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STATE OF CALIFORNIA STATE OF CALIFORNIA STATE OF CALIFORNIA
<br /> Nonresidential Building Commissioning Nonresidential Building Commissioning Nonresidential Building Commissioning
<br /> NRCC-CXR-E(Created 7/18) CALIFORNIA ENERGY COMMISSION NRCC-CXR-E(Created 7/18) CALIFORNIA ENERGY COMMISSION NRCC-CXR-E(Created 7/18) CALIFORNIA ENERGY COMMISSION A
<br /> CERTIFICATE OF COMPLIANCE NRCC-CXR-E CERTIFICATE OF COMPLIANCE NRCC-CXR-E CERTIFICATE OF COMPLIANCE NRCC-CXR-E
<br /> Project Name: In-N-Out Burger =�LReport Page:
<br /> This document is used to demonstrate compliance with mandatory commissioning requirements in§120.8for nonresidential buildings and hotellmotel or high-rise residential Project Name: In-N-Out Burger Report Page: Page 2 of 5 Page 3 of 5
<br /> buildings with nonresidential spaces.This document does not demonstrate compliance with commissioning requirements within Title 24,Part 11,which need to be documented ProjectAddress: SECI Riverlslancl Pkwy&Golden Valley Pkwy JDate Prepared: 2018-10-16 Project Address: SEQ of River Island Pkwy&Golden Valley Pkwy IDate Prepared: 2018-10-16 Llr==EEEErE]=El==LIE E]EILI
<br /> separately if they apply.
<br /> ,Project Name: In-N-Out Burger IReportPage: Page I of 5 C.COMPLIANCE RESULTS Table Continued 0:1E0:1ET1 0:1r-1E FTI r IF-L
<br /> Project Address: SEQof River Island Pkwy&Golden Valley Pkwy jDate Prepared: 2018-10-16 Table Instructions:Table C will indicate if the project data input into the compliance document is compliant with commissioning requirements per§120.8 This table is not The design reviewer(s)must be licensed professional engineers or licensed architects,or licensed contractors representing services Do the Design Reviewer(s)meet F-1 F_1=1_10
<br /> editable by the user. If this table says"DOES NOT COMPLY"or"COMPLIES with Exceptional Conditions"refer to Table D.for guidance. performed by or under the direct supervision of a licensed engineer or architect,as specified in the provisions of Division 3 of the Business these qualifications?
<br /> A.GENERAL INFORMATION 0 01 02 03 04 05 06 07 08 09 and Professions Code. _1L1ffiLLL1LLL1LLL[1I 11 1
<br /> 01 Project Location(city) Lathrop 04 Building Size(ft') 4,611 Functional In addition,for buildings with<10,000 ft',the design reviewer(s)may be the engineer or architect of record.The design reviewer(s) YES NO
<br /> 02 Occupancy Type Nonresidential 05 Nonresidential Conditioned Floor Area(ft') <10,000 ft2 Design Review Owner's Project Basis of Design Design Review Commissioning Performance Documentation Commissioning 03 may also be a qualified in-house engineer or architect with no other project involvement or a third party engineer,architect or
<br /> 03 Project Type Newly constructed 06 HVAC System Type Unitary or packaged equipment each serving one zone Kickoff Requirements Plan Testing and Training Reporl: Compliance Results contractor. David Lippe (Z ISSUE RECORD
<br /> Table F Table G Table H Table I Table J Table K Table I Table M 04 The design reviewer(s)for this project will be:
<br /> B.PROJECT SCOPE ki Yes Yes COMPLIES Preliminary Construction Schedule R
<br /> Table Instructions:Based on project information provided in Table A,Table B indicates which commissioning related requirements applyper§120. Table B is not editable by 10 Design Reviewer(s)for the project include: Start Date Completion Date URBAN PROTOTYPE DESIGN
<br /> the user. 05 Schematic Design 2018-09-05 2018-09-05 10-22-2018 ISSUED FOR PERMIT
<br /> Commissioning Requirements per§120.8 D.EXCEPTIONAL CONDITIONS 06 Design Development 2018-09-05 2018-10-11
<br /> 01 Table F:Design Review Kickoff §120.8(d)l and The design review kickoff meeting establishes who will play the role of the design reviewer,the project schedule and This table is auto-filled with uneditable comments because of selections made or data entered in tables throughout the form. 07 Construction Documents 2018-09-20 2018-10-12
<br /> Table G:Owner's Project §120.8(d)2 identify owner's requirements. This meeting should be conducted during schematic design. 08 Construction 2019-03-05 1 2020-03-05
<br /> 02 Requirements(OPR) 4 20.8(b) This requirement does not apply. Table 1.indicates that a Design Review document is attached to the permit application. 09 Building Turnover 2020-03-05 2020-03-05
<br /> Project Goals Related to Energy Efficiency
<br /> 03 Table I Basis of Design(BOD) §121 This requirement does not apply. E.ADDITIONAL REMARKS 10 Operational Costs The plan is to achieve a building that uses high efficiency equipment,with the appropriate controls to minimize end-use.
