|
CERTIFICATE OF COMPLIANCE- USER INSTRUCTIONS NRCC-LTI-01-E
<br /> Indoor Lighting (Page 1 of 5) CERTIFICATE OF COMPLIANCE- USER INSTRUCTIONS NRCC-LTI-01-E
<br /> Project Name: ARCO ESCALON CA Date Prepared: 1/18/2016 Indoor Li Lighting CERTIFICATE OF COMPLIANCE- USER INSTRUCTIONS NRCC-LTI-01-E
<br /> � � pg g (Page 2 of 5) Indoor Lighting
<br /> (Page 3 of 5
<br /> Project Name: ARCO ESCALON, CA Date Prepared: 1/18/2016 Project Name: ARCO ESCALON,CA Date Prepared: 01/18/16
<br /> Climate Zone: 3 Conditioned Floor Area: 3171 sq.ft.
<br /> Unconditioned10F
<br /> Floor Area: Declaration of Required Installation Certificates—Declare by selecting yes for all Installation Certificates that will be submitted. A separate Lighting Schedule Must Be Filled Out for Conditioned and Unconditioned Spaces. Installed Lighting Power listed on this Lighting Schedule is only for:
<br /> General Information (Retain copies and verify forms are completed and signed.) AROO
<br /> BuildingType: ❑ ❑ ❑ YES NO Form/Title ❑ CONDITIONED SPACE ❑ UNCONDITIONED SPACE
<br /> yp X Nonresidential High Rise Residential Hotel/Motel
<br /> ❑ Schools ❑Relocatable Public Schools ®Conditioned Spaces [:]Unconditioned Spaces 0 ❑ NRCI-LTI-01-E- Must be submitted for all buildings ❑ Field Inspector A. INDOOR LMHTIHG SCHEDULE and FIELD INSPECTION ENERGY CHECKLIST
<br /> Phase of Construction: ❑X New Construction NRCI-LTI-02-E-Must be submitted for a lighting control system, or for an Energy F—] FieldInspector
<br /> ❑ ❑Addition Alteration FV] Management Control System (FMCS),to be recognized for compliance. ❑ The actual indoor lighting power listed on this page and on the next page includes all installed permanent and planned portable lighting systems.
<br /> Method of Compliance: ❑Complete Building ®Area Category ❑Tailored ❑✓ When Complete Building Method is used for compliance, list each different type of luminaire on separate lines.
<br /> ❑ Q NRCI-LTI-03-E- Must be submitted for a line-voltage track lighting integral current ❑ Field Inspector
<br /> limiter, or for a supplementary overcurrent protection panel used to energize only ❑ When Area Category Method or Tailored Method is used for compliance, list each different type of luminaire by each different function area on separate lines
<br /> LIGHTING COMPLIANCE DOCUMENTS (Select Yes for each document included) line-voltage track lighting,to be recognized for compliance. ❑ Also include track lighting in schedule,and submit the track lighting compliance form(LTG-5C)when line-voltage track lighting is installed.
<br /> For detailed instructions on the use of this and all Energy Efficiency Standards compliance documents, refer to the ❑ ❑ NRCI-LTI-04-E-Must be submitted for two interlocked systems serving an ❑ Field Inspector
<br /> Nonresidential Manual published by the California Energy Commission. auditorium,a convention center,a conference room,a multipurpose room, or a Bo Installed Portable Luminaires in Offices- Exception to Section 140,6(a)
<br /> YES NO FORM TITLE theater to be recognized for compliance.
<br /> ❑ NRCC-LTI-01-E Certificate of Compliance. All Pages required on plans for all submittals. ❑ This section shall be filled out ONLY for portable luminaires in offices(As defined in§100.1).All other planned portable luminaires shall be documented on next page of this compliance
<br /> 0 ❑ NRCI-LTI-05-E- Must be submitted for a Power Adjustment Factor(PAF)to be ❑ Field Inspector form.
<br /> 7 ❑ NRCC-LTI-02-E Lighting Controls, Certificate of Compliance, and PAF Calculation.All Pages required on plans for recognized for compliance. Q This section is used to determine if greater than 0.3 watts of portable lighting is planned for any office.
<br /> all submittals. ❑ ❑ NRCI-LTI-06-E-Must be submitted for additional wattage installed in a video ❑ Field Inspector ❑
<br /> Fill out a separate line for each different office.Small offices that are typical(having the same general and portable lighting) may be grouped together.This allowance shall not be
<br /> ❑✓ ❑ NRCC-LTI-03-E Indoor Lighting Power Allowance conferencing studio to be recognized for compliance. traded between offices having different lighting systems.
