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STATE OF CALIFORNIA STATE OF CALIFORNIA STATE OF CALIFORNIA Domestic Water Heating System Domestic Water Heating System Domestic Water Heating System NRCC-PLB-E CALIFORNIA ENERGY COMMISSION NRCC-PLB-E CALIFORNIA ENERGY COMMISSION NRCC-PLB-E CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-PLB-E CERTIFICATE OF COMPLIANCE NRCC-PLB-E CERTIFICATE OF COMPLIANCE NRCC-PLB-E 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 Name: Gospel Center Rescue Mission Kitchen Remodel Report Page: (Page 2 of 7) Project Name: Gospel Center Rescue Mission Kitchen Remodel Report Page: (Page 3 of 7) ri 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: 445 S San Joaquin Street Date Prepared: 12/14/2020 Project Address: 445 S San Joaquin Street Date Prepared: 12/14/2020 requirements in 110.1 110.3 120.3 150.0 and§150.1(c)8,and with requirements 150.2 for additions. Project Name: Gospel Center Rescue Mission Kitchen Remodel Report Page: (Page 1 of 7) Project Address: 445 S San Joaquin Street Date Prepared: 12/14/20201 C.COMPLIANCE RESULTS F.DOMESTIC HOT WATER EQUIPMENT 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 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 A.GENERAL INFORMATION Exceptional Conditions"refer to Table D.or the table indicated as not compliantfor guidance. prescriptive requirements in150.1 c 8 must also be demonstrated and with 1150.2 for addition and alteration scopes. W M B 01 lProject Location(city) IStockton 102 IClimate Zone 112 01 02 03 04 Equipment Schedule:Individual Systems 03 loccupancy Types Within Project(select all that apply): Domestic Hot Water Equipment Distribution Systems Controls Compliance Results 01 02 03 04 05 ARCHITECTS ® Nonresidential El High-RiseResidential ElHotel/Motel Table F Table G Table H Max GPM/First Rated Uniform Name or Equipment T e Volume al Hour Rating Ener Factor Minimum Required Uniform Ener Factor UEF ' ❑ State Building ❑ Healthcare Facility ❑ Other(Write In) Yes Yes Yes COMPLIES Item Tag Yp (gal) g gy q Energy ( } (FHR) (UEF) B.PROJECT SCOPE D.EXCEPTIONAL CONDITIONS BRADFOR D WHITE Residential-Duty Commercial Gas-Fired 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 This table is auto filled with uneditable comments because of selections made or data entered in tables throughout the form. D WHITE Storage Duty Commercial BTUH) 56-60 0<=GPM<1.7 0.6 0.21 5757 Pacific Avenue §150.1(08.and§141.0(c) or§141.0(b)2N for additions or alterations.Solar water heating systems are documented on the NRCC-SRA compliance document. Combined hydronic water E3N Suite 226 heating systems are documented on the NRCC-MCH compliance document. E.ADDITIONAL REMARKS 'FOOTNOTE:Compliant equipment may befound in the Modernized Appliance Efficiency Database System MAED85 on the Energy Commission website: Stockton, CA 95207 01 02 03 1 This table is includes remarks made by the permit applicant to the Authority Having Jurisdiction. https://cacertappliances.energy.ca.gov/Pages/Search/Advancedsearch.aspx My project consists of(check all that apply): System Type'' System Components Water Heating Equipment All Occupancies New system(DHW system being installed for the first time in newly Yes No Not Applicable Requirement 2000 L Street ® Individual System(serving nonresidential spaces) ® Equipment ® Distribution ® Controls Suite 125 constructed building} 18 Unfired storage tank insulation shall have Internal+External>=R-16 OR External>=R-12.Label required 1. ❑ System Alteration(equipment,distribution or controls) ❑ Equipment ❑ Distribution ❑ Controls ® per§11o.3(c)3 Sacramento, CA 95811 'FOOTNOTES:Point of use water heaters,or other non-central systems used to serve nonresidential spaces,are considered individual systems. 