<br /> The design reviewer(s)reviews the construction documents for clarity,completeness,and adherence to the owner's This table includes remarks made by the permit applicant to the Authority Having Jurisdiction. 11 Desired Building Lifespan The lifespan of the building is for 75+years
<br /> goals. Commissioning measures must be included in the construction clocuments to faciliate the design review and 12 Equipment I Equipment will be serviced regularly to ensure optimum performance and prolonged life.
<br /> 04 Table 1:Design Review §120.8(d)and commissioning process.For projects with�!10,000 ft'of nonresidential conclitioned floor area,or with complex The expected EUI of the TDV is expected to be around 2,181.45 kBtulsflyr. The building is in use 2417 due to late hours of
<br /> §120.8(e) mechanical systems,the design review is for adherence with the Owner's Project Requirements(OPR)and Basis of 13 Project Energy Efficiency Goals being open and cleaning and prep crew coming in before closing stafffinish duties.
<br /> Design(BOD).This should be conducted during design. F.DESIGN REVIEW KICKOFF MEETING 14 Envelope Goals The envelope is using woodframing instead of metal,and insulating the cavityfully. The roof is the same,and the windows
<br /> 05 Table J:Commissioning Plan §120.8(f) This requirement does not apply. Table Instructions:Complete this table to indicate that the design reviewer meets the qualification requirements per Title 24,Part 1 Section 10-103(a)l and to demonstrate are site built and using metal thermal breaks with high VT to ensure maximum benefit of daylighting controls
<br /> .Table K:Functional compliance with design review kickoff requirements per§120.81 This meeting should occur during the Schematic Design phase of the project 15 HVAC System Goals 2 carrierpackage rooft top unitsfor the dining area,and 1for the kitchen,along with a small minisplitfor the MIS room to
<br /> 06 §120.8(g This requirement does not apply. Design Review Kickoff Meeting Details keep equipment coal. The kitchen utilizes makeup air and exhaust fans to ensure fresh,clean air is circulated. RE[IISION RECORD
<br /> Performance Testing 01 Date of Design Review Kickoff Meeting -----710/8/2018 16 Indoor Lighting System Goals LED lighting with some decorative LED lighting for the dining area.hat utilizes a combination of controls that meet the code
<br /> 07 Table L:Documentation and §120.8(h) This requirement does not apply. requirements to minimize electricity use.
<br /> Training 02 Meeting Attendees:(one person may play multiple roles) 17 Outdoor Lighting System Goals All LED lighting that utilizes a combination of controls that meet the code requirements to minimize electricity use.
<br /> Table M:Commissioning Owner/Facility Manager: In-N-Out Burger Design Reviewer(s): 18 Water Heating System Goals 2 water heaters are usedfor bathroom and cleaning and cooking needs. These are high efficient condensing units.
<br /> 08 Report §U2U8Ci) This requirement does not apply. Project Manager: Alex Romero,GHA Design Architect/Engineer(s): Andy Gerdes,GHA 19 Equipment and System Specifications All kitchen equipment and mechanical units either meet or exceed Title-20 and Title-24 equipment efficiency requirements
<br /> Contractor: Certified Acceptance Test Tech(s): thus ensuring high performance and reduced energy use.
<br /> Commissioning Provider: Energy/T24 Part 6 Consultant: Travis Wade;Wade Energy IN-N-OUT burger has staff on call that make routine checks on the building to ensure all HVAC,applicances,and lighting
<br /> IDesign Reviewer Qualifications per Title 24,Part 1 Section 10-103Lall 20 Operations and Maintenance continue to operate as designed as well as replace and change filters and equipment under a planned scheudle to ensure
<br /> Table Continued maxinjum efficiency output
<br /> CA Building Energy Efficiency Standards-2016 Nonresidential Compliance:http://www.energy.ca.gov/title24/2016standards July 2018 CA Building Energy Efficiency Standards-2016 Nonresidential Compliance:http://www.energy.ca.gov/title24/2016standards July 2018 CA Building Energy Efficiency Standards-2016 Nonresidential Compliance:htLp://www.energy.ca.gov/title24/2016standards July 2018
<br /> STATE OF CALIFORNIA
<br /> Nonresidential Building Commissioning
<br /> NRCC-CXR-E(Created 7/18) CALIFORNIA ENERGY COMMISSION
<br /> CERTIFICATE OF COMPLIANCE NRCC-CXR-E PROFESSIONAL SEAL
<br /> Project Name: In-N-Out Burger �port Page. Page 4 of 5
<br /> Project Address: SEQ of River Island Pkwy&Golden Valley Pkwy JDate Prepared: 2018-10-16
<br /> 1G.OWNER'S PROJECT REQUIREMENTS(OPIR)
<br /> 1 This Section Does Not Apply
<br /> IH.BASIS OF DESIGN(BOD) M2W
<br /> This Section Does Not Apply
<br /> 1.CONSTRUCTION DOCUMENT DESIGN REVIEW CHECKLIST Ott)
<br /> Table Instructions:The design reviewer(s)mayfill out the table below or attach a design review document that lists the items checked by the design reviewer(s)during the
<br /> construction document review. For buildings with 2�10,000ft'conditionedfloor area,the design review will ensure the construction documents meet the Owner's Project ID
<br /> Requirements(Table G.)and the Basis of Design Documents(Table H.). For buildings with<10,000 ft'conditioned floor area,the design review will ensure the construction
<br /> documents meet the goals documented in Table F.during the Design Review Kickoff.
