct pressure difference of 25 Pa (0.1 inches water) relative 02 to the duct surroundings, with all grilles and registers in the duct system sealed. 02 Compliance Statement: Pass System passes if no smoke emanates from all accessible portions of the HVAC system including the package unit, furnace, ducts, plenums, wyes, tees.. This includes the air handler refrigerant line, door panels, and curb. Accessible includes having access thereto, but which first may require removal or opening of access panels, doors, or similar obstructions including moving insulation. Requires 100%testing by HERS rater. No sampling allowed. 03 1 Final Duct Leakage(CFM): E. Low Leakage Air -Handling Unit (LLAHU) 01 Installed Air -Handling Unit Manufacturer Name: 02 02 Installed Air -Handling Unit Model Number: If cloth backed tape was used it was covered with Mastic and draw bands. 03 The installed Low Leakage Air -Handling Unit Model is listed here http://www.energy.ca.goy/title24/equipment cert/Ilahu/low leakage air handling unitL.pdf 05 04 Compliance Statement: this document I certify that all the above applicable requirements have been met. Pass if Manufacturer Name, Model Number of installed equipment is listed with the Energy Commission. F. Additional Requirements for Compliance 01 System was tested in its normal operation condition. (No temporary taping except for the damper used for outside air) 02 Building cavities for new ducting were not used as plenums or platform returns in lieu of ducts. 03 If cloth backed tape was used it was covered with Mastic and draw bands. 04 All connection points between the air handler and the supply and return plenums are completely sealed including at the curb. 05 Temporary Taping over registers to perform duct leakage test. When registers are installed in drywall tape covers register and drywall. For t -bar mounted registers taping of register can occur to the register or to the t -bar. By signing this document I certify that all the above applicable requirements have been met. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 b] A I L. Ur GALII-UKNIA AIR DISTRIBUTION DUCT LEAKAGE CEC-NRCA-MCH-04-A (Revised 01/16) -.- CERTIFICATE OF ACCEPTANCE liAurvrtlV l/i tN CKIiY I..UNI NIISJIUN. -- - - Documentation Author Name: - Dean Ferreira NRCA-MCH-04-A AIR DISTRIBUTION DUCT LEAKAGE Pa (ge 3 of 3) Pa - Project Name: T -Mobile - - Enforcement Agency: u - - Permit Num Project Address: - - 10815 N. Wolfe Rd, Suite 103 City: C Cupertino 1. The information. provided on this Certificate of Acceptance is true and correct. - Zip Code; DOCUMENTATION'AUTHOR'S DECLARATION STATEMENT I. I certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: - Dean Ferreira Documentation signature: Dean Ferreira `°�°° - �°°°-F•°-°®°�� G= -Documentation Author Company Name: - MESA3 1 Date Signed`. - - - 7/20/17 Address: - 1945 Las Plumas AV CEA/HERS/ATT Certification Identification_(Jf applicable): BB1153475TMT City/State/Zip: San Jose, CA. 95133 Phone: 408-928-3000 FIELD TECHNICIAN'S DECLARATION STATEMENT certify the following under penalty of perjury, under the laws of the State of Californias 1. The information. provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: - - Dean Ferreira Field Technician signature: Dean .Ferreira' - Field Technician company Name: MESA3 Position with Company (Title): Field Supervisor Address: 1945 Las Plumas AV ATT Certification 'Identification (ifapplicable) BB1153475TMT cty/state/Zip:San Jose, CA. 95133 Phone:Datesig�ed: 408-928-3000 7/20/17 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction, or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance, and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. - 4. 1 understand that a HERS rater will check the installation to verify compliance, and that if such checking identifies defects the responsible builder/installer shall be required to take corrective action at his expense. I understand that Energy Commission and HERS Provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at the responsible builder/installer's expense. 5. 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. 6. 1 will ensure that a completed', signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all 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: Jarrod R1Cherson Responsible Acceptance Person Signature: a s� s, - - Jarrod Richerson �o.aa p, , Responsible Acceptance Person Company Name: :Air Craft, .Inc. Position with Company (Title): Officer Address: 3053 Freeport Blvd., Suite 104 CSLBLicense: 1018104 City/State/Zip: Sacramento, CA 95818 Phone: (916) 318-6060 Date Signed: 6/26/17 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 S I A I E Ur UALIFURNIA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CERTIFICATE OF ACCEPTANCE Constant Volume, Single Zone, Project Name: T -Mobile Project Address: 10815 North Wolfe Rd Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Enforcement Agency: Permit City: Cupertino Zip System Name or Identification/ rag:- System Location or Area Served: RTU -1 Entire space Note: Submit one Certificate of Acceptance for each system that must Enforcement Agency Use: Checked by/Date demonstrate compliance. NRCA-MCH-03-A Page 1 of 3 A. Construction Inspection L Supporting documentation needed to perform test includes, but not limited to: a. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.2 Constant Volume, Single -zone, Unitary Air Conditioner and Heat Pumps Systems Acceptance At -A -Glance). b. 2016 Building Energy Efficiency Standards Manual. 2. Instrumentation to perform test may include: a. Temperature Meter b. Amp Meter 3. Installation (check if applies): Z✓ Thermostat is located within the space -conditioning zone that is served by the HVAC system. 4. Programming (check all those that apply): ❑✓ Thermostat meets the temperature adjustment and dead band requirements of 2016 Building Energy Efficiency Standards Manual Section 120.2(b). Minimum heating setpoint: 55 °F. Maximum cooling setpoint 85 OF. Deadband: 5 OF. Z✓ Occupied, unoccupied, and holiday schedules have been programmed per the schedule provided. ❑✓ Pre -occupancy purge has been programmed to meet the requirements of 2016 Building Energy Efficiency Standards Manual Section 120.1(c)2. 