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STATE OF CALIFORNIA STATE OF CALIFORNIA Domestic Water Heating System Domestic Water Heating System NRCC-PLB-E CALIFORNIA ENERGY COMMISSION NRCC-PLB-E CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-PLB-E CERTIFICATE OF COMPLIANCE NRCC-PLB-E Project Name: Crumbl Cookies-Interior Tenant Improvement Report Page: (Page 5 of 6) This document is used to demonstrate compliance for nonresidential occupancies with requirements in 110.1 110.3 120.3 and 140.5 and with requirements in 141.0 for Project Address: 864 W.Benjamin Holt Drive Date Prepared: 5/29/2021 additions and alterations,for domestic water heating scopes using the prescriptive path.For high-rise residential and hotel/motel occupancies compliance is demonstrated with requirements in 110.1 110.3 120.3 150.0 and§150.1(c)8,and with requirements 150.2 for additions. Project Name: Crumb)Cookies-Interior Tenant Improvement Report Page: (Page 1 of 6) I.DECLARATION OF REQUIRED CERTIFICATES OF INSTALLATION Project Address: 864 W.Benjamin Holt Drive Date Prepared: 5/29/2021 Selections have been made based on information provided in this document.If any selection have been changed by permit applicant an explanation should be included in Table E. Additional Remarks. These documents must be provided to the building inspector during construction and can be found online at A.GENERAL INFORMATION https://www.energy.ca.gov/title24/2019standards/2019_compliance_documents/Nonresidential Documents/NRCl/ 01 Project Location(city) Stockton 02 Climate Zone 12 Field Inspector Yes No Form/Title Pass Fail 03 loccupancy Types Within Project(select all that apply): • 0 NRCI-PLB-01-E-Must be submitted for all buildings ❑ ❑ 0 Nonresidential ❑ High-Rise Residential ❑ Hotel/Motel 0 NRCI-PLB-02-E-Must be submitted for high-rise residential and hotel/motel central hot water distribution systems to be El ElEl State Building El Healthcare Facility El Other(Write In) recognized for compliance. B.PROJECT SCOPE tJ NRCI-PLB-03-E-Must be submitted for high-rise residential and hotel/motel single dwelling unit hot water distribution systems to ❑ ❑ be recognized for compliance. This table includes domestic water heating systems that are within the scope of the permit application and are demonstrating compliance using the prescriptive paths outlined in 140.5 §150.1(c)8,and§141.0(a) or§141.0(b)2N for additions or alterations.Solar water heating systems are documented on the NRCC-SRA compliance document.Combined hydronic water J.DECLARATION OF REQUIRED CERTIFICATES OF ACCEPTANCE heating systems are documented on the NRCC-MCH compliance document. 01 02 03 There are no Certificates of Acceptance applicable to service water heating requirements. My project consists of(check all that apply): System Type 1,2 System Components K. DECLARATION OF REQUIRED CERTIFICATES OF VERIFICATION ® New system(DHW system being installed for the first time in newly Individual System(serving nonresidential spaces) ® Equipment ® Distribution ® Controls Selections have been made based on information provided in this document.If any selection have been changed by permit applicant an explanation should be included in Table E. constructed building) Additional Remarks. These documents must be completed by a HERS Rater and provided to the building inspector during construction. The final documents must be created by a HERS ElSystem Alteration(equipment,distribution or controls) El Equipment El Distribution El Controls Providers registry,but drafts can be found online at https://www.energy.ca.gov/title24/2019standards/2019 compliance_documents/Nonresidential Documents/NRCl/ 'FOOTNOTES:Point of use water heaters,or other non-central systems used to serve nonresidential spaces,are considered individual systems. Yes No Form/Title Field Inspector z Dwelling units refers to hotel/motel guest rooms and units in a high-rise residential occupancy. Pass Fail 0 • NRCV-PLB-21-H High-rise Residential Central Hot Water Distribution HERS Verification ❑ ❑ 0 0 NRCV-PLB-22-H High-rise Residential Individual Dwelling Unit Hot Water Distribution HERS Verification ❑ ❑ Registration Number: Registration Date/Time: Registration Provider:Energysoft Registration Number: Registration Date/Time: Registration Provider:Energysoft CA Building Energy Efficiency Standards-2019 Nonresidential Compliance Report Version:2019.1.003 Report Generated:2021-05-29 13:04:22 CA Building Energy Efficiency Standards-2019 Nonresidential Compliance Report Version:2019.1.003 Report Generated:2021-05-29 13:04:22 Schema Version:rev 20190401 Schema Version:rev 20190401 STATE OF CALIFORNIA STATE OF CALIFORNIA Domestic Water Heating System Domestic Water Heating System NRCC-PLB-E CALIFORNIA ENERGY COMMISSION NRCC-PLB-E CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-PLB-E CERTIFICATE OF COMPLIANCE NRCC-PLB-E Project Name: Crumbl Cookies-Interior Tenant ImprovementReport Page: (Page 6 of 6) Project Name: Crumbl Cookies-Interior Tenant Improvement Report Page: (Page 2 of 6) Project Address: 864 W.Benjamin Holt Drive Date Prepared: 5/29/2021 Project Address: 864 W.Benjamin Holt Drive Date Prepared: 5/29/2021 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT C.COMPLIANCE RESULTS certify that this Certificate of Compliance documentation is accurate and complete. con Table C will indicate if the project data input into the compliance document is compliant with water heating requirements.If this table says"DOES NOT COMPLY"or"COMPLIES with v Documentation Author Name: Documentation Author Signature: Exceptional Conditions"refer to Table D.or the table indicated as not compliant for guidance. Theodore Brandvold 01 02 03 04 O Company: Signature Date: Domestic Hot Water Equipment Distribution Systems Controls Commercial Architecture,Inc. 2021-05-29 Compliance Results Table F Table G Table H Address: CEA/HERS Certification Identification(if applicable): 616 14th Street C-25449 Yes Yes Yes COMPLIES City/State/Zip: Phone: Modesto CA 95350 209-571-8158 D.EXCEPTIONAL CONDITIONS In RESPONSIBLE PERSON'S DECLARATION STATEMENT iThis table is auto filled with uneditable comments because of selections made or data entered in tables throughout the form. 1 I certify the following under penalty of perjury,under the laws of the State of California: 1. The information provided on this Certificate of Compliance is true and correct. E.ADDITIONAL REMARKS - 2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance(responsible designer) 3. The energy features and performance specifications,materials,components,and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the requirements This table is includes remarks made by the permit applicant to the Authority Having Jurisdiction. n of Title 24,Part 1 and Part 6 of the California Code of Regulations. 4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents,worksheets,calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. S 5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permit(s)issued for the b e available to the enf t agency for all applicable inspections.I understand that a completed signed copy of this Certificate of Compliance is required to be included with the documentation th builder provides to the building ow r at occ cy. Responsible Designer Name: Responsible Designer Signature: Theodore Brandvold Company: Date Signed: Commercial Architecture,Inc. 2021-05-29 Address: License: T 616 14th Street C 25449 N City/State/Zip: Phone: Modesto CA 95354 209-571-8158 T M D Z Registration Number: Registration Date/Time: Registration Provider:Energysoft Registration Number: Registration Date/Time: Registration Provider:Energysoft CA Building Energy Efficiency Standards-2019 Nonresidential Compliance Report Version:2019.1.003 Report Generated:2021-05-29 13:04:22 CA Building Energy Efficiency Standards-2019 Nonresidential Compliance Report Version:2019.1.003 Report Generated:2021-05-29 13:04:22 Schema Version:rev 20190401 Schema Version:rev 20190401 - STATE OF CALIFORNIA Domestic Water Heating System r NRCC-PLB-E CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-PLB-E 1-1 Project Name: Crumbl Cookies-Interior Tenant Improvement Report Page: (Page 3 of 6) Project Address: 864 W.Benjamin Holt Drive Date Prepared: 5/29/2021 A, F.DOMESTIC HOT WATER EQUIPMENT T This table is used to demonstrate compliance with mandatory equipment requirements in 110.1 and 110.3.For high-rise residential and hotel/motel occupancies,compliance with prescriptive requirements in§150.1(c)8 must also be demonstrated