<br /> 01 �Attaching Completed Design Review Documentation? YES NO
<br /> J.COMMISSIONING PLAN t
<br /> This Section Does Not Apply
<br /> M
<br /> IK.FUNCTIONAL PERFORMANCE TESTING
<br /> This Section Does Not Apply engineering consultants
<br /> 14901 Quorum Dr. #565 Dallas, TX 75254
<br /> IL.DOCUMENTATION AND TRAINING rtmassociates.com 1 972.387.3500
<br /> This Section Does Not Apply
<br /> I 8,GHAA.033
<br /> M.COMMISSIONING REPORT
<br /> This Section Does Not Apply PROTOTYPE []ERSION
<br /> URBAN DESIGN
<br /> IN.DECLARATION OF REQUIRED CERTIFICATES OF INSTALLATION
<br /> There are no Certificates of Installation applicable to commissioning requirements. STATE OF CALIFORNIA AV%, STATE OF CALIFORNIA AOII& PRO[JECT NAME
<br /> 0.DECLARATION OF REQUIRED CERTIFICATES OF ACCEPTANCE COMMERCIAL KITCHEN REQUIREMENTS M. COMMERCIAL KITCHEN REQUIREMENTS
<br /> Although there are no"CXR"Certificates of Acceptance required to document commissioning requirements,Certificates of Acceptance may be used to supplementfunctional CEC-NRCC-PRC-03-E(Revised 01/16) CALIFORNIA ENERGY COMMISSION CEC-NRCC-PRC-03-E(Revised 011/16) CALIFORNIA ENERGY COMMISSION
<br /> performance testing required by§120.8(g) CERTIFICATE OF COMPLIANCE NRCC-PRC-03-E CERTIFICATE OF COMPLIANCE NRCC-PRC-03-E IN-N-OUT
<br /> Commercial Kitchen Requirements (Page 1 of 2) Commercial Kitchen Requirements (Page 2 of 2)
<br /> Prclect Name: In-N-Out Burger Date Prepared: 10/16/2018 Project Name: In-N-Out Burger DatePrepare'; 10/16/2018 BURGER
<br /> KITCHEN ROOM NUMBER: Kitchen DOCUMENTATION AUTHORS DECLARATION STATEMENT
<br /> CA Building Energy Efficiency Standards-2016 Nonresidential Compliance:htLp://www.energy.ca.gov/title24/2016standards July 2018 TOTAL INSTALLED TYPE I and 11 KITCHEN HOOD EXHAUST(CFM): 2,990 1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
<br /> Documentation Author Name: Alex Garcia Documentation Author Signature:H�
<br /> TOTAL BYPASS HOOD MUA(CFM): 2,100 C,,,,n,: Wade Energy Signature Date: 10/16/2018 LATHROP
<br /> TOTAL TRANSFER AIR AIRFLOW(CFM): 7,000
<br /> TOTAL MECHANICALLY HEATED OR COOLED MAKE UP AIR(CFIVI 7,000 Address; 1942 Linda Dr. CEA/HERS Certification Identification(if applicable); CALIFORNIA
<br /> TOTAL AIR NEEDED FOR HEATING OR COOLING(CFM): 7,000 City/State/Zip: Pleasant Hill,CA 94523 Phone: (925)326-6330
<br /> STATE OF CALIFORNIA TOTAL EXHAUST AIR WITH DEMAND VENTILATION SYSTEMS: 2,990 RESPONSIBLE PERSON'S DECLARATION STATEMENT
<br /> Nonresidential Building Commissioning I certify the following under penalty of perjury,under the laws of the State of California: 16514 GOLDEN OALLEY POO Y
<br /> NRCC-CXR-E(Created 7/18) CALIFORNIA ENERGY COMMISSION Equipment Tags and System Description Kitchen Exhaust Fans 1. The information provided on this Certificate of Compliance is true and correct.
