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<br /> STATE OF CALIFORNIA STATE OF CALIFORNIA LIJ W
<br /> STATE OF CALIFORNIA I--i
<br /> Mechanical Systems Mechanical Systems Mechanical Systems Co
<br /> CALIFORNIA ENERGY COMMISSION NRCC-MCH-E(Created 1/22) CALIFORNIA ENERGY COMMISSION
<br /> NRCC-MCH-E(Created 1/22) CALIFORNIA ENERGY COMMISSION NRCC-MCH-E(Created 1/22) 00
<br /> CERTIFICATE OF COMPLIANCE NRCC-MCH-E CERTIFICATE OF COMPLIANCE NRCC-MCH-E CERTIFICATE OF COMPLIANCE NRCC-MCH-E
<br /> Project Name: T4 TEA lReport Page: Page 5 of 8 Project Name: T4 TEA lReport Page: Page 6 of 8 Project Name. T4 TEA lReport Page: Page 7 of 8 T
<br /> Project Address: 15346 S.HARLAN RD. JDate Prepared: 1/12/2022 Project Address: 15346 S.HARLAN RD. JDate Prepared: 1/12/2022 Project Address: 15346 S.HARLAN RD. JDate Prepared: 1/12/2022
<br /> t`
<br /> NRCA-MCH-02-A Outdoor Air must be submitted for all newly installed HVAC units. P.DECLARATION OF REQUIRED CERTIFICATES OF VERIFICATION Q. MANDATORY MEASURES DOCUMENTATION LOCATION
<br /> T
<br /> (� (, Note:MCH02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance(if applicable)since testing ❑ ❑ Table instructions:Selections have been made based on information provided in previous tables of this document.If any selection needs to be changed,please explain why in Table Instructions:indicate where mandatory measures are documented in the plan set or construction documentation.For any mandatory measures that do not apply, mark CD
<br /> activities overlap. Table E.Additional Remarks. These documents must be completed by a HERS Rater and provided to the building inspector during construction. The final documents must be the plan sheet or construction document location as"NIA,any active cells that are left blank will result in non-compliance in Table C.
<br /> NRCA-MCH-03-A Constant Volume Single Zone HVAC created by a HERS Providers registry,but drafts can be found online at htW.V www energy ca goy/title24/2019standards/2019 compliance documents/ 02
<br /> C {j NOTE:This form does not automatically move to"Yes". If Constant Volume Single Zone HVAC Systems are included in the ❑ ❑ Nonresidential Documents/NgCV[ 01
<br /> Plan sheet or construction document location
<br /> scope,permit applicant should move this form to"Yes". Field Inspector
<br /> (i NRCA-MCH-04-A Air Distribution Duct Leakage ❑ ❑ YES NO Form/Title !E1
<br /> Fail Compliance with Mandatory Measures documented through Yes M1
<br /> NRCA-MCH-05-A Air Economizer Controls ❑ ❑ MCH Mandatory Measures Note Block: C: �; o 0= 0
<br /> NRCV-MCH-04-H Duct Leakage Test ° ' > � cNRCA-MCH-06-A Demand Control Ventilation S stems Acce tance must be submitted for all stems re uired to em to C (0 ❑ {'
<br /> Y p q employ NOTE:Must be completed by a HERS Rater o o v ° n
<br /> C demand controlled ventilation(refer to§120.1(c)3)can vary outside ventilation flow rates based on maintaining interior ❑ ❑
<br /> aD
<br /> NRCV-MCH 24 Enclosure Air Leakage Worksheet �'-0 v L
<br /> carbon dioxide(CO2)concentration setpoints. C ❑ ❑ a�•- o a,
<br /> NOTE:Must be completed by a HERS Rater N�' ° o o o w
<br /> C` �; NRCA-MCH-07-A Supply Fan Variable Flow Controls El El - 0
<br /> C (01 NRCA-MCH-08-A Valve Leakage Test
<br /> E] ElElHigh-rise Residential El ❑ o v o � 3 0
<br /> C, T NOTE:Must be completed by a HERS Rater
<br /> C (01 NRCA-MCH-09-A Supply Water Temperature Reset Controls ❑ ❑
<br /> O 0-C E�
<br /> O�
<br /> C U C
<br /> Cs NRCA-MCH-10-A Hydropic System Variable Flow Controls ❑ ❑ NRCV-MCH-32 Local Mechanical Exhaust ❑ ❑ v, °> 0 c ° 5
<br /> ( {� NRCA-MCH-11-A Automatic Demand Shed Controls ❑ ❑ NOTE:Must be completed by a HERS Rater rn T °_ L c
<br /> c N O i U o V W
<br /> 3 ° uso ° �
<br /> ° O d N � O_U J
<br /> C NRCA-MCH-12-A FDD for Packaged Direct Expansion Units ❑ ❑
<br /> -0 W CLO a�'0 v c-I
<br /> C (0- NRCA-MCH-13-A Automatic FDD for Air Handling Units and Zone Terminal Units Acceptance El 11 W 0-a� 0
<br /> " 0 `
<br /> NRCA-MCH-14-A Distributed Energy Storage DX AC Systems Acceptance ,co, 3 o L v m v
<br /> co NOTE. This form does not automatically move to"Yes". If Distributed Energy Storage DX AC Systems are included in the scope, ❑ Ll >o 3 N c° a o c
<br /> permit applicant should move this form to"Yes ,
<br /> NRCA-MCH-15-A Thermal Energy Storage(TES)System Acceptance rn-0 0 (n <:5 0 C1_0� N w
<br /> (, NOTE:This form does not automatically move to"Yes". if Chilled Water Storage,Ice-on-Coil internal Melt,ice-on-Coil Externa!
