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HomeMy WebLinkAboutX2021-2737 - Inspection Final Docs (4)STATE OF CALIFORNIA COVERED PROCESSES CEC-NRCI-PRC-01-E iRevised 01/2M P Ai iCnRnue CAiCof-`v!`nKARAiQQinKI CERTIFICATE OF INSTALLATION NRCI-PRC-01-E Covered Processes (Page 1 of 2) Project Name: L�¢otwa r atbbr o.vA Enforcement Agency: Q f 2.0 cr Pernik Number: C�Ch O? -2737 Project Address: O riew . (ac My: 1J�.io r•i e--oA Zip Code: 92"() GENERAL INFORMATION DATE OF BUILDING PERMIT: PERMIT #: ,X`2021 2737 PHASE OF CONSTRUCTION New Construction -❑ Addition ❑ Alteration If more than one person has responsibility for building construction, each person shall prepare and sign an Installation Certificate document applicable to the portion of construction for which they are responsible, alternatively, the person with chief responsibility for construction shall prepare and sign the Installation Certificate document(s) for the entire construction. SCOPE OF RESPONSIBILITY Enter the date of approval by enforcement -agency of the Certificate of Compliance thdt provides Date: the specifications for the energy efficiency measures for the scope of responsibility for this 1 O _ ( Z - zo Zz Installation Certificate. In the table below identify all applicable construction documents that specify the requirements for the scope of responsibility for this Installation Certificate. Document Title or Description Applicable Sheets or Pages, Tables, Schedules, etc. Date Approved By the Enforcement Agency >n�cs^1 -r#le 5h'e-, AAA- 0 1 to— 12-'ZO2Z Me VAC.\, -CC j ScV1ed-Zte. j'` 010 , AAO. 03 to-sz-ZoZZ CA Building Energy Efficiency Standards - 2019 Nonresidential Compliance January 2020 STATE OF CALIFORNIA COVERED PROCESSES PC^ kiml i oo/ n4 C ro...dd n4m CAI IFORNIA ENERGY COMMISSION VCERTIFICATE OF INSTALLATION NRCI-PRC-01-E Covered Processes (Page 2 of 2) Project Name: ) ` ew'fV-- i (1 & c 0164 Se&: i cvzo Enforcement.Agenry: ('k4 6F Cw ct Permit Number. 701V -2.737 Project Address: 101 n Pl,�e. 1 V QY Y � C ul+ f _ c": New s t� LpCode: � �Z t� O DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name: 3-ohm Gs4'CErcw Documentation Author Signature: Documentation Author Company Name: Date Signed: ^ �� L %2©z y :C roer`� ecwuK:Lc+ S�rv".t�S Address: "1'vtv�Sko>1 CEA/HERS Certification Identification (If applicable): Illr'ib �avt City/State/Zip: M;rc, Lo�,,o, CA 91`) .2 Phone: 951 - 2- Lit - 5392 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of installation is true and correct. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction, or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Installation and attest to the declarations in this statement (responsible builder/installer), otherwise I am an authorized representative of the responsible builder/installer. 3. The constructed or installed features, materials, components or manufactured devices (the installation) identified on this Certificate of Installation conforms to all applicable codes and regulations, and the installation conforms to the requirements given on the plans and specifications approved by the enforcement agency. 4. 1 reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the specific requirements for the scope of construction or installation identified on this Certificate of Installation, and I have ensured that the requirements that apply to the construction or installation have been met. S. I will ensure that a completed signed copy of this Certificate of Installation shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a completed signed copy of this Certificate of Installation is required to be included with the documentation the b ' r provides to the building owner at occupancy. Responsible Builder/Installer Name: %/ _ �I��'1Y11n• `O��'re,YFAS Responsible Builder/Installer5ignature: Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Position With Company (Title): p L,r; %ravt vo-�%-tc ACV%a►zcc;, 5arv:ce$ Address: i I Llo I-Kyc- Lc► CSLB License: 995y City/state zip: M Phone: 95I— ZL(1_539Z Date Signed: Z- y j -ZczA try CA CERTIFICATE OF INSTALLATION —USER INSTRUCTIONS NRCI-PRC-01-E Covered Processes (Page 1 of 1) NRCI-PRC-01-E User Instructions General Information DATE OF BUILDING PERMIT- enter the date wheh.the building department issued the permit PHASE OF CONSTRUCTION indicates the status of the building project described in the compliance.documents. Refer to the Nonresidential Compliance Manual Section 1.7 for detailed discussion of the various choices. 1. NEW CONSTRUCTION should be checked for all new buildings, newly conditioned space or for new construction in existing buildings (tenant improvements, see Section 1.7.11 and 1.7.12) that are submitted for envelope compliance. 2. ADDITION should be checked for an addition which is not treated as a stand-alone building, but which uses option 2 described in Section 1.7.14. Tenant improvements that increase conditioned floor area and volume are additions. 3. ALTERATION should be checked for alterations to an existing building mechanical systems (see Section 1.7.13). Tenant improvements are usually alterations. Scope of Responsibilities DOCUMENT TITLE OR DESCRIPTION — Enter the construction document that specifies the installed feature, material, component, manufactured device or system performance diagnostic results required for compliance as specified on the certificate of compliance APPLICABLE SHEETS — Identify the corresponding pages that address the scope of responsibilities in the document. DATE - Enter the date the enforcement agency approved the Certificate of Compliance (NRCC-PRC-XX) that used as the basis of the specifications used to demonstrate compliance. Documentation Author's Declaration Statement The CERTIFICATE OF INSTALLATION is signed by both the Documentation Author and the Principal Designer who is responsible for preparation of the plans of building. This latter person is also responsible for the energy compliance documentation, even if the actual work is delegated to a different person acting as Documentation Author. It is necessary that the compliance documentation be consistent with the plans. DOCUMENTATION AUTHOR is the person who prepared the energy compliance documentation and who signs the Declaration Statement. The person's telephone number is given to facilitate response to any questions that arise. A Documentation Author may have additional certifications such as a Certified Energy Analyst or a Home Energy Rating System certification number. Enter number in the CEA# or HERS# field provided. Declaration Statement of Principle Designer The Declaration Statement is signed by the person responsible for preparation of the plans for the building and the documentation author. This principal designer is also responsible for the energy compliance documentation, even if the actual work is delegated to someone else (the Documentation Author as described above). It is necessary that the compliance documentation be consistent with the plans. The Business and Professions Code governs who is qualified to prepare plans and therefore to sign this statement. See Section 2.2.2 Permit Application for applicable text from the Business and Professions Code. CA Building Energy Efficiency Standards - 2019 Nonresidential Compliance January 2020 STATE OF CALIFORNIA COMMERCIAL KITCHEN EXHAUST SYSTEM ACCEPTANCE CEC-NRCA-PRC-02-F iRevised MMM CAI IMPNIA FNFRGY CAMMIRAIAN CERTIFICATE OF ACCEPTANCE NRCA-PRC-02-F Commercial Kitchen Exhaust System Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: City of Newport -Beach Permit Number: X2021 Project Address:101 Bayview Place `ky'Newport Beach Zip Code:92660- Compliance Results:. Enforcement Agency Use: Checked by/Date ®' COMPLIES Q DOES NOT COMPLY Intent: I Verify that airside economizers function properly A. Construction Inspection iNA7.11.1.i1 ❑✓ a, I Exhaust and replacement air systems are installed ❑✓ b. Control systems (such as demand control ventilation) are calibrated C. For kitchen/dining facilities having total Type 1 and Type II kitchen hood exhaust airflow rates greater than 5,000 cfm, calculate the maximum allowable exhaust rate for each Type 1 hood as specified by Table 140.9-A. Construction Inspection Compliance: (9 Complies 0 Does Not Comply B. Functional Testing (NA7.11.1.2) The following acceptance test applies to systems with and without demand control ventilation exhaust systems. These tests shall be conducted at full load conditions for each hood. Step 1: Setup: a. Operate all sources of outdoor air providing replacement air for the hoods. +� P / F 0 b. Operate all sources of recirculated air providing conditioning for the space in which the hoods are located. O P / F O C. Operate all appliances under the hoods at operating temperatures. V P / F Step 2: Verify the following: Verify that the thermal plume and smoke is completely captured and contained within each hood at full load conditions by observing smoke or steam produced by actual cooking operation and/or by visually seeding the thermal plume using devices such as smoke candles or smoke puffers. Smoke bombs shall not be used (note: smoke a bombs typically create a large volume of effluent from a point source and do not necessarily confirm whether the O P / F cooking effluent is being captured). For some appliances (e.g., broilers, griddles, fryers), actual cooking at the normal production rate is a reliable method of generating smoke). Other appliances that typically generate hot moist air without smoke (e.g., ovens, steamers) need seeding of the thermal plume with artificial smoke to verify capture and containment. b Verify that space pressurization is appropriate (e.g. kitchen is slightly negative relative to adjacent spaces and all P / F doors open/close properly). C. Verify that each Type 1 hood has an exhaust rate that is at or below the maximum allowed. PQQ F QNA Step 3: Make adjustments as necessary until full capture and containment and adequate space pressurization are achieved and maximum allowable exhaust rates are not exceeded. Adjustments may include: adjust exhaust hood airflow rates; Add hood side panels; Add rear seal (back plate); Increase hood overhang by pushing hood back; and Relocate supply outlets to improve the capture and containment performance Step 4: Measure and record the final airflow for each Type I hood. P (DF ONA O The following additional acceptance test shall be performed on all exhaust hoods with demand control ventilation exhaust systems. Step 5: Turn off all kitchen hoods, makeup air and transfer systems Step 6: Turn on one of the appliances on the line and bring to operating temperature. Confirm that: a. DCV system automatically switches from off to the minimum flow setpoint. t P / F O b The minimum flow setpoint does not exceed the larger of: 50% of the design flow; or, the ventilation rate required @ P / F per Section 120.1. C. The makeup air and transfer air system flow rates modulate as appropriate to match the exhaust rate. O P / F d. Appropriate space pressurization is maintained. Q P / F Step 7: Press the timed override button. Confirm that system ramps to full speed and back to minimum speed after override Q P / F times out. Step 8: Operate all appliances at typical conditions. Apply sample cooking products and/or utilize smoke puffers as appropriate to simulate full load conditions. Confirm that: a. DCV system automatically ramps to full speed. Q P / F Q CA Building Energy Efficiency Standards - 2019 Nonresidential Compliance January 2019 STATE OF CALIFORNIA COMMERCIAL KITCHEN EXHAUST SYSTEM ACCEPTANCE r.Fr-NRr.A-PRC-ro-F (Ravicwri n1/1Q1 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-PRC-02-F Commercial Kitchen Exhaust System Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: City of Newport. Beach Permrt Number: X2021 Project Address.101 Bayview Place City: Newport Beach zip Code:92660 b. . Hood.maintains full capture and containment during ramping to and at full -speed. Q. Pj F O c. Appropriate space pressurization is maintained. QQ P / F 0 Functional Testing Compliance: Q Complies O Does Not Comply CA Building Energy Efficiency Standards - 2019 Nonresidential Compliance January 2019 STATE OF CALIFORNIA COMMERCIAL KITCHEN EXHAUST SYSTEM ACCEPTANCE CEC-NRCA-PRC-02-F Revised 01/19`1 _ CAI CERTIFICATE OF ACCEPTANCE Commercial Kitchen Exhaust System Acceptance Project Name` Clearwater Harbor Point Senior Living Enforcement Agency: City of Newport Beach Project Address. 101 Bayview Place Cam` Newport Beach OMISSION 30 N RCA-PRC-02-F (Page 3 of 3) Permit Number: X2021 Zip Code: 92660 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical �- Date Signed: _©� Address:11140 Thurston Lane CEA/HERS/A Certification IdendfYwti applicable): city/state/zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with t e building p r it(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Servi Position with Company (Title): Techni an Address` 11140 Thurston Lane CEA/HERS/ATTCertification Identification (If applicable): city/state' `P: Mira Loma, CA 91752 / Phone: 951-361-2247 Date Signed: ZIS/ ZGZ y RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provide a ilding owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: r Responsible Acceptance Person Company Name: Christian Brothers Mecha& Position with Company (Title): Project M ager Address:11140 Thurston Lane CSLB License:499547 city/state/zip:Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: 7, 1/2pzI 5 CA Building Energy Efficiency Standards - 2019 Nonresidential Compliance January 2019 STATE OF CALIFORNIA ENCLOSED PARKING GARAGE EXHAUST SYSTEM ACCEPTANCE CEC-NRCA-PRC-03-F (Revised 01/1A) rtni Me'APKnn GUGar-v enneneiccinu ------ -------------- CERTIFICATE OF ACCEPTANCE -------------- NRCA-PRC-03-F Enclosed Parking Garage Exhaust System Acceptance (Page 1.of 2) Project Name: Clearwater Harbor Point Senior Living a^�rceme°`tee°"`City of Newport Beach Permit Number: X2021-27 fi Project Address:101 Bayview Place `iwNewport Beach Zip Code:62660 - Compliance Results: Enforcement Agency Use: Checked by/Date 0 COMPLIES 0 DOES NOT COMPLY Intent: I Verify that airside economizers function properly A. Construction Inspection NA7.12.1 Prior to Functional Testing, verify and document the following: ❑✓ a. Carbon monox' ide.control sensor is factory -calibrated & 120.6 c . ❑✓ b.. . The'sensor is located in the highest expected concentration location in its zone ( 120.6 c . ✓❑ c. Control setpoint is at or below the CO concentration permitted ( 120.6 c)1. Construction Inspection Compliance: @ Complies Q Does Nat Comply B. Functional Testing (NA7.i2.2 Step 1: During a time of low activity (e.g. after hours or mid -morning or mid -afternoon) verify the following: a. All sensors active and reading a setpoint of <25ppm (2) P / F O b. Exhaust fans are running at minimum speed. @ P / F O C. Exhaust fans are drawing <30 rated power. (DP OF ®NA Step 2: Apply CO span gas with a concentration of 30 ppm, and a concentration accuracy of +/- 2%, one by one to 50% of the sensors but no more than 10 sensors per garage and to at least one sensor per proximity zone. For each sensor tested observe: a. CO reading is between 25 and 35ppm Q P / F O b. Exhaust fans go back to maximum speed when span gas is applied. Q P / F Q C. Exhaust fans go back to minimum speed when span gas is removed. (DP OF ®NA Step 3: Temporarily override the programmed sensor calibration/replacement period to 5 minutes. a. Wait 5 minutes and observe that fans ramp to full speed and an EMCS alarm is set. Restore calibration/replacement period. Q Step 4: Temporarily place the system in unoccupied mode and override the programmed unoccupied sensor alarm differential from 30% for 4 hours to 1%for 5 minutes. Wait 5 minutes and observe that fans ramp to full speed and an alarm is received by the facility operators. Restore a. programming. Q P / F O Step 5: Temporarily override the programmed occupied sensor proximity zone alarm differential from 30% for 4 hours to 1%for 5 minutes. a Wait 5 minutes and observe that fans ramp to full speed and an alarm is received by the facility operators. Restore programming. Q P / F Functional Testing Compliance: 0 Complies Q Does Not Comply CA Building Energy Efficiency Standards - 2019 Nonresidential Compliance January 2019 STATE OF CALIFORNIA ENCLOSED PARKING GARAGE EXHAUST SYSTEM ACCEPTANCE ror_siore_ooc_nzc rig —ion 1 M ilgi CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-PRC-03-F Enclosed Parking Garage Exhaust System Acceptance (Page 2 of 2) Project Name: Enforcement Agency: City Clearwater Harbor Point Senior Living City of Newport Beach Number: X2021-27E Project Address: 101 Bayview Place CRY: Newport Beach Zip Code: 92660 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT _ 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Brothers Mechanical S Date Date Signed:��/ ZC)ZLi Address: 11140 Thurston Lane CEA/HERS/ATTCertification Identification (Ifapplicable): city/state/zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available witl the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Servi Position with Company (Title): Techn cian Address:11140 Thurston Lane CEA/HERS/ATT Certification Identification (if applicable): City/state/Zip: Mira Loma, CA 91752 Phone:951-361-2247 Date Signed: Z / 5 zOz / RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provide uilding owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechan:T' Position with Company (Title): Project ana Address:11140 Thurston Lane CSLB License:499547 city/state/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 Date signed: CA Building Energy Efficiency Standards - 2019 Nonresidential Compliance January 2019 a I H I t yr tiHLlrvKrvlH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) r^AI IMIDNIA CnICGGv r•nKARA1cmnn1 CERTIFICATE OF ACCEPTANCE v NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/rag: AC-1-Ol System Location or Area Served: Elec Note: Submit one Certificate of Acceptance. for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply'Fon VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). L Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV); ❑ VAV 0 CAV a. Check if Variable Air Volume (VAV) and complete the following: I. Outside airflow is either factory calibrated or field calibrated. 0 Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): 0 Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: 0 System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) 5. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): 0 The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handier. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 01 A 1 t_ Ur %,ALIT V Krv1A OUTDOOR AIR ACCEPTANCE (';=('NRCA-Ur'14-19-A 1Ra%isad 07/1fil CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number. X2021-2737 Project Address: 101 Bayview Place City: - - Newport Beach zip Code: 92660 System Name or Identification rag: AC-1-Ol System Location or Area Served: Elec B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) - ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 699 cfm cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or C. Mechanical Equipment Schedules . 689 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 1.01 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5 110%) Yes @ No O Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes 0 No O Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes Q No o Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation �✓ PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J IA It: Ur UAL11-UM NIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System Name or Identification/Tag: AC-1-01 City: Newport Beach System Location or Area Served: Elec DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. I certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: Address: 11140 Thurston Lane ATTCertifica ' n I tification (ifa City/State/Zip: Mira Loma, CA 91752 Phone: 9 -241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT ENERGY NRCA-MCH-02-A (Page 3 of 3) Permit Number: X2021-2737 Zip Code: 92660 2 /S%zo2�f I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Todd Alpert ' Field Technician Signature: ^ Field Technician company Name: Christian Brothers Mechanical Services Position with company (T' e). Technician Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/state/Zip:Mira Loma, CA 91752 Phone: Date Signed: 951-361-2247 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: ResponsibleAc eP rsooLienafura• Johnny Contreras �l ter` - Acceptance Person Company Name: Christian Brothers Mechanical Address: 11140 Thurston Lane Mira Loma, CA 91752 (Title): Project Manager - 499547 Phone: 951-241-5392 Date Signed: 2/ZdZ CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I /%1 C Ur I.ALWUMNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System Name or Identification/Tag: AC-1-02 Enforcement Agency: City: Newport Beach System Location or Area Served: IDF NRCA-MCH-02-A (Page 1 of 3) Permit Number: X2021-2737 Zip Code: 92660 Note: Submit one Certificate of Acceptance for each system 1 Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction I Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) .since testing activities overlap. 1, Supporting documentation needed to perform test includes: a. As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NAZ5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NAZ5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). c. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). I. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ✓❑ CAV a. Check if Variable Air Volume (VAV) and complete the following: L Outside airflow is either factory calibrated or field calibrated. 0 Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (Le. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): M The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 JIAIt Vr• L.AL.1rUMNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07116) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System Name or Identification/Tag: AC-1-02 Enforcement Agency: City: Newport Beach System Location or Area Served: IDF B. NA7.5:1.1 Outdoor Air Acceptance Functional Testing Step 1: Disable demand control ventilation (if applicable) Step 2: Verify unit is not in economizer mode during test (economizer disabled) Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). b. Measured outdoor airflow reading (cfm) Required outdoor airflow (cfm) (from MCH-03, Column 14, or C. Mechanical Equipment Schedules). d Time for outside air damper to stabilize after full supply airflow is achieved - - - Step 4: VAV testing at reduced supply airflow a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). b. Measured outdoor airflow reading (cfm). C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): Step 5: Return to initial conditions (check) C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. Lai IA ENERGY COMMISSION N RCA-MCH-02-A (Page 2 of 3) Permit Number: X2021-2737 Zip code: 92660 CAV _L+A�VAV ❑✓ ❑ Hz 699 cfm cfm 689 cfm cfm CAV I VAV ❑✓ i ❑ min Hz cfm cfm min a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 1.01 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes @ No Q Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes Q No O Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA:5 110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes Q No Q Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I H I - Ur WALIrUMIH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07116) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System Name or identification/Tag: AC-2-O3 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT Enforcement Agency: city: Newport Beach System Location or Area Served: - Elec 1. , I certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: Address: 11140 Thurston Lane ATT Certification uryr�TaTeiaprMira Loma, CA 91752 FIELD TECHNICIAN'S DECLARATION STATEMENT Phone: (If applicable): IA ENERGY COMMISSION NRCA-MCH-02-A (Page 3 of 3) Pewit Number: X2021-2737 Zip Code: 92660 �2lVro-z I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician company Name: Christian Brothers Mechanical Services Address: 11140 Thurston Lane Mira Loma, CA 91752 RESPONSIBLE PERSON'S DECLARATION STATEMENT Position with Company (Title): Technician ATT Certification Identification (if applicable); Phone: 951-361-2247 Date Signed: Z / 51 zoz. I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the build rovides to the building owner at occupancy. Responsible Acceptance Person Name: Responsible Acceptance Person Si ure: Johnny Contreras Responsible Acceptance Person Company Name: Position with Company (Title): Pr a ana er Christian Brothers Mechanical' g Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone: Date Signed: Z I //2� 951-241-5392 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I /i i t Ur t.ALIr V rcry IF► OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place N RCA-MCH-02-A (Page 1 of 3) Enforcement Agency: Permit Number: X2021-2737 City: Zip Code: Newport Beach 92660 System Name or Identification/Tag: System Location or Area Served: AC-2-01 Elec Note:'Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02 A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). i. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: L Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) S. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ✓❑ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 JIHI - Ur I.HLIrVKIVIH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System location or Area Served: AC-2-O3 Elec B. NA7.5.1.1`Outdoor Air Acceptance Functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) Z ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a: cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 713 cfm cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or 689 C. Mechanical Equipment Schedules). cfm cfm Time for outside air damper to stabilize after full supply airflow is achieved d (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). efm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 1.03 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes @ No Q Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes Q No O Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OAR, = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) _ % b. %OAR, is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes Q No Q Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation 0 I PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A I r- Vr L,/%L1t-UM WA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY_ CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System location or Area Served: AC-1-02 IDF DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: G � 02 Address: 11140 Thurston Lane ATT Certification Id tion (If applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title • Technician Address: 11140 Thurston Lane j ATr Certification Identification (if applicable): City/state/Zip:Mira Loma, CA 91752 Phone: 951-361-2247 / �` Date Signed: f,e i'Gz y RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical Position with Company (Title): Pro a er 1 Address: 11140 Thurston Lane CSLEI license: 499547 city/state/Zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A. IAIr- Ur ldiLl rUMNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) f`AI IC^MKIIA C41C0^W nn•IYIIb. . VVIVIIYIIV VIV IY � CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: e Permit Number: X2021-2737 ProjectAddress: 101 Bayview Place city: Newport Beach Zip Code: 92660 System Name or Identificatlon!rag: AC-2-02 System Location or Area Served: IDF Note: Submit one Certificate of Acceptancefor each system Enfprcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. I A. Construction Insnection Note: MCH-02 A can be performed in conjunction with MCH-07-A Supply Pon VFD Acceptance (if applicable) since testing activities overlap. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). i. Method and equipment used:._ ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: I. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ✓❑ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) S. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 .J IAIC Vr" %,ALI rVKIV IA OUTDOOR AIR ACCEPTANCE nGn w10— ..nu nn A /oA A n71491 ('A[ IFCARNIA FNFR[.Y COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/rag: AC-2-02 System Location or Are_ a Served: IN B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing CAV .VAV Step 1: Disable demand -control ventilation (if applicable) ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 696 cfm cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or C. Mechanical Equipment Schedules). 689 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑� ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 1.01 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes @ No O Yes O No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes Q No O Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes 0 No o Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 b I P1I r yr ldiLirvmiiiH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System Name or Identification/Tag: AC-2-02 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT Enforcement Agency: City: Newport Beach System Location or Area Served: IDF 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author5ignature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: Address: 11140 Thurston Lane ATT Certification Identification (IL City/State/Zip: Mira Loma, CA 91752 FIELD TECHNICIAN'S DECLARATION STATEMENT Phone: 951-241-5392 CALIFORNIA ENERGY N RCA-MCH-02-A (Page 3 of 3) Permit Number: X2021-2737 Zip Code: 92660 Z is/1o2 I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Address: 11140 Thurston Lane Loma, CA 91752 RESPONSIBLE PERSON'S DECLARATION STATEMENT Position with Company (Title): /Technician ATT Certification Identification (if applicable); Phone: 951-361-2247 I Date Signed: 2 / 5 r o-2 I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Responsible Acceptance Person Signature:_ Johnny Contreras Responsible Acceptance Person Company Name: Position with Company (Title): Christian Brothers Mechanical ' Project 11140 Thurston Lane CSLs License: 499547 C--� (Zip: Mira Loma, CA 91752 j Phone: 951-241-5392 Date Signed: 2 15 /2O CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 a I A I t yr t,r�LirvrciviH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) rAi irnDr uA DKIoor_v rn.uuo 1-1 CERTIFICATE OF ACCEPTANCE v NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identiflcationrrag: - - AC-2-03 System Location -or Area served: Elec Note: Submit one Certificate of Acceptance for.each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance., Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction I Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). c. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). i. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV 0 CAV a. Check if Variable Air Volume (VAV) and complete the following: L Outside airflow is either factory calibrated or field calibrated. 0 Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): 0 Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) 0 Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: __ b. Check if Constant Air Volume (CAV) and verify the following: 0 System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): 0 Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) S. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 drn per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J 1 A I t Vr I.ALIrUKNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System Name or Identiflcation/rag: AC-2-03 I Enforcement Agency: City: Newport Beach System Location or Area Served: Elec NRCA-MCH-02-A (Page 2 of 3) Permit Number: X2021-2737 Zip Code: 92660 B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) ❑✓ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz): liz b. Measured outdoor airflow reading (cfm) 690 cfm cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or C. Mechanical Equipment Schedules). 689 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑� ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 1.00 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes 0 No O Yes Q No 0 C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes Q No O Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes 0 No Q Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation Q PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 D I H I C ur W%U!" VKIWH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) rei irno�ue onioor_v r n��euoein�i CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: AC-2-03 System Location or Area Served: Elec DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: _ Z%s/zOZ Address: 11140Thurston Lane ATTCertifiicationlde cati Ifapplicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241 5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: J Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Tec ician Address: 11140Thurston Lane ATT Certification Identification (if applicable): city/state/zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: 2 /S/ZO7 f( !!J RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical f Position with Company (Title): Project er Address: 11140 Thurston Lane CSI.B License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 u 1 A I t Ur UALI rUKN IA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: Clearwater Harbor Point Senior Living 101 Bayview Place System Name or Identification/Tag: AC-3-O3 Enforcement Agency: City: Newport Beach System Location or Area Served: Elec COMMISSION_" NRCA-MCH-02-A (Page 1 of 3) Permit Number. X2021-2737 Zip Code: 92660 Alote: Submit one Certificate of Acceptance for each system Enforcement. Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a. Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). i. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: L Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) 5. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 .]IA1L Vr VALIr-VKNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFC)KNIA LNLKUY I;UMM1bWUN -W� CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System Location or Area Served: AC-3-01 Elec B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) ❑� ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a. cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 695 cfm cfm Required outdoor airflow, (cfm) (from MCH-03, Column 14, or C. Mechanical E ui ment Schedules]. 689 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step S: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 1.01 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes @ No O Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes 0 No O Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OAR„ = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes Q No o Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation �✓ PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A I t_ Ur I.rALIrUKIVIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION 19 CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identificationtrag: System Location or Area Served: AC-3-01 Elec DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: L Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: %z02� Address: 11140 Thurston Lane ATT Certification Identification (If applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technician Address: 11140 Thurston Lane ATT Certification Identification (if applicable): City/State/Zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical " Position with Company (Title): Project M er Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 Date signed: Z .,�ZOZ CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 01AIt Vr I.ALIrvKrv1A OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION le CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach zip Code: 92660 System Name or Identification/rag: AC-3-02 system location or Area Served: Elec . Note: Submit one Certificate of Acceptance for.each system - Enforcement Agency use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since.testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical.Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.S.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). i. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV❑ CAV a. Check if Variable Air Volume (VAV) and complete the following: I. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) 5. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A I t Vr t MLIrvKrvIA OUTDOOR AIR ACCEPTANCE r:Ff`-NRCA-MCH-n9-A 1Ravieafl n711A1 CAI IFORNIA FNFRf.Y COMMISSION le CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number. X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification rag: - AC-3-02 System Location or Area Served: Elec B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing : CAV VAV Step 1: Disable demand control ventilation (if applicable) - ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow, at full a' cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 709 cfm cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or C. Mechanical Equipment Schedules). 689 cfm cfm d Time for outside air damper to stabilize after full supply airflow, is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow, is achieved (minutes): min Step 5: Return to initial conditions (check) FZ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 1.03 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA S 110%) Yes Q No O Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes O No Q Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow, reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OApA is within 10% of design Outside Air. (90% 5 %OAR, 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes 0 No Q Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation �✓ PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 oiAirz Vr UALWU"'NIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CAI IFnRNIA FNFRr;V CCIMMIRRIAN CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 ProjectAddress: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: AC-3-02 System Location or Area Served: Elec DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature:. Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: Address: 11140 Thurston Lane ATT Certification I tifi n (If applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical $erVlteS Position with Company (Title): ChniClan Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/state/zip:Mira Loma, CA 91752 Phone: Date Signed: 951-361-2247 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical ' Position with Company (Title): Project ag Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: 2I5/��z CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I A I C Ur' liAL11' V KN IA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA FNFRGY COMMIRRION 4e CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 system Name or IdentiHcation/Tag: A63-03 System Location or Area Served: IDF Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Ins Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). L Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: i. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ ,Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted -directly to the unit, outside air is provided independent of the unit, or economizer) S. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 AIAit Vr %,1%UrVKNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number. X2021-2737 Project Address: 101 Bayview Place City: Newport Beach- Zip Code: 92660 System Name or Identifiation/rag: AC-3-03 System location or -Area Served: IDF 7J B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing . CAV VAV Step 1: Disable demand control ventilation (if applicable) ✓❑ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow, reading (cfm) 710 cfm cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). 689 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow, to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 1.03 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5 110%) Yes Q No 0 Yes 0 No 0 C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes 0 No O Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OApJ, = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA S 110%) Yes 0 No 0 C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes 0 No 0 Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation 0 PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A 11k I t Ur L ALIrUMr4IA OUTDOOR AIR ACCEPTANCE n I wionw Rims n UALI1-UKNIA t_NtKUY UVMMI551UN CERTIFICATE OF ACCEPTANCE _ NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: - System Location or Area Served: AC-3-03 IDF DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: Z /)f 2 Address: 11140 Thurston Lane ATT Certification Identification p icable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technician Address: 11140 Thurston Lane ATT Certification Identification (ifapplicable): City/State/zip: Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: _ Responsible Acceptance Person Company Name: Christian Brothers Mechanical Position with Company (Title): Project Mana Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A I c Ur tlfi -11-U NIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: AC-B-01 System Location or Area Served: Elev !Vote: Submit. one Certificate of Acceptance for each system Enforcement Agency use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection . I Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since. testing activifies.overlap. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment. a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.S.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). c. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). L Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV 0 CAV a. Check if Variable Air Volume (VAV) and complete the following: I. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) 0 Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: 0 System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): 0 Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑- Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 .J I A I t Ul- t.ALm V KrvIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION �& CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identifirationfrag: AC-B-01 System location or Area Served: Elev B.. NA7.5.1.1 Outdoor Air Acceptance Functional Testing CAV VAV. Step 1: Disable demand control ventilation (if applicable) ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ✓❑ ❑ Note: Shaded boxes do not apply for CAV systems Step_ 3: CAV and VAV testing at full supply airflow Adjust supply air.to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 825 cfm cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical E uipment Schedules). 813 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step S: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 1.01 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5 110%) Yes Q No Q Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes Q No Q Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OAR,,, = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) ,Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes Q No 0 Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation ❑✓ PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 AIHI r Ur' I,ALIrVKNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) r-A ICnGrdle CnICOMV r+neenA1cQ1nn1 CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: - 92660 System Name or Identification/Tag: AC-B-Ol System Location or Area Served: Elev DOCUMENTATION AUTHOR'S.DECLARATION STATEMENT 1. - I certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: , Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: toz � Address: 11140 Thurston Lane ATT Certification Identification (If app (cable): City/State/zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with he building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician company Name: Christian Brothers Mechanical Services Position with Company (Title): Technicla Address: 11140 Thurston Lane ATr Certification Identification (if applicable): city/State/Zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date signed: RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the uilding owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical Position with Company (Title): Project Mana er Address: 11140 Thurston Lane CSLB License: 499547 City/St ate/zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: is/ZOZu CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A I C Ur I.AL1rUKIV11k OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) rA1 ICnDKIIA CAICDr]V t' RA\/IQQlnrd OM CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Enforcement Agency: Clearwater Harbor Point Senior Living Permit Number. X2021-2737 ProjectAddress: 101 Bayview Place - City: Newport Beach zip Code: 92660 System Name or Identification/Tag: AC-B-02 System Location or Area Served: Electrical B16 Note: Submit one Certificate of Acceptance for each -system - Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform.test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). I. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: L Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ✓❑ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) 5. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate.from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I A I C Vr t,ALIrUKMIA OUTDOOR AIR ACCEPTANCE f1oc_e101 `A-Ker'14-n9-A rao ago i mil aN (:AI IFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place city: - Newport Beach Zip Code: 92660 System Name or Identificatlontrag: AC-B-02 System location or Area Served: Electrical B16 B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). _ Hz b. Measured outdoor airflow, reading (cfm) 821 cfm cfm Required outdoor airflow (cfm).(from MCH-03, Column 14, or C. Mechanical Equipment Schedules). 813 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes):_ min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 1.01 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes Q No 0 Yes 0 No 0 C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes 0 No O Determine Percent Outside Air at reduced supply airflow (%OAR,) for Step 4. (VAV only) a. %OAR, = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OAR, is within 10% of design Outside Air. (90% 5 %OARA5110%) Yes 0 No 0 C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes 0 No 0 Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation Q PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 Z. 1 H I C V r• t'HLI r-UKN IH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place' System Name or Identification/Tag: AC-B-02 Enforcement Agency: City: Newport Beach System Location or Area Served: Electrical B16 CALIFORN[A ENERGY NRCA-MCH-02-A (Page 3 of 3) Permit Number: X2021-2737 Zip Code: 92660 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: Z / 5 / tco2 Address: 11140 Thurston Lane ATT Certification Identification (If applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT' I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technician Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/state/Zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: 2 /S/zo2 y RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. - 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the b 'J&ng owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers McChanIC21 ^ Position with Company (Title) project Manager Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone:.951-241-5392 Date Signed: 2_/5 ZOZ4 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 I I H I r= yr t.�IrvrtrvlH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION 4T CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification rag: AC-B-03 System Location or Area Served: Elev Note: Submit one Certificate of Acceptance for each system - Enforcement Agency use: Checked by/Date that must demonstrate compliance. ` Intent: I Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Eaulament Schedules. A. Construction I Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) sincetesting activities overlap. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical. Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). i. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: i. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) 5. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): _ ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I A I t ur, t1ALI r V KIv 1A OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 1018ayview Place City: Newport Beach Zip Code: 92660 System Name or Identification rag: AC-B-03 system Location or Area Served: Elev B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing CAV VAV . Step 1: Disable demand control ventilation (if applicable) ❑✓ ❑ Step 2: Verify unit is not In economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a. cooling. Record VFD speed (Hz). Hz. b. Measured outdoor airflow, reading (cfm) 804 cfm cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). 813 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 0.99 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA:5 Yes Q No Q Yes Q No Q c. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes Q No Q Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes Q No 0 Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation 0 PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A I t ur W%U rvmN IA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) PAi ienor.nA onioor_v nneARueeinsi CERTIFICATE OF ACCEPTANCE v NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach zip Code: 92660 System Name or Identification/rag: AC-B-03 System location or Area Served: Elev DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: DocumentationAuthorcompanyName: Christian Brothers Mechanical Services Date Signed: 2 15/zQ 2L Address: 11140 Thurston Lane ATTCertiflcation Identification (If applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technician Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/state/zip: Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: 7, 0 t 7 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical ` Position with Company (Title): Project Man r Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 � Phone:951-241-5392 Date Signed: 2 S Z�2 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I H I - Ur t.ALIrUKrvIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: Clearwater Harbor Point Senior Living ProjectAddress: 101 Bayview Place System Name or Identification/Tag: AC-B-04 Enforcement Agency: City: Newport Beach System Location or Area Served: Equipment B21 Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use: checked by/Date that must demonstrate compliance. I` N RCA-MCH-02-A (Page 1 of 3) Permit Number. X2021-2737 Zip Code: 92660 Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance. (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a. Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). i. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: I. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) 5. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 SIAIt Vr I.ALIrVKrvIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07116) CALIFaRNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zlp Code: 92660 System Name or Identification/rag: AC-B-04 System Location or Area Served: Equipment B21 B. NA1.5.1.1 Outdoor Air Acceptance Functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) ✓❑ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ✓❑ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a. cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 821 cfm cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules . 813 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 1.01 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA15 110%) Yes Q No O Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes O No O Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) - % b. %OARA is within 10% of design Outside Air. (90% S %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes 0 No Q Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation �✓ PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A 1AIt Vr I�HLIrVKIVIH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA. ENERGY COMMISSION 4S CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System Location or Area Served: AC-B-04 Equipment B21 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: Address: 11140 Thurston Lane ATTCertification Identification (if applicable); City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-S392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. _ Field Technician Name: Todd Alpert Field Technician Signature: — Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technician Address: 11140 Thurston Lane ATT Certification Identification (if applicable): City/state/Zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: �151ZO2 4 1 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: f� Responsible Acceptance Person Company Name: Christian Brothers Mechanical ' Position with Company (Title): Project M age Address: 11140 Thurston Lane CSLB License: 499547 city/State/Zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: 2 C2 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J IAI r- Vr uALIrumrVIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA FNFRGY CAMMIRRIAN -a CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place city: - Newport Beach Zip Code: 92660 System Name or Identification/Tag:. AC-B-06 System Location or Area Served: M POE i Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since -testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). L Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year):. 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: I. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) 5. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 o I A it: yr %,i+urvmNIt% OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 ProjectAddress: 101 Bayview Place city: Newport Beach Zip Code: 92660 System Name or Identification/Tag: AC-B-06 System location or Area Served: M POE B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing. CAV VAV Step 1: Disable demand control ventilation (if applicable) ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling..Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 840 cfm cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equi mentSchedules). Ns cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow, (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) NaN % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes (2) No O Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes 0 No O Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OAgA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes Q No 0 Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation �✓ PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I tk I C ur I.ALirvmNtA OUTDOOR AIR ACCEPTANCE n ctU-NKL,A-MUN-oz-A (Kevisea ur/iu) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: - Enforcement Agency: Permit Number. Clearwater Harbor Point Senior Living X2021-2737 ProjectAddress; City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identlflcationfrag: System Location or Area Served: AC-B-06 MPOE DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1: I certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: h /Sh, Address: 11140 Thurston Lane ATT Certification Identification ( cable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. — Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services I Position with Company (Title): Technician Address: 11140 Th u rston Lane ATT Certification Identification (if applicable): Phone: Date Signed: 951-361-2247 2 ��zc.2C{ Cit"State'zlp:Mira Loma, CA 91752 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: _ J Responsible Acceptance Person Company Name: Christian Brothers Mechanical ' Position with Company (Title): / Project Manger Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone:951-241-5392" Date Signed: 2 S 202-[ CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 Aimit Vr VALIrVKr411% OUTDOOR AIR ACCEPTANCE CEGNRCA-MCH-02-A (Revised 07116) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: - Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: city: Zip Code: 101 Bayview Place Newport Beach 92660 system Name or IdentRication/rag: - System Location or Area Served: AC-B-07 Emergency Note: Submit one Certificate.of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection, Note: MCH-02-A can be performed in conjunction with. MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a. Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems, Variable Air Systems At -A -Glance and NA 7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). i. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 1L/14/[3 3. System type (check either VAV or CAA: ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: i. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to providejone of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handier. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 AIAIr Ur W%L11-VKNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Permit Number: Pe Enforcement Agency: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/rag: System Location or Area Served: AC-B-07 Emergency B. NAIA.1 1 Outdoor Air Acceptance Functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) 0 ❑ Step 2. Verify unit is not in economizer mode during test (economizer disabled) , ✓0 Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow, Adjust supply air to achieve design airflow or maximum airflow at full a' cooling, Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 1267 cfm cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or C. Mechanical Equipment Schedules). Ns cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): Step 4: VAV testing at reduced supply airflow CAV min VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): cfm Step 5: Return to initial conditions (check) min ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow, (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) NaN % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes •) No Q Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes Q No O Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes Q No 0 Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation 0 PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 o I Aur- ur t,HururcrvlH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: AC-B-07 System Location or Area Served: Emergency DOCUMENTATION AUTHOR'S DECLARATION STATEMENT' 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: Z/5/�0�� Address: 11140 Thurston Lane A1TCertification Identification (If applicable): City/State/zip: Mira Lorna, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Position with Company(Title): Technician Field Technician Company Name: Christian Brothers Mechanical Services Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/state/zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: 2r 5�2oz RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical Position with Company (Title): Project Manager Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: `��� CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A I t Ur- I.ALI1"UMN11A OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identificatlontrag: FCU-1-01 System location or Area Served: Laundry `Noe: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date I that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A: Construction Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). I. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: I. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) 5. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A I t yr t.HL._IrI.JKIVIH OUTDOOR AIR ACCEPTANCE CEGNRCA-MCH-02-A (Revised 07/16) CAI IFORNIA FNFRGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identiicetlontrag: FCU-1-01 System Location or Area Served: Laundry B. NA7.5.1.1.0utdoor Air Acceptance Functional.Testing CAV" VAV Step 1: Disable demand control ventilation (if applicable) ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow, Adjust supply air to achieve design airflow or maximum airflow, at full a' cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 640 cfm cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or C. Mechanical Equipment Schedules). 640 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). dm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 1.00 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes @ No O Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes Q No O Determine Percent Outside Air at reduced supply airflow, (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes © No C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes 0 No 0 Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation 0 PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 u 1 A 1 t Ur' I.HLIr VKrv1A OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) f:A1 IFARAIIA FAIFRrZV f:AMM1CC1nK1 4e CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-1-01 System Location or Area Served: Laundry DOCUMENTATION'ALITHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: c` Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: 2 /S/Z©Zy r Address: 11140 Thurston Lane ATT Certification Identification (if applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available wit' he building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technici rn Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/state/zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: ! RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical r :. Position with Company (Title): Project Man Address: 11140 Thurston Lane csLs License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 Date Signed: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 b II%I= Vr I.AL11-UMNIA OUTDOOR AIR ACCEPTANCE CEC•NRCA-MCH-02-A (Revised 07/16) CAI IFORNIA FNFRMV MUMIRAinkI CERTIFICATE OF ACCEPTANCE f NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach - Zip Code: 92660 System Name or Identification/Tag: FCU-1-02 System Location orArea Served: Office Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 1096 of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A: Construction Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). L Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: i. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) S. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to -provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handier. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J f A l t yr %,ALlrvKrvlA OUTDOOR AIR ACCEPTANCE CFC-NRCA-MCH-02-A lReAsed 07/161 CALIFORNIA ENERGY COMMISSION �Q CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Perrnft Number: X2021-2737 Project Address: 101 Bayview Place My: Newport Beach Zip Code: •92660 System Name or Identiflcation/rag: FCU-1-02 System Locatlon or Area Served: Office B.-.NA7.5.1.1'Outdoor Air Acceptance Functional Testing CAV VAV Step is Disable demand control ventilation (if applicable) LJ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply. for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow:at full a' cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 643 cfm cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or C. Mechanical Equipment Schedules). 640 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 1.00 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes Q No Q Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes Q No 0 Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes p No Q Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation �✓ PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 01AIt Vr �,ALWUKNIA OUTDOOR AIR ACCEPTANCE W ��-rv1c�.A-m�.n-ucw trcewsea u�noj CALIFORNIA ENERGY COMMISSION "'ice" CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: - City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System Location or Area -Served: FCU-1-02 Office DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: 2 Address: 11140 Thurston Lane ATT Certification Identification (If applicable): City/state/zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with th building permit(s) issued for the building. _ Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technicia Address: 11140 Thurston Lane ATT Certification Identification (if appli le): city/state/zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: z RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical � Position with Company (Title): Project Ma Address: 11140 Thurston Lane CSLB License: 499547 city/state/zip: Mira Loma, CA 91752 Phone: 951-241-5392 Date Signed: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 AIHIr Ur %,1%LIr'VKIVIH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) r.AI IFARNIC FNFRr.V MMMICCIM CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag; System Location or Area Served: FCU-1-03 Office Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a. Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). L Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: i. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) 5. . Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J r H1C Vr, f11kLr1-VKNIk% OUTDOOR AIR ACCEPTANCE r:Fr-N IQrA-Mr..H-n9-A (RPvicPd W/16) CALIFORNIA ENERGY COMMISSION le CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: _ - FCU-1-03 System Location or Area Served: Office B. NA7.5.1.1 Outdoor Air Acceptance Functional ;Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test.(economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV, testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 691 cfm cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or C. Mechanical Equipment Schedules). 660 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes). min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 1.05 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes @ No O Yes O No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes O No O Determine Percent Outside Air at reduced supply airflow (%OAR,) for Step 4. (VAV only) a. %OAR, = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OAR, is within 10% of design Outside Air. (90% S %OAR, 5110%) Yes Q No p C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes O No o Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation ❑✓ PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I t%l r yr t ALirvrcrvlH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CAI IFf1RNIA FNFRr;V CAUMIARInN CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance . (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-1-03 System Location or Area Served: Office DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services DateSigned:.2/5/ZG2-J Address: 11140 Thurston Lane ATTCertification Identification (ifapplicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available wit .i the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technl an Address: 11140 Thurston Lane ATT Certification Identification (if appIrcable): City/State/zip: Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: Z / s /zo z RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the bu' ing owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical ' Position with Company (Title): Project ManaCe Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone: Date Date signed: L(S 20 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 IH C Ur WNUrVMIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) ZCALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place city: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-1-04 System Location or Area Served: Kitchen Note: Submit one Certificate of Acceptance for each system i Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Insoection Note: MCH-02-A can be performed in conjunction with MCH-07 A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). c. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). L Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: i. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) S. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 o i rt i r- yr wit- rvmmA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION 4 CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identifiwtionrrag: FCU-1-04 System Location or Area Served: ' Kitchen B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a. cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 645 cfm cfm C. Required outdoor airflow, (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). 640 cfm cfm Cl.Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 1.01 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5 110%) Yes @ No Q Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) I Yes O No Determine Percent Outside Air at reduced supply airflow (%OAR,) for Step 4. (VAV only) a. %OAR, = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OAR, is within 10% of design Outside Air. (90% 5 %OAR, 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes 0 No 0 Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I Al C ur l.AL11-UMNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) ('Al IFCIRNIA FNFRr,Y CAMMIRRION '0 CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-1-04 System Location or Area Served: Kitchen DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: Z15 j Z 0 Z Address: 11140 Thurston Lane ATT Certification Identification (If ap icable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392' FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technician Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/state/zip: Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: l RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the buding owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: ` Responsible Acceptance Person Company Name: Christian Brothers Mechanical'' Position with Company (Title): Project Mana Address: 11140 Thurston Lane CSLs License: 499547' City/State/Zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: /S�ZOZ CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A IAIt Vr I.HL1rVKN1A OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number. X2021-2737 Project Address: 101 Bayview Place city: Newport Beach Zip Code: 92660 System Name or Identifiation%rag: FCU-1-05 System Location or Area Served: Co' rridor Note: Submit one Certificate of Acceptance for each system. Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). i. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: i. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) 5. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 JIAIt Vr'.ALI rVKN IA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION �& CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-1-05 System Location or Area Served: Corridor B. NA7.5.1.1 Outdoor Air Acceptance -FunctionaI Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) j 845 cfm cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). 880 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved f minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 0.96 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes Q No O Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes O No Determine Percent Outside Air at reduced supply airflow (%OAR,) for Step 4. (VAV only) a. %OAR, = Measured outdoor airflow, reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OApA is within 10% of design Outside Air. (90% 5 %OAR, 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes O No O Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. 1 D. Evaluation I ✓❑ PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A i t yr, ldiLIrVKIWH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identificationlrag: FCU-1-05 System Location or Area Served: Corridor DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author, Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed:. 7/5/2oz Address: 11140 Thurston Lane ATT Certification Identification (If applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technician Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/state/zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: Z l'Sf Zo2 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical- Position with Company (Title): Project Ma Address: 11140 Thurston Lane CSLS License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone: Date Signed: 951-241-5392 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A I t Vr t,AL11-VK11JIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION 4e- CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: e Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code:101 Bayview Place Newport Beach 92660 System Name or Identification/rag: System Location or Area Served: FCU-1-06 Restaurant Note Submit one Certificate of Acceptance for -each EnforcQment Agency use: checked by/gate that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required, for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.S.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). i. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ✓❑ CAV a. Check if Variable Air Volume (VAV) and complete the following: i. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. -(Le. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) 5. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I H I t V r tiHL1r V KNIH OUTDOOR AIR ACCEPTANCE n w io....t....AA Ma% r:Al I1:nPKJ1A FNFR(.Y r:OMMISSION Q CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Ident1 ication/rag: FCU-1-06 System Location or Area Served: Restaurant B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems _ Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 1070 cfm cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or C. Mechanical Equi ment5chedules). 1080 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 0.99 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes @ No O Yes O No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes O No Q Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OApA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes Q No Q c. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes Q No o Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation 0 PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 M A I L Ut UAL11-UKN1A OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CAI 3:f1RNIA FNFRrV Ctf1MMISS:ICIN le CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identificationtrag: FCU-1-06 System Location or Area Served: Restaurant DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Compa ny Name: Christian Brothers Mechanical Services Date Signed: 2/S/toe Address: 11140 Thurston Lane ATT Certification Identification (if a e): City/State/Zip: Mira Loma, CA 91752 phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with t building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technician Address: 11140 Thurston Lane ATT Certification Identification (if applicabl6): city/state/zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the uilding owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: ` Responsible Acceptance Person Company Name: Christian Brothers Mechanical ^ Position with Company (Title): Project Ma Address: 11140 Thurston Lane CSLE1 License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 a i A i r- ter trfturUrcrviH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-1-07 System Location or Area Served: . - Dr' s Pub Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply fan VFD Acceptance (if applicable) since. testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NAZ5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). c. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). i. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV 0 CAV a. Check if Variable Air Volume (VAV) and complete the following: i. Outside airflow is either factory calibrated or field calibrated. 0 Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): 0 Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: 0 System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. 0 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) 5. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): 0 The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 O IA I t Ur t.ALIrUKIVIH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CAI IFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: - Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place city: Newport Beach Zip Code: 92660 System Name or Identffication/rag: - FCU-1-07 System Location or Area Served: - - Dr's Pub B. N..A7.5.1.1 Outdoor Air Acceptance Functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) •1042 cfm cfm C. Required outdoor airflow (efm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). 1040 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 1.00 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes Q No O Yes O No 0 C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes 0 No O Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes 0 No 0 C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes 0 No 0 Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation 0 PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A IIII r Ur t I%Llt-VKNIH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) r Al ICnDMIA r-Mr9)rav rnKAPLAIQeInn1 CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-1-07 System Location or Area Served: . Dr's Pub DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: '2 /e/7oZ Address: 11140 Thurston Lane ATTCertifiication Identification (If applicable): City/State/Zip: Mira Loma; CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with th `building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician company Name: Christian Brothers Mechanical Services Position with company (Title): Technician Address: 11140 Thurston Lane ATT Certification Identification (if applicable): City/state/zip: Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: Z / 51 7 O Z RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the ilding owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical ` Position with Company (Title): Project Man r Address: 11140 Thurston Lane 6-1 CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: 2 r.5/2cOZ t CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A l A i t yr �,�irvrtrvir� OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07116) CALIFORNIA ENERGY COMMISSION 0 CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identifirationtrag: - FCU-1-08 System Location or Area Served: Kitchen Note: Submit one Certificate of Acceptance for each system I Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). I. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): VAV R CAV a. Check if Variable Air Volume (VAV) and complete the following: L Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) 0 Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): 0 Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) 5. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): 0 The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A 1 H i t Ur UALir-UMNIH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number. X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or !dentification/Tag: - FCU-1-08 System Location or Area Served: Kitchen B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) ✓❑ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow, or maximum airflow, at full a. cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) .. 1100 cfm cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or C. Mechanical Equipment Schedules). 1210 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow, reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 0.91 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes G) No Q Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes Q No O Determine Percent Outside Air at reduced supply airflow (%OAPA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow, reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARS, is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes p No Q Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation 0 PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I HI t Ur I.HLIrVKIVIH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) rrei IC n onuA CnICGlry f`nRA\AICQIn K1 CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-1-08 System Location or Area Served: Kitchen DOCUMENTATION AUTHOR'S.DECLARATION. STATEMENT. 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: 215 /202 Address: 11140 Thurston Lane ATT Certification Identification (If applicable): city/state/zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technic) Address: 11140 Thurston Lane ATTCertificationIdentification (if applic le): city/State/Zip:Mira Loma, CA 91752 j Phone: 951-361-2247 j Date Signed: Z15,/Z()z`+ 1 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the b 'Iding owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical I Positlon with Company (Title): Project Man Address: 11140 Thurston Lane CSLB License: 499547 City/state/zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: Z/Sfi-GZ CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 a 1 H 1 t Ut- t /%LI r-VKN IA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: Enforcement Agency: Clearwater Harbor Point Senior Living Project Address: City: 101 Bayview Place Newport Beach System Name or Identification/Tag: System Location or Area Served: _ FCU-1-09A Kitchen Note: Submitone Certificate-af Acceptance for eachsystem Enforcement Agency Use: Checked by/Date that must demonstrate compliance. IA ENERGY COMMISSION N RCA-MCH-02-A (Page 1 of 3) Permit Number. X2021-2737 zip Code: 92660 Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02'-A. can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap.. 1. Supporting documentation needed to perform test includes: a' As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). L Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: I. Outside airflow is either factory calibrated or field calibrated. 0 Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: 0 System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. 0 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is - provided independent of the unit, or economizer) S. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 a i A i r yr WXUrumrcm OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A (Page 2 of 3) Outdoor Air Acceptance Project Name: Enforcement Agency: Clearwater Harbor Point Senior Living Permit Number: X2021-2737 Project Address: City: 101 Bayview Place Newport Beach zip Code: 92660 System Name or identification/Tag: System Location or Area Served: FCU-1-09A Kitchen B. iVA7:5.ia Outdoor Air Acceptance functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 1335 .cfm cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or 1450 C. Mechanical E ui ment Schedules). cfm cfm Time for outside air damper to stabilize after full supply airflow is achieved d. _ min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). _ cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 0.92 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA:5 110%) Yes Q No O Yes Q No O C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes O No O Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA S 110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes Q No 0 Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation 0 I PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 o 1 HI t ur %,/AL1t VKN1f% OUTDOOR AIR ACCEPTANCE 40 CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE � NRCA-MCH-02-A (Page 3 of 3) Outdoor Air Acceptance Enforcement Agency: Permit Number: Project Name: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: 71p Code: 92660 101 Bayview Place Newport Beach System Name or Identcation/Tag: system Location or Area Served: fCU-1-09A Kitchen DOCLIMENTATION-AUTHOR'S DECLARATION STATEMENT 1. 1 certify -that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Johnny Contreras Documentation Author Company Name: Date Signed: Christian Brothers Mechanical Services Z/��t02 Address: ATT Certification identification (If 11140Thurston Lane City/state/zip; . Phone: 951-241-5392 Mira Loma,�CA 91752 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available w' h the building permit(s) issued for the building. 1 Field Technician Signature: � Field Technician Name: Todd Alpert Field Technician Company Name: Position with Company (Title): Technician Christian Brothers Mechanical Services I I Address: ATT Certification Identification (if applicable): 11140 Thurston Lane City/State/Zip: Mira Loma, CA 91752 Phone: 951-361-2247 Date signed: RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Responsible Acceptance Person Signature: Johnny Contreras Position with Company (Title): Responsible Acceptance Person Company Name: Christian Brothers Mechanical ` Project Mana Address: 11140Thurston Lane CSLB License: 499547 City/state/zip: Phone: Date Date signed: 9 5-le3Z Mira Loma, CA 91752 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A I r- Ur �.HLIrUKNIH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X it Numb : Project Address: Zip Code: 737 101 Bayview Place �v Newport Beach 92660 System Name or Identification rag: System Location or Area Served: FCU71-09B Kitchen Note:.submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow: Required for all newly installed HVAC units. -Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction, Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing nctivities.overlap. 1. Supporting documentation needed to perform test includes: a. As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). L Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: L Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) S. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 AIAit Vr LALIrumN IA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System Name or Identification/rag: 1. FCU-1-09B Enforcement Agency: City: Newport Beach system Location or Area served: Kitchen B.' NA7.5;1'A Outdoor Air Acceptance Functional.Testing Step is Disable demand control ventilation (if applicable) Step 2: Verify unit is not in economizer mode during test (economizer disabled) Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' - -cooling. Record VFD speed (Hz). b. Measured outdoor airflow, reading (cfm) Required outdoor airflow (cfm) (from MCH-03, Column 14, or C. Mechanical E ui ment Schedules). d Time for outside air damper to stabilize after full supply airflow is achieved (minuted: COMMISSION NRCA-MCH-02-A (Page 2 of 3) Permit Number. X2021-2737 Zip Code: 92660 CAV. VAV ❑✓ ❑ ❑✓ ❑ Hz 1480 cfm cfm 1450 cfm cfm min Step 4: VAV testing at reduced supply airflow CAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). b. Measured outdoor airflow reading (cfm). C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): Step 5: Return to initial conditions (check) C. Testina Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes 0 No 0 C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes 0 No 0 Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. VAV Hz cfm cfm min ❑✓ , ❑ 1.02 % % Yes @ No O Yes 0 No 0 Yes 0 No O D. Evaluation �✓ PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 a I A 1 t Ur %,ALI1-UMNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) RAI IF(1RNI0 FNFRr:V C(1fUMICCIf1N CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: - 101 Bayview Place City: Newport Beach zip Code: 92660 System Name or Identification/Tag: FCU-1-09B System Location or Area Served: Kitchen DOCUMENTATION -AUTHOR'S DECLARATION STATEMENT 1. I certify -that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: VVZ02-4 Address: 11140 Thurston Lane ATT Certification Identification (If applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with th building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technician Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/state/zip: Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: 2 /-5/2.0ZLl RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. I am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras i Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical '� Position with Company (Title): Project Mana r Address: 11140 Thurston Lane CSI B License; 499547 City/State/Zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: 215 /zC3Z� CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A It: up, \.ALI r V KIV IA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07116) CALIFORNIA ENERGY COMMISSION 4S CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number. X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identificationfrag: FCU-1-10 1 System Location or Area Served: Dining Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC I units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction. Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activiiies overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). I. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: L Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I t%I t ur t,nuru'1Nif% OUTDOOR AIR ACCEPTANCE l:Fr IURr'A-W'FI119-A Ma Agpri n7HRl Z CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: - Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/rag: FCU-1-10 System Location or Area Served: Dining B. NA7.5.1.1..Outdoor Air Acceptance Functional Testing ` Uv VAV Step 1: Disable demand control ventilation (if applicable) ❑� ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ✓❑ ❑ Note. Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). Hz b._ Measured outdoor airflow reading (cfm) 648- cfm cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or C. Mechanical Equipment Schedules). 640 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). I ion Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 1.01 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes @ No 0 Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes Q No O Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OAR, = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OAR, is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes O No Q Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation �✓ PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 oiHIC ur U/%LI1-V"N1A OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CAI IFORNIA FNFRAY COMMMAION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/rag: FCU-1-10 System Location or Area Served: Dining DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical. Services Date Signed: '2151?GZ'f Address: 11140 Thurston Lane ATTCertification identification (if applica le): city/state/zI. Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): TechniC n Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/state/zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical � x Position with Company (Title): Project Ma ag Address: 11140 Thurston Lane CSL9 License: 499547 City/state/zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: Z S►/��� CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A I t Ur L,/%LIrUKNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07116) aft CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permft Number: X2021-2737 Project Address: 101 Bayview Place city: - Newport Beach Zip Code: 92660 System Name or Identificationtrag: FCU-1-11 System Location or Area Served: Living Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules._ A. Construction Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFDAcceptance -(if..applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical. Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). i. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: L Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑J System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) 5. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A I t Url koAL11-VM 1f% OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION 0 CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: PermR Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach zip Code: 92660 System Name or Identification/Tag: FCU-1-11 System Location.or Area Served: - Living B. NA7.5.1.1 Outdoor Air Acceptance Functional Usting : CAV VAV Step 1: Disable demand control ventilation (if applicable) ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 724 cfm cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). 725 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step S: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 1.00 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes @ No Q Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) ALYes Q No O Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes p No o Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A I t- Ur- U1%L1t'UKN1A OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CAI IFnRNIA FNFRAY CAMMI.SSInN 'S CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: - Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-1-11 System Location or Area Served: Living DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services DateSigned: Z �S/ZoZ Address: 11140 Thurston Lane ATT Certification Identification (If applic e): City/State/Zip: Mira Loma, CA 91752 Phone: -951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available wit he building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Techni Ian Address: 11140 Thurston Lane ATTCertifiication Identification (if applicable): city/state/zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: Z( 51 ZOZ Lf RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical f E Position with Company (Title): Project Maria Address: 11140 Thurston Lane CSIB license: 499547 City/state/zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: Z 151 ZoZ U CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 o i ri i t ur t,nLar-umr % OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/rag: FCU-1-12 System Location or Area Served: Gameroom Note: Submit one Certificate of Acceptance for each system I Enforcement Agency Use: Checked by/Date that must demonstrate compliance. 1 Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note. MCH-02-A can.be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment. Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.S.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.S.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). c. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). I. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: I. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) 0 Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: 0 System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): 0 Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) 5. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): 0 The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 JIHI r Vr I,ALIrVKIVIH OUTDOOR AIR ACCEPTANCE C9Zr11dRCA-MCH-n9-A 1RPvicBd n7M Bl ('Al IFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Zip Code: Newport Beach 92660 System Name or Identification/Tag: FCU-1-12 System Location or Area Served: Gameroom B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing CAV. VAV Step 1: Disable demand control ventilation (if applicable) ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz).. Hz b. Measured.outdoor airflow reading (cfm) 746 cfm cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or C. Mechanical Equipment Schedules). 755 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 0.99 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes 0 No O Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes O No Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes O No Q Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation ✓� PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 b IA It: Ur UALIrUMIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: - 101 BayView Place City: Newport Beach Zip Code: 92660 System Name or Identificationfrag: FCU-1-12 System Location or Area Served: Gameroom DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. . I certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers MechanicalServices Date Signed: Address: 11140 Thurston Lane ATT Certification Identification (If appiicable): city/stag/zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with t e building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: / Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technici Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/state/zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: 2C Z L( RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: JOhnnyCOntrera5 Responsible Acceptance Person Signature: := Responsible Acceptance Person Company Name: Christian Brothers Mechanical ` Position with Company (Title): Project Mana Kz Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: r 5! Z02 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I H I t Ur UALIrUKIVIH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) �•. 3r` (`AI WA12KIIA CAICOf_V f`nhARAICCInAI lr CERTIFICATE OF ACCEPTANCE y NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agenry: Permit Number: X2021-2737 Project Address: - 101 Bayview Place city: Newport Beach Zip Code: 92660 System Name or Idemification/rag: FCU-1-13 System Location or Area Served: Discovery .Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/ Date that must demonstrate compliance. intent.• Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). I. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: I. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A [Air Vr Wki-11-VKINIA OUTDOOR AIR ACCEPTANCE W1 CEC-NRCA-MCH-02-A (Revised 07116) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System Name or Identification/Tag: FCU-1-13 Enforcement Agency: City: Newport Beach System location or Area Served: Discovery CALIFORNIA ENERGY N RCA-MCH-02-A (Page 2 of 3) Permit Number: X2021-2737 Zip Code: 92660 B. NA7.5'.1.1 Outdoor Air Acceptance Functional Testing CAV vav Step 1: Disable demand control ventilation (if applicable) ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 604 cfm cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or C. Mechanical Equipment Schedules). 640 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 0.94 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes @ No O Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes O No Q Determine Percent Outside Air at reduced supply airflow (%OAR,) for Step 4. (VAV only) a. %OAR, = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) J % b. %OAR, is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes 0 No o Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation 0 PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 ZPIAIt Vr, t'ALIr-UKNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification rag: FCU-1-13 System Location or Area Served: Discovery DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: /ZO 2 7 Address: 11140 Thurston Lane ATT Certification Identification (I able): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT J I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. I Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technicia Address: 11140 Thurston Lane ATT Certification Identification (if applica e): city/state/zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: /Zdz� RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical 1 ; Position with Company (Title): Project Man r Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 OIHI - Ur %,ALIruKN1A OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) ('Al WOPNIA FNFRr:V (a UhA1QCIAN is CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living I Enforcement Agency: Permit Number: Ij X2021-2737 Project Address: 101 Bayview Place city: Newport Beach Zip Code: 92660 System Name or Identiflcationjrag: FCU-1-14 System Location or Area Served: - Corridor Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent• Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply fan VFD Acceptance' (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). I. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: i. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b.. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) 5. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handier. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A i A I t ur wiLi rvKN lA OUTDOOR AIR ACCEPTANCE CFC-NRCA-MCH-n2-A (Revised n7H61 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/rag: FCU-1-14 System Location or -Area Served: Corridor S. NA7.5.1.1 Outdoor Air Acceptance Functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems ' Step 3: CAV and VAV testing at full supply airflow Adjust.supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 892 cfm cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or C. Mechanical E ui mentSchedules). 920 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). 0 cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 0.96 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5 110%) Yes Q No Q Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) - Yes Q No O Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OAR, = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OAR, is within 10% of design Outside Air. (90% 5 %OAR, 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) M Yes Q No Q Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation.' D. Evaluation �✓ PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 a I H I t �r li/iLlr V Kry IH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07116) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: - Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 eayview Place city: Newport Beach Zip Code: 92660 System Name or Identification rag: FCU-1-14 System Location or Area Served: Corridor DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: �- Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: n /5j ZO2 Address: 11140 Thurston Lane ATT Certification Identification (If applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. I have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with th building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: _� Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technicia Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/state/Zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: l RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical' Position with Company (Title): Project Manag Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone:951-241-5392 Date signed: Z/S/r62 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 JIAI t: Ur LALI1-UKNI/i OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: - 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-2-01 System Location or Area Served: Dining Note: Submit one Certificate of Acceptanc_ a for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction. Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. - 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). c. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). I. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV 0 CAV a. Check if Variable Air Volume (VAV) and complete the following: I. Outside airflow is either factory calibrated or field calibrated. 0 Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): 0 Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: _ b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): 0 Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) 5. Pre -occupancy purge has been programmed for -the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 drn per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I A I t_ Ur WiLir V MNIA OUTDOOR AIR ACCEPTANCE CFC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION' CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: - 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or IdenUFlcatlon/Tag: FCU-2-Ol System Location or Area served: - Dining B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or. maximum airflow at full a. cooling. -Record VFD speed (H2). Hz b. Measured outdoor airflow reading (cfm) 1465cfm cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or C. Mechanical Equipment Schedules). 1590 .cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). efm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 0.92 % % b. %OAFA is within 10% of design Outside Air. (90% S %OAFA 5110%) Yes Q No Q Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes Q No O Determine Percent Outside Air at reduced supply airflow (%OARt) for Step 4. (VAV only) a. %OAR, = Measured outdoor airflow, reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OApA is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes p No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes O No p Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation �✓ PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 u 1AIt: Ur W%LIrVMNI.% OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07116) ref ICnoAue Cnlco!_•v rnRA4IIO0In K1 CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place city: Newport Beach Zip Code: 92660 System Name or Identification/rag: FCU-2-01 System Location or Area Served: Dining DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: 2 W ZOZ Address: 11140 Thurston Lane ATT Certification Identification (If appli l : city/state/zip: Mira Loma, CA 01752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available wit he building permit(s) issued for the building. �. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Tec Klan Address: 11140 Thurston Lane ATf Certification Identification (i applicable): city/state/zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation forthe construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to th ilding owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical' Position with Company (Title): Project Man .1 Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: Z 51"o 1 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 uIHI - vr%,HLLrVKIVI/i OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-2-02 System Location or Area Served: Living Note: Submitone Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 1096 of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.S.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). L Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ✓❑ CAV a. Check if Variable Air Volume (VAV) and complete the following: L Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) S. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 din per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handier. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 .7I/iIt Ur I,rALIrUMN11k OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION 0 CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place city: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-2-02 System location or Area Served: Living B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing CAV VAV .. Step 1: Disable demand control ventilation (if applicable) ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a. cooling. Record VFD.speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 1360 cfm cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). 1290 cfm. cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 1.05 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes Q No Q Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes Q No O Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) - Yes Q No Q C. I Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes 0 No o Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation ❑✓ I PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 b I A i t Ut' UALlr V MN IA OUTDOOR AIR ACCEPTANCE liCti-NMt,A-Mlin-UL-A (KByISeU Ufilt)) P'�ir 1 CALIFORNIA ENERGY COMMISSION -40E- CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: - Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System Location or Area Served: _ FCU-2-Q2 Living DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. A certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: 215 %Zc•2 Address: 11140Thurston Lane ATTCertificationIdentification(ifappli City/state/zip: Mira Loma, CA 91752 Phone: 9S1-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with,the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: f Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): TechnVcian Address: 11140 Thurston Lane ATT Certification Identiflcation (if applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: E RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides t9,0e building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: y Responsible Acceptance Person Company Name: Christian Brothers Mechanical Position with Company (Title): Project Mina`ger Address: 11140 Thurston Lane CSLa License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J 1 A I C Vr VAL11_UKN1A OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: - 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/rag: FCU-2-03 System location or Area Served: Office Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02 A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). i. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: L Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) S. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I H I t ur wki-iruKNIH OUTDOOR AIR ACCEPTANCE ^0n Morn RAt Li MLA /o—A—A n711R1 r'AI IFORNIA FNFRGY COMMISSION vCERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 ProjectAddress: 101 Bayview Place City: � Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-2-03 System Location or Area Served: Office B NS SA.1 Outdoor_ Air Acceptance Functional Testing CAV' 'VAV .. Step 1: Disable demand control ventilation (if applicable) ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). Hz b. Measured out airflow reading (cfm) 648 cfm cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or C. Mechanical Equipment Schedules). 640 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑� ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 1.01 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes @ No O Yes 0 No O C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes Q No O Determine Percent Outside Air at reduced supply airflow (%OAR,) for Step 4. (VAV only) a. %OAR, = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OAR, is within 10% of design Outside Air. (90% 5 %OAR, 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes O No Q Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation Q✓ PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 I l Al - ur U LLWUMNIN OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) rAl IFnPMIA FIJFRr:V rnMM1_QCInN CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A _ Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-2-03 System Location or Area Served: Office DOCUMENTATION AUTHOR'S DECLARATIONSTATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: �j/ 7,t4 �O Address: 11140 Thurston Lane ATT Certification Identification (If applicable): City/State/zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with t building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technicl? Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/state/zip: Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: Z1S zin-Z RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to a building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical ` Position with Company (Title): Project M ager Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: 2 Is�zC. y CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I A It: Ur L ALIrUMN IA OUTDOOR AIR ACCEPTANCE r:Fr1NRCA-MCH-n9-A 1RPviced n7/161 CALIFORNIA ENERGY COMMISSION '& CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number. X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-2-04 System Location or Area Served: Office Note: Submit one Certificate of Acceptance for each system I Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-01-A`can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). i. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: i. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) 5. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑� The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I H l t yr l.Aur V nrvlA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A(Revised 07/16) nAi irnonuA CKIMM v—RAR11 c1 r 10 CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 ProjectAddress: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-2-04 System Location or Area Served: Office S. NA7.5.1.1 Outdoor Air Acceptance Functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) ✓�El Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). Hz b. Measuredoutdoor airflow reading (cfm) .655 cfm cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules . 640 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 1.02 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes (2) No Q Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes Q No Determine Percent Outside Air at reduced supply airflow, (%OARA) for Step 4. (VAV only) a. %OAR, = Measured outdoor airflow reading /Required outdoor airflow, reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes Q No o Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation 0 PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A IAI L Ur L.ALIrUKNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System Location or Area Served: FCU-2-04 Office DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: Address: 11140.Thurston Lane ATT Certification Identification (if applicable): City/State/Zip: Mira Loma, CA> 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available wii the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: - Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technl Ian Address: 11140 Thurston Lane ATTCertification Identification (if applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: ChrlStlahBrOtherSMeChanlLal� Position with Company (Title): Project Man r Address: 11140Thurston Lane CSLBLicense: 499547 City/State/Zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 AIlk It Ur I.HLIrIJKNIH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION 4T CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permft Number: . X2021-2737 Project Address: - 101 Bayview Place City: Zip Code: Newport Beach 92660 System Name or Identification/rag: FCU-2-05 System Locatton or Area Served: Kitchen Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Note: MCH-02-A can. be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. .1 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At A -Glance). c. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). i. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): VAV FZ CAV a. Check if Variable Air Volume (VAV) and complete the following: i. Outside airflow is either factory calibrated or field calibrated. 0 Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): 0 Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) FvJ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): 0 Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) S. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): 0 The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 JIAIt VI-',ALI I-VMR 1A OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07116) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number. X2021-2737 Project Address: - 101 Bayview Place City: Zip Code: Newport Beach 92660 System Name or Identification/Tag: FCU-2-05 System Location or Area Served: Kitchen B.`NA7.5.1.1 Outdoor Air Acceptance Functional Testing CAV VAV. Step 1: Disable demand control ventilation (if applicable) ❑✓ ❑- Step 2: Verify unit is not in economizer mode during test (economizer disabled) ✓❑ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at, full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed, (Hz). Hz- b.. Measured outdoor airflow reading (cfm) 635 cfm cfm C Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). 640 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). m cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 0.99 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA:5 110%) Yes Q No Q Yes O No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes Q No O Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes 0 No o Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation ✓❑ PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J 1Air Vr I.AL.IrVKIVIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: - 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-2-05 System Location or Area Served: Kitchen DOCUMENTATION AUTHOR'S, DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: 2/5 /ZGZ Address: 11140 Thurston Lane ATT Certification Identification (If applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technl an Address: 11140 Thurston Lane ATT Certification Identification (ifapplicable): city/state/zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: G S /!5/Z0Z{ RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical Position with Company (Title): Project Manag Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: I 7c CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 ZIIAIt Ur W%Ll rvKN lA OUTDOOR AIR ACCEPTANCE CFC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: - 101 Bayview Place - City: Newport Beach Zip Code: 92660 system Name or Identification rag: FCU-2-06 System Locatlonor Area Served: Corridor f Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date ` that must demonstrate compliance. Ij 1 Intent, Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02-A can lie performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. . 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). i. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ✓❑ CAV a. Check if Variable Air Volume (VAV) and complete the following: L Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) 5. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A 1 A 1 t ur, VHLmvKN IA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CAI 1Cn0A11A. CfJCGr]V r`n 11ARI100In Al CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-2-06 System Location or Area Served: Corridor B. NA7.5.1.1-Outdoor'AirAcceptance Functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems . Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or.maximum airflow at full a' cooling. Record-VFD speed (Hz). -Hz b. Measured outdoor.airflow.reading (cfm) 920 . cfm cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or C. Mechanical Equipment Schedules). 915 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow _ CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 1.01 % % Yes Q No Q b. %OAFA is within 10% of design Outside Air. (90%5 %OAFA 5110%) Yes @ No O C. Outside air damper position stabilizes within S minutes. (Step 3d < 5 minutes) Yes Q No O Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OAgA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 109A of design Outside Air. (90% 5 %OAR, 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes Q No Q Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation ❑✓ PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 AIAIt Vr 4HLIrUKIVIH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview-Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-2-06 System Location or Area Served: Corridor DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. I certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: i7 /,5) ZO Address: 11140 Thurston Lane ATTCertificationldentiffiication'(Ifapplicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Techn clan Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/state/zip: Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permits) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides t, the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical Position with Company (Title): Project Mariag� Address: 11140 Thurston Lane CSLB License: 499547 City/state/zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I H I- Ur I.ALIr-UKN1A OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) rei �rno�ue or.ioon_v rnu.uee�r.., _ ��,.,,. CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X20 X20 21-2737 ProjectAddress: 101 Bayview Place City: Newport Beach Zl 92660 System Name or Identification/Tag: FCU-2-07 System Location or Area Served: Corridor Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply fan VPD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). L Method and equipment used:_ ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: i. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) 5. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 0 1 A I t: Ur' UAL11-VKIVIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System Name or Identification/Tag: FCU-2-07 Enforcement Agency: City: Newport Beach System Location or AreaServed: Corridor CALIFORNIA NRCA-MCH-02-A (Page 2 of 3) Permit Number: X2021-2737 Zip Code: 92660 B. NA7.5.11 Outdoor Air Acceptance Functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow, reading (cfm) 660 cfm cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or C. Mechanical Equipment Schedules). 650 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD spr ed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): cfm min Step 5: Return to initial conditions (check) ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 1.02 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes Q No O Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes 0 No O Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow, reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% S %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes Q No o Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation �✓ PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 .J I AI t Ur- t,ALIrVKrvIA OUTDOOR AIR ACCEPTANCE CFC.NRCA-MCH-09-A (Rexised 07/161 CAI IFORNIA FNFRGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Zip Code: Newport Beach 92660 System Name or Identification/Tag: FCU-2-07 System Location o� Area Served: Corridor DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: 2/S rov- Address: 11140 Thurston Lane ATT Certification Identification (if applicable): City/State/zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician company Name: Christian Brothers Mechanical Services Position with Company (Title): Techniqlan Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/state/zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: 2 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides t the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical 'r Position with Company (Title): Project Ma Address: 11140 Thurston Lane CSLa License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 Date Signed: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I /A I t: Ur I.rHLIr VKrvIH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: PermR Number: X2021-2737 Project Address: 101 Bayview Place city: Newport Beach Zip Lode: 92660 System Name or Identificationtrag: FCU-3-1 System Location or Area Served: Corridor Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. I Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). i. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: i. Outside airflow is either factory calibrated or field calibrated. 0 Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): 0 Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) Q Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): 0 Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. 0 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) 5. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): 0 The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 JIAlr Vl- W%LIrVKNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA FNFRGY COMMISSION le CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach zip Code: 92660 System Name or Identlflcatlon/Tag: FCU-3-1 System location or Area Served: Corridor B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) 0 ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). - Hz b. Measured outdoor airflow reading (cfrd) 653 cfm drn C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). 640 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). drn cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 1.02 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA:5 110%) Yes (2) No O Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) -IRYes Q No Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% S %OARA 5 110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes O No Q Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation ✓❑ PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 Ai Air Ur UALWUMNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/161 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3)' Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number. X2021-2737 Project Address: 101 Bayview Place city: Newport Beach Zip Code: 92660 System Name or Identtfication/Tag: FCU-3-1 System Location or Area Served: - Corridor DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: �7 / G S . ZoZ Address: 11140 Thurston Lane ATTCertification'Identification a le): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 f FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available wit the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: I Field Technician company Name: Christian Brothers Mechanical Services Position with Company(Title): Techn' Ian Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/state/zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date signed: 2 / S/ZoZc� RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical ' Position with Company (Title): Project Ma ag Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: 2�S/Z-oz CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J 1 /11 t_ Ur' Wki-I rUKN IA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Permit Number: Pe Enforcement Agency: Clearwater Harbor Point Senior Living X2021-2737 Project Address: - City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/rag: System Location or Area Served: FCU-3-2 Corridor Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH 03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection. Note: MCH-02-A can be performed in'conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap.. 1. Supporting documentation needed to perform test includes: a' As -built anal/or design documents (for example, Mechanical Equipment Schedules, Equipment Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). c. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). I. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): VAV Ftf� CAV a. Check if Variable Air Volume (VAV) and complete the following: i. Outside airflow is either factory calibrated or field calibrated. 0 Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) S. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): 0 The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 JIHI - Vr LWiLIrVKIVIH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: Enforcement Agency: Clearwater Harbor Point Senior Living ProjectAddress: cm' 101 Bayview Place Newport Beach System Name or Identification/Tag: System Location or Area Served: FCU-3-2 Corridor B. NA7.5AA Outdoor Air Acceptance Functional Testing CAV Step 1: Disable demand control ventilation (if applicable) ❑✓ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a• cooling: Record VFD speed (Hz). b. Measured outdoor airflow reading (cfm) 630. Required outdoor airflow (cfm) (from MCH-03, Column 14, or 640 C. Mechanical Equipment Schedules). Time for outside air damper to stabilize after full supply airflow is achieved d (minutes): Step 4: VAV testing at reduced supply airflow CAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). b. Measured outdoor airflow reading (cfm). C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): Step 5: Return to initial conditions (check) COMMISSION N RCA-MCH-02-A (Page 2 of 3) Permit Number. X2021-2737 Zip Code: 92660 cfm cfm C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 0.98 % VAV Hz cfm cfm min VAV Hz cfm cfm min Q b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes 0 No Yes O No O C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes O No O Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OAR„ = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OApA is within 10% of design Outside Air. (90% 5 %OARA 5 110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes O No Q Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation �✓ 1 PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A I C UI- UALIrUMIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION ' CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-3-2 System Location or Area Served: Corridor DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: -V 20 I Address: 11140 Thurston Lane ATTCertifiication Identification (If applicable): city/state/zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available wi e b ding per issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technl an Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/state/Zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date signed: RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to a building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical ` Position with Company (Title): Project Ma ger Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone: Date Signed: 951-241-5392 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 a i A l t yr wm_irvmmA OUTDOOR AIR ACCEPTANCE "13,11 laG-N muA-mLm-UL-A kmevisea u//7OJ _ UALWUMIA tNtKUT I:UMMIAAIUIV CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Enforcement Agency: j Permit Number. Clearwater Harbor Point Senior Living II X2021-2737 Project Address: city: Zip Code: 101 Bayview-Place Newport Beach 92660 System Name or Identification/rag: System Location or Area Served: FCU-3-3 Corridor Note: Submit one Certificate. of Acceptance for each system u Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). I. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: i. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J i H 1 t Ur I.ALIY V K[W% OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) l:ei WnDMIA Gnioocv rnKAKAIQmnnl CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number. X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: - 92660 System Name or Identification/rag: FCU-3-3 System Location or Area Served: Corridor B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CA V systems Step 3: CAV and VAV testing at full supply airflow AAW Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 672 cfm cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or C. Mechanical Equipment Schedules). 640 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 1.05 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes @ No O Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes Q No O Determine Percent Outside Air at reduced supply airflow (%OAgA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OAR, is within 10% of design Outside Air. (90% 5 %OARAA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes O No O Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation ❑✓ � PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 u 1 H 1 t Vr WkLIr VKrv1H OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) at CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/rag: FCU-3-3 System Location or Area Served: Corridor DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: 2- Address: 11140 Thurston Lane ATT Certification Identification (if applicable): City/State/Zip: Mira Loma, CA 91152 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with th building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technician Address: 11140 Thurston Lane ATT Certification Identification (if applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: Z/S�Zp'Z RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to t building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: r Christian Brothers Mechanical . Position with Company (Title): Project Man e Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 o I H I t ur t,rLLlrumrviA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07116) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: Enforcement Agency: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place city: Newport Beach System Name or Identification/Tag: System Location or Area Served: FCU-3-4 Corridor Note: Submit -one Certifcate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. ENERGY N RCA-MCH-02-A (Page 1 of 3) X2021-2737 Code: 92660 Intent: Verify measured outside airflow reading is within.10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14J or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities. overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a. Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.1 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). i. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): lc/1•+11a 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: i. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) 5. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I H I r Ut- t.AL1YVKIVIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07116) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Enforcement Agency: Clearwater Harbor Point Senior Living Permit Number: Project Address: X2021-2737 101 Bayview Place city: Newport Beach Zip Code:92660 System Name or Identificationtrag: System Location or Area Served: FCU-3-4 Corridor B.. NA7.5.1.1 Outdoor Air Acceptance Functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) ❑✓ El Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design.airflow or maximum airflow at full a. -cooling.. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 687 cfm cfm Required outdoor airflow, (cfm) (from MCH-03, Column 14, or C. Mechanical Equipment SchedulesJ. 640 cfm I cfm d Time for outside air damper to stabilize after full supply airflow is achieved Step 4: VAV testing at reduced supply airflow min � CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): Step 5: Return to initial conditions (check) min C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 1.07 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA S 110%) Yes & No Q Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes Q No O Determine Percent Outside Air at reduced supply airflow, (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes Q No Q Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation Q✓ PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I H I - Ur' l.Alir'UKINIA OUTDOOR AIR ACCEPTANCE "Cl, ctL,-NmL,A-mL,n-uz-A tmevisea urrioj CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System Location or Area Served: FCU-3-4 Corridor DOCUMENTATION ALITHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: J /C ft0 Zy 77 Address: 11140 Thurston Lane ATT Certification Identification (If applicable): City/State/Zip:' Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. _ Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technician Address: 11140 Thurston Lane ATT Certification Identification (if applicable): City/State/Zip: Mira Loma, CA 91752 Phone: Date Signed: 951-361-2247 2,j' RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to he building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical Position with Company (Title): Project Ma d rzffl� Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: 2I/ /7-0'ZV CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 a i r� i t yr t,rw!r�l<rvlrj OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION 4T CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or ldenti!,cation/Tag: - System Location or Area Served: FCU-B-Ol Staff Break Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03. (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection_ _ Note: MCH-02-A can beperformed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap.: 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.S.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.S.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). c. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). L Method and equipment used: ELECTRONIC MANOMETER U. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: i. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) S. Pre -occupancy purge has been programmed for the.1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 drn per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handier. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 a i N i a yr t,AL irvKrwk OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: - 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-B-Ol System Location or Area Served: Staff Break B. NA7.5.1.1 Outdoor Air Acceptance functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air•to-achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 640 cfm cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or C. Mechanical E ui meet Schedules). 640 cfm cfm d Time -for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 1.00 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5 110%) Yes QQ No Q Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes Q No O Determine Percent Outside Air at reduced supply airflow (%OARt) for Step 4. (VAV only) a. %OAR, = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes 0 No o Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation 0 PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 o IHi t ur W%LIt-U" VIf% OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 ProjedAddress: ' City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System Location or Area Served: FCU-B-01 Staff Break DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature:�� Documentation Author Compa ny Name: Christian Brothers Mechanical Services Date Signed: Z151Z0Z , Address: 11140 Thurston Lane ATTCertification Identification (If applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with th building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: �— Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technic) Address: 11140 Thurston Lane ATT Certification Identification IN applicable): city/state/Zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: 2 %El2d Zy ! J[ RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to ne building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical ' Position with Company (Title): Project Mana Address: 11140 Thurston Lane CSLR License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone:951-241-5392 DateSlgned: n �G / 2,C57-11' CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A I r ur- I.HLWUKMA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07116) at CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place city: Newport Beach Zip Code: 92660 System Name or Identt ication/rag: FCU-B-02A System Location or Area Served: Corridor. Note: Submit one Certificate of Acceptance for each system � Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02-A can be performed in conjunction with.MCH-07.--A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). c. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). i. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV 0 CAV a. Check if Variable Air Volume (VAV) and complete the following: i. Outside airflow is either factory calibrated or field calibrated. 0 Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) 0 Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: 0 System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): 0 Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. 0 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) S. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 AIHI t: Ur I,ALIrVKrvIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CAI IMRNIA FNFRGY COMMISSION 'e CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification rag: FCU-B-02A System Location or Area Served: - Corridor B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing : CAV VAV Step 1: Disable demand control ventilation (if applicable) - ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note:. Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a. cooling. Record VFD speed (Hz).- Hz b. Measured outdoor airflow reading (cfm) 978 cfm cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical E ui mentSchedules). 935 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 1.05 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes @ No Q Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes O No iD Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes O No O Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation �✓ PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016.Nonresidential Compliance July 2016 JIAit Vr VALIrVKIVIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identificatlonfrag: FCU-B-02A System Location or Area Served: Corridor DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: 2/ I iZ0 Address: 11140 Thurston Lane ATT Certification Identification (If applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the budding permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: .............r Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technician 71 Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/state/zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: !� / S�ZGZ. LI ! ✓ 1 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical ' Position with Company (Title): Project Mana Address: 11140 Thurston Lane CSLR License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 Signed: Date Si g Z15 zo CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 AIAir Ur %'Al_I1_UKN11A OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07116) CALIFORNIA ENERGY COMMISSION 4T CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living ^ Enforcement Agency: Permit Number. X2021-2737 Project Address: 101 Bayview Place- City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: System Location or Area Served: FCU-B-03 Corridor Note: Submit One Certif,ICate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. - 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). i. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: L Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) S. Pre -occupancy purge has been programmed for -the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 AIAIt Vr VALIrVKN1A OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07116) CALIFORNIA ENERGY COMMISSION 4Z CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: - 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identificationfrag: FCU-B-03 System Location or Area Served: Corridor B. NA7:5AA Outdoor Air. Acceptance Functional Testing cav " VAV Step 1: Disable demand control ventilation (if applicable) ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling: Record VFD speed (Hz). Hz b.. Measured outdoor airflow reading (cfm) 672. cfm cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical E ui ment Schedules . 620 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). dm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 1.08 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes Q No Q Yes Q No 0 C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes Q No Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OAR, is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes 0 No 0 Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation ✓� PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 b I R I r Vr W%Lir'VKIVIH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) 11� CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/rag: FCU-B-03 - System Location or Area Served: Corridor DOCUMENTATION AUTHOR'S DECLARATION'STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: Z/S ZOZ Address: 11140 Th urston- Lane ATT Certification Identification (if applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with t e building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician company Name: Christian Brothers Mechanical Services Position with company (Title): Technician Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/state/zip: Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: Z/S/ ZO7,If RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical ' : Position with Company (Title): Project Manag ;-'- Address: 11140 Thurston Lane CSLB license: 499547 City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 Date Signed: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A 1 A I C Ur L.ALII-UKI41/i OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) AMIN MTL CALIFORNIA ENERGY COMMISSION RIW- CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: zip Code: Newport Beach 92660 System Name or Identification/Tag: FCU-B-04 System Location orArea Served: Salon Note: Submit one Certificate- of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02-A can be'performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). c. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). i. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: i. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) S. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 . I /i I t Ur t.ALIrUKNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview-Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-B-04 System Location or Area Served: Salon B. NA7.5.1.1 Outdoor Air. AcceptanceFunctional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not.apply for CAV systems Step 3: CAV and VAV testing at full supply airflow - Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed. (Hz). Hz b. Measured. outdoor airflow reading (cfm) 677 cfm drn- Required outdoor airflow (cfm) (from MCH-03, Column 14, or C. Mechanical Equipment Schedules). cfm cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). _ cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). WP cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 1.01 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA:5 110%) Yes Q No Q Yes O No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes p No Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARAA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes 0 No 0 Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation ✓❑ PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 OIlk I t Ur- 11AI-11"VKIVI/► OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) it I CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: I Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: � 92660 System Name or Identification/rag: FCU-B-04 System Location or Area Served: Salon DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: 2151 gGZ Address: 11140 Thurston Lane ATT Certification Identification (If applicable): City/State/Zip; Mira Loma, CA 917S2 Phone: 951-241-S392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: _ Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): T chnIcIan Address: 11140 Thurston Lane ATT Certification Identification (if applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: ,/zC) RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical Position with Company (Title): Project Man a Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 Date Signed: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 bIAIt Ur VALI rUKN IH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION e' CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Paint Senior Living Enforcement Agency: Permit Numher: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-B-05 System Location or Area Served: Activity Note: Submit one Certificate of Acceptance for each system I Enforcement Agency Use:. Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 24) or Mechanical Equipment Schedules. A. Construction Inspection. i Note: MCH-02-A can be performed in conjunction- with MCH-07-A Supply Fan- VFD Acceptance (if applicable) since testing activities overlap. , 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example,. Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). L Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: I. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ✓❑ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 AIlk 11- VF L.ALIrVMNIk% OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) r.AI IMPNIA I:WIQrY r_rHu Wgc:Ir1N 'e CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 eayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-B-05 Activity. System Location or Area Served: - B. NA7.5.1.1 Outdoor Air Acceptance FunctionalTesting CAV VAV Step 1: Disable demand control ventilation ('if applicable) ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at.full a' cooling. Record VFD speed (Hz). 41100 Hz b. Measured outdoor airflow reading(cfm) 810 cfm cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or C. Mechanical Equipment Schedules). 730 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 1.11 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes Q• No Q Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes Q No O Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OApA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OApA is within 100A of design Outside Air. (90% 5 %OARA5110%) Yes Q No C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes 0 No Q Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation 0 PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 o I H i C ur L I%LI r V KIV IH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) 33e CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-B-05 System Location or Area Served: Activity DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: n 15/ z 0 7, Address: 11140 Thurston Lane ATT Certification Identification (If applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws. of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: `J Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technician Address: 11140 Thurston Lane ATT Certification Identification (if applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-361-2247 Date signed: RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical � - Position with Company (Title): Project M Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: ` Mira Loma, CA 91752 Phone: 951-241-5392 Date Signed: tr �Jr' 2®z7 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 AIAI rUr t.AL1rVKN11A OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/rag: FCU-B-08 System Location or Area Served: Laundry Note. Submit one Certificate of Acceptance for each system Enforcement Agency use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A..Construction Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since, testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a. Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). L Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: I. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) S. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 a I A it: yr w%Li rumrq ir+ OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07116) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agenry: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-B-08 System Location or Area Served: Laundry B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing CAV " VAV Step 1: Disable demand control ventilation (if applicable) ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ✓❑ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. -Record VFD speed (Hz). Hz b. Measured outdoor airflow, reading (cfm) 595 cfm efm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). 595 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow, (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 1.00 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA15 110%) Yes Q No Q Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes Q No O Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OAR = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OAR, 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes 0 No o Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 WAl t Ur LALirUKrviA OUTDOOR AIR ACCEPTANCE W LCL-rvKLA-mt.n-uc-A imewseu uri io) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System Name or Identification/Tag: FCU-B-08 Enforcement Agency: City: Newport Beach System Location or Area Served: - Laundry tN1=11t7y LUMMI0.I.I1J N RCA-M CH-02-A (Page 3 of 3) Permit Number: X2021-2737 Zip Code: 92660 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: Address: 11140 Thurston Lane ATT Certification Identification (if applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technician Address: 11140 Thurston Lane ATT Certification Identification (if applicable): City/State/zip: Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: Z / C )Z d Z �+ J / RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued forthe building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to t building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical F-i�, Position with Company (Title): Project Mana Address: 11140 Thurston Lane CSLB License: 499547 City/state/zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: ry /5 J q Q.Zcr CA Building Energy Efficiency Standards- 2016 Nonresidential Compliance July 2016 A I A i t Ur t..AL1 r'UKN IA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identiflcationtrag: FCU-B-09 System Location or Area Served: Main Elec. Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-ASupply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). I. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: L Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ✓❑ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) 5. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J l Alt Vr (,1%L1rVKIWt% OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION 4Z CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place Qty: Newport Beach Zip Code: 92660 System Name or Identification rag: FCU-B-09 System Location or Area Served: Main Elec. B. NA7.5.1.1 Outdoor Air Acceptance'Functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) 0 ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 1493 cfm cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules. 1412 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 1.06 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes QQ No Q Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes 0 No O Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes O No O Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation ❑✓ PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A Ilk I t Ur- S AI-irVKNit% OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) reI ICnGfWe c>ticor_v rnr�R�iccin� CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 ProjectAddress: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-B-09 System Location or Area Served: Main Elec. DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: ZOZti Address: 11140 Thurston Lane ATT Certification Identification (If applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Tech Klan Address: 11140 Thurston Lane ATT Certification Identification (if applicable): City/State/zip- : Mira Loma, CA 91752 Phone: Date Signed: 951-361-2247 2l S�ZO Z y RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical.' Position with Company (Title): Project ManaCeyl Address: 11140 Thurston Lane CSLB License: 499547 city/state/zip: Mira Loma, CA 91752 Phone: 951-241-5392 Date Signed: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I H It: ur 11./1LI1-uKr4lik OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living Project Address: City: 101 Bayview Place � Newport Beach - System Name or Identification rag: System Location or Area Served: EF-01 Staff Break Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use' Checked by/Date that must demonstrate compliance. Zip Code: 92660 Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC Intent: units. Reference MCH-03 (Column 14J or Mechanical of Schedules. A. Construction Inspection Note: MCH-02-A can be performed in conjunction with MCH-07 A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). L Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): iZ/14/c5 3. System type (check either VAV or CAV): ❑ VAV 0 CAV a. Check if Variable Air Volume (VAV) and complete the following: i. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ✓❑ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is -ducted directly to the unit, outside air is provided independent of the unit, or economizer) Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 Alillt Ur I.HLIrVKIVI/i OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION 41& CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Enforcement Agency: Permit Number. Clearwater Harbor Point Senior Living Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 SystemNameor Identificationtrag: System Location or Area Served: EF-Ol Staff Break B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing `' CAV VAV Step is Disable demand control ventilation (if applicable) ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) 0✓ 0 Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 85 cfmrt cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or C. Mechanical Equipment Schedules . 90 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): cfm min Step 5: Return to initial conditions (check) C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3 a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 0.94 % I % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA15 110%) Yes Q No 0 Yes 0 No 0 C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) IYes 0 No 0 Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes 0 No 0 C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes 0 No 0 Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation 0 I PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 Z. I Air Vr W%1_11-VKNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) COI IFARNIA FNFRf�V Cfth.SAAICCir1N CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: Project Address: 101 Bayview Place City; 1 Newport Beach Zip Code: 92660 System Name or Identification/Tag: EF-Ol System Location or Area Served: .Staff Break DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Slgnature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: /C '(. J / Z6Z t Address: 11140 Thurston Lane ATT Certification Identification (If applicable): city/state{zlp: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technician Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/state/zip: Mira Loma, CA 91752 Phone: Date Signed: 951-361-2247 2 2 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to he building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical ' Position with Company (Title): Project Marta r Address: 11140 Thurston Lane CSLe License: 499547 City/State/zip: Mira Loma, CA 91752 Phone:.951-241-5392 Date Signed: 2/57/ 7— ` CA Building Energy Efficiency Standards- 2016 Nonresidential Compliance July 2016 A i m i t V r t,i,,u r V KNIH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Enforcement Agency: Project Name: Clearwater Harbor Point Senior Living Project Address: Ctty. 101 Bayview Place Newport Beach System Location or Area Served: Women System Name or Ident�fication/Tag: EF-02 Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate -compliance. NRCA-MCH-02-A (Page 1 of 3) Permit Number: ZIP code: 92660 Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC Intent: units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02•A can be performed in conjunction with MCH-07-A Supply Fan VFO Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a. Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). L Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: I. Outside airflow is either factory calibrated or field calibrated. 0 Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): 0 Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: _ b. Check if Constant Air Volume (CAV) and verify the following: 0 System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) S. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. M rmmniete air chances to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 AIAIC Vh i.ALIr-UKrvIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System Name or Identification/Tag: EF-02 Enforcement Agency: City: Newport Beach system Location orArea served: Women es. NA7.5.1.1 Outdoor Air Acceptance Functional Testing Step 1: Disable demand control ventilation (if applicable) Step 2: Verify unit is not in economizer mode during test (economizer disabled) Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow a. Adjust supply air to achieve design airflow or maximum airflow at full cooling. Record VFD speed (Hz). b. Measured outdoor airflow reading (cfm) C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment.Schedules . d Time for outside air damper to stabilize after full supply airflow is achieved (minutes : Step 4: VAV testing at reduced supply airflow a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). b. Measured outdoor airflow reading (cfm). C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): Step 5: Return to initial conditions (check) C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) IA CAV NRCA-MCH-02-A (Page 2 of 3) Permit Number: Zip Code: 92660 VAV 210 cfm 237 cfm CAV VAV Hz cfm cfm min Hz cfm cfm min Z ❑ Es@N .89Eo0l % ]YeEsQEN Q Determine Percent Outside Air at reduced supply airflow, (%OARA) for Step 4. (VAV only) Yes Q No O a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) % Yes Q No Q c. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynnamiYes 0 c o Q controls to avoid over ventilation. D. Evaluation P1 I PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CAPuilding Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 .b I AI t_ UI- t/HL 1r'UKNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A CALIFORNIA ENERGY CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living Project Address: - City: Zip Code: 101 Bayview Place Newport Beach - 92660 System Name or Identification/Tag: - System Location or Area Served: - EF-02 Women DOCUMENTATION AUTHOR'S DECLARATION STATEMENT. 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: 2 /C ZC) Z Address: 11140 Thurston Lane ATT Certification Identification (If applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available wit the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: -f Field Technician Company Name: Brothers Mechanical Services Position Position with Company (Title): Technician Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/State/zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to th building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical ' Position with Company (Title): Project Mana Address: 11140 Thurston Lane CSLB license: 499547 City/State/zip: Mira Loma, CA 91752 Phone: 951-241-5392 Date Signed: Z ! Zo! 4 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I A r t Ur t,1kL11-UKN IA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identificetiontrag: EF-03 System Location or Area Served: Men Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. 4 Note: MCH-02-A can be performed in conjunction with MCH-07 A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 11 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). L Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: i. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): 0 Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: 0 System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ✓❑ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) S. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): 0 The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A IHIt Ur, 111iL-11"U rvIH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION I& CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identiflcationfrag: - EF-03 System location or Area Served: - Men B: NA7.5,1.1 Outdoor Air Acceptance Functional Testing cav VAV. Step 1: Disable demand control ventilation (if applicable) ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CA V systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling..Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 210 cfm cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). 213 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step S: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 0.99 % % b. %OAFA is within 10% of design Outside Air. (90% S %OAFA 5110%) Yes @ No Q Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes 0 No Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes 0 No Q Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation ✓❑ PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 0IAIC Vr VALIrVKN1A OUTDOOR AIR ACCEPTANCE rcC_u RCA_aACH-M-A (Re Aa-d n7MA1 CALIFORNIA ENERGY COMMISS[ON CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: EF-03 System Location or Area Served: Men ` DOCUMENTATION AUTHOR'S- DECLARATION STATEMENT I 1. - I certifv that this Certificate of Acceptance documentation is accurate and complete. ____7 J Documentation Author Name: Johnny Contreras Documentation Author Signature: l Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: 2 /5/ZO2_ Address: ATT Certification Identification (If applicable): 11140 Thurston Lane City/State/Zip: Mira Loma, CA 91152 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available jvith the building permit(s) issued for the buildine. I __' Name:Todd Alpert Field Technician Signature:Technician LFleIdTechnician Company Name: Christian Brothers Mechanical Services Position with Company (Title):TeC nician ess: 11140 Thurston Lane ATT Certification Identification (if applicable): city/state/zip: Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: Z/S/Z�jZy RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to a building nwner at occunancv. f Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical - Position with Company (Title): I Project MAt 'r Address: 11140 Thurston Lane CSLB Ljcense: 499547 City/state/zip: Mira Loma, CA 91752 Phone: Date Date Signed: 21 �/ ZOZy CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I A l t OF t./iLIrUMNIH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION 'S' CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: EF-04 System Location or Area Served: Salon/Spa B04 Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. ' Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02 A can be performed in conjunction with MCH-07--A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). i. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV 0 CAV a. Check if Variable Air Volume (VAV) and complete the following: i. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: . b. Check if Constant Air Volume (CAV) and verify the following: 0 System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. 0 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) S. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): 0 The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A I F ur' t,ALItUMN IA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA FNFRGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: Project Address: 101 Bayview Place city: Newport Beach Zip Code: 92660 System Name or Identification/rag: EF-04 System Location or Area Served: Salon/Spa B04 B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 400 cfm cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedulesl. 403 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 0.99 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5 110%) Yes @ No Q Yes O No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes Q No A Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90%5 %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) I Yes 0 No o Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation ❑✓ PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A I t V r UALI r V KIV IA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) L'AI WnDKIIA CnlcoG`v rn►acl1 a CdnKl 4S ~ CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: EF-04 System Location or Area Served: Salon/Spa B04 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: L/5 f zo Address: 11140 Thurston Lane ATT Certification Identification (If applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with a building permit(s) issued for the building. _ Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technic) Address: 11140 Thurston Lane ATT Certification Identification (if applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-361-2247 Signed: Date si ,j 202 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the ilding owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical rrt �i Position with Company (Title): Project Mana r Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: �L/C/ Zc`Zfl CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I A i t Ur I,ALIr V KIV IH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) e CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/rag: EF-05 System Location or Area served: Laundry 147 Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC I I units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). L Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: L Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: _ b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) 5. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 o l A I C yr %,1%Ur V Krvlfi OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: EF-05 System Location or Area Served: Laundry 147 B. NA7SAA Outdoor Air Acceptance Functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 450 -cfm cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). 475 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 0.95 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5 110%) Yes @ No 0 Yes 0 No 0 C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes 0 No O Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) I Yes 0 No 0 C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes 0 No 0 Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation 0 PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 D IA I t Ur L.AUrUKNIf% OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) �Al CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: EF-05 System Location or Area Served: Laundry 147 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: 2 /f / Z cz Address: 11140 Thurston Lane ATT Certification Identification (If applicable): city/state/Zip:.Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S -DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with th wilding permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician company Name: Christian Brothers Mechanical Services Position with Company (Title): Technicla Address: 11140 Thurston Lane ATT Certification Identification (if applicable): City/State/zip: Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: J/ RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: ChrlStlanBrOtherSMEChanIC21 Position with Company (Title): Project Manager Address: 11140 Thurston Lane C518 License: 499547 City/State/Zip: Mira Loma, CA '91752 Phone:951-241-5392 Date Signed: 2/s 1 c CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A I t V r 1,AL11­V KIYIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Protect Name: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place Enforcement Agency: CRY: Newport Beach System Name or IdeM9fication/rag: - System Location or Area Served: EF-06 Corridor Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. ENERGY COMMISSION 4T NRCA-MCH-02-A (Page 1 of 3) Permit Number: Zip Code: 92660 Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. rA.onstruction Inspection MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. Supporting documentation needed to perform test includes: a. As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). I. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: L Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibratjon certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) S. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 DIAIt Ur %.ALIrVKIVIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07116) CALIFORNIA ENERGY CCMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: ` Enforcement Agency: Permit Number. Clearwater Harbor Point Senior Living Project Address: City: Zip Code. 92660 101 Bayview Place Newport Beach System Name or Identification/Tag: ` System Location or Area Served: EF-06 1 Corridor B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing _CAV VAV Step 1: Disable demand control ventilation (if applicable) ✓❑ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ Note: Shaded boxes do not apply for CA V systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 470 cfm cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or 513 cfm C. Mechanical Equipment Schedules). cfm Time for outside air damper to stabilize after full supply airflow is achieved d (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 0.92 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes & No 0 Yes O No O C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes 0 No Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes 0 No 0 C. Outside air damper position stabilizes within 5 minutes. (Step 4d < S minutes) Yes 0 No 0 Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I A I t V r %.ALIT VKIV IA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) ..... __.....__._.. VVIVIIYeJJIV IY CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Numher. Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 'System Name or Identification/rag: EF-06 System Location or Area Served: Corridor DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1-certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: /Zd ,Zrc J Address: 11140 Thurston Lane ATT Certification Identification (If applicable): City/State/Zip: Mira Loma, CA ' 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with th building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technic) Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/State/Zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: J RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical t, �a Position with Company (Title): Project Manager Address: 11140 Thurston Lane CSLa License: 499547 city/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 z r f Date Signed: 2 /51Z0 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 o I ik i C Vr W%Llr-VKIVIH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CAI IFARMIA r-MFRr:V rOUKAICP2Ir1M CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Idertificatlon/Tag: EF-07 System Location or Area Served: Roof Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use; Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). L Method and equipment used:_ ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ✓❑ CAV a. Check if Variable Air Volume (VAV) and complete the following: L Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I A I r Ur' WIU-11"V MIA OUTDOOR AIR ACCEPTANCE 1'9=r-AIRrA-MCP-n9-A IRPvAQP i n711Rl CAI IFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or-Identification/Tag: EF-07 .System Location or Area Served: Roof B. NA7.5.1.1 Outdoor Air Acceptance Functionai Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at .full a. cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 360 cfm cfm Required outdoor airflow () (from MCH-03, Column 14, or C. cfmMechanical Equipment Schedules). 394 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 0.91 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA!; 110%) Yes @ No O Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes 0 No Q Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5 110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes Q No Q Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation ✓� PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 AIHI - Vr• L.ALIr-VKNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: EF-07 System Location or Area Served: Roof DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: .7 fi//ZQZ Address: 11140 Thurston Lane ATT Certification Identification (If applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with a building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: - Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technic) n Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/State/zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to a building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical Position with Company (Title): Project Mana Address: 11140 Thurston Lane CSLEI License: 499547 city/state/zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 AIHIt VI_ VHLIrVKrvW OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number. Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/tag: EF-12 System Location or Area Served: HSKP Note: Submit one Certificate of Acceptance_ for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction I I Note: MCH-02-A can be performed in conjunction -with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). L Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: i. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) 5. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 Z. to i C yr UAL11'vKIV1A OUTDOOR AIR ACCEPTANCE CEGNRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living Project Address: p City: Zip Code: 101 Bayview Place Newport Beach 92660 - System Name or Identification/Tag: System location or Area Served: EF-12 HSKP B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) R1 El Step 2: Verify unit is not in economizer mode during test (economizer disabled) 51� Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to -achieve design airflow or maximum airflow at full a' cooling. Record-VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 70 cfm cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or C. Mechanical Equipment Schedules). 73 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): dm min Step S: Return to initial conditions (check) El C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3 a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 0.91 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA:5 110%) Yes QQ No Q Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes Q No O Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OAR, = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) 96 b. %OARA is within 10% of design Outside Air. (90% 5 %OAR„ 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes Q No Q Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation 0 I PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A IlkI t Vr I.HLIruKIVIH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System Name or Identification/Tag: EF-12 City: Newport Beach System t.oation or Area served: HSKP DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: -2 Address: 11140 Thurston Lane ATT Certification Identification (If City/State/zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT Zip Code: 92660 I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with t e building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Address: 11140 Thurston Lane city/state/zip:Mira Loma, CA 91752 RESPONSIBLE PERSON'S DECLARATION STATEMENT Position with company (Title): ATT Certification identification (if applicable): Phone: 951-361-2247 I Date Signed: 2lS I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical ' Position with Company (Title): Project Mana r Address: 11140 Thurston Lane CSLB License: 499547 city/state/zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: 2�s CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I ri l r ur wii-i rumrwA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identiricationtrag: system Location or Area Served: EF-13 Unisex .Note: Submit one Certificate of Acceptance for each system -f Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent• Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As - built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NAZS.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NAZ5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). I. Method and equipment used:_ ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ✓❑ CAV a. Check if Variable Air Volume (VAV) and complete the following: L Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) S. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 O r H It ur t,AUrur%NtA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System Name or Identiflcation/Tag: EF-13 Enforcement Agency: City: Newport Beach System Location or Area Served: Unisex B. NA7.5.1.1.Outdoor'Air Acceptance Functional Testing CAV Step 1: Disable demand control ventilation (if applicable) Step 2: Verify unit is not in economizer mode during test (economizer disabled) ✓❑ Note: Shaded boxes do not apply for CA V systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a. A full . . COMMISS ON NRCA-MCH-02-A (Page 2 of 3) Permit Number: Zip Code: 92660 b. Measured outdoor airflow reading (cfm) 90 cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or 91 C. Mechanical Equipment Schedules). cfm Time for outside air damper to stabilize after full supply airflow is achieved d. Step 4: VAV testing at reduced supply airflow CAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). b. Measured outdoor airflow reading (cfm). C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): Step 5: Return to initial conditions (check) I ❑✓ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. VAV` El Hz cfm cfm min VAV Hz cfm cfm min El a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 0.91 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA:5 110%) Yes & No Q Yes O No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes O No O Determine Percent Outside Air at reduced supply airflow (%OAR,) for Step 4. (VAV only) a. %OAR, = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OApA is within 10% of design Outside Air. (90% 5 %OARAA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes O No o Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation 0✓ 1 PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A I r Ur' %,/ALIrUKIVIA OUTDOOR AIR ACCEPTANCE GEC-NRCA-MCH-02-A (Revised 07/16) f�-!