1. Check method used to determine pre -occupancy purge: ❑ Lesser of: conditioned floor area times ventilation rate from 2016 Building Energy Efficiency Standards TABLE 120,1-A or 15cfm per person times the expected number of occupants. Z 3`complete air changes. Notes: _ CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 S I A I E OF UALIFURNIA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CERTIFICATE OF ACCEPTANCE CALIFORNIA ENEF Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems :Project Name: - Enforcement Agency: T -Mobile Permit Num6erx 10815 North Wolfe Rd city: zip code: Cupertino Name or Identification/Tag: - System Location or Area Served: RTU -1 Entire space JMMISSION NRCA-MCH-03-A Page 2 of 3 B. Functional Testing; Requirements operatingModes Step 1: Disable economizer control and demand -controlled ventilation (if applicable) to prevent unexpected interactions. Occupied Mode 4 Step 2: Heating load during occupied condition z Step 3: No-loadduring occupied condition P P Step 4: Cooling load during occupied condition p P P Unoccupied Mode Step 5: No-load during unoccupied condition Step 6: Heating load during unoccupied condition Step 7: Cooling load during unoccupied condition Step 8: Manual override 8 7 6 5 4 3 2 Step 2 — 8: Check and verify the following for each simulation mode required 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 f. Gas-fired furnace, heat pump, or electric heater stages on ✓ g. No heating is provided by the unit ✓ ✓ ✓ h. No cooling is provided by the unit ✓ ✓ ✓ i. Compressor stages on ✓ ✓ j. Outside air damper is open to minimum position ✓ ✓ ✓ k. Outside air damper closes completely —Step 9: System returned to initial operating conditions after all tests have been completed: Yes No C. Testing Results 8 7 6 5 4 3 z Indicate if Passed (P), Failed (F), or N/A (X), fill in appropriate letter P P P P p P P D. Evaluation Z I PASS: All Construction Inspection responses are complete and all applicable Testing Results responses are "Pass" (P). CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 I S I A I E Ur UALWURNIA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-NRCA-MCH-03-A (Revised 07/16) CERTIFICATE OF ACCEPTANCE. Constant Volume, Single Zone, Project Name: T -Mobile Project Address: 10815 North Wolfe Rd System Name or Identification/Tag: RTU -1 Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Enforcement Agency: Permit Number: DOCUMFNTATInki AIITunorc nrrawnwr..... City: Cupertino System Location orArea Entire space Zip Code: )MMISSION 0 N RCA -MCH -03-A Page 3 of 3 I. I certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: n Dean Ferreira Dean Ferreira �..®s Documentation Author Company Name: MESA3 Date Signed: 7/25/17 Address: 1945 Las Plumas Av ATT Certification Identification (If applicable): City/State/zip: B61153475TMT San Jose, CA 95133 Phone: 408-928-3000 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificates) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Dean Ferreira Field Technician Signature: Dean Ferreira Field Technician Company Name: MESA3 Position with Company (Title): field Tech Address: 1945 Las Plumas Av ATT Certification Identification (if applicable): BB1153475TMT City/State/Zip: San Jose, CA 95133 Phone: 408-928-3000 Date signed:_?/25/17 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. I am the Field Technician;, or the Field Technician is acting on my behalf as my employee or my agent and i have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided' on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the'Certificate(s) of Installation for the construction or installation identified' on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permits) 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: Jarrod Rlcherson Responsible Acceptance Person Signature: asr„ Jarrod Richer L Responsible Acceptance Person Company Name: Air Craft, Inc. Position with Company (Title): Officer Address: 3053 Freeport Blvd., Suite 104 CSLB License: 1018104 C'ty/state/zip:Sacramento, CA 95818 Phone: (916) 318-6060 Ded: ates'gn6/26/17 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 Namc: TE OF ACCEPTANCE 10815 N. Wolf Rd. Suite 103 CITY OF B201 Enforcement Agency Use: Checked by/Date _5 _ �_? LIGHTING COI T AL ACCEPTANCE DOCUMENT Automatic but -off Controls: : Autom tic Time Switch Control and occupant Sensor FAM Intent: Lights are turned off or set to a lower Level when net needed per Section 110.9(a) & 130.1(c). ITZ I L Eta. A. Construction Inspection Fill out Section A to confer spaces 1 through 3 that are functionally tested under Section B. Instruments needed to performs tests include, but are not limited to: hand-held amperage meterr power meter, or light meter 1. Automatic Time Switch Controls Construction Inspection—cOnfirm for all listed in Section a, All automatic time switch controls are programmed for (check all): Weekdays 17 Weekend F Holidays b. Document for the owner automatic time switch programming (check all): F Weekday settings R Weekend settings r Holidays settings Set-up settings Preference program setting Verify the correct time and date is properly set in the time switch K Verify the battery is installed and energized r Override time limit is no more than 2 hours F_ 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 2. occupancy Sensor Construction Inspection --confirm for all listed in Section Occupancy sensors are not located within 4 feet of any HVAC diffuser Ultrasonic occupancy sensors do riot emit audible sound S feet from source This is page 1 of 19 'IFICATE OF ACCL+ Y'I A1VCE ;Control Enforcement Agency: CITY OF CUPERTINO Pem tNutnber: B2017-0254 Name• T Mobil Cupertino Zip Code: 95014 Address' 10815 N Wolf Rd Suite 103 City' C�petOn°. B. Functional Testing ,of Lighting Controls For every space in the building, conduct functional tests 1 through 5 below if applicable. If there are several geometrically similar spaces that use the same lighting controls, test only one space and fist in tate cells below which "untested spaces" are represented bythat tested space. EXCEPTION: For buildings with up to seven (7) occupancy sense€s, all occupancy sensors shall be tested. (NA7,6.2.3) Representative Spaces Selected Tested space/room name: Back of House space Type (office, corridor, etc) Retail Untested areas/rooms Confirm compliance for all control system types (1-5) present in each space: .x Automatic Time Switch Controls Steil 1: Simulate occupied condition a. All lights can be turned on and off by their respective area control switch b. Verify the switch only operates lighting in the ceiling -height partitioned area in which the switch is located. Step 2. Simulate unoccupied condition a, All lighting, including emergency and egress lighting, turns off. Exempt lighting may remain on per Section 130.1(c)l and 130<1(a)l, b. Manual override switch controls only the lights in the selected ceiling height partitioned space where the override switch is located and the lights remain on no longer than 2 hours (unless serving public areas and override switch is captive key type). Step 3: System returned to initial operating conditions . occupancy Sensors . Step is Simulate an unoccupied condition a. Lights controlled by occupancy sensors turn off within a maximum of 20 minutes from start of an unoccupied condition per Standard Section 110.9(b) b. The occupant sensor does not trigger a false 'on' from movement in an area adjacent to the controlled space or from HVAC operation. Step 2- Simulate an occupied condition a. Status indicator or annunciator operates correctly b. Lights controlled by occupancy sensors turn on immediately upon an occupied condition OR sensor indicates space is 'occupied' and lights may be turned on manually IN IN IN A 0 51 IM This is page 2 of 19 System returned to initial operating conditions Step I- Simulate an unoccupied condition a. Lights go to partial off state within a maximum of 20 minutes from start of an unoccupied condition per Standard Section 110.9(a) b. The occupant sensor does not trigger a false 'on` from movement: in all area adjacent to the controlledspace or from