19 ,Q ® New state buildings 60%of energy for service water heating from site solar energy or recovered energy Dwelling units refers to hotel/motel guest rooms and units in a high-rise residential occupancy. per§11o.3(c)5 20 ❑ ® Isolation valves for instantaneous water heater with input rating<6.8 kBTUH or 2 kW has been specified T 209.944.9110 per§11o.3fc)6 F 209.944.5711 www.wmbarchitects.com Registration Number: Registration Date/Time: Registration Provider:Energysoft 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:2020-12-14 15:38:36 CA Building Energy Efficiency Standards-2019 Nonresidential Compliance Report Version:2019.1.003 Report Generated:2020-12-14 15:38:36 CA Building Energy Efficiency Standards-2019 Nonresidential Compliance Report Version:2019.1.003 Report Generated:2020-12-14 15:38:36 Schema Version:rev 20190401 Schema Version:rev 20190401 Schema Version:rev 20190401 STATE OF CALIFORNIA STATE OF CALIFORNIA STATE OF CALIFORNIA Domestic Water Heating System Domestic Water Heating System Domestic Water Heating System NRCC-PLB-E CALIFORNIA ENERGY COMMISSION NRCC-PLB-E CALIFORNIA ENERGY COMMISSION NRCC-PLB-E CALIFORNIA ENERGY COMMISSION Gospel Center Rescue CERTIFICATE OF COMPLIANCE NRCC-PLB-E CERTIFICATE OF COMPLIANCE NRCC-PLB-E CERTIFICATE OF COMPLIANCE NRCC-PLB-E Project Name: Gospel Center Rescue Mission Kitchen Remodel Report Page: (Page 4 of 7) Project Name: Gospel Center Rescue Mission Kitchen Remodel Report Page: (Page 5 of 7) Project Name: Gospel Center Rescue Mission Kitchen Remodel Report Page: (Page 6 of 7) Mission Kitchen Project Address: 445 S San Joaquin Street Date Prepared: 12/14/2020 Project Address: 445 S San Joaquin Street Date Prepared: 12/14/2020 Project Address: 445 S San Joaquin Street Date Prepared: 12/14/2020 Remodel G.DOMESTIC HOT WATER DISTRIBUTION SYSTEM H.DOMESTIC HOT WATER CONTROLS J.DECLARATION OF REQUIRED CERTIFICATES OF ACCEPTANCE 445 S San Joaquin St. This table is used to demonstrate compliance for nonresidential occupancies with distribution requirements in 120.3 and 140.5.For high-rise residential and hotel/motel occupancies, This table is used to demonstrate compliance with control requirements in q110.3 for all occupancies.For high-rise residential and hotel/motel occupancies,compliance is also IThere are no Certificates of Acceptance applicable to service water heating requirements. Stockton, CA 95203 compliance is demonstrated with requirements 110.3c 120.3 150.0 150.1 demonstrated with requirements in§150.1(c)$. Mandatory Pipe Insulation All Occupancies Yes No Requirement A Not K.DECLARATION OF REQUIRED CERTIFICATES OF VERIFICATION 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 : Applicable 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. 12 ® Recirculating system piping,including supply and return piping of the water heater 01 ® El ElConstruction documents require manufacturer certification that service water-heating systems are equipped with automatic Additional Remarks. These documents must be completed by a HERS Rater and provided to the building inspector during construction.Thefincl documents must be created by a HERS • The first 8 ft of hot and cold outlet piping,including between storage tank and heat trap,for a nonrecirculating storage system temperature controls capable of adjusting temperature settings per110.3 a . Providers registry,butdrafts can be found online at https://www.energy.ca.gov/title2412019standcirds/2019 compliance_documents/Nonresidential DocumentsINRCiI ENERGY • Pipes thatare externally heated Systems with capacity>167,000 BTUH equipped with outlet temperature controls per§110.3(c)1 unless covered by California Field Inspector oz ® El 11 Systems No Form/Title COMPLIANCE 13 ® Insulation shall be protected from damage,including that due to sunlight,moisture,equipment maintenance,and wind.Insulation exposed to weather shall Plumbing Code 613.0. Pass Fail be installed with a cover suitable for outdoor service per§120.3(b) and§150.0(0)3 03 ❑ ❑ ® Controls for circulating pumps or electrical heat trace systems are capable of automatically turning off the system per 0 • NRCV-PLB-21-H High-rise Residential Central Hot Water Distribution HERS Verification ❑ ❑ TABLE 120.3-A PIPE INSULATION THICKNESS 110.3 c 2 unless systems serves healthcare facility. 