<br /> o❑ ❑ a) 0 ° ^ Q
<br /> rn s o
<br /> Melt Ice Harvester,Brine,Ice-Slurry,Eutectic Salt Clathrate Hydrate Slurry(CHS),Cryogenic or Encapulated(Ice Ball)Systems I E ci 0 0
<br /> a� 0 4
<br /> �n 3�� E�'� szoQ
<br /> are included in the scope,permit applicant should move this form to"Yes".
<br /> (` (01 NRCA-MCH-16-A Supply Air Temperature Reset Controls ❑ ❑
<br /> REVISIONS DATE
<br /> (" (0' NRCA-MCH-17-A Condenser Water Temperature Reset Controls ❑ ❑
<br /> (' 4 NRCA-MCH-18 Energy Management Control Systems ❑ ❑
<br /> (` C NRCA-MCH-19 Occupancy Sensor Controls ❑ ❑
<br /> C (07NRCA-MCH-20 Multi-Family Ventilation ❑ I ❑
<br /> (" 1 (0; NRCA-MCH-21 Multi-Family Envelope Leakage ❑ ❑
<br /> t�
<br /> CA Building Energy Efficiency Standards-2019 Nonresidential Compliance:http://www.energy.ca.gov/title24/2019standards January 2022 CA Building Energy Efficiency Standards-2019 Nonresidential Compliance:http://www.energy.ca.ggv/title24/`2019standards January 2022 CA Building Energy Efficiency Standards-2019 Nonresidential Compliance:http-//www energy ca goy/title24/2019standards January 2022 A
<br /> Seal:
<br /> STATE OF CALIFORNIA STATE OF CALIFORNIA QHAIV o
<br /> STATE OF CALIFORNIA
<br /> Mechanical Systems Domestic Water Heating System Domestic Water Heating System
<br /> NRCC-MCH-E(Created 1/22)
<br /> CALIFORNIA ENERGY COMMISSION NRCC-PLB-E(Created 11/19) CALIFORNIA ENERGY COMMISSION NRCC-PLB-E(Created 11/19) CALIFORNIA ENERGY COMMISSION C?
<br /> CERTIFICATE OF COMPLIANCE NRCC-MCH-E CERTIFICATE OF COMPLIANCE NRCC-PLB-E CERTIFICATE OF COMPLIANCE NRCC-PLB-E N0. 63640
<br /> p f p q ���0 0 0 q f j P g g Exp. 09/30/2022
<br /> Project Name: T4 TEA Report Page: Page 8 of 8 This document is used to demonstrate cam liance or nonresidential occupancies with requirements in 110.1 110.3 12 .3 and 14 .5 and with requirements in 141.0 or Project Name: T4 TEA Re ort Page: Page 2 of 5 * *'
<br /> Project Address: 15346 S.HARLAN RD. JDate Prepared: 1/12/2022 additions and alterations,for domestic water heating scopes using the prescriptive path. For high-rise residential and hotel[motel occupancies,compliance is demonstrated with Project Address: 15346 S.HARLAN RD. JDate Prepared: 1/12/2022 / v P
<br /> requirements in110.1 1§ 10.3, 120.3 1§ 50.0 and§150.1(c18,and with requirements in 150.2 for additions and alterations.
<br /> DOCUMENTATION AUTHOR'S DECLARATION STATEMENT Project Name: T4 TEA lReport Page: Page 1 of 5 D.EXCEPTIONAL CONDITIONS C
<br /> 1.1 certify that this Certificate of Compliance documentation is accurate and complete. Project Address: 15346 S.HARLAN RD. Date Prepared: 1/12/2022 This table is auto filled with uneditable comments because of selections made or data entered in tables throughout the form.
<br /> Documentation Author Name: ANDY DANG Documentation Author Signature:
<br /> g A.GENERAL INFORMATION No exceptional conditions apply to this project.
<br /> Company: AD ENGINEERING Signature Date: 1/12/2022 . 01 Project Location(city) LATHROP 102 IClimate Zone 12
<br /> Address: 9587 DAPPLE GRAY PL CEA/HERS Certification Identification(if applicable):
<br /> 03 Occupancy Types Within Project(select all that apply): E.ADDITIONAL REMARKS
<br /> ® Nonresidential ❑ High-Rise Residential F-] Hotel/Motel This table includes remarks made by the permit applicant to the Authority Having Jurisdiction.