HVAC operation For library book stacks or warehouse aisle, activity beyond the stack or aisle shall not activate the lighting in the aisle or stack. c. In the partial off state, lighting shalt consume no more than 50% of installed lighting power, or; No more than 60% of installed lighting power for metal halide or high pressure sodium lighting in warehouses. No more than 60% of installed lighting power for corridors and stairwells in which the installed lighting'''power is 80"/6 or less of the value allowed under the Area Category Method. Light level may be used as a. proxy for lighting power when measurements are taken Step 2. Simulate an occupied condition FThe occupant sensing controls shall turn lights fully ON in each separately controlled areas, immediately upon'an occupied condition . partial On Occupancy Sensors Steil 1. -Simulate an occupied condition Verify partial on operation. a.. Immediately upon an occupied condition, the first stage activates between 50 to 70% of the lighting auto€natically. b. After the first stage occurs, manual switches allow an occupant to activate the alternate set of lights, activate 100°la of the lighting power, and manually deactivate all of the lights. Step 2. Simulate an unoccupied condition Fa�Both stages (automatic on and manual on) lights turn off within a maximum of 20 minutes fromr start of an unoccupied condition per Standard Section 110.9(a) b. The occupant sensor does not trigger- a false 'on` from movement in an area adjacent to the controlled space or from HVAC operation. 151 IN ra F - This is page 3 of 19 TE OF ACCEPTANCE Project Name: T-MobiLCupertmo Enforcemeut Agency: CITY OF CUPERTINO IlPermitNumber: B2017-0254 Project Address: 10815 N. Wolf Rd. Suite 103 City: Cupertino Zip Code: 950]4 S. Ad "tional test for Occupancy Sensors Serving Small Zones in Office Spaces Larger than 250 ft , to Qualify for a Power Adjustment Factor (PAF) Step 0. First, complete 'Functional Test 2 (above) for each controlled zone. Step 1. Verify area served and compare actual PAF with claimed PAF. Refer to Functional Test 2. a. Area served by controlled lighting ft2 b. Enter PAF corresponding to controlled area from line (a) alcove (<125 ft2 for PAF=0,4, 126-250 ft2 for PAF -0.3, 251-500 ft2 for PAF=0.2). c. Enter PAF claimed for occupant sensor control in this space frorn the Certificate of Compliance. d. The PAF corresponding to the controlled area (line b), is greater than or equal to the PAF claimed in the compliance documentation (line c).' e. Sensors shall not trigger in,, response to movement in adjacent walkways or workspaces f. All steps are conducted in Functional Test 2 'Occupancy Sensor (On off Cantrell)' and all answers are Yes. This is page 4 of 19 CERTIFICATE OF ACCEPTANCE LigbpngControl Project Names T -Mobil Cupertino Project Address: 10815 N. WOrfRd. Suite 103 C. Testing Results CITY OF B2017-0254 1. Automatic Time Switch Controls (ail answers must be Yes). 177 2. Occupancy Sensor (On Off Control) (all answers must be Yes). We 3. Partial Off Occupancy Sensor (all answers must be Yes). For warehouses, library book stacks, corridors, stairwells in nonresidential buildings must also be 11-4 accompanied by passing Test 1 or Test 2, 4. Partial On Occupant Sensor for PAF (all answers must be Yes). 5. Occupant Sensor serving small zones for PAF (all answers must be Yes), Also must pass Test 2. Representative Spaces Selected Tested space/room name: RR Space Type (office, corridor, etc) Restroom Untested areas/rooms Confirm compliance for all control system types (1-5) present in each space . Automatic Time Switch ontr ctee i- Cimiant¢ arcupied condition a, All lights can be turned on; and cuff by their respective area control switch b. Verify the switch only operates lighting in the ceiling -height partitioned area in which the switch is located. ce.. -j-,te LnoCcttniPd rnndi$ion a, All lighting, including emergency and egress fighting, turns off. Exempt lighting may remain an per Section I ().1(c)1 and I30.1(a)1. b. Manual override switch controls only the lights in the selected ceiling height partitioned space where the override switch is located and the lights remain on no longer than 2 hours (unless serving public areas and override switch is captive key type) a, Lights controlled by occupancy sensors turn off within a maximum of 20 minutes This is page 5 of 19 CERTIFICATE OF ACCEPTANCE Lighting Control Project Name: T -Mobil Cupertino Enforcement Agency: CITY OF CUF Project Address: 10815 N. Wolf Rd. Suite 103 City: Cupertino from start of an unoccupied condition per standard Section 110.9{b} b. The occupant sensor does not trigger a false 'on' from movement in an area adjacent to the controlled space or from HVAC operation. Step 2: Simulate an occupied condition a. Status indicator or annunciator operates correctly b. Lights controlled by occupancy sensors turn on immediately upon ail occupied condition OR sensor indicates space is 'occupied' and lights may be turned on manually System returned to initial operating conditions . Partial Off Occupancy Sensor Steps 9r Simulate an unoccupied condition Number: B2017-0254 a, Lights go to partial off state within a maximum of 20 minutes from start: of an unoccupied condition per Standard Section 110.9(x) %. b. The occupant sensor does not trigger a false 'on' from movernent in an area adjacent to the controlled space or from HVAC operation. For library book stacks or warehouse aisle, activity beyond the stack or aisle shall not activate the lighting in the aisle or stack. c. In the partial off state, lighting shall consume no more than 50% of installed lighting power, or: No more than 601°/b of installed lighting power for metal halide or high pressure sodium lighting in warehouses. No more than 60% of installed lighting power or corridors and stairwells in which the installed lighting power is 8£1% or less of the value allowed under the Area Category "Method. FT Light level may be used as a proxy for lighting power when measurements are taken tees 2 Simulate an occuDied condition The occupant sensing controls shalt turn lights fully ON in each separately controlled r areas, Immediately upon an occupied condition . Partial On Occupancy Sensors a. Immediately upon an occupied condition, the first stage activates between 50 to 7011,1c, of the lighting automatically. b. After the first stage occurs, manual switches allow an occupant to activate the alternate set of lights, activate 10011% of the lighting power, and manually deactivate all of the lights. Steps 2.. Simulate an, unoccupied condition This is page 6 of 19 OF ACCEPTANCE Name: T-Mobil.Cupertino Euforcemeut Agency: CITY OF CUPERTINO IlPetmitNutnber. B2017-0254 Address: 10815 N.WolfRd. Suite 103 City: Cupertino. - Zip Code: 95014 a. Both stages (automatic can and manual on) lights turn off Mthin a maximum of 20 minutes from start of an unoccupied condition per Standard Section 110.9(x) I ' i?. The occupant sensor does not trigger a false 'on' from movement in an area adjacent to the Controlled space or from HVAC operation. This is page 7 of 19 OF ACCEPTANCE Name: T -Mobil Cupertino IEnforcement Agency: CITY OF CUPERTINO address: 10315 N. Wolf