<br /> ❑ ❑ NRCC-LTI-04-E Tailored Method Worksheets Field
<br /> Office Portable Luminaire Schedule Office Installed Portable Luminaire Watts Per Square Foot Accountable Office Location
<br /> Line Voltage Track Lighting Worksheets Declaration of Required Certificates of Acceptance —Declare by checking all of the Certificates of Acceptance that will be Inspector
<br /> ❑ ❑ NRCC-LTI-05-E g g g submitted. (Retain copies and verify forms are completed and signed.) Watts p
<br /> YES NO Form/Title A B C D E F G H I J
<br /> Summary of Allowed Lighting Povuer ❑ ❑ NRCA-LTI-02-E-Must be submitted for occupancy sensors and automatic time ❑ Field Inspector r portable o
<br /> Conditioned and Unconditioned Space Lighting must not be combined for compliance switch controls. c s = ®
<br /> Complete Luminaire Description (i.e., �• watts in this Watts per If F<_0.3, Identify Office area in �9
<br /> Indoor Lighting Power for Condtioned Spaces Indoor Lighting Power for Uncondtioned Spaces o (o p fY .
<br /> WATTS WATTS ❑ ❑ NRCA-LTI-03-E- Must be submitted for automatic daylight controls. ❑ Field Inspector LED, under cabinet,furniture mounted Watts per �'• office square enter zero; if F which these portable
<br /> Installed Lighting Installed Lighting ✓ direct/indirect) Luminaire H °, (B x C) rD feet (D/E) >0.3, (F-0.3) E x G luminaires are installed Pass Fail �7�� �N G\���'
<br /> 1 NRCC-LTI-01-E, page 4 + 2383.4 NRCC-LTI-01-E, page 4 +
<br /> ❑ ❑ NRCA-LTI-04-E- Must be submitted for demand responsive lighting controls. ❑ Field Inspector N/A p 0 0 Q ❑ ❑
<br /> PORTABLE ONLY FOR OFFICES 0 0 0 0 ❑ ❑ 18215 72ND AVENUE SOUTH
<br /> 2 NRCC-LTI-01-E, page 3 + 0 0 0 0 El DENT, A 96032
<br /> Minus Lighting Control Credits Minus Lighting Control Credits CA Building Energy Efficiency Standards-2013 Nonresidential Compliance June 2013 0 0 0 0 1:1 ❑ (425)251-6222
<br /> 3 NRCC-LTI-01-E, page 2 _ -215.64 NRCC-LTI-01-E, page 2 _ (425)251-8782 FAX
<br /> Adjusted Installed Lighting Power Adjusted Installed Lighting Power 0 0 0 0 ❑ ❑
<br /> 4 (row 1 plus row 2 minus row 3) = 2167.76 (row 1 plus row 2 minus row 3) _
<br /> 0 0 0 0 ❑ F-1CML ENGINEERING, LAND PLANNING,
<br /> 5 Complies ONLY if Installed<Allowed Complies ONLY if Installed:5 SUNG, ENNiRON6��A! SERVICES
<br /> 0 0 0 0 ❑ ❑
<br /> Allowed Lighting Power Allowed Lighting Power Enter sum total of all NO. DATE REVISION DESCRIPTION
<br /> 6 Conditioned NRCC-LTI-03-E, page 1 3350.4 Unconditioned NRCC-LTI-03-E, page 1 pages into NRCC-LTI-01-E; 1.18.15 PERMii SUBMITTAL
<br /> Total installed portable luminaire watts that are greater than 0.3 watts per square foot per office: 0 Page 2
<br /> CA BuildingEner Efficient Standards-2013 Nonresidential Compliance 1
<br /> Energy Y p June 2013
<br /> 2
<br /> CA Building Energy Efficiency Standards-2013 Nonresidential Compliance June 2013 3
<br /> S
<br /> B
<br /> CERTIFICATE OF COMPLIANCE-USER INSTRUCTIONS NRCC-LTI-01-E I
<br /> Indoor Lighting (Page 4 of 5 CERTIFICATE OF COMPLIANCE-USER INSTRUCTIONS NRCC-LTI-01-E
<br /> Project Name: ARCO ESCALON, CA Date Prep red: 01/18/16 Indoor Lighting (Page 5 of S
<br /> Project Name: ARCO ESCALON,CA Date Prepred: 01/18/16
<br /> A separate Lighting Schedule Must Be Filled Out for Conditioned and Unconditioned Spaces. Installed Lighting Power listed on this Lighting Schedule is only for:
<br /> 0SEAL
<br /> DOCUMENTATION OF AUTHOR'S DECLARATION STATEMENT CONDITIONED SPACE ❑ UNCONDITIONED SPACE I certify that this Certificate of Compliance documentation is accurate and complete.