<br /> CERTIFICATE OF COMPLIANCE NRCC-CXR-E 2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design LATHROP, CA 95330
<br /> Project Name: In-N-Out Burger :J�:e:p:o:rt Page: Page 5 of 5 PRESCRIPTIVE MEASURES T-24 Sections Reference to the Requirements in the Contract Documents? identified on this Certificate of Compliance(responsible designer).
<br /> Project Address: SEQ of River Island Pkwy&Golden Valley Pkwy IDate Prepared: 2018-10-16 Bypass Hood Exhaust and MUA 140.9(b)IA M2.0 3. The energy features and performance specifications,materials,coimponents,and manufactured devices for the building design or system
<br /> 140.9(b)18, design identified on this Certificate of Compliance conform to the requirements of Title 24,Part I and Part 6 of the California Code of
<br /> DOCUMENTATION AUTHOR'S DECLARATION STATEMENT Type 1/11 Hood Exhaust M2.0 Regulations.
<br /> 16 Table 140.9-A 4. The building design features or system design features identified on this Certificate of Compliance a consis n with the information
<br /> Documentation Author Name: Alex Garcia Documentation Author Signature: kA<11117X Mechanically Heated or Cooled Make 140.9(b)2Ai and M2.0 provided on other applicable compliance documents,worksheets,calculations,plans and specific ion submitted to the enforcement
<br /> Company: Wade Energy Signature Date: 10/16/2018 Up Air ii agency for approval with this building permit application.
<br /> Replacement Air/Transfer Air Exhaust 140.9(b)28i M2.0 5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be made avail wit the building permit(s)issued for the
<br /> Address: 1942 Linda Dr. CEA/HERS Certification Identification(if applicable): building,and made available to the enforcement agency for all applicable inspections.I un er d th a completed signed copy of this
<br /> In ea r c'
<br /> _I c 'on
<br /> I _it
<br /> d th
<br /> Demand Ventilation Systems 140.9(b)2Bii n/a Certificate of Compliance is required to be included with the docurnentation the builder p vi $to t4 IyAf4a ancy.
<br /> City/State/Zip: Pleasant Hill,CA 94523 Phone: (925)326-6330 Energy Recovery Systems 140.9(b)2Biii n/a Responsible Designer Name:David Lippe Responsible Designer Signature: $1 kowner at occupancy.
<br /> RESPONSIBLE PERSON'S DECLARATION STATEMENT
<br /> I certify the following under penalty of perjury,under the laws of the State of California: Tempered/Non Mechanical Cooling Air 140.9(b)2Biv M2.0 company:RTM Engineering Consultanting Date Signed: V 10-18-2018 NoNmOUT
<br /> 1.The information provided on this Certificate of Compliance is true and correct. Systems Address: 14901 Quorum Drive,#565 License: M29234 11LBURGERe
<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 City/State/ZiP: Dallas,Texas 75254 Phone: (972)387-3500
<br /> Compliance(responsible designer)
<br /> 3.The energy features and performance specifications,materials,components,and manufactured devices for the building design or system design identified on this GOD BLESS AMERICA
<br /> Certificate of Compliance conform to the requirements of Title 24,Part I and Part 6 of the California Code of Regulations.
<br /> 4.The building design features or system design features identified on this Certificate of Compliance are consistent with the inforp�atlon provided on other applicable
<br /> compliance documents,worksheets,calculations,plans and specifications submitted to the enforcement agency for approv wit this building permit application.
<br /> S. I will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permi lss�edl for the building,and made available
<br /> to the enforcement agency for all applicable inspections.I understand that a completed signed copy of this Certificate of C 311apce is required to be included with the
<br /> documentation the builder provides to the building owner at occupancy. F A PRO[]ECT NUMBER
<br /> Responsible Designer Name: David Lippe Responsible Designer Signature: W 180641.001
<br /> Company: RTM Engineering Consultanting Date Signed: W- - 10-18-2018
<br /> Address: 14901 Quorum Drive,Suite 565 License: M29234 SHEET TITLE
<br /> City/State/Zip: Dallas,TX 75254 Phone: (972)387-3500
<br /> TITLE 04
<br /> COMPLIANCE
<br /> co
<br /> FORMS
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<br /> C)
<br /> SHEET NUMBER
<br /> C:) CD
<br /> CA Building Energy Efficiency Standards-2016 Nonresidential Compliance January 2016 CA Building Energy Efficiency Standards-2016 Nonresidential Compliance January 2016 T04= 4
<br /> CA Building Energy Efficiency Standards-2016 Nonresidential Compliance:htLp://www.energy.ca.gov/title24/2016standards July 2018
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