Rd. Suite 103 llt,ny: wperuna _---- --- 5, Adtion l test for occupancy sensors Serving Small Zones in Office Spaces Larger than 250 ft , to Qualify for a Power Adjustment en Factor (PAF) Step O: First, complete Functional Test 2 (above) for each controlled zone. Step 1: Verify area served and compare actual PAF with claimed PAF. Refer to Functional Test 2, a. Area served by controlled lighting ft2 b. ;ranter PAF Corresponding to controlled area from line (a) above (<125 ft2 for PAF=0.4, 126-250 ft2 for PAF=0.3„ 251-500 ft2 for PAF=0.2). c. Enter PAF claimed for occupant sensor control in this space from the Certificate of Compliance, d. The PAF corresponding to the controlled area (line b), is greater than or equal to the PAF claimed in the compliance documentation (line c). e. Sensors shall not trigger in response to movement in adjacent walkways or workspaces f. All steps are conducted in Functional Test 2 'Occupancy Sensor (On off Cartrol)' and all answers are Yes. This is page 8 of 19 [CATE OF ACCEPTANCE nnol ne: T -Mobil Cupertino Iress: 10815 N. Wolf Rd. Suite 103 C. Testing Results CITY OF CUPERTINO " Code: 1. Automatic Time Switch Controls (all answers must be Yes).` 2. Occupancy Sensor (On Off ;Control) (all answers must be Yes). 3. Partial Off Occupancy Sensor (all answers must be Yes), For warehouses, library book stacks, corridors, stairwells in nonresidential buildings must also be accompanied by passing Test 1 or "rest 2, 4. Partial On Occupant Sensor for PAF (all answers must be Yes). 5. Occupant Sensor serving small zones for PAF (all answers must be Yes). Also must pass Test 2. Representative Spaces Selected Tested space; room name: Hall space Type (office, corridor, etc) Retail Untested areasjroonas Confirm compliance for all control system types (1-5) present in each space: 5 a. All lights can be turned on and off by their respective area control switch b. Verify the switch only operates lighting in the ceiling -height partitioned area in which the switch is located. Y iii^ :f3• �� "3 A '1! F-� a, All lighting, including emergency and egress lighting, turns off, Exempt lighting may remain on per Section 130.1(c)1 and 130.1(a)1. b, Manual override switch controls only the lights in the selected ceiling height partitioned space where the override switch is located and the lights remain on no longer than 2 hours (unless serving public areas and override switch is captive key type). System returned to initial operating conditions :Z. Occupancy Sensors Stela 1* simulate an unoccupied condition a. Lights controlled by occupancy sensors turn off within a maximum of 20 minutes I . 1 This is page 9 of 19 'MCATE OF ACCEPTANCE NBCA-I,TI-02-A Control Names T -Mobil Cupertino Enforcement Agency: CITY OF CUPERTINO PermitNumbec B2017-0254 Address: 10815 N. Wolf Rd. Suite 103 City: Cuperflno Zip Code: 95014 from start of an unoccupied, condition per Standard Section 110.9(b) b. The occupant sensor does not trigger a false 'on' from movement in an area adjacent to the controlled space or from HVAC operation. >tep 2.- Simulate ars occupied condition a. Status indicator or annunciator operates correctly r` b. Lights controlled by occupancy sensors turn on immediately upon an occupied condition OR sensor indicates space is 'occupied' and lights may be turned on FIT manually M System returned to initial operating conditions 3. Partial Off Occupancy Sensor a, Lights go to partial off state within a maximum of 20 minutes from start of an unoccupied condition per Standard Section 110.9(a) b. The occupant sensor does not trigger a false 'on' from movement in an area adjacent to the controlled space or from HVAC operation. For library book stacks or warehouse aisle, activity beyond the stack or aisle shall not activate the lighting in the aisle or stack. c. In the partial off state, lighting shall consume no more than 5011/9 of installed lighting power', or', No more than 60% of installed lighting power for metal halide or high pressure sodium lighting in warehouses. No more than 60% of installed lighting power for corridors and stairwells in which the installed lighting power is 80% or less of the value allowed under the Area Category Method. rl. Light level may be used as a proxy for lighting power when measurements are taken Ct— ^s> :.r.x®ia€s. nn rsrrrtnipff r`nnditlan FTheoccupant sensing controls shall turn lights fully ON in each separately controlled eas, Immediately upon an occupied condition 4. partial On Occupancy Sensors F7WOT,/a mediately upon an occupied condition, the first stage activates between 50 to of the lighting automatically. b. After the first stage occurs, manual switches allow an occupant to activate the alternate set of lights, activate 1.00% of the lighting power, and manually FETT deactivate all of the lights. Step 2. Simulate an unoccupied condition This is page 10 of 19 TE OF ACCEPTANCE Proiect Name: T -Mobil CupeRino Enforcement A,,,cT CITY O CCUPERTINO ��Pertnit Number: B2017-0254 ,s: 10815 N. Wolf Rd. Suite 103 lleiry: Lupemno a. Both stages (automatic on and manual on) lights turn off within a maximum of 20 minutes from start of an unoccupied condition per Standard Section 110.9(a) b. The occupant sensor does not trigger a false 'can` from movement in an area adjacent to the controlled space or from HVAC operation. This is page 11 of 19 OF Fnfnrcemmt Aeenev: CITY OF CUPERTINO PemitNumber: B2017-0254 address: 10815 N. W olf Rd. Suite 103 City: Cupertino JlZip Code: 95014 5. Ad 4tlonal test for Occupancy Sensors Serving Small Zones in Office Spaces Larger than 250 ftr-, to Qualify fora Power Adjustment Factor (IAAF) Step 0. First, complete Functional Test 2 (above) for each controlled zone. Step 1: Verify area served and comi pare actual PAF with claimed PAF. Refer to Functional Test 2, a, Area served by controlled lighting ft2 b. Enter PAF corresponding to;Icontrolled area from line (a) above (<125 ft2 for PAF=0.4, 126-250 ft2 for PAF=0.3, 251-500 ft2 far PAF=0.2). c. Enter PAF claimed for occupant sensor control in this space from the Certificate of Compliance. d. The PAF corresponding to the controlled area (line b), is greater than or equal to the PAF claimed in the compliance documentation (line c). e. Sensors shall not trigger in response to movernent in adjacent walkways or in workspaces f, All steps are conducted in Functional Test 2 'Occupancy Sensor (On Off Co€trol)' r and all answers are Yes, This is page 12 of 19 CERTIFICATE OF ACCEPTANCE Lighting Control Project Name: T -Mobil Cupertino Project Address: 10815 N. Wolf Rd. Suite 103 C. Testing Results 1. Automatic Time Switch Controls (all answers must be Yes). 2. Occupancy Sensor (inn Off Control) (all answers must be Yes). 171, 3. Partial Off occupancy Sensor (all answers roust be Yes). For warehouses, library, book stacks, corridors, stairwells in nonresidential buildings must also be FF accompanied by passing Test 1 or Test 2, 4. Partial on Occupant Sensor for PAF (all answers must be Yes). 