<br /> City/State/Zip: ELK GROVE,CA 9562416 Phone: (916)761-4858 ® State Building Healthcare Facility Other(Write In):
<br /> RESPONSIBLE PERSON'S DECLARATION STATEMENT
<br /> I certify the following under penalty of perjury,under the laws of the State of California:
<br /> B. PROTECT SCOPE
<br /> 1.The information provided on this Certificate of Compliance is true and correct. Table Instructions:Include any domestic water heating systems that are within the scope of the permit application and are demonstrating compliance using the prescriptive F.DOMESTIC HOT WATER EQUIPMENT
<br /> 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 paths outlined in 4140.5 §150.1(c)8,and 141.0 a or§141.0(b)2N for additions or alterations. Solar water heating systems should be documented on the NRCC SRA
<br /> This Section Does Not Apply
<br /> Compliance(responsible designer) compliance document. Combined hydronic water heating systems should be documented on the NRCC-MCH compliance document.
<br /> 3.The energy features and performance specifications,materials,components,and manufactured devices for the building design or system design identified on this 01 02 03 G.
<br /> Certificate of Compliance conform to the requirements of Title 24,Part 1 and Part 6 of the California Code of Regulations. My project consists of(check all that apply): System Type'•z System Components DOMESTIC HOT WATER DISTRIBUTION SYSTEM
<br /> 4.The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable Table Instructions:Complete the following Coble to demonstrate compliance for nonresidential occupancies with distribution requirements in 1§ 20.3 and 140.5. For high-rise
<br /> g g New System(DHW system being installed for the first
<br /> compliance documents,worksheets,calculations,plans and specifications submitted to the enforcement agency for approval with this building permit application. L] Equipment Distribution Controls residential and hotelfmotel occupancies,compliance is demonstrated with requirements in 110.3 c 120.3 150.0 150.1.
<br /> time in newly constructed building)
<br /> S. I will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permit(s)issued for the building,and made available Distribution in Individual Dwelling Units
<br /> to the enforcement agency for all applicable inspections.I understand that a completed signed copy of this Certificate of Compliance is required to be included with the
<br /> occupancy. ,.. ,q ,o , Yes No Not Requirement
<br /> documentation the builder provides to the building owner at occu � O
<br /> p � System Alteration(equipment,distribution or controls) Individual Dwelling Unit System(s)Z � Equipment ✓0 Distribution ❑ Controls Applicable
<br /> Responsible Designer Name: ANDY DANG Responsible Designer Signature: The dwelling unit is designed to have fenestration products with a weighted average U-factor<=0.24 plus one of the following
<br /> options per§150.1(cL8Aii:(New Construction Only) Dp
<br /> Company: AD ENGINEERING Date Signed: 1/12/2022 'FOOTNOTE:Point of use water heaters,or other non-centra!systems used to serve nonresidential spaces,are considered individual systems. 08 i t 4
<br /> Compact hot water distribution system field verified by a HERS Rater per Reference_Appendix RA4 4.16 Q
<br /> Address: 9587 DAPPLE GRAY PL License: C63640 2 Dwelling units refers to hotel[motel guest rooms and units in a high-rise residential occupancy.
<br /> A drain water heat recovery system that is field verified by a HERS Rater per Reference Appendix RA3,_6.9 Q
<br /> City/State/Zip: ELK GROVE,CA 9562416 Phone: (916)761-4858 C.COMPLIANCE RESULTS One of the following options is included in the design per§150.lk)R iv:(New Construction Only)
<br /> Table instructions:Table C will indicate if the project data input into the compliance document is compliant with water heating requirements. This table is not editable by the Compact hot water distribution system field verified by a HERS Rater per Reference Appendix RA4.4.6 and a drain
<br /> user. If this table says"DOES NOT COMPLY"or"COMPLIES with Exceptional Conditions"refer to Table D.,or the table indicated as not compliant for guidance. 09 i" (' r water heat recovery system that is field verified by a HERS Rater per Reference Appendix RA3 6.9.
<br /> 01 02 03 04 ❑ A photovoltaic system capacity of 0.3 kWdc(for climate zones 2-1S)or 1.1 kWdc(for climate zones 1&16)larger
<br /> Domestic Hot Water Equipment Distribution Systems Controls than the requirement specified in�150.1jc)_14.
<br /> Y Compliance Results One of the following options is included in the design per§150_ cL8Av:(New Construction Only)
<br /> (See Table F) (See Table G) (See Table H) g Q
<br /> Yes COMPLIES10 ( Compact hot water distribution system per Reference Appendix RA4_4.6 for projects in climate zones 1 and 16. Q
<br /> A photovoltaic system capacity of 0.3 kWdc(for climate zones 1&16)larger than the requirement specified in
<br /> §15.0.1(c)14•
<br /> Table Continued
<br /> CA Building Energy Efficiency Standards-2019 Nonresidential Compliance:http:L www.enerey.ca.Lzov/title24/2019standards January 2022 CA Building Energy Efficiency Standards-2019 Nonresidential Compliance:httD://www.enerev.ca.¢ov/title24/2019standards November 2019 CA Building Energy Efficiency Standards-2019 Nonresidential Compliance:http:/Iwww.enerev.ca.izov/title24/2019standards November 2019
<br /> Drawn By A. DAN G
<br /> Checked By
<br /> Dote 10-28-21
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