<br /> C. INDOOR LIGHTING SCHEDULE and (MELD INSPiECT110N ENERGY CHECKLIST Documentation Author Name:
<br /> STEVEN CRUZ Documentation Author Signature: gyp0
<br /> Luminaire Schedule installed Watts Location Field Inspector' Company: ABOSSEIN ENGINEERING Signature Date:
<br /> A C ® E F CCS HI 1/18/2016 ZZ:
<br /> How wattage Address: 829 2ND ST CEA/HERS Certification Identification (if applicable): ® El 7915
<br /> was
<br /> m v Cit /State/Zi ��r, 9 , �6��
<br /> 3 3Y p MUKILTEO,WA 98275 Phone: 4254629441 •
<br /> b0 "' O D �- _ an Qf CAt-0�
<br /> M W ,� �, Primary Function area in RESPONSIBLE PERSON'S DECLARATION STATEMENT
<br /> E Complete Luminaire Description (i.e.,3 lamp fluorescent Watts per D c o = rD ° ":iD which these luminaires are I certify the following under penalty of perjury, under the laws of the State of California:
<br /> z troffer, F32T8, one dimmable electronic ballast) Luminaire 00 P CL installed Pass Fail 1. The information provided on this Certificate of Compliance is true and correct.
<br /> 0 ❑ BACKROOM/UTILITY El 2• 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified
<br /> A PANEL LIGHT, (1) LED, 34W ELECTRICAL,OFFICE on this Certificate of Compliance(responsible designer).
<br /> 34 11 374 RESTROOMS 3. The energy features and performance specifications, materials, components,and manufactured devices for the building design or system
<br /> B 12" DECORATIVE PENDANT, (1) LED,98W 98 0 ❑ 17 1667 SALES AREA ❑ ❑ design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of
<br /> C PENDANT FIXTURE, (1) LED, 7.2W 7.2W Z 1:112 86.4 FOOD PREPARATION AREA El ElRegulations.
<br /> 4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information
<br /> D REFRIGERATION LIGHTING, (1) LED, 14W 14 0 1:1 8 112 WALK-IN COOLER/FREEZER ❑ ❑ provided on other applicable compliance documents,worksheets, calculations,plans and specifications submitted to the enforcement
<br /> E DOWNLIGHT FIXTURE, (1) LED, 7.2W 7.2 Z ❑ 20 144 CASHIER/WASHROOMS ❑ ❑ agency for approval with this building permit application.
<br /> ❑ ❑ ❑ ❑ 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 DEVELOPMENT INF ?WR N:
<br /> ❑ ❑ ❑ ❑ building,and made available to the enforcement agency for all applicable inspections. I understand that a completed signed copy of this ARCO HTI
<br /> Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy.
<br /> nn 1/ 3000 am/pm/ QSR
<br /> ❑ ❑ ❑ ❑ Responsible Designer Name: Responsible Designer Signature: � �
<br /> STEVEN CRUZ CANOPY
<br /> ❑ ❑ ❑ ❑ Company: ABBOSSEIN ENGINEERING Signature Date: / 6 MPO's
<br /> ❑ ❑ ❑ ❑ 1/18/2016
<br /> ❑ ❑ ❑ ❑ Address: 829 2ND ST License: E17915
<br /> SITE
<br /> ADDRESS-
<br /> El ❑ ❑ ❑
<br /> City/State/Zip: MUKILTEO,WA 98275 Phone: 4254629441 ESCALON AVENUE
<br /> El E] ID El
<br /> ❑ ❑ ❑ ❑ @ HIGHWAY 120
<br /> ESCALON,CAL
<br /> ❑ El L1 ❑ IFORNIA
<br /> INSTALLED WATTS PAGE TOTAL:
<br /> Enter sum total of all pages into CA Building Energy Efficiency Standards-2013/Nonresidential Compliance June 2013
<br /> 2383.4 NRCC-LTI-01-E; Page 2 FAC[IL0TY # TBD
<br /> 1. If Fail then describe on Page 2 of the Inspection Checklist Form and take appropriate action to correct. Verify building plans if necessary. Usm BY =910E '%
<br /> Abossein Ii:
<br /> CA Building Energy Efficiency Standards-2013 Nonresidential Compliance June 2013 Engineering, BY
<br /> ff ft
<br /> L. L. C. 17223
<br /> MECHANICAL — ELECTRICAL A E 24 FORMS
<br /> CIVIL — LEED WOOR ❑GHTH
<br /> FIRE PROTECTION
<br /> 2100 112TH AVE. NE PART I
<br /> BELLEVUE, WA 98004 SHM NO.
<br /> PH: (425) 462-9441
<br /> FAX: (425) 462-9451
<br /> E—Mail: cseruice@abosseia.com
<br /> www.abossein.com
<br /> EOm3
<br /> N ASOSSEiN #215064
<br />
|