5. Occupant Sensor serving small zones for PAF (all answers roust be Yes). Also must pass Test 2. El Representative Spaces Selected Tested space/room name: Sales Space Type (office, corridor, etc) Retail Untested areas/roams Confirm compliance for all control system types (1-5) present in each space: . Automatic Time Switch'Controls sten i- Aim€dateacctanied condition a, All lights can be turned on and off by their respective area control switch b. Verify the switch only operates lighting in the ceiling -height partitioned area in which the switch is located. e^a.... ^x:. c.�..e9�tr: ss rreenissri rran4lefirsra P7�rernain l lighting, including emergency and egress lighting, turns off. Exempt lighting mayI F7 J on per Section 130',1(c)i and 130.1(a)1. b. Manual override switch controls only the lights in the selected ceiling height partitioned space where the override switch is located and the lights remain on no longer than 2 hours (unless serving public areas and override switch is captive key 17, type). System returned to initial operating conditions . Occupancy sensors Step 1; Simulate an unoccupied condition a. Lights controlled by occupancy sensors turn off within a maximum of 20 minutes 1 r . This is page 13 of 19 Name: OF ACCEPTANCE CITY OF Number: )815 N. Wolf Rd. Suite 103 - IIcily: Cupertino Ih'p Uoue: yDU 4 from start of an unoccupied,' condition per Standard Section 110.9(b) b. The occupant sensor does not trigger a false 'on' from movement in an area adjacent to the controlled space or from HVAC operation. Y a. Status indicator or annunciator operates correctly b. Lights controlled by occupancy sensors turn on immediately upon an occupied condition OR sensor indicates space Is 'occupied' and lights may be turned on manually System returned to initial operating conditions 31. i, i Ir M, C+.- 9 • G.erexceimios .. scnnrragnipd rnnelifinn a, Lights go to partial off state within a maximum of 20 minutes from start of an unoccupied condition per Standard Section 110.9(x) b, The occupant sensor does not trigger a false 'on' from movement in an area adjacent to the controlled space or from HVAC operation. For library book stacks or warehouse aisle, activity beyond the stack or aisle shall not activate the lighting in the aisle or stack. c. In the partial off state, lighting shall consume no more than 50% of installed lighting power, or: No more than 60% of installed lighting power for metal halide or high pressure sodium lighting in warehouses. No more than 60% of installed lighting power for corridors and stairwells in which the installed lighting power is 80% or less of the value allowed under the Area Category Method. Light level may be used as a proxy for fighting power when measurements are taken Ccr... '29 Simulate an ecctinipd rn nelition r . -7-17 The occupant sensing controls shall turn lights fully ON in each separately controlled areas, 1.mr-mediately upon an occupied condition 4. Partial On Occupancy Sensors 4 _c. ...ei, A rnnriitinn, Vprifv nartial on oDeration. a. Immediately upon an occupied condition, the first stage activates between 50 to 709A. of the lighting autom aticallY. b. After the first stage occurs, manual switches allow an occupant to activate the alternate set of lights, activate 1.00% of the lighting power, and manually deactivate all of the lights.. Step 2. Simulate an unoccupied condition This is page 14 of 19 OF ACCEPTANCE Name: T CITY OF CUPERTMO ;s: 10815 N. Wolf Rd. Suite 103 IICity: Cupertino a. Both stages automatic on and manual on) lights turn off within a maximum of 20 minutes from start of an unoccupied condition per Standard Section 110.9(a) b. The occupant sensor does not trigger a false 'on' from movement in an area adjacent to the controlled space or from HVAC operation. IN This is page 15 of 19 OF ACCEPTANCE Project Name: T -Mobil Cupertino - �IEnforcement Agency: CITY OF CUPERTINO llremt¢ rvumoer. nzui i-uzo4 5. AdVional test for occupancy sensors Serving Small Zones in Office Spaces Larger than 250 ft , to Qualify for a Power Adjustment Factor (PAF) Step o: First, complete Functional Test 2 (above) for each controlled zone. Step 1. Verify area served and compare actual PAF with claimed PAF. Refer to Functional Test 2, a. Area served by controlledlighting ft2 b. Enter PAF corresponding to controlled area from line (a) above (<125 ft2 for PAF=0.4, 126-250 ft2 for PAF=0.3, 251-500 ft2 for PAF=0,2), c. Enter PAF claimed for occupant sensor control in this space from the Certificate of Compliance, d. The PAF corresponding to the controlled area (line b), is greater than or equal to IMP the PAF claimed in the compliance documentation (line c), e, Sensors shall not trigger in response to movement in adjacent walkways or workspaces f, All steps are conducted in Functional Test 2 `Occupancy Sensor (On off Control)' and all answers are Yes. This is page 16 of 19 [CATE OF ACCEPTANCE. ntrol ic: T -Mobil Cupertino Enforcement Agency: CITY OF CUPERTINO tress: 10815 N. Wolf Rd. Suite 103 City: Cupertino C. Testing t. s lts 1. Automatic Time Switch Controls (ail answers must be Yes). 1 ��' I 2. Occupancy Sensor (On Off Control) (all answers must be Yes). 3. Partial Off Occupancy Sensor (all answers must be Yes). For warehouses, library book stacks, corridors, stairwells in nonresidential buildings must also be accompaniers by passing Test 1 or Test 2. 4. Partial Can Occupant Sensor for PAF (all answers Must be Yes). S. Occupant Sensor serving small zones for PAF (all answers must be Yes). Also must pass Test 2. D. Evaluation ; F. PASS: All applicable Construction Inspection responses are complete and all applicable Equipment Testing Requirements responses are positive. This is page 17 of 19 TE OF ACCEPTANCE Ellie: T -Mobil Cupertino IlEnforcement Agency: CITY OF CUPERTINO ldress: 10815 N. Wolf Rd. Suite 103 City: Cupert no DOCUMENTATION AUTHOR'S DECLARATION STATEMENT I . -Y fy t3 t tars Certificate of A ceptan e d rcur 3 ntatsor. i 3 c :rate and cc-. p.r.te. rlocum_ntatio:r Author Tom Blanchard. Company Name _,St :€tie 24'1'es€:r3g Nanrne _ Address : City 2146 ill Berkeley >t, Orange Zip Code 8286.5 'hone CEA/Al" Certification AuOlor Signature Identificatioh (if TC-AS1425y al hlicablei ._ Date of Signature: 07•/18/2131." TI -02-A FIELD TECHNICIAN'S B )ECLA TION STATEMENT I certify the following undo€' perialty of perjury, under the. €avis of the State of California: 2 inf o rma inn orovWed or. this Certificate of iccep e :s true arid correct. am the person who Performed .,ae acceptance verification reported on :tris Certificate of acceptance it el f recbnr San). 3. 9 he construction or installation identified on :tri:, Ceriir Cate of Acceptance complies „illi the applicabie accetitance requ€rernents indicated in the pians and specifications approved by trie enforcement agency, and conforms to the applicablo acceptance requirements and procedures specified in Reference iJonresid a lii Appendix NA7 4, i have r_o ifi med that the ertifi '2 (s) of Installation for the Construction or *;nstailati n identified on this Certificate of Acceptance has been competed and signed by the responsible ouildertamstai[er and 1,as beer) posted or made available with the building peiini (5) issued fol ;he burid.ng. Field'fechnieian Name Company Name Torn Gianch�ard 1st Title 24 Testing ,Address: City 2546 Ni, Berkeley St, Grange Zit. Code? 1714,334-3383 92865 A— Certification Position wAth Company Identification TC -A614250 Tltie Owner t %cid Technician Signature Date of Signature: 07/18/2017 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the `nilowIng order penalty of ocrJury, under the law's of the State of tat. orola: 2. I am tine Field Technician, or the F'Md Technician is acting err n:y beiaai€.as my employee or my agent and I have reviewed tie information provided on this Certtt tr at of r.ccaptance 2. _ ani c.,,,e under Division 3 of she Business and. Pro'essioras Coda rn the applicab e lassificat or to accept respcns b' ity forthe system design, con:st u t:or: or insta aban of features, marr=.riais, components, or inanrrtactured devices for the srope of o k irentled oil .