0 ! NRCV-PLB-22-H High-rise Residential Individual Dwelling Unit Hot Water Distribution HERS Verification ❑ ❑ Nominal Pipe Diameter In For recirculation systems serving multiple dwelling units,design includes automatic pump controls per§150.1(c)8Bi(,or 150.2 Conductivity Range P (� ) 04 ❑ ❑ ® for additions or alterations. Fluid Temperature Range(°F) (Btu-in per hour Insulation Mean Rating Temp(°F) <1 1 to<1.5 1.5 to<4 per ft'per°F) Minimum Insulation Required 05 ❑ ❑ ® For recirculation systems serving individual dwelling units,design includes manual on/off controls as specified in Reference Appendix RA4.4.9 per 150.1 c 8. 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 For replacement single heat pump water heaters serving individual dwelling units in climate zone 1-15,design includes 06 El L3 ® communication interface that meets demand responsive control requirements of§110.12 .2(b1H .a I.DECLARATION OF REQUIRED CERTIFICATES OF INSTALLATION 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 https://www energy.ca.gov/title24/2019standards/2019 compliance documents/Nonresidential Documents/NRCl/ Yes No Form/Title Field Inspector Pass Fail • 0 NRCI-PLB-01-E-Must be submitted for all buildings ❑ ❑ 0 411111 NRCI-PLB-02-E-Must be submitted for high-rise residential and hotel/motel central hot water distribution systems to be ❑ ❑ recognized for compliance. 411111 NRCI-PLB-03-E-Must be submitted for high-rise residential and hotel/motel single dwelling unit hot water distribution systems to ❑ ❑ The recognized for compliance. Registration Number: Registration Date/Time: Registration Provider:Energysoft 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:2020-12-14 15:38:36 CA Building Energy Efficiency Standards-2019 Nonresidential Compliance Report Version:2019.1.003 Report Generated:2020-12-14 15:38:36 CA Building Energy Efficiency Standards-2019 Nonresidential Compliance Report Version:2019.1.003 Report Generated:2020-12-14 15:38:36 Schema Version:rev 20190401 Schema Version:rev 20190401 Schema Version:rev 20190401 C A U STATE OF CALIFORNIA co Domestic Water Heating System PUBLISH HISTORY: NRCC-PLB-E CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-PLB-E No. DATE PURPOSE QProject Name: Gospel Center Rescue Mission Kitchen Remodel Report Page: (Page 7 o 7) 12.17.20 PERMIT SUBMITTAL Project Address: 445 S San Joaquin Street date Prepared: 12/14/2020 03.12.21 PLAN CHECK#1 N DOCUMENTATION AUTHOR'S DECLARATION STATEMENT N I certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: N �- Emiliano Solorio Company: Signature Date: OCTALEXANDER SCHEFLO&ASSOCIATES 2020-12-14 L Address: CEA/HERS Certification Identification(if applicable): a 2926 Pacific Ave. City/State/Zip: Phone: Stockton CA 95204 209-948-9761 sT 3 RESPONSIBLE PERSON'S DECLARATION STATEMENT 1 certify the following under penalty of perjury,under the laws of the State of California: O 1. The information provided on this Certificate of Compliance is true and correct. � N 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) F_ 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 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. (C) 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 building,and made available to the enforcement agency for all applicable 0) Cp inspections.I understand that a completed signed mPY of this Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy. Y• u7 Responsible Designer Name: Responsible Designer Signature: Mitch Scheflo Company: Date Signed: Alexander Scheflo&Associates Inc. 2020-12-14 n Address: License: Q 2926 Pacific Avenue M025588 WMB PROJECT: / City/State/Zip: Phone: CL E Stockton CA 95204 209-948-9761 �, 20-04 / U O J / ° ALEXANDER SCHEFLO \_ A S and ASSOCIATES, Inc. T24 .0 L Registration Number: Registration Date/Time: Registration Provider:Energysoft Mechanical Engineers (209) 948-9761 2926 Pacific Ave. Stockton, Ca. 95204 CA Building Energy Efficiency Standards-2019 Nonresidential Compliance Report Version:2019.1.003 Report Generated:2020-12-1415:38:36 025 8 /n Schema Version:rev 20190401 * Exp. 09-30-22 ALL DRAWINGS AND WRITTEN MATERIAL APPEARING HEREIN CONSTITUTE THE ORIGINAL AND UNPUBLISHED WORK OF THE o, 9l F�HAN��P pQ� ENGINEER AND THE SAME MAY NOT BE USED, DUPLICATED, OR j F OF- CAS �F DISCLOSED WITHOUT THE WRITTEN CONSENT OF THE ENGINEER. © Alexander Scheflo & Assoc., Inc �j Copyright WI J_ FT