and with 150.2 for addition and alteration scopes. Equipment Schedule:Individual Systems 0 01 02 03 04 05 06 Name or Max GPM/First Rated Uniform K Item Tag Equipment Type Volume(gal) Hour Rating Energy Factor Minimum Required Uniform Energy Factor(UEF)' (FHR) (UEF) ma AO Smith Gas-Fired Instantaneous(50,000-200,000 <=2 GPM>=4.0 0.81 0.81 r CT-199 BTU H) 'FOOTNOTE:Compliant equipment may be found in the Modernized Appliance Efficiency Database System(MAEDBS)on the Energy Commission website: - https://cocertapplionces.energy.ca.gov/Pages/Search/AdvancedSearch.aspx Water Heating Equipment All Occupancies Yes No Not Applicable Requirement 18 ❑ ❑ ® Unfired storage tank insulation shall have Internal+External>=R-16 OR External>=R-12.Label required n per JILQ.3 c 3 19 ❑ ❑ ® New state buildings 60%of energy for service water heating from site solar energy or recovered energy per110.3 c 5 20 ❑ ❑ ® Isolation valves for instantaneous water heater with input rating<6.8 kBTUH or 2 kW has been specified M9 per J11E3 c 6 O G.DOMESTIC HOT WATER DISTRIBUTION SYSTEM T This table is used to demonstrate compliance for nonresidential occupancies with distribution requirements in 1§ 20.3 and 1§ 40.5.For high-rise residential and hotel/motel occupancies, N compliance is demonstrated with requirements110.3 c 1§ 20.3, 150.0 150.1 Mandatory Pipe Insulation All Occupancies For systems serving nonresidential spaces,pipe insulation for the following applications is specified to comply with Table 120.3-A(see below)per 120.3: 12 ® Recirculating system piping,including supply and return piping of the water heater • The first 8 ft of hot and cold outlet piping,including between storage tank and heat trap,for a non recirculating storage system • Pipes that are externally heated 13 ® Insulation shall be protected from damage,including that due to sunlight,moisture,equipment maintenance,and wind.Insulation exposed to weather shall be installed with a cover suitable for outdoor service per120.3 b and 150.0 3 Registration Number: Registration Date/Time: Registration Provider:Energysoft CA Building Energy Efficiency Standards-2019 Nonresidential Compliance Report Version:2019.1.003 Report Generated:2021-05-29 13:04:22 Schema Version:rev 20190401 STATE OF CALIFORNIA Domestic Water Heating System NRCC-PLB-E CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-PLB-E Project Name: Crumbl Cookies-Interior Tenant Improvement Report Page: (Page 4 of 6) Project Address: 864 W.Benjamin Holt Drive Date Prepared: 5/29/2021 G.DOMESTIC HOT WATER DISTRIBUTION SYSTEM TABLE 120.3-A PIPE INSULATION THICKNESS Conductivity Range Nominal Pipe Diameter(in) Fluid Temperature Range(°F) (Btu-in per hour Insulation Mean Rating Temp(°F) <1 1 to<1.5 11.5 to<4 per ftz per°F) Minimum Insulation Required 105-140 0.22-0.28 100 1.0 in or R-7.7 1.5 in or R-12.5 1.5 in or R-11 H.DOMESTIC HOT WATER CONTROLS This table is used to demonstrate compliance with control requirements in 110.3 for all occupancies.For high-rise residential and hotel/motel occupancies,compliance is also demonstrated with requirements in§150.1(c)8. Yes No qpp ict Requirement 01 ® ❑ ❑ Construction documents require manufacturer certification that service water-heating systems are equipped with automatic temperature controls capable of adjusting temperature settings per 110.3 a . 02 ❑ ❑ ® Systems with capacity>167,000 BTUH equipped with outlet temperature controls per 110.3 c 1 unless covered by California Plumbing Code 613.0. 03 ❑ ❑ ® Controls for circulating pumps or electrical heat trace systems are capable of automatically turning off the system per §110.3(c)2 unless systems serves healthcare facility. 04 ❑ ❑ ® For recirculation systems serving multiple dwelling units,design includes automatic pump controls per§150.1(c)8Bii,or 150.2 for additions or alterations. 05 ❑ ❑ ® For recirculation systems serving individual dwelling units,design includes manual on/off controls as specified in Reference Appendix RA4.4.9 per150.1 c 8. 06 ❑ ❑ ® For replacement single heat pump water heaters serving individual dwelling units in climate zone 1-15,design includes communication interface that meets demand responsive control requirements of§110.12(a) per§150.2(b)1Hiii. 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