-his Cer,if tate of Acceptance and attest to the declar,,tzolts it t. s statement responsible a rcpt me person), he information p. ovided on this Certificate of Acceptance substantiates that the construction or it stailatCon identified oil this Certificate of ar eptance complies ,with the acceptance requirements indicated in the plans and specifications app;ovect by the enforcement agency, arid conforms to the applicable accept - e requirerrrenes amid procedures specified in Reference Nonresidential Appendix NAT 4. 1 have. confirmed that the Certificate. of Installation for the construc€Cor. or installation :dentfieri lir this i erti:`iCatP. of ACcapta lire has beenomp[etad and ES pasted cr :mare availablei:h the building perE:3it(s) .55(1 ed farthe building. 5. I will ensure that a completed, signer! copy of th's Certificate of Acceptance shall be posted, lir made av'ailab`o tiit.3 the b�.ilding perm;t(s) issued for the buiio rig, and rnade atiail ble to the rfpreem_nt agency for air applicab e inspections. I understand t rat u signed copy of this Certificate of Acceptance is required to be. Enc€uded with the docurnentatlon the builder provides to the building o;aner at occupancy. FCesponsibl=.. AcceptanceCompany Name Torn Blanchard '_st Title 24 Testing Person Nance. Address, City Orange 2546N, Berkeley St. Glp Code phone (714)334^3383 J2g6s C5L6 License Position with Company Owner822911 ("Nde) Responslb e. Ar_" =.°anc'e Person Sigria.ture Oa. of :'signature' 1;7,'SS?2f1S, This is page 18 of 19 ACCEPT Name: T -Mobil Cupertino IlEnforcement Agency: CITY OF CUPERTWO j1permit Nu Address: 10815 N. Wolf Rd. Suite 103 ICitT Cupertino Zip Code: This is page 19 of 19 --------- ]INRCA-LTI-03-A CERTIFICATE OF ACCEPTANCE CITY OF P nicer Iress: 10815 N. Wolf Rd. Suite 103 JFC-jty. CupertinoIZip Code; 95014 ...................... i 'ING CONTROL ACCEPTANCE DOCUMENT AUTOMATIC DAYLIGHT Agency Use: Checked by/Date Check boxes for all pages of this; NRCA-LTt-03-A completed and it in this su.bmittat 13 NRCA-LTI-03-A Page Constructionfrispection, This page required for all submittals. 1 &2 NRCA-LTi-03-A Page Continuous dimmingcontrol functional performance test—watt-meter or amp -meter measurement 3&4 ❑ NRCA-LTi-03-A Page reent Stepped switching/ Stepped Dimmingfunctional performance test —watt -meter Or amp -meter measum 5 &.6 NRCA-LTi-03-A Page Continuous dimming control functional performance test—light meter power measurement, and default look -up 7&9 table of fraction of rated power versus fraction; of rated light output. NRCA-LTI-03-A Page al perforance test —based on light output Stepped Switchng/ iStepped Dimming functionm 9&10 1. NA7.6.1.1 Construction Inspection: 1. Drawing of Daylit Zone(s) must be shown on plans or attached to this compliance document. By checking this box, technician certifies that plans have been attached to this webform V Document Name Find- Page P's Lightmg Plan E1.1 Add Control Systems below if sampling method is used it, accordance with NAT -6.1.2. Iff addalig, attach a page with names of other controls in sarnPle (OnlY for buildings ;gin th > 5 daylight control systems, sample group glazing same Orientation) Sales Sales l,,13ns Page Number Ire Check if Tested Control is Representative of Sample. 2. System Information PS Zone Type: r r Sid li (SS "; y�jt (Svv'�, Primary Sidelit (PS), or Secondary -elit C, s (C), Stepper.] Dirlin-ing (SM, Switching (SVII) C Control Type� Continuous Dirnming with more than 10 light level Design Footcandzes: (Enter footcandle "A) Value Or "U" if unknown): 3. Sensors and Controls Closed _oop (CQ CL. Sensor Location: outside (01, Ins'wde Skylight (IS), Near Windows facing out INW), In ContrGlleO Zone (CZ) C Yes I loop type is Open Loop (0Q: Enter yes (Y) ;f location Sensor Location is Appropriate to Control Loop T; ype: (Yes/No) 7 f Outside (0), Inside Skyltght .IS),:or Near Windows facing out ;'NW); Otherwise, enter no fN), If Control loop type is Closed Loop (CL): Elite..-' yes "! if locat:On ---- Ih Controiled Zone "CZ); othenwise, enter no (N). I 'ClUal Control AdjuStnneotS are in Appropriate Location (Yes./NO): Yes, if Readily Accessible or Yes if in Ceiling less than or equal to 11 ft, IYes This is page 1 of 5 OF ACCEPT Project Na nc: T -Mobil Cupertino _ IlEnforcement Agency: CITY OF CUPERTINO I�re[murvumuer. nw+a- +ddress: 10815 N. wort lerl. suue IW - INo for all other. iia Has ocumentation Been Provided by the Installer: -� Installation Manuals and Ca fibra ion Instructions Provided to Building Owner (Yes./No) Yeas Loca.: oa of Light Sensor an Plans: (Yes; Ne) Yes Location of Light Senor or: Plans: (:Page [Number) E.t.t.... �. S. Separate Controls of Luminaires s in Dayllt ones. ,ore lurmnaires controlled by autorr.ati=_ daylighting controlsonly in daylit zones: (Yes/No) Yes Separately circuited for daylit zones: by windows and daylit zones under skylights; (Yes/No) Yeas - 6. Daylrc hting Control Device Certification D yl ghting control has been certified is accordance with §110.3: (Yes/No) Yes -� {_ons: ru.::rton Inspection PASS/FAIL: If an responses on Construction Inspection pages I & 2 are complete arid .all yes/No questions Pass shave. a Yes response. the tests PASS'S; If any responses on tis page are incomplete OR there. are any No respo'1aes,. the tests FAIL PASSIFAIL Evaluation (check orae) PASS: If all responses on Construction ction Insoecdon pages. .t & 2 are cwnp[ete and. all Yes/Ne questions have a Yes (Y', response, the tests PASS ... ` FAIL: Any applicable Construction. Inspection responses are incomplete 0,2 there is cne or more negative (N - no) responses in any applicable Functional Performance -est€ng Re.gui-ements section. System+ does not pass and is NOT eligible. for Certificate of Occupancy according to Section 10- 103(a)3B. Fix problems) and retest until the systems, passes a:° portion., of his test before retesting and resubmitting iNRCA-0I-03 -A with PASSED test to the enforcement agency, D,e cruse below the failure mode and corrcadve action needed. This is page 2 of 5 OF CITY OF CUPERTINO Proicct Address; 10815 N. Wolf Rd. Suite 103 _ City: Cupertino IZip Code: 95014 t 2. NA7.6.1.2.1 Functional Performance Testing - Continuous Dimming Systems: Power estimation using light meter measurement Complete all tests on page 7 & 8 (No Daylight Test. Full€ Daylight Test, and Partial Daylight'fest) and fiii out Pass; Failsect=or. on Page S. Sales Step i Identity KeTerenCe LOCZ1110n ,lo atlr r€ v neve :n3ttitttum dayligLt 'llurninance is measired it) zone served by the contro'led lighting,) - f. Method used: Illuminance or Distance? (I or D) override daylight control system and drive electric lights to highest light level for the following* • y. Highest light level fc ... enter €-7easured controlled thecitis lighting footcandles (fc) 6G =�:] h. Indicate whether this is Full Output (FO), or Task Tuned (Lumen Maintenance) (TT) FO Step No Daylight Test controls enabled & daylight less than 1 fc at reference location F od Used; Night time manual.. meas_rement ;Night;, Night Time llur:3 nance logging (Log;, Cover Fenestration (CF),Cover Night Loop photosensor (COLP) j. Reference ce Illurninance. (foetcanfes). as measured at Reference Location fsee Step 1). Enter footcandles 66 k. Enter Y if either of the follovling statements are true: If line h = FO; [Reference Illuminance {line DI 'I [Full Output fc { it:e g)� > fes %f%n? or [Reference Illuminance (line )I. r [deslan footcandles (line d j > f30 o? (Yes./No) Step : Full Daylight Test conducted when daylight > 150% of reference illuminance (lige I. Daylight illuminance llfight level with electric lighting turned off) measured at Reference Location (fc) 93 in. Daylight iliunirnance (Ime I) greater that Ref tcn' Yes ceu€n:jd—� Fill out lines p through t only if electric lighting] is turned down or off. n. Total (daylight + e:ectr c light) iht rninanre n easured at the Reference [ovation (fr.). 103 o. Electric lighting illuminance at the Reference Location (fc) [(ilne n) - time p.. E€ec`.ric :fighting illuminance ti ne o) divided. by Highest light Level fc (line g). Enter S.s.1515i:i15i.515 .52 q. DirTmed lurnanaite fraction of rates! poorer. Attach manufar_turer's cut -sheet or' use default graph of rated power to light output. 30 —1 Label applicable control system on, cut -sheet or graph. Enter fraction of rated power in 4;0. r. System Power Reduction = [1 - line pj 5. Is System Power Reduction (line ) > 65e,i, when =fine °r _ FO,. or > 56%when i€rye h ...I..i (Yes/NO). t. Witt uncontro'Hed lights also on, no lamps dimmed outside of day it 'Zone by control (Yes/No). Lt. Dimmed :amps have stable o atput, no perceptible flicker (Yes/No), Yes Yes Yes This is page 3 of 5 a. Control Loop 'type: Open Loop or Closed Loop? (O or C) C b. Indicate if Mandatory control M (required for skyltt zone or primary side:€t zone win installed general lighting power > 120 W); fF for Control Credit - CC; or Voluntary. not forcredit -V (hl, CC_', 4') c. If automatic daylighting. controls are mandatory, are all general Iirhting ; nronaires in daylit zones cor:troll'ed by automatic Yes - daylight controls? (Yes,•'No) d. General lighting design footcar°dles. (Ener footcandle (FC) value, ur "U" if 4nknowr-0 e, power :.st t:aat_iert mettrgv. (see line q) Default ratio of power to light (Dfc), .cut -sheet ratio of power to light (CSic) If CSFc ._ Dfc attach cut -sheet. Enter Dfc or C:Sfc Step i Identity KeTerenCe LOCZ1110n ,lo atlr r€ v neve :n3ttitttum dayligLt 'llurninance is measired it) zone served by the contro'led lighting,) - f. Method used: Illuminance or Distance? (I or D) override daylight control system and drive electric lights to highest light level for the following* • y. Highest light level fc ... enter €-7easured controlled thecitis lighting footcandles (fc) 6G =�:] h. Indicate whether this is Full Output (FO), or Task Tuned (Lumen Maintenance) (TT) FO Step No Daylight Test controls enabled & daylight less than 1 fc at reference location F od Used; Night time manual.. meas_rement ;Night;, Night Time llur:3 nance logging (Log;, Cover Fenestration (CF),Cover Night Loop photosensor (COLP) j. Reference ce Illurninance. (foetcanfes). as measured at Reference Location fsee Step 1). Enter footcandles 66 k. Enter Y if either of the follovling statements are true: If line h = FO; [Reference Illuminance {line DI 'I [Full Output fc { it:e g)� > fes %f%n? or [Reference Illuminance (line )I. r [deslan footcandles (line d j > f30 o? (Yes./No) Step : Full Daylight Test conducted when daylight > 150% of reference illuminance (lige I. Daylight illuminance llfight level with electric lighting turned off) measured at Reference Location (fc) 93 in. Daylight iliunirnance (Ime I) greater that Ref tcn' Yes ceu€n:jd—� Fill out lines p through t only if electric lighting] is turned down or off. n. Total (daylight + e:ectr c light) iht rninanre n easured at the Reference [ovation (fr.). 103 o. Electric lighting illuminance at the Reference Location (fc) [(ilne n) - time p.. E€ec`.ric :fighting illuminance ti ne o) divided. by Highest light Level fc (line g). Enter S.s.1515i:i15i.515 .52 q. DirTmed lurnanaite fraction of rates! poorer. Attach manufar_turer's cut -sheet or' use default graph of rated power to light output. 30 —1 Label applicable control system on, cut -sheet or graph. Enter fraction of rated power in 4;0. r. System Power Reduction = [1 - line pj 5. Is System Power Reduction (line ) > 65e,i, when =fine °r _ FO,. or > 56%when i€rye h ...I..i (Yes/NO). t. Witt uncontro'Hed lights also on, no lamps dimmed outside of day it 'Zone by control (Yes/No). Lt. Dimmed :amps have stable o atput, no perceptible flicker (Yes/No), Yes Yes Yes This is page 3 of 5 'IFICATE OF ACCEPTANCE NBCA -I TI -o3 -a Ric Daylighting Control Name: T -Mobil CupertinoEnforcement Agency: CITY OF CUPERTINO Zip Code: 95014 Number: B2017-0254 Address: 10815 N, Wolf Rd. Suite 103 City: Cupertino Zip Co v. Daylight Dimming plus OFF Controls PAF Y'es This portion of tate full daylight testi so Hes to lighting systems that are claiming a PAF for daylight dlni: irsa plus OFF controls. This portion of the full daylight test shall be conducted instead of stens I. that u.) Does the s'y'stem automatically turn'OFF the lulima res urhen full daylight is ava lable?'Yes/No) — _ -x- .-__._. —_rte ---A ®a,.,K--..a...gH-9® 4, rMo/ and OR01 of fiinp il_ ,v. Daylight measured.una?t.m7ce (light level githout electric light) measureat Reference Location f, -'c). 41 —� x. Daylight i lu€ninance divided by the Reference Illuminance = (:€r e w it dine j). Enter %. 62.12 .2Y2.121212 25 y. Is Ratio of Daylight illufn:nance to Ref. ill It, mina rice (line x) between 60% and 95"Y'? (Yes/No). Yes Z, Total (Gayhynt 1' elf''::'1C I yt, iil��u niEnance measured at the Reference Location (fc). '� 7 _ aa. Total illuminance divided by the R erence Illuminance = (line z )t tine j); Ener f;,,, 11f,.66 66666666 5e bb. is. i otal ::luminance divided by the Reference wflurninance (lane aa) between 10,01% and 15Mb? (Yes/No). yes - PASS FAIL Evaluation (check one). ` PASS;. A:€ applicable Construction. Inspection responses are complete and a.1 appli:able. Functional Performance Testing Recu'.rements responses are } positive (Y - yes) 4 PAIL: An applicabl_. Construction Inspection responses are incomplete OR there. one. or more negative (N - no) responses in ally applicable Functional Performance esting Requirements section. System does not pass and is NOT eligible for Certificate of Occupancy according to Section 1a- 1.03(a)3E. Fix problem`s) and rete:,( until the system(s) passes a portions of this test before retesting and resuon iltting NRCA-LTI:-iia-A with PASSED tes to the enforcement agency. Describe below the fi lure triode and corrective action: needed. This is page 4 of 5 (CERTIFICATE OF ACCEPTANCE lAutQinatic Dayl'ghting Control Project Name: T -Mobil Cupertino - Enforcement Agency: CITY OF CUPERT NO PertnitNumber: B2017-0254 Project Address: 10815 N. Wolf Rd. Suite 103 - City: Cupertino Zip Code: 95014 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT f r. ,£ y *.. tl . rtl Iia[ n A ceptanr co u 1 t;tl.a: s :.rn;rate. ;nr, complete.. to im ;1r-1 ?.,.erJ.a.d 3i'3.'tzhe 2b '&sfihQr city 2S15 N. P.eri<eiey St, C):zr.:je Zip C>s to ph .nr: C'EAIAP Cr.:tiflczhor. Ir.;r.;re firaticn f AuEnor Slq.atore ryri!icab1s) FIELD TECHNICIAN'S DECLARATION STATEMENT . certify Cite {'i'le6t^iinG ilndcl— (:Soni tf of Perpry, und'iir .t e !]ns o` tl`.e :.to Cf-.1tfll-nia" 1 he info—au- P - 9-'i ar t C r fl ate of cpt- f_ is t,,il and c rrcc .t a, z? --s- who i r _d (e act tame v f c3t'lf er It c all this Ce ' ra of A= ceptar re fFlewd < : he .dn. .:riloi ; 1 f da,la.ion IAeI t. lyd or ti 1.. t.. rt t. r. A.. ejltan• „ f I`ipli:_5 )'iti' the appli-bl t... _ arf-. ' .q.l-rP . s :Crated t 1= p:ans and sFec:i stir app�cvaFj ,^,'r '!tie r-. nforrr ne st at,,—ye an7 rrnforms to the n I ahie a,;mptanlne req.ireriientsnod r cce+e—.., spef<r 1 inp f r 1 . lJnn id-itf I o r ci. NA-;, 3.Lve c.,r ftm. Fat t.l. _ rt! at •sl t In:: �i �t or .o. the cir ,trod ,n =.r .r;ta.la- • +.drlla_6 or t.ls Co1 tifl Fe cf Aac�ptancc na+, -co rmpicted and si ned b} Ihn, e;poo,b bui.Y'err?nstailer and h.?v aeerl (_�'i' r tad =va=fa5 r t nF u iJ ry o''rn t( :issued for tate SJ.id.f:y. fi lrl Tc.. r.)..:,ar. .Jar7t. C.nlpary N., -tam B.an=ta 7�: 7s. TRIe `F _est:rg AddreSS ,.:ty 254 ( N. Be,kcley St.. Orange 'x,P Code 923G phone. (714)334 3333 ATT C ert.iica{tit?r: Faenitficat rn pusitian 1YiL i Corn,^.:5n'Y i = i:s;; ReEd ': echr:lriz z€ ssmllza . :zEi 70t: RESPONSIBLE PERSON'S DECLARATION STATEMENT i tl<z fci-r nda t nEivc Pe a lain r..a i.e f i n F rhe r �c f_+a an Y t hPi ? n' .^n;t r e f ti a. rt zno i t an r s : ') rf. 'nation 1-ri.vlded ^ El t t r• I tare of Acrel �t•,rce. cede, G n 3 f F Bs_c` s- and f.o ssl n' roc n tile appl atl, fa r o c.l t 'Ft p h in, th 4s rr d s c _ r t a fen c I s:alfat:or of `-W,ss,—torwais prrphn ns, or r arui 'cru cd d .. _c or tic 'oo % a. � t f -d c F t}, s t_ t : _I - of eo a .c:. a d a: to t s d to t,l o 1 stat r - l fsPu s,t C a ePta i - vc sir). 'Ytte Y Tilt n�tltlCi J - 1 ,r Ui: tt tl 3 t h..Lcf.1;�t1� t taY3 I i.l_..F.0 C''.n ac IJ n-3'stall f IJ` I t J ti crit iC t '1 A cl oncs C I p h the a_�eptince r- Irf:Y:tei f 1 ca•cd 111 the I -A :n., elft sf --! tC ? 1t3- di 'tn )-.I`ar:t atjerlcy, 3:lj T't t'1 'iphC:bi: aC It f EI"gill '.f`"P t: 3d Pi _dJY I(:.i.l dt F. '.t` EI•CYYe' nY'<I ::'iji?ndlk :ii' -4 : hr...•..,-f.-lor hat ih is=r. ..ate•>, o llst7aa;ion rot .he r..n.,t ,,,: Ic i •. installation. .atmf r f rr' tl I [..rt1 f. • te. .,f r•.:rr ,.al c>. hae h ear mr ,,Ee ed and is t.estec or Hied= = a Iz e ✓with tF= 6uild:rg Pern: tf�; cd far th,,bur' 1g. S �I v.',I 'r:�r r .tat a run:Gl=_ted _r: _d ce y of :h > ie:tlficc:e of fia epta I sn !i E F s C n made available av:th th F_ tlufiJ ry pc miti STAT E OF CALIFORNIA RUMOR LIGHTING CEC-HRCI-LTI-09-E (ReviSed 1211b) - "- NRGI LTI 01-E CERTIFICATE OF INSTALLATION PERMIT NUMBER: Indoor Lighting Page I of 2 Pr�jecF ldame: - T-Mob€le 39SD Enforcement Agency: Cupertino Permit Number. B2017-4254 Project Address: 10815 Wolfe RLI city Cupertino z;p code: 95414 GENERAL INFORMATION s [SATE OF BUILDING PERMIT: 6/9/17 PERMIT NUMBER: B2017-4254 BUILCJiNts TYPE:❑ Nonresidential [� High -Elise Residential (common area) (_] HoteljMotel {Common Area} PHASE OF CONSTRUCTION: i ❑ New Construction [] Add'stlon ❑ Alteratian =E] onditioned SCOPE OF RESPONSIBILITY _ Enter the date of approval by enforcement agency of the Certificate of Compliance that provides the Applicable Sheets or Pages, Tables, Schedules, etc. specifications for the energy efficiency measures for the scope of responsibility for this Installation Date: Certificate. In the table below identify all! applicable construction documents that specify the requirements for the scope of responsibility ;reported by this Installation Certificate (continued). Document Title or Description Applicable Sheets or Pages, Tables, Schedules, etc. Date Approved by Enforcement Agency Douglas Lite Pak Installation. and Operations Manua{ -Y Sensor Switch CMR -ADC Sensor Installation and Operations Manual Approved Plans E-1 thru E-7 6 9-17 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance 2415 STATE OF CALIFORNIA INDOOR LIGHTING CEG-NRCi-LTI-o1-E (Revised 12115) CALIFCsRiUW ENERGY COMMISSION IM CERTIFICATE Of INSTALLATION RCI-LTI-01-E Indoor Lighting Page 2 of 2 Project Name: T,Mobile 39SC1 En£nrcemerti figs rerv: Cupertino €>ermEt Num6ec B2017-0254 PrmectAddress: 10815 Wolfe Rd " Cupertino rpCade: 95014 ....... __ _ _....._....._ DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1, i certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Names Russ Finnegan Documentation Author Signature; Documentation Author Company Name: Premier Contracting Group, Inc Date signed: 7/18/17 Address: 27758 Santa Margarita Pkwy, #336 CEA certification identification ltfappticab3el: City/State/zip:Mission Viejo, CA 92691 Phone: 949-305-0900 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the lavas of the State of California: 1.. The information provided on this Certificate of Installation is true and correct. 2. l am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction, or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Installation and attest to the declarations in this statement (responsible builder/installer), otherwise I am an authorized representative of the responsible builder/installer. 3. The constructed or installed features, materials, components or manufactured devices (the installation) Identified on this Certificate of installation conforms to all applicable codes and regulations, and the installation conforms to the requirements given an the plans and specifications approved by the enforcement agency. i 4. I reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the specific requirements for the scope of construction or installation identified on this Certificate of Installation, and I have ensured that the requirements that apply to the construction or installation have been met. 5. 1 will ensure that a completed signed copy of this Certificate of Installation shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable Inspections_ I understand that a completed signed copy of this Certificate of Installation is required to be included with the documentation, the build provides to the building owner at occupancy. Responsible Builder/Installer Mame: Russ Finnegan Responsible Builder/installer Signature; , Position with Company (Title): Pres`tnt Company Name: (installing Subcontractor or General Contractor or Builder/owner) premier Contracting Group, Inc _._. _.._ Addrass'27758 Santa Margarita' Pkwy, #336 CSL8 License* 837472 .... _._......... .. City/state/Zip: Mission Viejo, CA 92691 e ( �s sigated= Phon949 305 29411 € 718/17