`el IrnO�11A r\Ir�I^_V f+AAA 11CCIn\I y CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: Project Address: 101 Bayview Place city: Newport Beach Zip Code: 92660 System Name or Identification/Tag: EF-13 System Location or Area Served: Unisex DOCUMENTATION AUTHOR'S DECLARATION STATEMENT -1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: �y Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: Z/s /Z62 Address: 11140 Thurston Lane ATT Certification Identification (If applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available wit the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician company Name: Christian Brothers Mechanical Services Position with Company (Title): Technician Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/state/zip: Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: �S1Z0 23 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical' Position with Company (Title): Project Ma Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 Date Signed: ZIsIZC� 3 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 I If+i t yr Iry lrvnrvlH OUTDOOR AIR ACCEPTANCE CFr_NRCA_MCH-02-A /Revised 07/16) Z It it CALIFORNIA ENERGY COMMISSION RiW- CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: Project Address: 101 Bayview Place Cfty: Newport Beach Zip Code: 92660 System Name or Identification/Tag: GEF-01 System location or Area Served: Garage Note: Subrn&one,Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate, compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap.. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). i. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: i. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ✓❑ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. .❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) 5. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handier. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 air%irUrL,rLLII-UKrvIH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07116) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: ENERGY NRCA-MCH-02-A (Page 2 of 3) Permit Number: Project Address: city: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System Location or Area Served: GEF-Ol Garage B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow, at full a' cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 17000 cfm cfm Required outdoor airflow, (cfm) (from MCH-03, Column 14, or C. Mechanical Equipment Schedules). 17003 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow, to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 0.91 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes Q No O Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes O No 0 Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes 0 No Q Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation �✓ PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J lAit Ur' UALi r`VKN11% OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: .Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System Location or Area Served: GEF-Ol Garage DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. DocumentationAuthor.Name: YOhnnyContrera5 Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: Address: 11140 Thurston Lane ATT Certification Identification (If applicable): city/state/Zip:Mira Loma,- CA 91752 Phone: 951-241-5392 FIELD TECHNICIAMS DECLARATION STATEMENT I certify the following under penalty of perjury,.under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available wit the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): TeC ic)an Address: 11140 Thurston Lane ATTCertification Identification (if applicable): city/state/zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: 2 Z6z9 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to th uilding owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical " Position with Company (Title): Project Ma Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 f! Date Signed: z / (� �2o 2 y CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 0 iH It: Ur' t,AI-Ir'UKINIH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CERTIFICATE OF ACCEPTANCE ;NIA ENERGY COMMISSION "4 NRCA-MCH-02-A Outdoor Air Acceptance rrojecr name: j Enforcement Agency: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place ]ystem Name or Identification/Tag: MAU-01 city: Newport Beach System Location or Area Served: Kitchen Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. (Page 1 of 3) Permit Number: X2021-2737 Zip Code: 92660 Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules, A. Construction Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). c. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). i. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV 0 CAV a. Check if Variable Air Volume (VAV) and complete the following: L Outside airflow is either factory calibrated or field calibrated. 0 Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): 0 Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: 0 System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) 5. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): 0 The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 drn per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handier. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J 1 A I t Ut- L AL1r V KIV If% OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: Enforcement Agency: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System Name or Iden ification/rag: MAU-01 City: Newport Beach System Location or Area Served: Kitchen ENERGY NRCA-MCH-02-A (Page 2 of 3) Permit Number: X2021-2737 Zip Code: 92660 B. NA7.5.1.i Outdoor Air. Acceptance Functional Testing cav VAV Step 1: Disable demand control ventilation (if applicable) ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow, Adjust supply air to achieve design airflow or maximum airflow at full a. cooling. Record VFD speed (Hz). Hz b.. Measured outdoor airflow reading (cfm) a5 drn cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or C. Mechanical Equipment Schedules). 90 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow, CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 0.91 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5 110%) Yes Q No O Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes O No O Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes 0 No Q Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation �✓ PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A I t Ut- WALIrUMN11% OUTDOOR AIR ACCEPTANCE �. CEC-NKCA-NICK-UZ-A (Ke%nsea U1/11b) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: ` Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identlf:cation/Tag: System Location or Area Served: MAU-01 Kitchen DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: - Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: L JS%Zo Address: 11140 Thurston Lane ATT Certification Identification (If applicable); city/State/zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): TeC iclan Address: 11140 Thurston Lane ATT Certification Identification (if applicable): j city/state/zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: L �1,�12GZ ) RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical " Position with Company (Title): Project M ger Address: 11140 Thurston Lane CSLB License: 499547 city/State/Zip; Mira Loma, CA 91752 Phone: Date Date signed: 2 /J/ZDz; CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A i t_ OF LALIr UMNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07116) la CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: - MAU-01/Kitchen Hood-01 System t.ocatlon or Area Served: Kitchen Note: Submit one Certificate.of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: M04-02-Acan be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment. a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). i. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: i. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) 5. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 AIHI - Vr %,ALIrUKrvw OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) ^A1--11 CERTIFICATE OF ACCEPTANCE y NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification rag: MAU-01/Kitchen Hood-Ol System Location or Area Served: Kitchen B. NAT.5.1.1 Outdoor Air Acceptance Functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ✓❑ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 4859 cfm cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). 4750 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes) min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) El C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 0.91 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5 110%) Yes Q No Q Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes Q No Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes O No Q Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation ✓� PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I /i I t UI- UALIr"UKNIA OUTDOOR AIR ACCEPTANCE 'l1. CEC-NRCA-MCH-02-A CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System Name or Identificationtrag: MAU-Ol/Kitchen Hood-01 GALIFVKNIA tNtKUY GUMMIJJIUN r N RCA-MCH-02-A (Page 3 of 3) Enforcement Agency: Permit Number: X2021-2737 City: Zip Code: Newport Beach 92660 System Location or Area Served: Kitchen DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras I Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: Address: 11140 Thurston Lane ATT Certification Identification (If applicable):�- City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELDTECHNiCIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with t e building permit(s) issued for the building. — Field Technician Name: Todd Alpert Field Technician Signature: — - Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Techniy�4n Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/state/zip:Mira Loma, CA 91752 j Phone: 951-361-2247 Date Signed: /� l 7, RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the bu' ding owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical " Position with Company (Title): Project Maria r Address: 11140 Thurston Lane il— CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 Date signed: 2 S 20 Z CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I H t t Ur Wki-Ir V KIWH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION 0 CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 ProjectAddress: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identificationtrag: MAU-01/Kitchen Hood-01/K-E System Location or Area Served: Kitchen Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A-Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). i. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV 0 CAV a. Check if Variable Air Volume (VAV) and complete the following: I. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): 0 Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) 0 Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: 0 System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): 0 Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ S ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A I C Ur- I.rHLItUKIVIH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CAI IFORNIA ENERGY COMMISSION r CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identtfication/rag: MAU-01/Kitchen Hood-01/1<-Uj Z System Location or Area Served: Kitchen R. NA7.5.1.1 Outdoor Air Acceptance Functional Testing cav VAV Step 1: Disable demand control ventilation (if applicable) ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ✓❑ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 4859 cfm cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical EcuipmentSchedules). 4750 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing'at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). dm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 0.91 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5 110%) Yes @ No Q Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes Q No Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OAR, = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OAgA is within 10% of design Outside Air. (90% 5 %OAR, 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes Q No Q Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation �✓ PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A I t Ur tiALItUKIVIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System Name or Identfication/Tag: MAU-01/Kitchen Hood - DOCUMENTATION AUTHOR'S DECLARATION STATEMENT Enforcement Agency: - Newport Beach System Location or Area Served: Kitchen 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: r Documentation Author Company Name: Date Signed: Christian Brothers Mechanical Services2/517-Oz Address: 11140 Thurston Lane ATTCertification Identification (If applicable): City/State/Zip: Mira Loma, CA 91752 FIELD TECHNICIAN'S DECLARATION STATEMENT Phone: 951-241-5392 N RCA-MCH-02-A (Page 3 of 3) Permit Number: X2021-2737 Zip Code: 92660 I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on tyieificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made availablee buildin permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Position with Company (Title): Christian Brothers Mechanical Services Tech clan Address: 11140 Thurston Lane AI I Certification Identification (if applicable): city/state/zip:Mira Loma, CA 91752 Phone: Date Signed: Z/S Z 951-361-2247 C RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Acceptance Person Company Name: Christian Brothers Mechanical r Address: 11140 Thurston Lane Mira Loma, CA 91752 Responsible Acceptance Person Signature: Position with Company (Title): Project Ma CSLB License: 499547 Phone: 951-241-5392 Date Signed: n !� CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J i A i t Ur WkUrummi% OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07l16) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: Enforcement Agency: Clearwater Harbor Point Senior Living Project Address: Cm'' 101 Bayview Place Newport Beach system Name or Identification/rag: System Location or Area Served: MAU-01/Kitchen Hood-01/1<-EFL$ Kitchen Note: Submit one. Certificate of Acceptance for each system Enforcement Agency Use that must demonstrate compliance. by/Date N RCA-MCH-02-A (Page 1 of 3) Permit Number: X2021-2737 Zip code: 92660 Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a. Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). c. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). L Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: L Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) 5. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handier. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A I C V r I.ALI r'V KN1A OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CAI IFC)RNIA FNF-krY COMMISSION 19 CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 ProjectAddress: 101 Bayview Place City: Newport Beach Zip Lode: 92660 System Name or Identification/rag: MAU-01/Kitchen Hood-01/K-EF. �` System Location or Area Served: Kitchen B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing, CAV VAV Step 1: Disable demand control ventilation (if applicable) ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 1419 cfm cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). 1400 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAPA) for Step 3. a. %OAEA= Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 0.91 % % b. %OAEA is within 10% of design Outside Air. (90% 5 %OAEA 5 110%) Yes @ No O Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes Q No Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes Q No o Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation 0 PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A I t Ur' '-ALI rUMN IA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place _ City: Zip Code: Newport Beach 92660 System Name or Identification/Tag: MAU-01/Kitchen Hood-Ol/K-EFI,�? System Location or Area Served: Kitchen DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. I certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author ijvature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: Address: 11140 Thurston Lane ATT Certification Identification (If applicable): city/state/ZIP: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with th building permits) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Techni n Address: 11140 Thurston Lane ATr Certification Identification (if applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: ,2r'$/ ZoZ4 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical Position with Company (Title): Project Manager Address: 11140 Thurston Lane CSL8l.jcense: 499547 City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 Date Signed: Z Z-6 ZC' CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I A I C ur, I.ALIr V MN IA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CERTIFICATE OF ACCEPTANCE CALIFORNIA hY,I� NRCA-MCH-02-A Outdoor Air Acceptance Project Name: -1 Enforcement Agency: Clearwater Harbor Point Senior Living -- - 101 Bayview Place System Name or ldentiHration/Tag: RF-1-01 City: Newport Beach System Location or Area Served: Corridor Note: Submit one Certificate of Acceptance for each system that must demonstrate compliance. Enforcement Agency Use: Checked (Pagel of 3) Permit Number: X2021-2737 Zip Code: 92660 Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). c. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated moans to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). L Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV 0 CAV a. Check if Variable Air Volume (VAV) and complete the following: I. Outside airflow is either factory calibrated or field calibrated. 0 Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: 0 System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) 5. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 2A 1 A It: ur %A%Urumr4iA OUTDOOR AIR ACCEPTANCE [.'l CEC-NRCA-MCH-02-A (Revised 07/16) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: - Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System Name or IdentiflcationMg: RF-1-01 CALIFORNIArNLKUY i.:VMMIt:iWU V N RCA-MCH-02-A (Page 2 of 3) Enforcement Agency: Permit Number. X2021-2737 city; Zip Code: Newport Beach 92660 System Location or Area Served: i Corridor B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing CAV VAV Step 1: Disable demand control ventilation -(if applicable) ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 540 cfm cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or C. Mechanical E ui ment Schedules). 595 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 0.91 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA:5 110%) Yes @ No Q Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes O No O Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes p No p Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 Al Alt Vr WkLIrVKIWA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION 'e CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place city: Newport Beach Zip Code: 92660 System Name or Identffication/Tag: RF-1-Ol System Location or Area Served: Corridor DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 10 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: Z / 5 ) M7- Address: 11140 Thurston Lane ATT Certification Identification (If applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: - Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title):TechnlC n Address: 11140 Thurston Lane ATf Certification Identification (if applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical '� Position with Company (Title): Project Manager Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A I t ur I.ALIrUMIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: :Newport Beach Zip Code: 92660 System Name or Identification/Tag: RF-1-02 System Lotation.orArea Served: Patio Note: Submit one Certificate of Acceptance for each system Enforcement Agency use: checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC I units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). L Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ✓❑ CAV a. Check if Variable Air Volume (VAV) and complete the following: i. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ✓❑ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) S. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I H I t V 1- %,1%L11' V Kr1I/i OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) _ CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: - System Location or Area Served: RF-1-02 Patio B. NA7.5.1.1 Outdoor Air Acceptance Functional_Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). - Hz b. Measured outdoor airflow reading (cfm) 110 cfm cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). 100 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 0.91 % % b. %OAFA is within 10% of design Outside Air. (90% S %OAFA s 110%) Yes Q No Q Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes Q No O Determine Percent Outside Air at reduced supply airflow (%OAR,) for Step 4. (VAV only) a. %OAR, = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OAR, is within 301A of design Outside Air. (90% S %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes Q No o Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation Q✓ PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I k%I t Ur' I.HLIrvKNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: _ RF-1-02 System Location or Area Served: Patio DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: I / 5 /tozq Address: 11140 Thurston Lane ATTCertifiication Identification (If applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available wit •the building permit(s) 7 issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technl Ian Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/state/Zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: J RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical ' Position with Company (Title): Project Man e Address: 11140 Thurston Lane CSLI3 License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 Date Signed: Z/S ZO Z ki CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 u i H i t yr %,AUrvKrgLA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07116) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permtt Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Ident'dicetion/rag: RF-2-02 � System Location or Area Served: Corridor Note: Submit one Certificate of Acceptance for each system I Enforcement Agency Use: Checked by/Date that must demonstrate comaliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a. Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). i. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: L Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) S. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I H I t V r k ALi rU"N 1A OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGYCOMMISSION 'e CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 City: Zip Code: Newport Beach 92660 Project Address: 101 Bayview Place System Name or Identification/Tag: RF-2-02 . System Location or Area Served: Corridor B. NA1.5.1.1 Outdoor Air Acceptance Functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow • Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 710 cfm cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). 780 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV Hz a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 0.91 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA S 110%) Yes Q No Q Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes Q No Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes 0 No o Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation ❑✓ PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 ,1 A I t- Ur UALWUKI141A OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07116) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: . 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identlflcation/rag: RF-2-02 System Location or Area Served: Corridor DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: 2/5 r to2q Address: 11140 Thurston Lane ATT Certification Identification (If applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with tt a building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: 11 Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technlcial Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/State/zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical � Position with Company (Title): Project Ma Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: 2 /�jZo2 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A IAIt Ur- I.ALIrVMMIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07116) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place city: Newport Beach Zip Code: 92660 System Name or Identlflcationfrag: RF-3-Ol System Location or Area Served: Corridor Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. !I Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note:-MCH-02-A can be performedinconjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). c. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). i. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year):_ 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: i. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ✓❑ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) 5. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I H I- ur- I.ALI F V KN IA OUTDOOR AIR ACCEPTANCE r+r-r_urorA_KAr1W-n,3_A m11a1 ('.Al IFORNIA ENERGY COMMISSION �T CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or identificationfrag: RF-3-01 SystemLocationor Area served: Corridor R. NA7.5.1.1.0utdoof Air Acceptance Functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) ❑ Step 2: Verify unit is not in econamizer'mode during test (economizer disabled) ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow, Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow, reading (cfm) 125 cfm cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or C. Mechanical E ui mentSchedules). 137 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑� ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 0.91 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA:5 110%) Yes 0' No 0 Yes 0 No 0 C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes 0 No O Determine Percent Outside Air at reduced supply airflow (%OAR,) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow, reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARt is within 10% of design Outside Air. (90% <_ %OAR, 5110%) Yes 0 No 0 C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes 0 No 0 Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 b Ilk I t Ur t.HLIr*VKN IH OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) rni �o�o.uw r•.��env nr....unm...� ` �, . CERTIFICATE OF ACCEPTANCE v NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification rag: RF-3-01 System Location or Area Served: Corridor DOCUMENTATION AUTHOR'S DECLARATION :STATEMENT 1. I certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: 215110 Address: 11140 Thurston Lane ATT Certification Identification (If applicable): city/State/zip: Mira Loma, CA 91752 Phone:. 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with tl}e building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: I Field Technician Company Name: Christian Brothers Mechanical Services ^ Position with Company (Title): Techni d n 1 Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/state/zip:Mira Loma, CA 91752 Phone: Date Signed: 951-361-2247 u 5 rfJ2 y RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical' Position with Company (Title): Project Man Address: 11140 Thurston Lane CSLB license: 499547 City/State/Zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: 2 g f S�Z Q Z CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 Z. IA I t Ur I.ALIrUMIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CAI IFARNIA FNFR[.Y rnMM1_qS1f7N CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agenry: Permit Number. X2021-2737 ProjectAddress: - 101 Bayview Place City: .Newport Beach Zip Code: 92660 System Name or Identification/Tag: RF-3-02 System Location or Area Served: Corridor Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection i Note: MCH-02-A. can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a. Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). I. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: i. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): 0 Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) 0 Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: 0 System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): 0 Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) 5. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): 0 The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A I t Ul- L ALII-UKNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07116) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/rag: System Location or Area Served: RF-3-02 Corridor B. NA7.5.1.1 Outdoor Air Acceptance functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) ❑✓ ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow, Adjust supply air to achieve design airflow or maximum airflow at full a. cooling. Record.VFD speed (Hz). -Hz b. Measured outdoor airflow reading.(cfm) 183 cfm cfm C. Required outdoor airflow, (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). 170 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). Cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 0.91 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5 110%) Yes Q No Q Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes 0 No O Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow, reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes 0 No o Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation 0 PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 a i n i t Ur �nurvrcrvrn OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) ,.,. ..... CERTIFICATE OF ACCEPTANCE v NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 ProjectAddress: 101 Bayview Place city: Newport Beach Zip Code: 92660 System Name or identification/Tag: RF-3-02 System Location or Area Served: Corridor DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: JOhnnyCOntreraS Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: Z 1 5 It 0 7, Address: 11140 Thurston Lane ATTCertification Identification (if applicable): City/State/Zip: Mira Loma; CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with a building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician company Name: Christian Brothers Mechanical Services Position with Company (Title):TeChn an Address: 11140 Thurston Lane ATT Certification Identification (if ap icable): city/state/zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: ZGZ RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical':. Position with Company (Title): Project Ma Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: ZIS�Z�2 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J IlkI It: UI_ % ALIrVMN IA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION 'e CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: EF-07 System Location or Area Served: Roof Note: Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 1096 of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection Note; MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap., Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a. Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). L Method and equipment used:. ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year):_ 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: L Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ✓❑ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A I t Ur' %,ALIr'VKNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) 'S COMMISSION CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance vrojecr rvame: Enforcement Agency: Clearwater Harbor Point Senior Living rroiea Aaares': 101 Bayview Place System Name or Identification/rag: EF-07 City: Newport Beach System Location or Area Served: Roof N RCA-MCH-02-A (Page 2 of 3) Permit Number: Zip Code: 92660 B. NA7.5.1.1 Outdoor Air Acceptance Functional Testing Step 1: Disable demand control ventilation (if applicable) CAV VAV �✓ Step 2: Verify unit is not in economizer mode during test (economizer disabled) El Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 360 cfm cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or C. Mechanical Equipment ment Schedules). 394 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑✓ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow, reading /Required outdoor airflow. (Step3b/Step3c) 0.91 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes •0 No 0 Yes 0 No O C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes 0 No Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) yes 0 No 0 C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes 0 No 0 Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. 1 D. Evaluation F✓ PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 AIAIt VY VALIrVKIVIA OUTDOOR AIR ACCEPTANCE non NMnA RAnu nq A /D .A A n71I9Z1 r.AI IFr1RNIA FNFRf;Y r:CSMMISSIOM vCERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: EF-07 System Location or Area Served: Roof DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation- is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: 77 Address: 11140 Thurston Lane ATT Certification Identification (If applica le): City/State/Zip: Mira Coma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with ttae building permit(s) issued for the building. Field Technician Name: : Todd Alpert Field Technician Signature Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technicia(n Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/State/Zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building _ owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: f f_ Responsible Acceptance Person Company Name: Christian Brothers Mechanical Its` Position with Company (Title): Project Ma ger Address: 11140 Thurston Lane CSLB License: 499547 City/state/zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A IHlt Ur - OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place Enforcement Agency: CRY: Newport Beach System Name or Identificatlon/Tag: System Location or Area Served: EF-08 Roof Note: Submit one Certificate of Acceptance for each system � Enforcement Agency Use: Checked by/Date that must demonstrate compliance. IA ENERGY COMMISSION -%W N RCA-MCH-02-A (Page 1 of 3) TF Permit Number: Zip Code: 92660 Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. Construction Inspection . Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: a As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). L Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: I. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑� 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside -air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) S. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A i t ur• I.ALir-VKNIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: - Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System Name or Identification/rag: EF-08 Enforcement Agency: City: Newport Beach system Location or Area served: Roof COMMISSION N RCA-MCH-02-A (Page 2 of 3) Permit Number: Zip Code: 92660 B. NA7.5.1.1 Outdoor -Air Acceptance- functional Testing _ CAV VAV Step 1: Disable demand control ventilation (if applicable) Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust.supply air to achieve design airflow or maximum airflow at full a. cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 250 cfm cfm Required outdoor airflow, (cfm) (from MCH-03, Column 14, or 271 C. Mechanical Equipment Schedules). cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the Hz total design airflow. Record VFD speed (Hz). b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 0.91 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes 0 No O Yes Q No 0 C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes Q No O Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OAgA is within 10% of design Outside Air. (90% 5 %OAR, S 110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes 0 No O Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation 0 I PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 JIAI - Vr IiALIrVKIVIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 3 of 3) Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living Project Address: City: Zip Code: 1018ayview Place Newport Beach 92660 System Name or Identification/Tag: System Location or Area Served: EF-08 Roof DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: _ l C� Documentation Author Company Name.. Christian Brothers MechanicalServices Date Signed: 2/r/Z0Z� Address: 11140 Thurston Lane ATT Certification Identification (If applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury; under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with t building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: ` Field Technician Company Name: Christian Brothers Mechanical Services i Position with Company (Title): Technl an [ Address: 11140 Thurston Lane ATT Certification Identification (if applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-361-2247 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical b Position with Company (Title): Project Marl Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: 2/S/�oZ� CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A i!i i t yr t,ALWUKNIA OUTDOOR AIR ACCEPTANCE VWNI CEC-NRCA-MCH-02-A (Revised 07/16) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System Name or IdentHication/rag: EF-10 CALIFORNIA ENLRUY(_;UnnnnlaalUN 'MOP' N RCA-MCH-02-A (Page 1 of 3) Enforcement Agency: PermB Number: Zip Code: Newport Beach 92660 System Location or Area Served: HSKP Note Submit one Certificate of Acceptance for each system that must demonstrate compliance. Enforcement Agency Use: Checked by/Date Intent Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical E uipment Schedules. A. Construction -inspection Note: MC9-02-A can be performed in conjunction with MCH-07-A Supply Fan VFD Acceptance (if applicable) since testing activities.overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a. Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.5.1.2 Constant Volume Systems Outdoor Air Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). I. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: L Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J 1 A 1 C Ur- I.HLIrUKNIH OUTDOOR AIR ACCEPTANCE P� Ch tmevlseu uinu) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System Name or Identification/Tag: EF-10 CALIFORNIA ENERGY COMMISSION N RCA-MCH-02-A (Page 2 of 3) Enforcement Agency: Permit Number: City: Zip Code: Newport Beach 92660 System location or Area Served: HSKP '13. NA7.5.1.1 Outdoor Air Acceptance Functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) 0✓El Step 2: Verify unit is not in economizer mode during test (economizer disabled) �✓ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) • 75 Cfm cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or C. Mechanical Equipment Schedules). 80 cfm cfm d Time for outside air damper to stabilize after full supply airflow is achieved (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 0.91 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5110%) Yes Q No Q Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes © No O Determine Percent Outside Air at reduced supply airflow (%OARA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) g6 b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes Q No Q Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation 0 PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 .7IHIt ur l.AUrvKNiA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System Name or Identiflcation/Tag: EF-10 .DOCUMENTATION AUTHOWS DECLARATION STATEMENT 1. 1 certify that this Certificate of Accept Documentation Author Name: Johnny Contreras Enforcement Agency: City: Newport Beach System Location or Area Served: HSKP documentation is accurate and complete. Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: '-/ J/ Address: 11140 Thurston Lane ATT Certification Identification (If applicable): City/State/zip- ' Mira Loma, CA 91752 Phone: 951-241-5392 I FIELD TECHNICIAN'S DECLARATION STATEMENT ` N RCA-MCH-02-A (Page 3 of 3) Permit Number: Zip Code: 92660 I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. 44 Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services `Position with Company(Title): Technlglan Address: 11140 Thurston Lane 1 ATT Certification identification (if applicable): Mira Loma, CA 91752 I RESPONSIBLE PERSON'S DECLARATION STATEMENT Phone: 951-361-2247 1 Date Signed: 1-15 Oro z I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical " Position with Company (Title): Project Ma Address-. 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone:951-241-5392 Date Signed: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J 1 H It: Ur l.AL11-UKIVIA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Project Name: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System Name or Identfficationfrag: - EF-11 Enforcement Agency: City: Newport Beach System Location or Area Served: RR COMMISSION N RCA-MCH-02-A (Page 1 of 3) Permit Number: ZIP Code: 92660 Note: -Submit one Certificate of Acceptance for each system Enforcement Agency Use: Checked by/Date that must demonstrate compliance. Intent: Verify measured outside airflow reading is within 10% of the total required outside airflow. Required for all newly installed HVAC units. Reference MCH-03 (Column 14) or Mechanical Equipment Schedules. A. (Construction Inspection Note: MCH-02-A can be performed in conjunction with MCH-07-A Supply Fan.VFD Acceptance (if applicable) since testing activities overlap. 1. Supporting documentation needed to perform test includes: As -built and/or design documents (for example, Mechanical Equipment Schedules, Equipment a' Start -Up Sheets or Balancing Reports). b. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.S.1.1 Ventilation Systems: Variable Air Systems At -A -Glance and NA7.S.1.2 Constant Volume Systems Outdoor Air Acceptance At A -Glance). c. 2016 Building Energy Efficiency Standards. 2. Instrumentation needed to perform test includes: a. Watch b. Calibrated means to measure airflow (i.e. hot-wire anemometer, velocity pressure probe, etc.). i. Method and equipment used: ELECTRONIC MANOMETER ii. Equipment calibration date (must be within one year): 12/14/23 3. System type (check either VAV or CAV): ❑ VAV ❑✓ CAV a. Check if Variable Air Volume (VAV) and complete the following: I. Outside airflow is either factory calibrated or field calibrated. ❑✓ Check if factory calibrated and attach calibration certification. ❑ Check if field calibrated and attach calibration results. ii. Damper Control (must be checked): ❑✓ Dynamic damper control is being used to control outside air. (This is NOT a fixed minimum position). iii. One of the following dynamic controls is being utilized to control outside air (check method used) ❑✓ Outdoor Air CFM Compensation ❑ Energy Balance Method ❑ Demand Control Ventilation ❑ Return Fan Tracking ❑ Injection Fan Method ❑ Dedicated Minimum Ventilation Damper with Pressure Control ❑ Other Active Control, Describe: b. Check if Constant Air Volume (CAV) and verify the following: ❑✓ System is designed to provide a fixed minimum OSA when the unit is on. 4. Method of delivering outside air to the unit (check one of the following): ❑✓ Outside air is ducted to the return air plenum. Confirm that outside air is ducted to within (check one of the following): ❑ 5 ft. of the unit. ❑✓ 15 ft. of the unit, with the air directed substantially toward the unit. ❑ Return air plenum is NOT used to distribute outside air to the unit. (i.e. outside air is ducted directly to the unit, outside air is provided independent of the unit, or economizer) 5. Pre -occupancy purge has been programmed for the 1-hour period immediately before the building is normally occupied to provide (one of the following methods must be verified and checked): ❑✓ The conditioned floor area times the ventilation rate from the 2016 Building Energy Efficiency Standards TABLE 120.1-A, or 15 cfm per person times the expected number of occupants, whichever is greater. ❑ Complete air changes to the zone served by the air handler. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 AIHIt: Ur UALirvttry IM _ OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-02-A Outdoor Air Acceptance (Page 2 of 3) Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living Project Address: - City: - Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Idendfication/rag: EF-il System Location or Area Served: RR 13-NAM.1.1 Outdoor. Air Acceptance Functional Testing CAV VAV Step 1: Disable demand control ventilation (if applicable) ❑ Step 2: Verify unit is not in economizer mode during test (economizer disabled) ❑✓ ❑ Note: Shaded boxes do not apply for CAV systems Step 3: CAV and VAV testing at full supply airflow Adjust supply air to -achieve design airflow or maximum airflow at full a' cooling. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm) 115 efm cfm Required outdoor airflow (cfm) (from MCH-03, Column 14, or 120 C. Mechanical Equipment Schedules). cfm cfm Time for outside air damper to stabilize after full supply airflow is achieved d (minutes): min Step 4: VAV testing at reduced supply airflow CAV VAV a. Adjust supply airflow to either the sum of the minimum zone airflows, full heating, or 30% of the total design airflow. Record VFD speed (Hz). Hz b. Measured outdoor airflow reading (cfm). cfm C. Required outdoor airflow (cfm) (from MCH-03, Column 14, or Mechanical Equipment Schedules). cfm d. Time for outside air damper to stabilize after reduced supply airflow is achieved (minutes): min Step 5: Return to initial conditions (check) ❑ C. Testing Calculations & Results Determine Percent Outside Air at full supply airflow (%OAFA) for Step 3. a. %OAFA = Measured outdoor airflow reading /Required outdoor airflow. (Step3b/Step3c) 0.91 % % b. %OAFA is within 10% of design Outside Air. (90% 5 %OAFA 5 110%) Yes 0 No Q Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 3d < 5 minutes) Yes Q No O Determine Percent Outside Air at reduced supply airflow (%OAPA) for Step 4. (VAV only) a. %OARA = Measured outdoor airflow reading /Required outdoor airflow reading. (Step4b/Step4c) % b. %OARA is within 10% of design Outside Air. (90% 5 %OARA 5110%) Yes Q No Q C. Outside air damper position stabilizes within 5 minutes. (Step 4d < 5 minutes) Yes Q No Q Note: The intent of this test is to ensure that 1) all air handlers provide the minimum amount of OSA and 2) VAV air handlers use dynamic controls to avoid over ventilation. D. Evaluation PASS: All Construction Inspection responses are complete and Testing Calculations & Results responses are positive. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 UP t.f1Llr' V KiV IA OUTDOOR AIR ACCEPTANCE CEC-NRCA-MCH-02-A (Revised 07/16) CERTIFICATE OF ACCEPTANCE Outdoor Air Acceptance Probed Name: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System Name or ldentiflcation/Tag: EF-11 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT Enforcement Agency: City: Newport Beach System Location or Area Served: RR 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: 2 Address: n5/z0z 11140 Thurston Lane ATTCertifcation Identification (Ifapplicayble ): City/State/Zip: IMira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT B 20 NRCA-MCH-02-A (Page 3 of 3) Permit Number: Zip Code: 92660 I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the Puilding permit(s) issued for the building. :field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Address: 11140 Thurston Lane Mira Loma, CA 91752 RESPONSIBLE PERSON'S DECLARATION STATEMENT Position with Company (Title): Technician ATT Certification Identification (if applicable): Phone: 951-361-2247 Date Signed: 2 I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. nesponsioie Acceptance Person Name: Johnny Contreras Address: Acceptance Person Company Name: Christian Brothers Mechanical " 11140 Thurston Lane Mira Loma, CA 91752 Responsible Acceptance Person Position with Company (Title): Project M CSLB License: 499547 Phone: 951-241-5392 Date Signed: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 JIAIL Vr t ALIrVKINIH CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CALIFORNIA 1i- CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 1 of 3 Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System Location or Area Served: AC-1-01, AC-1-02 Elec, IDF Note: Submit one Certificate of Acceptance for each system that must Enforcement Agency Use: Checked by/Date demonstrate compliance. A. Construction Inspection 1. Supporting documentation needed to perform test includes, but not limited to: a. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.S.2 Constant Volume, Single -zone, Unitary Air Conditioner and Heat Pumps Systems Acceptance At -A -Glance). b. 2016 Building Energy Efficiency Standards Manual. 2. Instrumentation to perform test may include: a. Temperature Meter b. Amp Meter 3. Installation (check if applies): ✓❑ Thermostat is located within the space -conditioning zone that is served by the HVAC system. 4. Programming (check all those that apply): Thermostat meets the temperature adjustment and dead band requirements of 2016 Building Energy Efficiency Standards Manual Section 120.2(b). Minimum heating setpoint: 87 OF. Maximum cooling setpoint 64 OF. Deadband: 88 OF. ❑ Occupied, unoccupied, and holiday schedules have been programmed per the schedule provided. ❑ Pre -occupancy purge has been programmed to meet the requirements of 2016 Building Energy Efficiency Standards Manual Section 120.1(c)2. 1. Check method used to determine pre -occupancy purge: ❑✓ Lesser of: conditioned floor area times ventilation rate from 2016 Building Energy Efficiency Standards TABLE 120.1-A or 15cfm per person times the expected number of of ❑ 3 complete air changes. Notes: �1 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I A It: UP L.ALWUKIV IA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-NRCA-MCH-03-A (Revised 07116 _ CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 2 of 3 Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification rag: System Location or Area Served: AC-1-Ol, AC-1-02 Elec, IDF B. Functional Testing Requirements Ioperating Modes Step 1: Disable economizer control and demand -controlled ventilation (if applicable) to prevent unexpected interactions. Occupied Mode Step 2: Heating load during occupied condition Step 3: No-load during occupied condition Step 4: Cooling load during occupied condition Unoccupied Mode Step 5: No-load during unoccupied condition Step 6: Heating load during unoccupied condition Step 7: Cooling load during unoccupied condition Step 8: Manual override Step 2 — 8: Check and verify the following for each simulation mode required a. Supply fan operates continually b. Supply fan turns off C. Supply fan cycles on and off d. System reverts to "occupied" mode to satisfy any condition e. System turns off when manual override time period expires f. Gas -fired furnace, heat pump, or electric heater stages on g. No heating is provided by the unit h. No cooling is provided by the unit i. Compressor stages on J. Outside air damper is open to minimum position k. Outside air damper closes completely Step 9: System returned to initial operating conditions after all tests have been completed: C. Testing Results Indicate if Passed (P), Failed (F), or N/A (X), fill in appropriate letter 8 1 7 1 6 1 5 1 4 1 3 1 2 Immill EMMONS MWOMME ■ M.0 ---anan SamEMEN oans .■EMS■. 8 1 7 1 6 1 5 14 13 1 2 PI PIPIPIPI PIP D. Evaluation �✓ I PASS: All Construction Inspection responses are complete and all applicable Testing Results responses are "Pass" (P). CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J IHIt VI' I.HLIrVKIV IH CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-NRCA-MCH-03-A Revised 07/16 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 3 of 3 Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System Location or Area Served: AC-1-01, AC-1-02 Elec, IDF DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: - Documentation Author Company Name: Christian Brothers Mechanical Date Signed: 215 Zo7. ATT Certification Identificati If ap able): Address: 11140 Thurston Lane City/State/Zip: Mira Lorna / CA / 91752 Phone: 951-361-2247 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has ilding permit(s) been completed and signed by the responsible builder/installer and has been posted or made available t!!� issued for the building. Field Technician Name: Todd Alpert Field Technician signature: Field Technician Company Name: Christian Brothers Mechanical Position with Company (Title):Techiyrian ATT Certification Identification (if applicable): Address: 11140 Thurston Lane City/State/Zip: Mira Loma/ CA/ 91752 Phone: 951-361-2247 Date Signed: y ozq l• RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accent resnonsihility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understan hat a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provide the bui ding owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical Address: 11140Thurtson Lane Mira Loma/CA/92509 Position with Company (Title): Project Ma CSLB License: Phone: 951-361-2247 — I Date Signed: Z 151 Z 0 Z, CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I H I t 1Jr %,.HLIt-UKIVIH CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-NRCA-MCH-03-A (Revised 07/16} CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 1 of 3 Project Name: b mer: Enforcement Agency: Permit Nu Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System Location or Area Served: AC-2-01, AC-2-02, AC-2-03 Elec, IDF, Elec Note: Submit one Certificate of Acceptance for each system that must Enforcement Agency Use: Checked by/Date demonstrate compliance. A. Construction Inspection 1. Supporting documentation needed to perform test includes, but not limited to: a. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.2 Constant Volume, Single -zone, Unitary Air Conditioner and Heat Pumps Systems Acceptance At -A -Glance). b. 2016 Building Energy Efficiency Standards Manual. 2. Instrumentation to perform test may include: a. Temperature Meter 3. 4. Notes: b. Amp Meter Installation (check if applies): ❑✓ Thermostat is located within the space -conditioning zone that is served by the HVAC system. Programming (check all those that apply): ❑✓ Thermostat meets the temperature adjustment and dead band requirements of 2016 Building Energy Efficiency Standards Manual Section 120.2(b). Minimum heating setpoint: 87 OF. Maximum cooling setpoint 64 OF. Deadband: 88 OF. ❑ Occupied, unoccupied, and holiday schedules have been programmed per the schedule provided. ❑ Pre -occupancy purge has been programmed to meet the requirements of 2016 Building Energy Efficiency Standards Manual Section 120.1(c)2. 1. Check method used to determine pre -occupancy purge: ❑✓ Lesser of: conditioned floor area times ventilation rate from 2016 Building Energy Efficiency Standards TABLE 120.1-A or 15cfm per person times the expected number of occupants. ❑ 3 complete air changes. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J IHIt Vr I.HLIrVKIVIH CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR (CONDITIONER AND HEAT PUMP SYSTEMS CEC-NRCA-MCH-03-A (Revised 07116) CALIFORNIA LNLIKUY UUMMIJJIVry CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 2 of 3 Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 1016ayview Place Newport Beach 92660 System Name or Identification/Tag: system Location or Area Served: AC-2-01, AC-2-02, AC-2-03 Elec, IDF, Elec B. Functional Testing Requirements Ioperating Modes Step 1: Disable economizer control and demand -controlled ventilation (if applicable) to prevent unexpected interactions. Occupied Mode Step 2: Heating load during occupied condition Step 3: No-load during occupied condition Step 4: Cooling load during occupied condition Unoccupied Mode Step 5: No-load during unoccupied condition Step 6: Heating load during unoccupied condition Step 7: Cooling load during unoccupied condition Step 8: Manual override Step 2 — 8: Check and verify the following for each simulation mode required a. Supply fan operates continually b. Supply fan turns off C. Supply fan cycles on and off d. System reverts to 'occupied" mode to satisfy any condition e. System turns off when manual override time period expires f. Gas -fired furnace, heat pump, or electric heater stages on g. No heating is provided by the unit h. No cooling is provided by the unit i. Compressor stages on j. Outside air damper is open to minimum position k. Outside air damper closes completely Step 9: System returned to initial operating conditions after all tests have been completed: 7 1 6 1 5 1 4 1 3 1 2 MM SEE an asso . Yes QQ No Q C. Testing Results s 7 6 Indicate if Passed (P), Failed (F), or N/A (X), fill in appropriate letter P I P I P D. Evaluation �✓ I PASS: All Construction Inspection responses are complete and all applicable Testing Results responses are "Pass" (P). 5 4 3 1 HP P P P CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J IiA It: Ur- l.ALII-UKNiA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-NRCA-MCH-03-A Revised 07116i CALIFORNIA ENERGY COMMISSION I CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 3 of 3 Project Name: i Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: 101 Bayview Place System Name or Identification/Tag: AC-2-01, AC-2-02, AC-2-03 City: Newport Beach System Location or Area Served: Elec, IDF, Elec Zip Code: 92660 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Date Signed: n r ;Zo (..+ ATT Certification Identifi on (If app' Ie): Address: 11140 Thurston Lane City/State/Zip: Mira Loma/ CA/ 91752 Phone: 951-361-2247 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Position with Company (Title): Technician Address: 11140 Thurston Lane ATT Certification Identification (if applicable): City/State/Zip: Mira Loma/ CA/ 91752 Phone: 951-361-2247 Date Signed: afsi zoZ4 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to ing owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: , � Responsible Acceptance Person Company Name: Christian Brothers Mechanical Position with Company (Title): Project Manage Address: 11140 Thurtson Lane CSLB License: Phone: Date Signed: 951-361-2247 g Z City/State/Zip: Mira Loma/CA/92509 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A IA It Ur' WAL 1FUKNIA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-NRCA-MCH-03-A i Revised 07/16 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 1 of 3 Project Name: i erm Enforcement Agency: Pt Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System Location or Area Served: AC-3-01, AC-3-02, AC-3-03 Elec, Elec, IDF Note: Submit one Certificate of Acceptance for each system that must Enforcement Agency Use: Checked by/Date demonstrate compliance. A. Construction Inspection 1. Supporting documentation needed to perform test includes, but not limited to: a. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.2 Constant Volume, Single -zone, Unitary Air Conditioner and Heat Pumps Systems Acceptance At -A -Glance). b. 2016 Building Energy Efficiency Standards Manual. 2. Instrumentation to perform test may include: a. Temperature Meter b. Amp Meter 3. Installation (check if applies): ❑✓ Thermostat is located within the space -conditioning zone that is served by the HVAC system. 4. Programming (check all those that apply): Thermostat meets the temperature adjustment and dead band requirements of 2016 Building Energy Efficiency Standards Manual Section 120.2(b). Minimum heating setpoint: 87 OF. Maximum cooling setpoint 64 OF. Deadband: 88 OF. ❑ Occupied, unoccupied, and holiday schedules have been programmed per the schedule provided. ❑ Pre -occupancy purge has been programmed to meet the requirements of 2016 Building Energy Efficiency Standards Manual Section 120.1(c)2. 1. Check method used to determine pre -occupancy purge: ❑✓ Lesser of: conditioned floor area times ventilation rate from 2016 Building Energy Efficiency Standards TABLE 120.1-A or 15cfm per person times the expected number of occupants. ❑ 3 complete air changes. Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 .l. IHI t_ Vh L.HLIFVKill IH CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-NRCA-MCH-03-A Revised 07/16 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 2 of 3 Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System Location or Area Served: AC-3-01, AC-3-02, AC-3-03 Elec, Elec, IDF B. Functional Testing Requirements I operating Modes Step 1: Disable economizer control and demand -controlled ventilation (if applicable) to prevent unexpected interactions. Occupied Mode Step 2: Heating load during occupied condition Step 3: No-load during occupied condition Step 4: Cooling load during occupied condition Unoccupied Mode Step 5: No-load during unoccupied condition Step 6: Heating load during unoccupied condition Step 7: Cooling load during unoccupied condition Step 8: Manual override Step 2 — 8: Check and verify the following for each simulation mode required a. Supply fan operates continually b. Supply fan turns off C. Supply fan cycles on and off d. System reverts to "occupied" mode to satisfy any condition e. System turns off when manual override time period expires f. Gas -fired furnace, heat pump, or electric heater stages on g. No heating is provided by the unit h. No cooling is provided by the unit i. Compressor stages on j. Outside air damper is open to minimum position k. I Outside air damper closes completely Step 9: System returned to initial operating conditions after all tests have been completed: C. Testing Results Indicate if Passed (P), Failed (F), or N/A (X), fill in appropriate letter 8 17 16 15 14 13 12 mmmmin oo■ ■ 00�0� eiin0o ✓ ✓ Yes QQ No p 8 7 6 5 4 3 2 P P P P P P F D. Evaluation ✓❑ I PASS: All Construction Inspection responses are complete and all applicable Testing Results responses are "Pass" (P). CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J IH It: Ut- t,,RL I FUKiVIH CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-NRCA-MCH-03-A [Revised 07/16� _ CALIFORNIA CERTIFICATE OF ACCEPTANCE QCOMMISSION _ N RCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 3 of 3 Project Name: ' Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System Location or Area Served: AC-3-Ol, AC-3-02, AC-3-03 Elec, Elec, IDF DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Date Signed: 2/5 Address: 11140 Thurston Lane ATT Certification Identification (If applicable): Phone:951-361-2247 City/state/zip: Mira Loma/ CA/ 91752 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician company Name: Christian Brothers Mechanical Position with Company (Title): Technician ATT Certification Identification (if applicable): Address: 11140 Thurston Lane City/State/Zip: Mira Loma/ CA/ 91752 Phone: 951-361-2247 1 Date Signed: ZIS%Zc�Z� RESPONSIBLE PERSON'S DECLARATION STATEMENT certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical Position with Company (Title): Project Manager Address: 11140 Thurtson Lane CSLB License: Phone: 951-361-2247 Date Signed: .Z1s1toz� City/State/zip: Mira Loma/CA/92509 _ CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 JIHIt Vr I.HLIYVKNIH CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-NRCA-MCH-03-A (Revised 07116 _ CALIFORNIA ENERGY COMMISSION it, CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 1 of 3 Project Name: i ermt Enforcement Agency: PNumber: Clearwater Harbor Point Senior Living X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: System Location or Area Served: AC-B-02, AC-B-03, AC-B-04, AC-B-06 Electrical B16, Elev, Elevator Equipment B21, MPOE Note: Submit one Certificate of Acceptance for each system that must Enforcement Agency Use: Checked by/Date demonstrate compliance. A. Construction Inspection 1. Supporting documentation needed to perform test includes, but not limited to: a. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NAZ5.2 Constant Volume, Single -zone, Unitary Air Conditioner and Heat Pumps Systems Acceptance At -A -Glance). b. 2016 Building Energy Efficiency Standards Manual. 2. Instrumentation to perform test may include: a. Temperature Meter 3. 4. Notes: b. Amp Meter Installation (check if applies): ❑✓ Thermostat is located within the space -conditioning zone that is served by the HVAC system. Programming (check all those that apply): ❑✓ Thermostat meets the temperature adjustment and dead band requirements of 2016 Building Energy Efficiency Standards Manual Section 120.2(b). Minimum heating setpoint: 87 OF. Maximum cooling setpoint 64 OF. Deadband: 88 OF. ❑ Occupied, unoccupied, and holiday schedules have been programmed per the schedule provided. ❑ Pre -occupancy purge has been programmed to meet the requirements of 2016 Building Energy Efficiency Standards Manual Section 120.1(c)2. 1. Check method used to determine pre -occupancy purge: ❑✓ Lesser of: conditioned floor area times ventilation rate from 2016 Building Energy Efficiency Standards TABLE 120.1-A or 15cfm per person times the expected number of occupants. ❑ 3 complete air changes. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 .7IHIt Vr t.HLIrVKNIH CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-NRCA-MCH-03-A Revised 07116 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 2 of 3 Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System Location or Area Served: AC-B-02, AC-B-03, AC-B-04, AC-B-06 Electrical 616, Elev, Elevator Equipment 621, MPOE B. Functional Testing Requirements Operating Modes Step 1: Disable economizer control and demand -controlled ventilation (if applicable) to prevent unexpected interactions. Occupied Mode Step 2: Heating load during occupied condition Step 3: No-load during occupied condition Step 4: Cooling load during occupied condition Unoccupied Mode Step 5: No-load during unoccupied condition Step 6: Heating load during unoccupied condition Step 7: Cooling load during unoccupied condition Step 8: Manual override Step 2 — 8: Check and verify the following for each simulation mode required a. Supply fan operates continually b. Supply fan turns off C. Supply fan cycles on and off d. System reverts to 'occupied" mode to satisfy any condition e. System turns off when manual override time period expires f. Gas -fired furnace, heat pump, or electric heater stages on g. No heating is provided by the unit h. No cooling is provided by the unit i. Compressor stages on j. Outside air damper is open to minimum position k. Outside air damper closes completely Step 9: System returned to initial operating conditions after all tests have been completed: C. Testing Results Indicate if Passed (P), Failed (F), or N/A (X), fill in appropriate letter 8 17 16 15 14 13 12 v■ME000 REEMEN MEN MEMN I'm In .o.Soo. ..o�.00 NamMEN ENE oams .. 8 7 6 5 4 3 2 P P P P P P P D. Evaluation �✓ I PASS: All Construction Inspection responses are complete and all applicable Testing Results responses are "Pass" (P). CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A I t Ur I.ALWUKIWA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-NRCA-MCH-03-A i Revised 07/161 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 3 of 3 Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/rag: AC-B-02, AC-B-03, AC-B-04, AC-B-06 System Location or Area Served: Electrical 816, Elev, Elevator Equipment B21, MPOE DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Date Signed: /5/z 2 6Zt{ Address: 11140 Thurston Lane ATT Certification Identification (If applicable): City/State/Zip: Mira Loma/ CA/ 91752 Phone: 951-361-2247 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with th uilding permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Position with Company (Title): Technician Address: 11140 Thurston Lane ATT Certification Identification (if applicable): City/State/Zip: Mira Loma/ CA/ 91752 Phone: 951-361-2247 Date Signed: 2 / s/ ZO Z� RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical Position with Company (Title): Project Ma goe Address: 11140 Thurtson Lane CSLEI License: City/State/Zip: Mira Loma/CA/92509 Phone: 951-361-2247 Date Signed: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 .J I A It U!" t.AL11-UM IA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS t,ct;-rq CERTIFICATE OF ACCEPTANCE CALIFORNIA ENERGY COMMISSION _'4W NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 1 of 3 Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: city: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System Location or Area Served: AC-B-07 Emergency Note: Submit one Certificate of Acceptance for each system that must Enforcement Agency Use: Checked by/Date demonstrate compliance. A. Construction Ins 1. Supporting documentation needed to perform test includes, but not limited to: a. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.2 Constant Volume, Single -zone, Unitary Air Conditioner and Heat Pumps Systems Acceptance At -A -Glance). b. 2016 Building Energy Efficiency Standards Manual. 2. Instrumentation to perform test may include: a. Temperature Meter b. Amp Meter 3. Installation (check if applies): ❑✓ Thermostat is located within the space -conditioning zone that is served by the HVAC system. 4. Programming (check all those that apply): ❑✓ Thermostat meets the temperature adjustment and dead band requirements of 2016 Building Energy Efficiency Standards Manual Section 120.2(b). Minimum heating setpoint: 87 °F. Maximum cooling setpoint 64 OF. Deadband: 88 OF. ❑ Occupied, unoccupied, and holiday schedules have been programmed per the schedule provided. ❑ Pre -occupancy purge has been programmed to meet the requirements of 2016 Building Energy Efficiency Standards Manual Section 120.1(c)2. 1. Check method used to determine pre -occupancy purge: ❑✓ Lesser of: conditioned floor area times ventilation rate from 2016 Building Ent 120.1-A or 15cfm per person times the expected number of occupants. ❑ 3 complete air changes. Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I A I t_ Ur I.ALIrUKN IA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) wio rmmnlr1nM1=R amn HEAT PUMP SYSTEMS r1ni -03-A Revised 07/161 CALIFORNIA ENERGY GUMMIJSIUN CE�-�Z R� CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 2 of 3 Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Zip Code: Project Address: City: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System Location or Area Served: AC-B-07 Emergency B. Functional Testing Requirements Ioperating Modes Step 1: Disable economizer control and demand -controlled ventilation (if applicable) to prevent unexpected interactions. Occupied Mode Step 2: Heating load during occupied condition Step 3: No-load during occupied condition Step 4: Cooling load during occupied condition Unoccupied Mode Step 5: No-load during unoccupied condition Step 6: Heating load during unoccupied condition Step 7: Cooling load during unoccupied condition Step 8: Manual override Step 2 — 8: Check and verify the following for each simulation mode required a. Supply fan operates continually b. Supply fan turns off C. Supply fan cycles on and off d. System reverts to "occupied" mode to satisfy any condition e. System turns off when manual override time period expires f. Gas -fired furnace, heat pump, or electric heater stages on g. No heating is provided by the unit h. No cooling is provided by the unit i. Compressor stages on j. Outside air damper is open to minimum position k. Outside air damper closes completely Step 9: System returned to initial operating conditions after all tests have been completed: C. Testing Results Indicate if Passed (P), Failed (F), or N/A (X), fill in appropriate letter 8 17 1 6 5 1 4 1 3 1 2 Yes QQ No p 8 7 6 5 4 3 2 P P P P P P P D. Evaluation 0✓ I PASS: All Construction Inspection responses are complete and all applicable Testing Results responses are "Pass" (P). July 2016 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance a IAI t yr t,r+urvKrvlH CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS r CEC-NRCA-MCH-03-A rRevised 071161 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 3 of 3 Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: 101 Bayview Place System Name or Identification/Tag: AC-8-07 City: Newport Beach j System Location or Area Served: Emergency Zip Code: 92660 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Date Signed: zC;Z`i Address: 11140 Thurston Lane ATT Certification Identification (If applicable): City/State/Zip: Mira Loma/ CA/ 91752 Phone: 951-361-2247 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with t e building permit(s) issued for the building. _ _ _ Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Position with Company (Title): Technician ' Address: 11140 Thurston Lane ATT Certification Identification (if applicable): City/State/Zip: Mira Loma/ CA/ 91752 Phone: 951-361-2247 Date Signed: 7 r s%Q2 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Responsible Acceptance Person Signature: 4.r Johnny Contreras Responsible Acceptance Person Company Name: Christian Brothers Mechanical Position with Company (Title): project Manager Address: 11140 Thurtson Lane CSLB License: City/State/Zip: Mira Loma/CA/92509 Phone: 951-361-2247 Date Signed: 2 .�f ZC52 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I H I t Ut- t.HL I r V KIV IH CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS ;m tt,-Ivrtt,A-nnt,n-uJ-A yKevisea u/rIs CALIFORNIA ENERGY COMMISSION —9=P' CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 1 of 3 Project Name: b umer: Enforcement Agency: Permit N Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification rag: System Location or Area Served: FCU-1-01, FCU-1-02,FCU-1-03 Laundry, Office, Office Note: Submit one Certificate of Acceptance for each system that must Enforcement Agency Use: Checked by/Date demonstrate compliance. A. construction Inspection 1. Supporting documentation needed to perform test includes, but not limited to: a. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.2 Constant Volume, Single -zone, Unitary Air Conditioner and Heat Pumps Systems Acceptance At -A -Glance). b. 2016 Building Energy Efficiency Standards Manual. 2. Instrumentation to perform test may include: a. Temperature Meter b. Amp Meter 3. Installation (check if applies): ❑✓ Thermostat is located within the space -conditioning zone that is served by the HVAC system. 4. Programming (check all those that apply): ❑✓ Thermostat meets the temperature adjustment and dead band requirements of 2016 Building Energy Efficiency Standards Manual Section 120.2(b). Minimum heating setpoint: 87 OF. Maximum cooling setpoint 64 OF. Deadband: 88 OF. ❑ Occupied, unoccupied, and holiday schedules have been programmed per the schedule provided. ❑ Pre -occupancy purge has been programmed to meet the requirements of 2016 Building Energy Efficiency Standards Manual Section 120.1(c)2. 1. Check method used to determine pre -occupancy purge: ❑✓ Lesser of: conditioned floor area times ventilation rate from 2016 Building Energy Efficiency Standards TABLE 120.1-A or 15cfm per person times the expected number of occupants. ❑ 3 complete air changes. Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I H It Ur I.HLIt-UKNIH CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CALIFORNIA ENERGY COMMISSION IQ CEC-NRCA-MCH-03-A (Revised 07/16 NRCA-MCH-03-A CERTIFICATE OF ACCEPTANCE Constant volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 2 of 3 Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System Location or Area Served: FCU-1-Ol, FCU-1-02,FCU-1-03 Laundry, Office, Office B. Functional Testing Requirements I Operating Modes Step 1: Disable economizer control and demand -controlled ventilation (if applicable) to prevent unexpected interactions. Occupied Mode Step 2: Heating load during occupied condition Step 3: No-load during occupied condition Step 4: Cooling load during occupied condition Unoccupied Mode Step 5: No-load during unoccupied condition Step 6: Heating load during unoccupied condition Step 7: Cooling load during unoccupied condition Step 8: Manual override 8 7 6 5 4 3 2 Step 2 — 8: Check and verify the following for each simulation mode required Supply fan operates continually Supply fan turns off Supply fan cycles on and off System reverts to "occupied" mode to satisfy any condition �- a. b. C. d. e. System turns off when manual override time period expires f. Gas -fired furnace, heat pump, or electric heater stages on No heating is provided by the unit g. No cooling is provided by the unit h. L Compressor stages on j. Outside air damper is open to minimum position Outside air damper closes completely ve k. 9: System returned to initial operating conditions after all tests have been completed: Yes QQ No p Step C. Testing Results 8 7 6 5 4 3 2 Indicate if Passed (P), Failed (F), or N/A (X), fill in appropriate letter P PIPIPIP1 PIP D. Evaluation Q✓ PASS: All Construction Inspection responses are complete and all applicable Testing Results responses are "Pass" (P). July 2016 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance ':,I /A It: Vh I.ALIrIJRN IA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS rril GALIFORNIA ENERGY G MIA 5510N r I CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A I Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 3 of 3 Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: 101 Bayview Place System Name or Identification/Tag: FCU-1-01, FCU-1-02,FCU-1-03 City: Zip Code: Newport Beach 92660 System Location or Area Served: Laundry, Office, Office DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Date Signed: 7-/ + Address: 11140 Thurston Lane ATT Certification Identification (If appl e): City/State/Zip: Mira Loma/ CA/ 91752 Phone: 951-361-2247 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Position with Company (Title): Technician Address: 11140 Thurston Lane ATT Certification Identification (if applicable): City/State/Zip: Mira Loma/ CA/ 91752 Phone: 951-361-2247 Date Signed: J RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the b ilding owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical Position with Company (Title): Project Man er Address: 11140 Thurtson Lane CSLB License: City/state/zip: Mira Loma/CA/92509 Phone: 951-361-2247 Date Signed: Z/c'�ZCl�f CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I A I in V Y UALI1-UKIV IA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS 0711 CERTIFICATE OF ACCEPTANCE CALIFORNIA Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems N RCA-M CH-03-A Page 1 of 3 Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: city: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identificationfrag: System Location or Area Served: FCU-1-04,FCU-1-05,FCU-1-06 Kitchen, Corridor, Restaurant Note: Submit one Certificate of Acceptance for each system that must Enforcement Agency Use: Checked by/Date demonstrate compliance. A. Construction Inspection 1. Supporting documentation needed to perform test includes, but not limited to: a. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.2 Constant Volume, Single -zone, Unitary Air Conditioner and Heat Pumps Systems Acceptance At -A -Glance). b. 2016 Building Energy Efficiency Standards Manual. 2. Instrumentation to perform test may include: a. Temperature Meter b. Amp Meter 3. Installation (check if applies): ❑✓ Thermostat is located within the space -conditioning zone that is served by the HVAC system. 4. Programming (check all those that apply): Thermostat meets the temperature adjustment and dead band requirements of 2016 Building Energy Efficiency Standards Manual Section 120.2(b). Minimum heating setpoint: 87 OF. Maximum cooling setpoint 64 OF. Deadband: 88 OF. ❑ Occupied, unoccupied, and holiday schedules have been programmed per the schedule provided. ❑ Pre -occupancy purge has been programmed to meet the requirements of 2016 Building Energy Efficiency Standards Manual Section 120.1(c)2. 1. Check method used to determine pre -occupancy purge: Lesser of: conditioned floor area times ventilation rate from 2016 Building Energy Efficiency Standards TABLE 120.1-A or 15cfm per person times the expected number of occupants. ❑ 3 complete air changes. Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J IHI t Vt' t,HLlr UKIM IH CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CALIFORNIA ENERGY CERTIFICATE OF ACCEPTANCE JMMISSION Q. N RCA-M CH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-273i Zip Code: Project Address: City: 101 Bayview Place Newport Beach 92660 System Name or Identificationtrag: System Location or Area served: FCU-1-04,FCU-1-05,FCU-1-06 Kitchen, Corridor, Restaurant Page 2 of 3 B. Functional Testing Requirements Operating Modes Step 1: Disable economizer control and demand -controlled ventilation (if applicable) to prevent unexpected interactions. Occupied Mode Step 2: Heating load during occupied condition Step 3: No-load during occupied condition Step 4: Cooling load during occupied condition Unoccupied Mode Step 5: No-load during unoccupied condition Step 6: Heating load during unoccupied condition Step 7: Cooling load during unoccupied condition Step 8: Manual override Step 2 — 8: Check and verify the following for each simulation mode required a. Supply fan operates continually b. Supply fan turns off, C. Supply fan cycles on and off Cl. System reverts to 'occupied" mode to satisfy any condition e. System turns off when manual override time period expires f. Gas -fired furnace, heat pump, or electric heater stages on g. No heating is provided by the unit h. No cooling is provided by the unit i. Compressor stages on J. Outside air damper is open to minimum position k. Outside air damper closes completely Step 9: System returned to initial operating conditions after all tests have been completed: C. Testing Results Indicate if Passed (P), Failed (F), or N/A (X), fill in appropriate letter mvv000U ON N MEN no MION11 E SEWD mono■ 40M0M D. Evaluation ✓Q I PASS: All Construction Inspection responses are complete and all applicable Testing Results responses are "Pass" (P). July 2016 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance J INIt Ut WAL-It-UMIA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS t,ct,-rvn� rj-m� n-us-H tnevisea uirlts. CERTIFICATE OF ACCEPTANCE COMMISSION r N RCA-M CH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 3 of 3 Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System Location or Area Served: FCU-1-04,FCU-1-05,FCU-1-06 Kitchen, Corridor, Restaurant DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Date Signed: 2S%ZG Address: 11140 Thurston Lane ATT Certification Identificatio (If app e): City/State/Zip: Mira Loma/ CA/ 91752 Phone: 951-361-2247 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificat of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the b Iding permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Position with Company (Title): Technician Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/state/zip: Mira Loma/ CA/ 91752 Phone: 951-361-2247 Date Signed: ,� ?, - Y RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. _ Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical Position with Company (Title): Project Manager Address: 11140 Thurtson Lane CSLB License: City/State/Zip: Mira Loma/CA/92509 Phone: 951-361-2247 Date Signed: �`S�ZGZi CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I A I t U!" URI-I r V KIN IA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-NRCA-MCH-03-A Revised 07116, CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 1 of 3 Project Name: it Nu mber: umer: Enforcement Agency: Pb Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or IdentificationPrag; System Location or Area Served: FCU-1-07,FCU-1-08,FCU-1-09A Dr's Pub, Kitchen, Kitchen Note: Submit one Certificate of Acceptance for each system that must demonstrate compliance. A. Construction I Enforcement Agency Use: Checked by/Date 1. Supporting documentation needed to perform test includes, but not limited to: a. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NAZ5.2 Constant Volume, Single -zone, Unitary Air Conditioner and Heat Pumps Systems Acceptance At -A -Glance). b. 2016 Building Energy Efficiency Standards Manual. 2. Instrumentation to perform test may include: a. Temperature Meter b. Amp Meter 3. Installation (check if applies): ✓❑ Thermostat is located within the space -conditioning zone that is served by the HVAC system. 4. Programming (check all those that apply): ❑✓ Thermostat meets the temperature adjustment and dead band requirements of 2016 Building Energy Efficiency Standards Manual Section 120.2(b). Minimum heating setpoint: 87 OF. Maximum cooling setpoint 64 OF. Deadband: 88 OF. ❑ Occupied, unoccupied, and holiday schedules have been programmed per the schedule provided. ❑ Pre -occupancy purge has been programmed to meet the requirements of 2016 Building Energy Efficiency Standards Manual Section 120.1(c)2. 1. Check method used to determine pre -occupancy purge: Lesser of: conditioned floor area times ventilation rate from 2016 Building Energy Efficiency Standards TABLE 120.1-A or 15cfm per person times the expected number of occupants. ❑ 3 complete air changes. Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I H It V r I.HLIt-V KIV IH CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-NRCA-MCH-03-A iRevised 07/161 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 2 of 3 Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System Location or Area Served: FCU-1-07,FCU-1-08,FCU-1-09A Dr's Pub, Kitchen, Kitchen B. Functional Testing Requirements IOperating Modes Step 1: Disable economizer control and demand -controlled ventilation (if applicable) to prevent unexpected interactions. Occupied Mode Step 2: Heating load during occupied condition Step 3: No-load during occupied condition Step 4: Cooling load during occupied condition Unoccupied Mode Step 5: No-load during unoccupied condition Step 6: Heating load during unoccupied condition Step 7: Cooling load during unoccupied condition I I I ` Step 8: Manual override 8 7 6 5 4 3 2 Step 2 — 8: Check and verify the following for each simulation mode required a. Supply fan operates continually ✓ ✓ ✓ ✓ b. Supply fan turns off C. Supply fan cycles on and off ✓ ✓ d. System reverts to "occupied" mode to satisfy any condition ✓ e. System turns off when manual override time period expires f. Gas -fired furnace, heat pump, or electric heater stages on ✓ ✓ g. No heating is provided by the unit ✓ ✓ ✓ h. No cooling is provided by the unit ✓ v IV ✓ i. Compressor stages on ✓ i. Outside air damper is open to minimum position ✓ ✓ ✓ ✓ ✓ k. Outside air damper closes completely ✓ ✓ Step 9: System returned to initial operating conditions after all tests have been completed: Yes QQ No p C. Testing Results 8 7 6 5 4 3 2 Indicate if Passed (P), Failed (F), or N/A (X), fill in appropriate letter P I P I P I P P I P I P D. Evaluation �✓ PASS: All Construction Inspection responses are complete and all applicable Testing Results responses are "Pass" (P). CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I A It Ut- L,ALIt- UKIV IA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS '& CEC-NRCA-MCH-03-A : Revised 07/16: r AI WOPKIIA FnII=Rr_v rnnenelcQInnl CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 3 of 3 Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-1-07,FCU-1-08,FCU-1-09A System Location or Area Served: Dr's Pub, Kitchen, Kitchen DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Date Signed: `Z f -z `j Address: 11140 Thurston Lane ATTCertification Identification (If applicable): City/State/Zip: Mira Loma/ CA/ 91752 Phone:951-361-2247 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with th building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Position with Company (Title): Technic' Address: 11140 Thurston Lane ATT Certification Identification (if applicable): City/State/Zip: Phone: Date Signed: zoa Mira Loma/ CA/ 91752 951-361-2247 `Z- C RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical Position with Company (Title): Project M r Address: 11140 Thurtson Lane CSLB License: City/State/Zip: Mira Loma/CA/92509 Phone: 951-361-2247 Date Signed: Z/,5'rrU, Zr, CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J IA It Vr L.ALIrVKNI/A CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-NRCA-MCH-03-A I Revised 07/16, CALIFORNIA ENERGY COMMISSION iQ CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 1 of 3 Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: � 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-1-096, FCU-1-10,FCU-1-11 System Location or Area Served: Kitchen,Dining, Living Note: Submit one Certificate of Acceptance for each system that must Enforcement Agency Use: Checked by/Date demonstrate compliance. A. Construction I 1. Supporting documentation needed to perform test includes, but not limited to: a. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.2 Constant Volume, Single -zone, Unitary Air Conditioner and Heat Pumps Systems Acceptance At -A -Glance). b. 2016 Building Energy Efficiency Standards Manual. 2. Instrumentation to perform test may include: a. Temperature Meter b. Amp Meter 3. Installation (check if applies): ❑✓ Thermostat is located within the space -conditioning zone that is served by the HVAC system. 4. Programming (check all those that apply): ❑✓ Thermostat meets the temperature adjustment and dead band requirements of 2016 Building Energy Efficiency Standards Manual Section 120.2(b). Minimum heating setpoint: 87 OF. Maximum cooling setpoint 64 OF. Deadband: 88 OF. ❑ Occupied, unoccupied, and holiday schedules have been programmed per the schedule provided. ❑ Pre -occupancy purge has been programmed to meet the requirements of 2016 Building Energy Efficiency Standards Manual Section 120.1(c)2. 1. Check method used to determine pre -occupancy purge: ❑✓ Lesser of: conditioned floor area times ventilation rate from 2016 Building Energy Efficiency Standards TABLE 120.1-A or 15cfm per person times the expected number of occupants. ❑ 3 complete air changes. Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 Z) I H I t V t- UALIF V I<IV IH CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-NRCA-vertu-03-n , Revised OTIM CALIFORNIA ENERGY COMMISSION �CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 2 of 3 Project Name: Enforcement Agency: Clearwater Harbor Point Senior Living Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-1-09B, FCU-1-10,FCU-1-11 System Location or Area Served: Kitchen,Dining, Living B. Functional Testing Requirements Operating Modes Step 1: Disable economizer control and demand -controlled ventilation (if applicable) to prevent unexpected interactions. Occupied Mode Step 2: Heating load during occupied condition Step 3: No-load during occupied condition Step 4: Cooling load during occupied condition Unoccupied Mode Step 5: No-load during unoccupied condition Step 6: Heating load during unoccupied condition Step 7: Cooling load during unoccupied condition Step 8: Manual override 8 7 6 5 4 3 2 Step 2 — 8: Check and verify the following for each simulation mode required a. Supply fan operates continually ✓ ✓ ✓ ✓ b. Supply fan turns off _ ✓ C. Supply fan cycles on and off ✓ ✓ d. System reverts to 'occupied" mode to satisfy any condition ✓ e. System turns off when manual override time period expires ✓ f. Gas -fired furnace, heat pump, or electric heater stages on ✓ ✓ g. No heating is provided by the unit ✓ ✓ ✓ ✓ h. No cooling is provided by the unit ✓ ✓ ✓ ✓ i. Compressor stages on ✓ ✓ J. Outside air damper is open to minimum position ✓ ✓ ✓ ✓ k. Outside air damper closes completely ✓ ✓ 400 Step 9: System returned to initial operating conditions after all tests have been completed: Yes QQ C. Testing Results 8 7 1 6 5 1 4 1 3 1 2 Indicate if Passed (P), Failed (F), or N/A (X), fill in appropriate letter P P I P P I P I P I P D. Evaluation �✓ PASS: All Construction Inspection responses are complete and all applicable Testing Results responses are "Pass" (P). CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 , IHIt Vr-kAI-IYVKNIA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS i , i ct.-IVKI H-min-us-H (Kevisea utilti) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 3 of 3 Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: city: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System Location or Area Served: FCU-1-096, FCU-1-l0,FCU-1-11 Kitchen,Dining, Living DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Date Signed: Address: 11140 Thurston Lane ATTCertification Identification (If applicable): City/state/zip: Mira Loma / CA / 91752 Phone: 951-561-2247 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available wit the building permit(s) issued for the building. Field Technician Name: Todd Alpert - Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Position with Company (Title): Technician Address: 11140 Thurston Lane ATT Certification Identification (if applicable): City/State/Zip: Mira Loma/ CA Phone: Date Signed: / 91752 951-361-2247 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to t building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical Position with Company (Title): Project ager Address: 11140 Thurtson Lane CSLB License: City/State/Zip: Mira Loma/CA/92509 Phone: 951-361-2247 Date Signed: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J IHIC Vr I.HLIrVKNIH CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS r�-9 A"Ilt-1 CERTIFICATE OF ACCEPTANCE CALIFORNIA ENERGY COMMISSION -'qW N RCA-M CH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 1 of 3 Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: SOl Bayview Place System Name or Identification/Tag: FCU-1-12, FCU-1-13, FCU-1-14 City: Newport Beach Zip Code: 92660 System Location or Area Served: Gameroom, Discovery, Corridor Note: Submit one Certificate of Acceptance for each system that must Enforcement Agency Use: Checked by/Date demonstrate compliance. A. Construction Inspection 1. Supporting documentation needed to perform test includes, but not limited to: a. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.2 Constant Volume, Single -zone, Unitary Air Conditioner and Heat Pumps Systems Acceptance At -A -Glance). b. 2016 Building Energy Efficiency Standards Manual. 2. Instrumentation to perform test may include: a. Temperature Meter b. Amp Meter 3. Installation (check if applies): ✓❑ Thermostat is located within the space -conditioning zone that is served by the HVAC system. 4. Programming (check all those that apply): ❑✓ Thermostat meets the temperature adjustment and dead band requirements of 2016 Building Energy Efficiency Standards Manual Section 120.2(b). Minimum heating setpoint: 87 OF. Maximum cooling setpoint 64 OF. Deadband: 88 OF. ❑ Occupied, unoccupied, and holiday schedules have been programmed per the schedule provided. ❑ Pre -occupancy purge has been programmed to meet the requirements of 2016 Building Energy Efficiency Standards Manual Section 120.1(c)2. 1. Check method used to determine pre -occupancy purge: ❑✓ Lesser of: conditioned floor area times ventilation rate from 2016 Building Energy Efficiency Standards TABLE 120.1-A or 15cfm per person times the expected number of occupants. ❑ 3 complete air changes. Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A I t Vr t.ALIr VKNIA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-NRCA-MCH-03-A Revised 07/16 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 2 of 3 Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System Location or Area Served: FCU-1-12,FCU-1-13,FCU-1-14 Gameroom, Discovery, Corridor B. Functional Testing Requirements I Operating Modes Step 1: Disable economizer control and demand -controlled ventilation (if applicable) to prevent unexpected interactions. Occupied Mode Step 2: Heating load during occupied condition Step 3: No-load during occupied condition Step 4: Cooling load during occupied condition Unoccupied Mode Step 5: No-load during unoccupied condition Step 6: Heating load during unoccupied condition Step 7: Cooling load during unoccupied condition Step 8: Manual override 8 7 6 5 4 3 2 Step 2 — 8: Check and verify the following for each simulation mode required _ a. Supply fan operates continually ✓ ✓ ✓ b. Supply fan turns off ✓ C. Supply fan cycles on and off ✓ ✓ d. System reverts to 'occupied" mode to satisfy any condition ✓ e. System turns off when manual override time period expires ✓ f. Gas -fired furnace, heat pump, or electric heater stages on ✓ ✓ g. No heating is provided by the unit ✓ ✓ ✓ '� h. No cooling is provided by the unit ✓ ✓ ✓ ✓ I. Compressor stages on ✓ ✓ j. Outside air damper is open to minimum position ✓ ✓ ✓ ✓ ✓ k. Outside air damper closes completely ✓ ✓ Step 9: System returned to initial operating conditions after all tests have been completed: Yes Q No Q C. Testing Results 8 1 7 1 615 mfl Indicate if Passed (P), Failed (F), or N/A (X), fill inappropriate letter P P P P D. Evaluation C0✓ PASS: All Construction Inspection responses are complete and all applicable Testing Results responses are "Pass" (P). CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 Z. A I L Ur UAL -It -UM lit CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-NRCA-MCH-03-A Revised 07/16 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 3 of 3 Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Zip Code: Newport Beach 92660 System Location or Area Served: Gameroom, Discovery, Corridor System Name or Identification/Tag: FCU-1-12,FCU-1-13,FCU-1-14 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Date Signed: / Address: 11140 Thurston Lane ATT Certification Identification (If le): City/State/Zip: Mira Loma/ CA/ 91752 Phone: 951-361-2247 FIELD TECHNICIAN'S DECLARATION STATEMENT certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with th uilding per 't s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Position with Company (Title): Technician Address: 11140 Thurston Lane ATT Certification Identification (if applicable): City/State/Zip: Mira Loma/ CA/ 91752 Phone: 951-361-2247 Date Signed: Z !! RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the_ building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical Position with Company (Title): Proje Manager Address: 11140 Thurtson Lane CSLB License: City/State/Zip: Mira Loma/CA/92509 Phone: 951-361-2247 Date Signed: I�l err CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 a I H I t tJr l.HuruKNIH CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CERTIFICATE OF ACCEPTANCE CALIFORNIA ENERGY COMMISSION 'qW NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 1 of 3 Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: 101 Bayview Place System Name or Identification/Tag: FCU-2-01, FCU-2-02,FCU-2-03 City: Zip Code: Newport Beach 92660 System Location or Area Served: Dining, Living, Office Note: Submit one Certificate of Acceptance for each system that must demonstrate compliance. A. Construction Inspection Enforcement Agency Use: Checked by/Date 1. Supporting documentation needed to perform test includes, but not limited to: a. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NAZS.2 Constant Volume, Single -zone, Unitary Air Conditioner and Heat Pumps Systems Acceptance At -A -Glance). b. 2016 Building Energy Efficiency Standards Manual. 2. Instrumentation to perform test may include: a. Temperature Meter b. Amp Meter 3. Installation (check if applies): ❑✓ Thermostat is located within the space -conditioning zone that is served by the HVAC system. 4. Programming (check all those that apply): ❑✓ Thermostat meets the temperature adjustment and dead band requirements of 2016 Building Energy Efficiency Standards Manual Section 120.2(b). Minimum heating setpoint: 87 OF. Maximum cooling setpoint 64 OF. Deadband: 88 OF. ❑ Occupied, unoccupied, and holiday schedules have been programmed per the schedule provided. ❑ Pre -occupancy purge has been programmed to meet the requirements of 2016 Building Energy Efficiency Standards Manual Section 120.1(c)2. 1. Check method used to determine pre -occupancy purge: ❑✓ Lesser of: conditioned floor area times ventilation rate from 2016 Building Energy Efficiency Standards TABLE 120.1-A or 15cfm per person times the expected number of occupants. ❑ 3 complete air changes. Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I A I L V t- UALIt• V KIV IA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-NRCA-MCH-03-A ; Revised 07/16 CALIFORNIA ENERGY CERTIFICATE OF ACCEPTANCE Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems WMISSION (D. N RCA-MCH-03-A Page 2 of 3 Project Name: Enforcement Agency: Permit Number: I Clearwater Harbor Point Senior Living i I X2021 2737 Project Address: 101 Bayview Place System Name or Identification/Tag: FCU-2-01, FCU-2-02, FCU-2-03 City: Newport Beach System Location or Area Served: Dining, Living, Office Zip Code: 92660 B. Functional Testing Requirements I Operating Modes Step 1: Disable economizer control and demand -controlled ventilation (if applicable) to prevent unexpected interactions. Occupied Mode Step 2: Heating load during occupied condition Step 3: No-load during occupied condition Step 4: Cooling load during occupied condition Unoccupied Mode Step 5: No-load during unoccupied condition Step 6: Heating load during unoccupied condition Step 7: Cooling load during unoccupied condition Step 8: Manual override 8 7 6 5 4 3 2 Step 2 — 8: Check and verify the following for each simulation mode required a. Supply fan operates continually ✓ ✓ ✓ ✓ b. Supply fan turns off ✓ C. Supply fan cycles on and off ✓ ✓ d. System reverts to "occupied" mode to satisfy any condition ✓ e. System turns off when manual override time period expires ✓ f. Gas -fired furnace, heat pump, or electric heater stages on ✓ ✓ g. No heating is provided by the unit Fe h. No cooling is provided by the uniti. Compressor stages on ✓ j. Outside air damper is open to minimum position ✓ ✓ ✓ ✓ ✓ k. Outside air damper closes completely ✓ ✓ Step 9: System returned to initial operating conditions after all tests have been completed: Yes QQ No O C. Testing Results 8 1 7 6 5 4 3 2 Indicate if Passed (P), Failed (F), or N/A (X), fill in appropriate letter P P P P P P P D. Evaluation 1 ❑✓ I PASS: All Construction Inspection responses are complete and all applicable Testing Results responses are "Pass" (P). CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I A It Vr' UALII'UKIV IA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS R)l CEC-NRCA-MCH-03-A Revised 07/16 CERTIFICATE OF ACCEPTANCE N RCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 3 of 3 Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living I X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System Location or Area Served: FCU-2-01,FCU-2-02,FCU-2-03 Dining, Living, Office DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Date Signed: ZJS/ Zp2 Address: 11140 Thurston Lane ATT Certification Identification (If pplicable): City/State/Zip: Mira Loma/ CA/ 91752 Phone: 951-361-2247 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permits) _ issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: i Field Technician Company Name: Christian Brothers Mechanical Position with Company(Title):Technician Address: 11140 Thurston Lane ATT Certification Identification (if applicable): City/State/zip: Mira Loma/ CA/ 91752 Phone: 951-361-2247 Date Signed: ! `t RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to t e building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical Position with company (Title): Proje Mana Address: 11140 Thurtson Lane CSLB License: City/State/Zip: Mira Loma/CA/92509 hone: P 951-361-2247 Date Signed: 7,14 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I It: U!" t.HLit-V11NIH CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS p ;l CERTIFICATE OF ACCEPTANCE IA ENERGY COMMISSION T N RCA-M CH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 1 of 3 Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: 101 Bayview Place System Name or Identificationfrag: FCU-2-04, FCU-2-05,FCU-2-6 City: Zip Code: Newport Beach 92660 System Location or Area Served: Office, Kitchen, Corridor Note: Submit one Certificate of Acceptance for each system that must Enforcement Agency Use: Checked by/Date demonstrate compliance. A. Construction Inspection 1. Supporting documentation needed to perform test includes, but not limited to: a. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.2 Constant Volume, Single -zone, Unitary Air Conditioner and Heat Pumps Systems Acceptance At -A -Glance). b. 2016 Building Energy Efficiency Standards Manual. 2. Instrumentation to perform test may include: a. Temperature Meter b. Amp Meter 3. Installation (check if applies): ❑✓ Thermostat is located within the space -conditioning zone that is served by the HVAC system. 4. Programming (check all those that apply): ❑✓ Thermostat meets the temperature adjustment and dead band requirements of 2016 Building Energy Efficiency Standards Manual Section 120.2(b). Minimum heating setpoint: 87 OF. Maximum cooling setpoint 64 OF. Deadband: 88 OF. ❑ Occupied, unoccupied, and holiday schedules have been programmed per the schedule provided. ❑ Pre -occupancy purge has been programmed to meet the requirements of 2016 Building Energy Efficiency Standards Manual Section 120.1(c)2. 1. Check method used to determine pre -occupancy purge: ❑✓ Lesser of: conditioned floor area times ventilation rate from 2016 Building Energy Efficiency Standards TABLE 120.1-A or 15cfm per person times the expected number of occupants. ❑ 3 complete air changes. Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J IHIt Vh I,HLIhVKNIH CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS 'Q CEC-NRCA-MCH-03-A Revised 07/1§1 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 2 of 3 Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System Location or Area Served: FCU-2-04, FCU-2-05,FCU-2-6 Office, Kitchen, Corridor B. Functional Testing Requirements I Operating Modes Step 1: Disable economizer control and demand -controlled ventilation (if applicable) to prevent unexpected interactions. Occupied Mode Step 2: Heating load during occupied condition Step 3: No-load during occupied condition Step 4: Cooling load during occupied condition Unoccupied Mode Step 5: No-load during unoccupied condition Step 6: Heating load during unoccupied condition Step 7: Cooling load during unoccupied condition Step 8: Manual override 8 7 6 5 4 3 2 Step 2 — 8: Check and verify the following for each simulation mode required a. Supply fan operates continually ✓ r ✓ ✓ ✓ b. Supply fan turns off ✓ C. Supply fan cycles on and off ✓ ✓ d. System reverts to 'occupied" mode to satisfy any condition _✓ ✓ e. System turns off when manual override time period expires f. Gas -fired furnace, heat pump, or electric heater stages on ✓ ✓ g. No heating is provided by the unit ✓ ✓ ✓ ✓ h. No cooling is provided by the unit ✓ ✓ ✓ ✓ i. Compressor stages on ✓ ✓ j. Outside air damper is open to minimum position ✓ ✓ ✓ ✓ ✓ k. Outside air damper closes completely ✓ ✓ Step 9: System returned to initial operating conditions after all tests have been completed: Yes 0• No p C. Testing Results 8 7 6 5 4 3 2 Indicate if Passed (P), Failed (F), or N/A (X), fill in appropriate letter P P P P I P I P P D. Evaluation 11.71 I PASS: All Construction Inspection responses are complete and all applicable Testing Results responses are "Pass" (P). CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I H I L UI- I.HLIrUKIVIH CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-NRCA-MCH-03-A (Revised 071161 rni II:naN1A F=nii:Rry rnnanelcclnnF CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 3 of 3 Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-2-04, FCU-2-OS,FCU-2-6 System Location or Area Served: Office, Kitchen, Corridor DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Date Signed: us/zo Address: 11140 Thurston Lane ATT Certification Identification (I icable): City/State/Zip: Mira Loma/ CA/ 91752 Phone: 951-361-2247 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with t e building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Position with Company (Title): Technicia Address: 11140 Thurston Lane ATT Certification Identification (if applicab e): City/State/Zip: Mira Loma/ CA/ 91752 Phone: 951-361-2247 Date Signed: 7-/5 Z07A RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical Position with Company (Title): Project na Address: 11140 Thurtson Lane CSLB License: City/State/Zip: Mira Loma/CA/92509 Phone: 951-361-2247 Date Signed: / Za CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I H I t Ur UALWUKIVIH CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS F-1 U 111 CERTIFICATE OF ACCEPTANCE CALIFORNIA ENERGY COMMISSION 'MW NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 1 of 3 Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System Location or Area Served: FCU-2-7, FCU-3-I,FCU-3-2 Corridor, Corridor, Corridor Note: Submit one Certificate of Acceptance for each system that must I Enforcement Agency Use: Checked by/Date demonstrate compliance. A. Construction Inspection 1. Supporting documentation needed to perform test includes, but not limited to: a. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.2 Constant Volume, Single -zone, Unitary Air Conditioner and Heat Pumps Systems Acceptance At -A -Glance). b. 2016 Building Energy Efficiency Standards Manual. 2. Instrumentation to perform test may include: a. Temperature Meter b. Amp Meter 3. Installation (check if applies): ❑✓ Thermostat is located within the space -conditioning zone that is served by the HVAC system. 4. Programming (check all those that apply): ❑✓ Thermostat meets the temperature adjustment and dead band requirements of 2016 Building Energy Efficiency Standards Manual Section 120.2(b). Minimum heating setpoint: 87 OF. Maximum cooling setpoint 64 OF. Deadband: 88 OF. ❑ Occupied, unoccupied, and holiday schedules have been programmed per the schedule provided. ❑ Pre -occupancy purge has been programmed to meet the requirements of 2016 Building Energy Efficiency Standards Manual Section 120.1(c)2. 1. Check method used to determine pre -occupancy purge: ❑✓ Lesser of: conditioned floor area times ventilation rate from 2016 Building Energy Efficiency Standards TABLE 120.1-A or 15cfm per person times the expected number of occupants. ❑ 3 complete air changes. Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I H I t yr L,Hurvt<ry IH CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-NRCA-MCH-03-A Revised 07/161 _ CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 2 of 3 Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System Location or Area Served: FCU-2-7, FCU-3-I,FCU-3-2 Corridor, Corridor, Corridor B. Functional Testing Requirements I Operating Modes Step 1: Disable economizer control and demand -controlled ventilation (if applicable) to prevent unexpected interactions. Occupied Mode Step 2: Heating load during occupied condition Step 3: No-load during occupied condition Step 4: Cooling load during occupied condition Unoccupied Mode Step 5: No-load during unoccupied condition Step 6: Heating load during unoccupied condition Step 7: Cooling load during unoccupied condition Step 8: Manual override 8 7 6 5 4 3 2 Step 2 — 8: Check and verify the following for each simulation mode required a. Supply fan operates continually ✓ ✓ ✓ ✓ b. Supply fan turns off ✓ C. Supply fan cycles on and off ✓ ✓ d. System reverts to 'occupied" mode to satisfy any condition ✓ System turns off when manual override time period expires ✓ Gas-firedfurnace, heat pump, or electric heater stages onNo rh. heating is provided by the unit ✓ ✓ ✓ ✓ No cooling is provided by the unit ✓ ✓ ✓ ✓ i. Compressor stages on ✓ ✓ j. Outside air damper is open to minimum position ✓ ✓ ✓ ✓ ✓ k. Outside air damper closes completely ✓ ✓ Step 9: System returned to initial operating conditions after all tests have been completed: Yes QQ No p C. Testing Results 8 7 6 5 4 1 3 2 Indicate if Passed (P), Failed (F), or N/A (X), fill in appropriate letter P P P P P P P D. Evaluation ✓❑ I PASS: All Construction Inspection responses are complete and all applicable Testing Results responses are "Pass" (P). CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I It: Ur VHLI hUKNIN CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-NRCA-MCH-03-A (Revised 07/16� (`AI MnPKIIA Fnlccr_v rnnAnAIQQlnnl CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 3 of 3 Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-2-7, FCU-3-I,FCU-3-2 System Location or Area Served: Corridor, Corridor, Corridor DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: ' Documentation Author Company Name: Christian Brothers Mechanical Date Signed: Z/5 �oZ Address: 11140 Thurston Lane ATT Certification Identification (If app icable): City/State/Zip: Mira Loma/ CA/ 91752 Phone: 9S1-361-2247 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the +Iding permit(s) issued for the building. Field Technician Name: Todd Alpert Y Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Position with Company (Title): Technician Address: 11140 Thurston Lane ATT Certification Identification (if applicable): City/State/Zip: Mira Loma/ CA/ 91752 Phone: 951-361-2247 Date Signed: RESPONSIBLE PERSON'S DECLARATION STATEMENT certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical Position with Company (Title): Project Ma ger Address: 11140 Thurtson Lane CSL8 License: City/State/zip: Mira Loma/CA/92509 Phone: 951-361-2247 Date Signed: 27� CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 M A I L Ur I.HLIYUKIVIH CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS t,tl NKI:A-rvit:ri-u3-H iKevisea u/TTbi CALIFORNIA ENERGY COMMISSION i' CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 1 of 3 Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: 101 Bayview Place System Name or Identification/Tag: FCU-3-3,FCU-3-4, FCU-B-01 City: Newport Beach Zip Code: 92660 System Location or Area Served: Corridor, Corridor, Staff Break Note: Submit one Certificate of Acceptance for each system that must Enforcement Agency Use: Checked by/Date demonstrate compliance. A. Construction Inspection _ 1. Supporting documentation needed to perform test includes, but not limited to: a. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.2 Constant Volume, Single -zone, Unitary Air Conditioner and Heat Pumps Systems Acceptance At -A -Glance). b. 2016 Building Energy Efficiency Standards Manual. 2. Instrumentation to perform test may include: a. Temperature Meter b. Amp Meter 3. Installation (check if applies): ❑✓ Thermostat is located within the space -conditioning zone that is served by the HVAC system. 4. Programming (check all those that apply): ❑✓ Thermostat meets the temperature adjustment and dead band requirements of 2016 Building Energy Efficiency Standards Manual Section 120.2(b). Minimum heating setpoint: 87 OF. Maximum cooling setpoint 64 OF. Deadband: 88 OF. ❑ Occupied, unoccupied, and holiday schedules have been programmed per the schedule provided. ❑ Pre -occupancy purge has been programmed to meet the requirements of 2016 Building Energy Efficiency Standards Manual Section 120.1(c)2. 1. Check method used to determine pre -occupancy purge: ❑✓ Lesser of: conditioned floor area times ventilation rate from 2016 Building Energy Efficiency Standards TABLE 120.1-A or SScfm per person times the expected number of occupants. ❑ 3 complete air changes. Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 ")I A It: Ur UALWUMMA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-NRCA-MCH-03-A , Revised 07/161 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 2 of 3 Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-3-3,FCU-3-4, FCU-B-01 System Location or Area Served: Corridor, Corridor, Staff Break B. Functional Testing Requirements I Operating Modes Step 1: Disable economizer control and demand -controlled ventilation (if applicable) to prevent unexpected interactions. Occupied Mode Step 2: Heating load during occupied condition Step 3: No-load during occupied condition Step 4: Cooling load during occupied condition Unoccupied Mode Step 5: No-load during unoccupied condition Step 6: Heating load during unoccupied condition Step 7: Cooling load during unoccupied condition Step 8: Manual override 8 7 6 S 4 3 2 Step 2 — 8: Check and verify the following for each simulation mode required a. Supply fan operates continually ✓ ✓ ✓ ✓ b. Supply fan turns off ✓ C. Supply fan cycles on and off ✓ ✓ d. System reverts to 'occupied" mode to satisfy any condition ✓ e. System turns off when manual override time period expires ✓ f. Gas -fired furnace, heat pump, or electric heater stages on ✓ ✓ g. No heating is provided by the unit ✓ ✓ ✓ ✓ h. No cooling is provided by the unit ✓ ✓ ✓ ✓ i. Compressor stages on ✓ ✓ j. Outside air damper is open to minimum position ✓ ✓ ✓ ✓ ✓ k. Outside air damper closes completely ✓ ✓ Step 9: System returned to initial operating conditions after all tests have been completed: Yes QQ No Q C. Testing Results 8 1 7 6 5 4 3 2 Indicate if Passed (P), Failed (F), or N/A (X), fill in appropriate letter P P P P P P P D. Evaluation �✓ I PASS: All Construction Inspection responses are complete and all applicable Testing Results responses are "Pass" (P). CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J IA I It Vr 1-ALIrVtQWA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-NRCA-MCH-03-A (Revised 07/16:• CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 3 of 3 Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-3-3,FCU-3-4, FCU-B-01 System Location or Area Served: Corridor, Corridor, Staff Break DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Date Signed: 2 /S r GLL Address: 11140 Thurston Lane ATT Certification Identification (If applicable): City/State/Zip: Mira Loma/ CA/ 91752 Phone: 951-361-2247 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with a building pe 't(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Position with Company (Title):Technic n ATT Certification Identification (if applicable): Address: 11140 Thurston Lane City/State/Zip: Mira Loma/ CA/ 91752 Phone: 951-361-2247 Date signed: RESPONSIBLE PERSON'S DECLARATION STATEMENT certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical Position with Company (Title): Project Man Address: 11140 Thurtson Lane CSLB License: City/state/zip: Mira Loma/CA/92509 Phone: 951-361-2247 Date Signed: Z /5 /Zoz CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 a I H I r= yr t,AurvKrvlH CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS Fn� l.tl.-IVRI,H-MI�rI-UJ-H rcevisea vine+ CERTIFICATE OF ACCEPTANCE CALIFORNIA ENERGY COMMISSION '"Ww NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 1 of 3 Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System Location or Area Served: FCU-B-02A,FCU-B-026,FCU-B-03 Corridor, Wellness, Corridor Note: Submit one Certificate of Acceptance for each system that must Enforcement Agency Use: Checked by/Date demonstrate compliance. I A. Construction Inspection 1. Supporting documentation needed to perform test includes, but not limited to: a. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.2 Constant Volume, Single -zone, Unitary Air Conditioner and Heat Pumps Systems Acceptance At -A -Glance). b. 2016 Building Energy Efficiency Standards Manual. 2. Instrumentation to perform test may include: a. Temperature Meter b. Amp Meter 3. Installation (check if applies): ❑✓ Thermostat is located within the space -conditioning zone that is served by the HVAC system. 4. Programming (check all those that apply): ❑✓ Thermostat meets the temperature adjustment and dead band requirements of 2016 Building Energy Efficiency Standards Manual Section 120.2(b). Minimum heating setpoint: 87 OF. Maximum cooling setpoint 64 OF. Deadband: 88 OF. ❑ Occupied, unoccupied, and holiday schedules have been programmed per the schedule provided. ❑ Pre -occupancy purge has been programmed to meet the requirements of 2016 Building Energy Efficiency Standards Manual Section 120.1(c)2. 1. Check method used to determine pre -occupancy purge: ❑✓ Lesser of: conditioned floor area times ventilation rate from 2016 Building Energy Efficiency Standards TABLE 120.1-A or 15cfm per person times the expected number of occupants. ❑ 3 complete air changes. Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I H I t Vh UALWUMNIA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS r.Fr.-NIQrA-Mr:H-nA-A IRavicPri n7/M CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems. Page 2 of 3 Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-B-02A,FCU-B-02B,FCU-B-03 System Location or Area Served: Corridor, Wellness, Corridor B. Functional Testing Requirements I Operating Modes Step 1: Disable economizer control and demand -controlled ventilation (if applicable) to prevent unexpected interactions. Occupied Mode Step 2: Heating load during occupied condition Step 3: No-load during occupied condition Step 4: Cooling load during occupied condition Unoccupied Mode Step 5: No-load during unoccupied condition Step 6: Heating load during unoccupied condition Step 7: Cooling load during unoccupied condition Step 8: Manual override 8 7 6 5 4 3 2 Step 2 — 8: Check and verify the following for each simulation mode required a. Supply fan operates continually ✓ ✓ ✓ ✓ b. Supply fan turns off ✓ C. Supply fan cycles on and off ✓ ✓ d. System reverts to "occupied" mode to satisfy any condition ✓ e. System turns off when manual override time period expires ✓ f. Gas -fired furnace, heat pump, or electric heater stages on ✓ ✓ g. No heating is provided by the unit ✓ ✓ ✓ ✓ h. No cooling is provided by the unit ✓ ✓ ✓ ✓ i. Compressor stages on ✓ ✓ j. Outside air damper is open to minimum position ✓ ✓ ✓ ✓ ✓ k. Outside air damper closes completely ✓ ✓ Step 9: System returned to initial operating conditions after all tests have been completed: Yes QQ No Q C. Testing Results 8 7 6 5 4 3 2 Indicate if Passed (P), Failed (F), or N/A (X), fill in appropriate letter P P P P P P P D. Evaluation �✓ I PASS: All Construction Inspection responses are complete and all applicable Testing Results responses are "Pass" (P). CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 o I A It: Vf- tAL1t-UKN1A CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-NRCA-MCH-03-A (Revised 07/161 CAI IFCIRNIA FNFRGY CC)MMISSIC)N CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 3 of 3 Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-B-02A,FCU-B-02B,FCU-B-03 System Location or Area Served: Corridor, Wellness, Corridor DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Date Signed: Address: 11140 Thurston Lane ATT Certification Identification (If applicable): City/State/Zip: Mira Loma/ CA/ 91752 Phone: 951-361-2247 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available withle building p s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Position with Company (Title): Technician Address: 11140 Thurston Lane ATT Certification Identification (if applicable): City/State/Zip: Mira Loma/ CA/ 91752 Phone: 951-361-2247 Date Signed: r / 5 ZO `7 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical Position with Company (Title): Project err Address: 11140 Thurtson Lane CSLB License: City/State/Zip: Mira Loma/CA/92509 Phone: 951-361-2247 Date Signed: 2-/5/zoz CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I A I t Ur t..ALIrUKINIA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-NRCA-MCH-03-A Revised 07/16. CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems . Page 1 of 3 Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification rag: FCU-B-04, FCU-B-05 System Location or Area Served: Salon, Activity Note: Submit one Certificate of Acceptance for each system that must I Enforcement Agency Use: Checked by/Date demonstrate compliance. fl A. Construction Inspection 1. Supporting documentation needed to perform test includes, but not limited to: a. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.2 Constant Volume, Single -zone, Unitary Air Conditioner and Heat Pumps Systems Acceptance At -A -Glance). b. 2016 Building Energy Efficiency Standards Manual. 2. Instrumentation to perform test may include: a. Temperature Meter b. Amp Meter 3. Installation (check if applies): ✓❑ Thermostat is located within the space -conditioning zone that is served by the HVAC system. 4. Programming (check all those that apply): ✓❑ Thermostat meets the temperature adjustment and dead band requirements of 2016 Building Energy Efficiency Standards Manual Section 120.2(b). Minimum heating setpoint: 87 OF. Maximum cooling setpoint 64 OF. Deadband: 88 OF. ❑ Occupied, unoccupied, and holiday schedules have been programmed per the schedule provided. ❑ Pre -occupancy purge has been programmed to meet the requirements of 2016 Building Energy Efficiency Standards Manual Section 120.1(c)2. 1. Check method used to determine pre -occupancy purge: ❑✓ Lesser of: conditioned floor area times ventilation rate from 2016 Building Energy Efficiency Standards TABLE 120.1-A or 15cfm per person times the expected number of occupants. ❑ 3 complete air changes. Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I A It: Ur l-ALIrUMIA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS r CEC-NRCA-MCH-03-A i Revised 07/161 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 2 of 3 Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-B-04, FCU-B-05 System Location or Area Served: Salon, Activity B. Functional Testing Requirements I Operating Modes Step 1: Disable economizer control and demand -controlled ventilation (if applicable) to prevent unexpected interactions. Occupied Mode Step 2: Heating load during occupied condition Step 3: No-load during occupied condition Step 4: Cooling load during occupied condition Unoccupied Mode Step 5: No-load during unoccupied condition Step 6: Heating load during unoccupied condition Step 7: Cooling load during unoccupied condition Step 8: Manual override 8 7 6 5 4 3 2 Step 2 — 8: Check and verify the following for each simulation mode required a. Supply fan operates continually ✓ ✓ ✓ ✓ b. Supply fan turns off Supply fan cycles on and off ✓ C. ✓ ✓ d. System reverts to "occupied" mode to satisfy any condition ✓ e. System turns off when manual override time period expires ✓ f. Gas -fired furnace, heat pump, or electric heater stages on ✓ ✓ g. No heating is provided by the unit ✓ ✓ ✓ ✓ h. No cooling is provided by the unit ✓ ✓ ✓ ✓ i. Compressor stages on ✓ ✓ j. Outside air damper is open to minimum position ✓ ✓ ✓ ✓ ✓ k. Outside air damper closes completely ✓ ✓ Step 9: System returned to initial operating conditions after all tests have been completed: Yes QQ No Q C. Testing Results 8 7 6 5 4 3 2 Indicate if Passed (P), Failed (F), or N/A (X), fill in appropriate letter P P P P P P P D. Evaluation ✓❑ I PASS: All Construction Inspection responses are complete and all applicable Testing Results responses are "Pass" (P). CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J Ilk It Ur I.ALIrUMIA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CEC-NRCA-MCH-03-A i Revised 07/1& CAI IF:OPMIA FNFRC:V r- AAKAIRCInAI ------ ------------ ------------ CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 3 of 3 Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: FCU-B-04, FCU-B-05 System Location or Area Served: Salon, Activity DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Date Signed: +J I Address: 11140 Thurston Lane ATT Certification Identification (If 0 e): City/State/Zip: Mira Loma/ CA/ 91752 Phone: 951-361-2247 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available Wth the build* g rmit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: ChrlStlanBfOtherSMEChanICal Position with Company (Title): Address: 11140 Thurston Lane ATT Certification Identification (if applicable): City/State/Zip: Mira Loma/ CA/ 91752 Phone: 951-361-2247 Date Signed: 2/s Zo. RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical Position with Company (Title): Project na Address: 11140 Thurtson Lane CSLB License: City/State/Zip: Mira Loma/CA/92509 Phone: 951-361-2247 Date Signed: tC CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 ',I A] t Vr 1-ALIrVKNIA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS off, I CERTIFICATE OF ACCEPTANCE CALIFORNIA ENERGY COMMISSION NRCA-MCH-03-A I Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 1 of 3 Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System Location or Area Served: FCU-B-08, FCU-B-09 Laundry, Main Elec. Note: Submit one Certificate of Acceptance for each system that must Enforcement Agency Use: Checked by/Date demonstrate compliance. A. Construction Inspection 1. Supporting documentation needed to perform test includes, but not limited to: a. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.S.2 Constant Volume, Single -zone, Unitary Air Conditioner and Heat Pumps Systems Acceptance At -A -Glance). b. 2016 Building Energy Efficiency Standards Manual. 2. Instrumentation to perform test may include: a. Temperature Meter b. Amp Meter 3. Installation (check if applies): ❑✓ Thermostat is located within the space -conditioning zone that is served by the HVAC system. 4. Programming (check all those that apply): ✓❑ Thermostat meets the temperature adjustment and dead band requirements of 2016 Building Energy Efficiency Standards Manual Section 120.2(b). Minimum heating setpoint: 87 OF. Maximum cooling setpoint 64 OF. Deadband: 88 OF. ❑ Occupied, unoccupied, and holiday schedules have been programmed per the schedule provided. ❑ Pre -occupancy purge has been programmed to meet the requirements of 2016 Building Energy Efficiency Standards Manual Section 120.1(c)2. 1. Check method used to determine pre -occupancy purge: ❑✓ Lesser of: conditioned floor area times ventilation rate from 2016 Building Energy Efficiency Standards TABLE 120.1-A or 15cfm per person times the expected number of occupants. ❑ 3 complete air changes. Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 A I A I t_ Vr' l,/ALI YVKN IA CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS -a CEC-NRCA-MCH-03-A (Revised 07/16 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-03-A Constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Systems Page 2 of 3 Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System Location or Area Served: FCU-B-08, FCU-B-09 Laundry, Main Elec. B. Functional Testing Requirements I Operating Modes Step 1: Disable economizer control and demand -controlled ventilation (if applicable) to prevent unexpected interactions. Occupied Mode Step 2: Heating load during occupied condition Step 3: No-load during occupied condition Step 4: Cooling load during occupied condition Unoccupied Mode Step 5: No-load during unoccupied condition Step 6: Heating load during unoccupied condition Step 7: Cooling load during unoccupied condition Step 8: Manual override 8 7 6 5 4 3 2 Step 2 — 8: Check and verify the following for each simulation mode required a. Supply fan operates continually ✓ ✓ ✓ ✓ b. Supply fan turns off ✓ C. Supply fan cycles on and off ✓ ✓ d. System reverts to 'occupied" mode to satisfy any condition ✓ e. System turns off when manual override time period expires ✓ f. Gas -fired furnace, heat pump, or electric heater stages on ✓ ✓ g. No heating is provided by the unit ✓ ✓ ✓ ✓ h. No cooling is provided by the unit ✓ ✓ ✓ ✓ i. Compressor stages on ✓ ✓ j. Outside air damper is open to minimum position ✓ ✓ ✓ ✓ ✓ k. Outside air damper closes completely ✓ ✓ Step 9: System returned to initial operating conditions after all tests have been completed: Yes Q• No Q C. Testing Results s 1 7 1 6 1 5 1 4 1 3 1 2 Indicate if Passed (P), Failed (F), or N/A (X), fill in appropriate letter P P P P P PIP D. Evaluation I ❑✓ I PASS: All Construction Inspection responses are complete and all applicable Testing Results responses are "Pass" (P). I CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July LUlb v - r - I — vnL1—im IV IH CONSTANT VOLUME, SINGLE ZONE, UNITARY (PACKAGED AND SPLIT) AIR CONDITIONER AND HEAT PUMP SYSTEMS CALIFORNIA H-1 CERTIFICATE OF ACCEPTANCE constant Volume, Single Zone, Unitary (Packaged and Split) Air Conditioner and Heat Pump Svstems Project Name: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System Name or Identification/Tag: FCU-B-08, FCU-B-09 Enforcement Agency: City: Newport Beach system Location or Area Served: Laundry, Main Elec. DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Johnn!!]rs Documentation Author Company NameDate Signed: Mechanical Address: 11140 Thurston Lane ATT Certification Identification (If; city/state/zip: Mira Loma/ CA/ 9Phone: 951-361-2247 FIELD TECHNICIAN'S DECLARATION STATEMENT N R CA-M CH-03-A Page 3 of 3 Permit Number: X2021-2737 Zip Code: 92660 I certify the following under penalty of perjury, under the laws of the State of California: I. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Address: 11140 Thurston Lane Mira Loma/ CA/ 91752 RESPONSIBLE PERSON'S DECLARATION STATEMENT Position with Company (Title): ---r— Technician ATT Certification Identification (if applicable): 951-361-2247 I Date Signed: Z !C I certify the following under penalty of perjury, under the laws of the State of California: 1. I am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras atuResponsible Acceptance Person Signre: Responsible Acceptance Person Company Name: Christian Brothers Mechanical 11140 Thurtson Lane Mira Loma/CA/92509 Position with Company (Title): Project Ma CSLB License: Phone: 951-361-2247 Date Signed.:-,, -f�/roe CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance July 2016 J I A It OF UALIFUKNIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Zip Code: Newport Beach 92660 System Name or Identification/Tag: EF-01 System Location or Area Served: ' Staff Break Note: Submit one Certificate of Acceptance for each system that must Enforcement Agency Use: Checked by/Date demonstrate compliance. Intent: I Verify that the supply fan speed in a variable air volume system modulates to meet system airflow demand. A. Construction Inspection Note: MCH-07 can be performed in conjunction with MCH-02 Outdoor Air Acceptance since testing activities overlap. 1. Supporting documentation needed to perform test includes: a. As -built and/or Design Documents including Mechanical Equipment Schedules. b 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.6Supply fan Variable Flow Controls Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation to perform test includes: a. Calibrated differential pressure gauge. Date of calibration: 12/14/23 (must be within one year) b. Static Pressure Probe c. Drill d. Rubber Plugs 3. Installation: a. The static pressure location, setpoint, and reset control meets the requirements of 2016 Building Energy Efficiency Standards Section 140.4(c)2B and 140.4(c)2C: (check all the following that apply). ❑ If sensor is located downstream of major dud splits, multiple sensors are installed in each major branch with fan capacity controlled to satisfy the sensor furthest below its setpoint. ❑✓ Set point is no greater than one-third of the total design fan static pressure. Design TSP: 0.5 in. w.c. Setpoint: 0.42 in.w.c. ❑ If system has DDC to the zone level it has reset control complying with 2016 Building Energy Efficiency Standards Section 140.4(c) 2C. Reset is based on the zone requiring the most pressure; i.e., the set point is reset lower until one zone damper is nearly wide open. b. Supply fan includes a device for modulating airflow, such as variable speed drive or electrically commutated motor. 4. Field calibrate all discharge static pressure sensors: ❑ Performed field -calibration using calibrated differential pressure gauge and static pressure probe. ❑ Calibration complete, all pressure sensors t 10% of calibrated reference sensor (provide supporting documentation). Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 JIAI t= VF I;ALIKJKNIH SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 2 of 3) Project Name: - Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place city: Newport Beach Zip Code: 92660. System Name or Identification/.Tag:, - EF-01 System Location or Area Served: - Staff Break B. Functional Testing Results - Step 1: Drive all VAV boxes to full design airflow. a. Refer to design documents and record system design airflow. 85 cfm b. Supply fan speed modulates to increase capacity. Yes O No O C. Record fan frequency: 60 Hz d Supply fan maintains discharge static pressure t 10% of the current operating set point. If NA, indicate reason in Notes section. Yes Q No ® NA Note: If NOT performing this test in conjunction with MCH-02, other methods for verifying Variable Flow operation include increasing static pressure setpoint or putting all the VAV boxes into full cooling. Was one of these methods used? Due to diversity in system design, static pressure setpoint will likely not be achieved when all VAV boxes are in full cooling, # this occurs, verify fwn speed is 60 Hz and indicate NA in Step 1.d. Yes Q No e. Verify that supply fan controls stabilize within a 5 minute period. Yes Q No Q Notes: Step 2: Drive all VAV boxes to reduced or minimum airflow a. Supply fan speed modulates to decrease capacity. Yes @ No O b. Record fan frequency: Hz C. Current operating static pressure setpoint has decreased (for systems with DDC to the zone level). es0 No 0 NAQ d. Supply fan maintains discharge static pressure t 10% of the current operating setpoint. Yes Q No O e. Supply fan controls stabilize within a 5 minute period. Yes Q No Q Notes: Step 3: System returned to initial operating conditions Yes 0 No C. Testing Results Pass / Fail Step 1: Drive all VAV boxes to achieve full design airflow (Pass if all answers are Yes and/ or NA) G Step 2: Drive all VAV boxes to minimum flow (Pass if all answers are Yes and/ or NA) 0 O D. Evaluation ❑ PASS: All Construction Inspection responses are complete and all Testing Results responses are "Pass". Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 JIAl -Ur L:ALIrUKNIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE I "o - GEG-NKGA-M(;N-Uf-A (Kevisea U111 CERTIFICATE OF ACCEPTANCE Supply Fan Variable Flow Controls Acceptance Project Name: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System Name or Identificationfrag: EF-01 UAL.IrVKNIA r-Nr-MUT UUMMIA.7IVI4 r NRCA-MCH-07-A (Page 3 of 3) Enforcement Agency: Permit Number: X2021-2737 City: Zip Code: Newport Beach 92660 System Location or Area Served: Staff Break DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: Z `rOZ Address: 11140 Thurston Lane ATTCertification Identification (if app able): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available w'th the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Techn ian Address: 11140 Thurston Lane ATT Certification Identification (if applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: 2/5/'EOZ3 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical ' i Position with Company (Title): Project ana Address: 11140 Thurston Lane CSLB License: 499547 city/state/zip: Mira Loma, CA 91752 Phone: 951-241-5392 Date Signed: Z%S�ZCiZ3 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 J I H I t_ V r Ulki-11- V rM IH SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/16) CERTIFICATE OF ACCEPTANCE Supply Fan Variable Flow Controls Acceptance Project Name: Enforcement Agency: . Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System Name or Identification/Tag: EF-02 City: - Newport Beach System Location or Area Served: Women Note: Submit one Certificate of Acceptance for each system that must I Enforcement Agency Use: Checked by/Date demonstrate compliance. i 3Y COMMISSION NRCA-MCH-07-A (Page 1 of 3) Permit Number: X2021-2737 Zip Code: 92660 Intent: I Verify that the supply fan speed in a variable air volume system modulates to meet system airflow demand. A. Construction Inspection Note: MCH-07 can be performed in conjunction with MCH-02 Outdoor Air Acceptance since testing activities overlap. 1. Supporting documentation needed to perform test includes: a. As -built and/or Design Documents including Mechanical Equipment Schedules. b 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.6 Supply Fan Variable Flow Controls - -- -- c. 2016 Building Energy Efficiency Standards. 2. Instrumentation to perform test includes: a. Calibrated differential pressure gauge. Date of calibration: 12/14/23 (must be within one year) b. Static Pressure Probe c. Drill d. Rubber Plugs 3. Installation: a. The static pressure location, setpoint, and reset control meets the requirements of 2016 Building Energy Efficiency Standards Section 140.4(c)2B and 140.4(c)2C: (check all the following that apply). ❑ If sensor is located downstream of major duct splits, multiple sensors are installed in each major branch with fan capacity controlled to satisfy the sensor furthest below its setpoint. ❑✓ Set point is no greater than one-third of the total design fan static pressure. Design TSP: 0.5 in. w.c. Setpoint: 0.42 in.w.c. ❑ If system has DDC to the zone level it has reset control complying with 2016 Building Energy Efficiency Standards Section 140.4(c) 2C. Reset is based on the zone requiring the most pressure; i.e., the set point is reset lower until one zone damper is nearly wide open. b. Supply fan includes a device for modulating airflow, such as variable speed drive or electrically commutated motor. 4. Field calibrate all discharge static pressure sensors: ❑ Performed field -calibration using calibrated differential pressure gauge and static pressure probe. ❑ Calibration complete, all pressure sensors ± 10% of calibrated reference sensor (provide supporting documentation). Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 J IHI t OF UALIFUMMA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/16) CERTIFICATE OF ACCEPTANCE Supply Fan Variable Flow Controls Acceptance Project Name: Enforcement Agency: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System Name or Identification/Tag: EF-02 City: Newport Beach System Location or Area Served: Women IM FORNIA ENERGY COMMISSION NRCA-MCH-07-A (Page 2 of 3) Permit Number: X2021-2737 Zip Code: 92660 B. Functional Testing Step 1: Drive all VAV boxes to full design airflow. a. Refer to design documents and record system design airflow. b. Supply fan speed modulates to increase capacity. C. Record fan frequency: d Supply fan maintains discharge static pressure ± 10% of the current operating set point. If NA, indicate reason in Notes section. Note: If NOT performing this test in conjunction with MCH-02, other methods for verifying Variable Flow operation include increasing static pressure setpoint or putting all the'VAV boxes into full cooling. Was one of these methods used? Due to diversity in system design, static pressure setpoint will likely not be achieved when all VAV boxes are in full cooling. If this occurs, verify fan speed is 60 Hz and indicate NA in Step 1.d. e. Verify that supply fan controls stabilize within a 5 minute period. Notes: Step 2: Drive all VAV boxes to reduced or minimum airflow a. Supply fan speed modulates to decrease capacity. b. Record fan frequency: C. Current operating static pressure setpoint has decreased (for systems with DDC to the zone level). d. Supply fan maintains discharge static pressure ± 10% of the current operating setpoint. e. Supply fan controls stabilize within a 5 minute period. Notes: Step 3: System returned to initial operating conditions C. Testing Results Step 1: Drive all VAV boxes to achieve full design airflow (Pass if all answers are Yes and/ or NA) Step 2: Drive all VAV boxes to minimum flow (Pass if all answers are Yes and/ or NA) D. Evaluation ] PASS: All Construction Inspection responses are complete and all. Testing Results responses are "Pass". Notes: Results 210 cfm O No O 60 Hz ONoONAO Yes O No O Yes O No O Yes es@ No Yes Q Yes Q Yes 0 No O Pass / Fail G O 0 O No O Hz NA O No O No Q CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 A' I A I t_ V F UAL.I r V KN 11k SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CF(1NRCA-MCH-n7-A (RPvisPd r111A1 CAI IFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 3 of 3) Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/rag: EF-02 System Location or Area Served: Women DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: s 15 ! LoZ Address: 11140 Thurston Lane ATT Certification Identification (If applicable): City/State/Zip: Mira Loma, CA 91752 Phone. 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the I—ilding permit(s) issued for the building. �- Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title):Techniclar� Address: 11140 Thurston Lane ATT Certification Identification (if applicable): City/State/Zip: Mira Loma, CA 91752 Phone: Date Signed: 7 0Z `j 951-361-2247 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the uilding owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical ' Position with Company (Title): Project Ma e Address: 11140 Thurston Lane CSL9 License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 Date Signed: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 J I A I t VF UALI I-VKNIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE RFr _NRCA_MCH_n7 A /R_icad mill CAI IFARNIA FNFRGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/rag: EF-03 System Location or Area Served: Men Note: Submit one Certificate of Acceptance for each system that must Enforcement Agency Use: Checked by/Date demonstrate compliance. Intent: I Verify that the supply fan speed in a variable air volume system modulates to meet system airflow demand. A. Construction Inspection Note: MCH-07 can be performed in.conjunction with MCH-02 Outdoor Air Acceptance since testing activities overlap. 1. Supporting documentation needed to perform test includes: a. As -built and/or Design Documents including Mechanical Equipment Schedules. b 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.6 Supply Fan Variable Flow Controls Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation to perform test includes: a. Calibrated differential pressure gauge. Date of calibration: 12/14/23 (must be within one year) b. Static Pressure Probe c. Drill d. Rubber Plugs 3. Installation: a. The static pressure location, setpoint, and reset control meets the requirements of 2016 Building Energy Efficiency Standards Section 140.4(c)2B and 140.4(c)2C: (check all the following that apply). ❑ If sensor is located downstream of major duct splits, multiple sensors are installed in each major branch with fan capacity controlled to satisfy the sensor furthest below its setpoint. ❑✓ Set point is no greater than one-third of the total design fan static pressure. Design TSP: 0.5 in. w.c. Setpoint: 0.42 in.w.c. ❑ If system has DDC to the zone level it has reset control complying with 2016 Building Energy Efficiency Standards Section 140.4(c) 2C. Reset is based on the zone requiring the most pressure; i.e., the set point is reset lower until one zone damper is nearly wide open. b. Supply fan includes a device for modulating airflow, such as variable speed drive or electrically commutated motor. 4. Field calibrate all discharge static pressure sensors: ❑ Performed field -calibration using calibrated differential pressure gauge and static pressure probe. ❑ Calibration complete, all pressure sensors t 10% of calibrated reference sensor (provide supporting documentation). Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 WA t Vr UAL11-UM4IA Apoks SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/16) r AI ICnCA1IA CnlCOM rnKAKAlcelnnl CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: J Permit Number. II X2021-2737 Project Address: 101 Bayview Place City: Newport Beach 71p Code: I 92660 System Name or Identification rag: EF-03 System Location or Area Served: Men B. Functional Testing Results Step 1: Drive all VAV boxes to full design airflow. a. Refer to design documents and record system design airflow. 210 cfm b. Supply fan speed modulates to increase capacity. Yes 0 No C. Record fan frequency: 60 Hz d Supply fan maintains discharge static pressure ± 10% of the current operating set'point. If NA, indicate reason in Notes section. Yes Ci No ® NA Q Note: If NOT performing this test in conjunction with MCH-02, other methods for verifying Variable Flow operation include increasing static pressure setpoint or putting all the VAV boxes into full cooling. Was one of these methods used? Due to diversity in system design, static pressure setpoint will likely not be achieved when all VAV boxes are in full cooling. l this occurs, verify fan speed is 60 Hz and indicate NA in Step 1.d. Yes O No e. Verify that supply fan controls stabilize within a 5 minute period. Yes Q No 0 Notes: Step 2: Drive all VAV boxes to reduced or minimum airflow a. Supply fan speed modulates to decrease capacity. Yes @ No O b. Record fan frequency: Hz C. Current operating static pressure setpoint has decreased (for systems with DDC to the zone level). Yes@NoONA0 d. Supply fan maintains discharge static pressure ± 10% of the current operating setpoint. Yes IS No O e. Supply fan controls stabilize within a 5 minute period. Yes Q• No Q Notes: Step 3: System returned to initial operating conditions Yes Q No C. Testing Results Pass Fail Step 1: Drive all VAV boxes to achieve full design airflow (Pass if all answers are Yes and/ or NA) 0 O Step 2: Drive all VAV boxes to minimum flow (Pass if all answers are Yes and/ or NA) D. Evaluation ❑ PASS: All Construction Inspection responses are complete and all Testing Results responses are "Pass". Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 i H I t ur t;AuruKrvlH SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 3 of 3) Project Name: Enforcement Agency: Clearwater Harbor Point Senior Living Permit Number: X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System Location or Area Served: EF-03 Men DOCUMENTATION AUTHOR'S DECLARATION STATEMENT . 1. 1 certify that this Certificate of Acceptance documentation is accurate -and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: Z1 51-toz Address: 11140 Thurston Lane ATT Certification Identification (If applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certifrate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with t building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: - Field Technician Company Name: Christian Brothers Mechanical Services Position with company (Title): Techn' Ian I Address: 11140 Thurston Lane ATT Certification Identification lif applicable): city/State/Zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical' Position with Company (Title): Project Mana Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 Datesigned: Z/�I�BZQr CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 J I A I t= Vr UALI1-UKN IA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01116) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: EF-04 System Location or Area Served: Salon/Spa B04 Note: Submit one Certificate of Acceptance for each system that must Enforcement Agency Use: Checked by/Date demonstrate compliance. Intent: I Verify that the supply fan speed in a variable air volume system modulates to meet system airflow demand. A. Construction Inspection Note: MCH-07 can be performed in conjunction with MCH-02 Outdoor Air Acceptance since testing activities overlap. 1. Supporting documentation needed to perform test includes: a. As -built and/or Design Documents including Mechanical Equipment Schedules. b 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.S.6Supply Fan Variable Flow Controls Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation to perform test includes: a. Calibrated differential pressure gauge. Date of calibration: 12/14/23 (must be within one year) b. Static Pressure Probe c. Drill d. Rubber Plugs 3. Installation: a. The static pressure location, setpoint, and reset control meets the requirements of 2016 Building Energy Efficiency Standards Section 140.4(c)2B and 140.4(c)2C: (check all the following that apply). ❑ If sensor is located downstream of major duct splits, multiple sensors are installed in each major branch with fan capacity controlled to satisfy the sensor furthest below its setpoint. ❑✓ Set point is no greater than one-third of the total design fan static pressure. Design TSP: 0.5 in. w.c. Setpoint: 0.42 in.w.c. ❑ If system has DDC to the zone level it has reset control complying with 2016 Building Energy Efficiency Standards Section 140.4(c) 2C. Reset is based on the zone requiring the most pressure; i.e., the set point is reset lower until one zone damper is nearly wide open. b. Supply fan includes a device for modulating airflow, such as variable speed drive or electrically commutated motor. 4. Field calibrate all discharge static pressure sensors: ❑ Performed field -calibration using calibrated differential pressure gauge and static pressure probe. ❑ Calibration complete, all pressure sensors t 10% of calibrated reference sensor (provide supporting documentation). Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 A"IHIt Vt UALIFVKNIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/161 CAI IFORNIA FNFRGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance I (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/rag: EF-04 System Location or Area Served: Salon/Spa 604 B. Functional Testing Results Step 1: Drive all VAV boxes to full design airflow.. a. Refer to design documents and record system design airflow. 400 cfm b. Supply fan speed modulates to increase capacity. Yes (D No 0 C. Record fan frequency: 60 Hz d Supply fan maintains discharge static pressure ± 10% of the current operating set point. If NA,. indicate reason in Notes section. Yes O No O NA 01 Note: If NOT performing this test in conjunction with MCH-02, other methods for verifying Variable Flow operation include increasing static pressure setpoint or.putting-all the VAV boxes into full cooling. . Was one of these methods used? Due to diversity in system design, static pressure setpoint will likely not be achieved when all VAV boxes are in full cooling. If this occurs, verifyfanspeed is 60 Hz and indicate NA in Step 1.d. Yes O No O e. Verify that supply fan controls stabilize within a 5 minute period. Yes Q No O Notes: Step 2: Drive all VAV boxes to reduced or minimum airflow a. Supply fan speed modulates to decrease capacity. Yes @ No b. Record fan frequency: Hz C. Current operating static pressure setpoint has decreased (for systems with DDC to the zone level). Yes@NoONA01 d. Supply fan maintains discharge static pressure ± 10% of the current operating setpoint. Yes B No e. Supply fan controls stabilize within a 5 minute period. Yes Q No Q Notes: Step 3: System returned to initial operating conditions Yes 0 No O C. Testing Results Pass / Fail Step 1: Drive all VAV boxes to achieve full design airflow (Pass if all answers are Yes and/ or NA) (D O Step 2: Drive all VAV boxes to minimum flow (Pass if all answers are Yes and/ or NA) Q O D. Evaluation ❑ PASS: All Construction Inspection responses are complete and all Testing Results responses are "Pass". Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 J I A It Ut- UAI-It-UKN IA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/161 ('Al Mnatile PnIPRr--v rnnAnAIQQInnl f CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place city: Newport Beach Zip Code: 92660 System Name or Identification/Tag: EF-04 System location or Area Served: Salon/Spa B04 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: 2 f Address: 11140 Thurston Lane ATTcertification Identification (if a able): City/state/zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician company Name: Christian Brothers Mechanical Services Position with Company (Title):Technl an Address: 11140 Thurston Lane ATT Certification Identification (if applicable): City/State/zip: Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical Position with Company (Title): Project Ma Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 Date Signed: 2 /� Zoz < CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 J I A I t Ur UALItUKNIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/16) ^Al Imo. 11A CERTIFICATE OF ACCEPTANCE v NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identigcationfrag: EF-05 !I System Location or Area Served: Laundry 147 Note: Submit one Certificate of Acceptance for each system that must Enforcement Agency Use: Checked by/Date demonstrate compliance. Intent: I Verify that the supplyfan speed in a variable air volume system modulates to meet system airflow demand. A. Construction Inspection. . Note: MCH-07 can be performed in conjunction with MCH-02 Outdoor Air Acceptance since testing activities overlap. 1. Supporting documentation needed to perform test includes: a. As -built and/or Design Documents including Mechanical Equipment Schedules. b 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.6 Supply Fan Variable Flow Controls Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation to perform test includes: a. Calibrated differential pressure gauge. Date of calibration: 12/14/23 (must be within one year) b. Static Pressure Probe c. Drill d. Rubber Plugs 3. Installation: a. The static pressure location, setpoint, and reset control meets the requirements of 2016 Building Energy Efficiency Standards Section 140.4(c)2B and 140.4(c)2C: (check all the following that apply). ❑ If sensor is located downstream of major duct splits, multiple sensors are installed in each major branch with fan capacity controlled to satisfy the sensor furthest below its setpoint. ❑✓ Set point is no greater than one-third of the total design fan static pressure. Design TSP: 0.5 in. w.c. Setpoint: 0.42 in.w.c. ❑ If system has DDC to the zone level it has reset control complying with 2016 Building Energy Efficiency Standards Section 140.4(c) 2C. Reset is based on the zone requiring the most pressure; i.e., the set point is reset lower until one zone damper is nearly wide open. b. Supply fan includes a device for modulating airflow, such as variable speed drive or electrically commutated motor. 4. Field calibrate all discharge static pressure sensors: ❑ Performed field -calibration using calibrated differential pressure gauge and static pressure probe. ❑ Calibration complete, all pressure sensors i 10% of calibrated reference sensor (provide supporting documentation). Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 J IAI t V1- liALII-UKINIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE cGr—nlar n-nerw-m-n iizp"iem ni11Al CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place city: Newport Beach Zip Code: 92660 System Name or Identification/Tag: EF-05 System location or Area Served: Laundry 147 B. Functional Testing Results Step 1: Drive all VAV boxes to full design airflow. a. Refer to design documents and record system design airflow. 450 cfm b. Supply fan speed modulates to increase capacity. Yes O No C. Record fan frequency: 60 Hz Supply fan maintains discharge static pressure t 10% of the current operating setpoint. If NA, indicate reason in d. Notes section. Yes O No ® NA O Note: If NOT performing this test in conjunction with MCH-02, other methods for verifying Variable Flow operation include increasing static pressure setpoint or putting all the VAV boxes into full cooling. Was one of these methods used? Due to diversity in system design, static pressure setpoint will likely not be achieved when all VAV boxes are in fullcooling. 11 this occurs, verify fan speed is 60 liz and indicate NA in Step 1.d. Yes O No e. Verify that supply fan controls stabilize within a 5 minute period. Yes Q No Notes: Step 2: Drive all VAV boxes to reduced or minimum airflow a. Supply fan speed modulates to decrease capacity. Yes @ No O b. Record fan frequency: Hz C. Current operating static pressure setpoint has decreased (for systems with DDC to the zone level). Yes@NoONA0 d. Supply fan maintains discharge static pressure t 10% of the current operating setpoint. Yes Q No e. Supply fan controls stabilize within a 5 minute period. Yes Q No Q Notes: Step 3: System returned to initial operating conditions Yes (D No C. Testing Results Pass / Fail Step 1: Drive all VAV boxes to achieve full design airflow (Pass if all answers are Yes and/ or NA) G Step 2: Drive all VAV boxes to minimum flow (Pass if all answers are Yes and/ or NA) G O D. Evaluation ❑ PASS: All Construction Inspection responses are complete and all Testing Results responses are "Pass". Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 ,1i IA I t- UI- UAL11- V KIV IJ% SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: EF-O5 System Loeatlonor Area Served: Laundry 147 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT _ 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: Z / 5/ Zo Address: 11140 Thurston Lane ATT Certification Identification (If applicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with the building permit(s) issued for the building. _ Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technician Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/state/zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: J/ RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. I am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical ' Position with Company (Title): Project Man er Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 Date Signed: 2 /�/L CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 '1 LAI t WY UALII-VKNIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE s* CEC-NRCA-MCH-07-A (Revised 01/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 1 of 3) j Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 f System Name or Identification/Tag: I` EF-07 System Location or Area Served: Roof Note: Submit one Certificate of Acceptance for each system that must Enforcement Agency Use: Checked by/Date demonstrate compliance. Intent: I Verify that the supply fan speed in a variable air volume system modulates to meet system airflow demand. A. Construction Inspection Note: MCH-07 can be performed in conjunction with MCH-02 Outdoor Air Acceptance since testing activities overlap. 1. Supporting documentation needed to perform test includes: a. As -built and/or Design Documents including Mechanical Equipment Schedules. b 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.6Supply Fan Variable Flow Controls Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation to perform test includes: a. Calibrated differential pressure gauge. Date of calibration: 12/14/23 (must be within one year) b. Static Pressure Probe c. Drill d. Rubber Plugs 3. Installation: a. The static pressure location, setpoint, and reset control meets the requirements of 2016 Building Energy Efficiency Standards Section 140.4(c)2B and 140.4(c)2C: (check all the following that apply). ❑ If sensor is located downstream of major duct splits, multiple sensors are installed in each major branch with fan capacity controlled to satisfy the sensor furthest below its setpoint. ❑✓ Set point is no greater than one-third of the total design fan static pressure. Design TSP: 0.5 in. w.c. Setpoint: 0.42 in.w.c. ❑ If system has DDC to the zone level it has reset control complying with 2016 Building Energy Efficiency Standards Section 140.4(c) 2C. Reset is based on the zone requiring the most pressure; i.e., the set point is reset lower until one zone damper is nearly wide open. b. Supply fan includes a device for modulating airflow, such as variable speed drive or electrically commutated motor. 4. Field calibrate all discharge static pressure sensors: ❑ Performed field -calibration using calibrated differential pressure gauge and static pressure probe. ❑ Calibration complete, all pressure sensors t 10% of calibrated reference sensor (provide supporting documentation). Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 b IAIt Vr t;ALlrUKNIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/16) CALIFORNIA ENERGY COMMISSION Z CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number. X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/rag: EF-07 System Location or Area Served: Roof B. Functional Testing Results Step 1: Drive all VAV boxes to full design airflow. a. Refer to design documents and record system design airflow. 360 cfm b. Supply fan speed modulates to increase capacity. Yes G No C. Record fan frequency: 60 Hz d Supply fan maintains discharge static pressure t 30%.of the.current operating set point. If NA, indicate reason in Notes section. Yes ®No ®NA Q Note: If NOT performing this test in conjunction with MCH-02, other methods for verifying Variable Flow operation include increasing static pressure setpoint or putting all the VAV boxes into full cooling. Was one of these methods used? Due to diversity in system design, static pressure setpoint will likely not be achieved when all VAV boxes are in full cooling. If this occurs, verify fan speed is 60 Hz and indicate NA in Step 1.d. Yes ® No e. Verify that supply fan controls stabilize within a 5 minute period. Yes Q No Notes: Step 2: Drive all VAV boxes to reduced or minimum airflow a. Supply fan speed modulates to decrease capacity. Yes Q No O b. Record fan frequency: Hz C. Current operating static pressure setpoint has decreased (for systems with DDC to the zone level). Yes@NoONA0 d. Supply fan maintains discharge static pressure t 10% of the current operating setpoint. Yes Q No e. Supply fan controls stabilize within a 5 minute period. Yes Q No Q Notes: Step 3: System returned to initial operating conditions Yes Q No O C. Testing Results Pass / Fail Step 1: Drive all VAV boxes to achieve full design airflow (Pass if all answers are Yes and/ or NA) q O Step 2: Drive all VAV boxes to minimum flow (Pass if all answers are Yes and/ or NA) 0 10 D. Evaluation PASS: All Construction Inspection responses are complete and all Testing Results responses are "Pass". Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 J I A I t_ Ul- UALIFVKNIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/16) CERTIFICATE OF ACCEPTANCE Supply Fan Variable Flow Controls Acceptance Project Name: Enforcement Agency: Clearwater Harbor Point Senior Living Project Address: City. 101 Bayview Place Newport Beach System Name or Identification/Tag: System Location or Area Served: EF-07 Roof DOCUMENTATION AUTHOR'S DECLARATION STATEMENT. I. I certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Date Signed: Christian Brothers Mechanical Services Z f$%ZC Z Address: 11140 Thurston Lane ATT Certification Identification (If applicable): -" Mira Loma, CA 91752 FIELD TECHNICIAN'S DECLARATION STATEMENT Phone: 951-241-5392 N RCA-MCH-07-A (Page 3 of 3) Permit Number: X2021-2737 Zip Code: 92660 I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with th building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: _ ^- Field Technician Company Name: Christian Brothers Mechanical Services Address: 11140 Thurston Lane Mira Loma, CA 91752 RESPONSIBLE PERSON'S DECLARATION STATEMENT Position with Company (Title): Technician' ATT Certification Identification (If applicable): Phone: 951-361-2247 Date Signed: I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to th building owner at occupancy. Responsible Acceptance Person Name: Responsible Acceptance Person Signature: Johnny Contreras Responsible Acceptance Person Company Name: Position with Company (Title): Christian Brothers Mechanical " Project ana Address: CSLB License: 11140 Thurston Lane 499547 City/State/Zip: Date Si Phone: Mira Loma, CA 91752 951-241-5392 fined: -15 `Z00 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 JIHI t_ Vr UALIYVKNIH SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE Utt.-IVKL:H-MUr1-U/-H mevlsea viii CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 1 of 3) Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification rag: System Location or Area Served: EF-08 Roof Note: Submit one Certificate of Acceptance for each.syste_m that must Enforcement Agency Use: Checked by/Date demonstrate compliance. Intent: I Verify that the supply fan speed in a variable air volume system modulates to meet system airflow demand. A. Construction Inspection Note: MCH-07 can be performed in conjunction with MCH-02 Outdoor Air Acceptance since testing activities overlap. 1. Supporting documentation needed to perform test includes: a. As -built and/or Design Documents including Mechanical Equipment Schedules. b 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.S.6Supply Fan Variable Flow Controls Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation to perform test includes: a. Calibrated differential pressure gauge. Date of calibration: 12/14/23 (must be within one year) b. Static Pressure Probe c. Drill d. Rubber Plugs 3. Installation: a. The static pressure location, setpoint, and reset control meets the requirements of 2016 Building Energy Efficiency Standards Section 140.4(c)2B and 140.4(c)2C: (check all the following that apply). ❑ If sensor is located downstream of major duct splits, multiple sensors are installed in each major branch with fan capacity controlled to satisfy the sensor furthest below its setpoint. ❑✓ Set point is no greater than one-third of the total design fan static pressure. Design TSP: 0.5 in. w.c. Setpoint: 0.42 in.w.c. ❑ If system has DDC to the zone level it has reset control complying with 2016 Building Energy Efficiency Standards Section 140.4(c) 2C. Reset is based on the zone requiring the most pressure; i.e., the set point is reset lower until one zone damper is nearly wide open. b. Supply fan includes a device for modulating airflow, such as variable speed drive or electrically commutated motor. 4. Field calibrate all discharge static pressure sensors: ❑ Performed field -calibration using calibrated differential pressure gauge and static pressure probe. ❑ Calibration complete, all pressure sensors ± 10% of calibrated reference sensor (provide supporting documentation). Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 J I A I F V r UALWUM IA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE i CEC-NRCA-MCH-07-A (Revised 01116) C.AI IFARNIA FNFR(:V RAMR AMQ1M] CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identdicationtrag: EF-08 System Location or Area Served: Roof B. Functional Testing Results Step 1: Drive all VAV boxes to full design airflow. a. Refer to design documents and record system design airflow. 250 cfm b. Supply fan speed modulates to increase capacity. Yes Q No O C. Record fan frequency: 60 Hz d Supply fan maintains discharge static pressure # 10% of the current operating set point. If NA, indicate reason in Notes section. Yes ® No ® NA Note: If NOT performing this test in conjunction with MCH-02, other methods for verifying Variable Flow operation include increasing static pressure setpoint or putting_ all the VAV boxes into full cooling. Was one of these methods used? Due to diversity in system design, static pressure setpoint will likely not be achieved when all VAV boxes are in full cooling. If this occurs, verify fan speed is 60 Hz and indicate NA in Step I.d. Yes ® No O e. Verify that supply fan controls stabilize within a 5 minute period. Yes Q No Notes: Step 2: Drive all VAV boxes to reduced or minimum airflow a. Supply fan speed modulates to decrease capacity. Yes Q No b. Record fan frequency: Hz C. Current operating static pressure setpoint has decreased (for systems with DDC to the zone level). Yes0 No O NAO d. Supply fan maintains discharge static pressure t 10% of the current operating setpoint. Yes Q No e. Supply fan controls stabilize within a 5 minute period. Yes Q No Q Notes: Step 3: System returned to initial operating conditions Yes Q No C. Testing Results Pass Fail Step 1: Drive all VAV boxes to achieve full design airflow (Pass if all answers are Yes and/ or NA) Q O Step 2: Drive all VAV boxes to minimum flow (Pass if all answers are Yes and/ or NA) Q O D. Evaluation ❑ PASS: All Construction Inspection responses are complete and all Testing Results responses are "Pass Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 b I A] t V 1- 1L:AL11- V KIV IH SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/16) CERTIFICATE OF ACCEPTANCE Supply Fan Variable Flow Controls Acceptance Project Name; Enforcement Agency: Clearwater Harbor Point Senior Living Project Address: City. 101 Bayview Place Newport Beach System Name or Identification/Tag: EF-08 System Location or Area Served: i Roof DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras ure: Documentation Author Signat Documentation Author Company Name: Date Signed: Christian Brothers Mechanical Services Address: 11140Thurston Lane ATT Certification Identification (If Mira Loma, CA 91752 I Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT, COMMISSION N RCA-MCH-07-A (Page 3 of 3) Permit Number: X2021-2737 ZIp Code: 92660 I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available wit a building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title):11 Te hnician Address: 11140Thurston Lane ATT Certification identification (if applicable): City/State/Zip: Phone: Mira Loma, CA 91752 951-361-2247 Date signed: RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to t - uilding owner at occupancy. Responsible Acceptance Person Name: Responsible Acceptance Person Signature: Johnny Contreras 17-` � Responsible Acceptance Person Company Name: Position with Company (Title): Christian Brothers Mechanical'- Project + nag-(' Address: CSLB License: 11140 Thurston Lane 499547 City/State/Zip: Date Signed: Phone: Mira Loma, CA 91752 951-241-5392 Z! s CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 .7'IHIt Vf• I:HLIFVKNIH SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CFC NRCA-MCH-07-A (Revised 011161 CAI-IFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number. X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: EF-10 System Location or Area Served: HSKP Note: Submit one Certificate of Acceptance for each system that -must Enforcement Agency Use: Checked by/Date demonstrate compliance. Intent: I verify that the supply fan speed in a variable air volume system modulates to meet system airflow demand. A. Construction Inspection . Note: MCH-07 can be performed in conjunction with MCH-02 Outdoor Air Acceptance since testing activities overlap. 1. Supporting documentation needed to perform test includes: a. As -built and/or Design Documents including Mechanical Equipment Schedules. b 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.6 Supply Fan Variable Flow Controls Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation to perform test includes: a. Calibrated differential pressure gauge. Date of calibration: 12/14/23 (must be within one year) b. Static Pressure Probe c. Drill d. Rubber Plugs 3. Installation: a. The static pressure location, setpoint, and reset control meets the requirements of 2016 Building Energy Efficiency Standards Section 140.4(c)2B and 140.4(c)2C: (check all the following that apply). ❑ If sensor is located downstream of major duct splits, multiple sensors are installed in each major branch with fan capacity controlled to satisfy the sensor furthest below its setpoint. ❑✓ Set point is no greater than one-third of the total design fan static pressure. Design TSP: 0.5 in. w.c. Setpoint: 0.42 in.w.c. ❑ If system has DDC to the zone level it has reset control complying with 2016 Building Energy Efficiency Standards Section 140.4(c) 2C. Reset is based on the zone requiring the most pressure; i.e., the set point is reset lower until one zone damper is nearly wide open. b. Supply fan includes a device for modulating airflow, such as variable speed drive or electrically commutated motor. 4. Field calibrate all discharge static pressure sensors: ❑ Performed field -calibration using calibrated differential pressure gauge and static pressure probe. ❑ Calibration complete, all pressure sensors t 10% of calibrated reference sensor (provide supporting documentation). Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 J I A It: V F KALIF V KN IA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/16) CAI _IF0RNIA FNFRrY r0MMISSIAN CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: EF-10 System Location or Area Served:. HSKP B. Functional Testing Results Step 1: Drive all VAV boxes to full design airflow. a. Refer to design documents and record system design airflow. 75 cfm b. Supply fan speed modulates to increase capacity. Yes O No O C. Record fan frequency: 60 Hz d Supply fan maintains discharge static pressure ± 10% of the current operating set point: If NA, indicate reason in Notes section. Yes O No O NA O Note: If NOT performing this test in conjunction with MCH-02, other methods for verifying Variable Flow operation include increasing static pressure setpoirt or putting all the VAV boxes into full cooling. Was one of these methods used? Due to diversity in system design, static pressure setpoint will likely not be achieved when an VAV boxes are in full cooling. If this occurs, verify fan speed is 60 Hz and indicate NA in Step I.d. Yes ® No O e. Verify that supply fan controls stabilize within a 5 minute period. Yes Q No 0 Notes: Step 2: Drive all VAV boxes to reduced or minimum airflow a. Supply fan speed modulates to decrease capacity. Yes @ No b. Record fan frequency: Hz C. Current operating static pressure setpoint has decreased (for systems with DDC to the zone level). Yes @ No Q NAO d. Supply fan maintains discharge static pressure ± 10% of the current operating setpoint. Yes A No O e. Supply fan controls stabilize within a 5 minute period. Yes Q No Q Notes: Step 3: System returned to initial operating conditions Yes 0 No C. Testing Results Pass / Fail Step 1: Drive all VAV boxes to achieve full design airflow, (Pass if all answers are Yes and/ or NA) Step 2: Drive all VAV boxes to minimum flow (Pass if all answers are Yes and/ or NA) O D. Evaluation PASS: All Construction Inspection responses are complete and all Testing Results responses are "Pass". Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 A" I A I t OF UAL1 FUKIV IA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01116) UALWUMIA tlVtKUT UUMMIJAIUIV CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 3 of 3) Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identiflcationfrag: System Location or Area Served: EF-10 HSKP DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: Zo%Zt�ZI._ Address: ATT Certification Identification (If applicable): 11140 Thurston Lane City/State/Zip: Mira Loma, CA 91752 Phone. 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with-, e building permit(s) issued for the building. - Field Technician Name: Todd Alpert Field Technician Signature: r Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): T nician Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/state/zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: q/5 2QZ q L RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the . ilding owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers ME!CharllCal�. Position with Company (Title): Project M a Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 Date Signed: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 A' I A I t Ut- UAL11-UMIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CFC>NRCA-MCM7-A 1Revised 01/161 i CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: EF-11 System Location or Area Served: RR Note: Submit one Certificate of Acceptance for each system. that must Enforcement Agency Use: Checked by/Date demonstrate compliance. Intent: I Verify that the supply fan speed in a variable air volume system modulates to meet system airflow demand. A. Construction Inspection Note: MCH-07 can be performed in conjunction with MCH-02 Outdoor Air Acceptance since testing activities overlap. 1. Supporting documentation needed to perform test includes: " a. As -built and/or Design Documents including Mechanical Equipment Schedules. b 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.S.6 Supply Fan Variable Flow Controls Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation to perform test includes: a. Calibrated differential pressure gauge. Date of calibration: 12/14/23 (must be within one year) b. Static Pressure Probe c. Drill d. Rubber Plugs 3. Installation: a. The static pressure location, setpoint, and reset control meets the requirements of 2016 Building Energy Efficiency Standards Section 140.4(c)2B and 140.4(c)2C: (check all the following that apply). ❑ If sensor is located downstream of major duct splits, multiple sensors are installed in each major branch with fan capacity controlled to satisfy the sensor furthest below its setpoint. ❑✓ Set point is no greater than one-third of the total design fan static pressure. Design TSP: 0.5 in. w.c. Setpoint: 0.42 in.w.c. ❑ If system has DDC to the zone level it has reset control complying with 2016 Building Energy Efficiency Standards Section 140.4(c) 2C. Reset is based on the zone requiring the most pressure; i.e., the set point is reset lower until one zone damper is nearly wide open. b. Supply fan includes a device for modulating airflow, such as variable speed drive or electrically commutated motor. 4. Field calibrate all discharge static pressure sensors: ❑ Performed field -calibration using calibrated differential pressure gauge and static pressure probe. ❑ Calibration complete, all pressure sensors ± 10% of calibrated reference sensor (provide supporting documentation). Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 6 1 A I t VY WAL1t-UM IA SUPPLY FAN VARIABLE FLOW CONTROLS- ACCEPTANCE CEC-NRCA-MCH-07-A(Revised 01/161 rAi irnoroA enicor_vnn..Ru��l^k CERTIFICATE OF ACCEPTANCE y NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identiflcatlon/Tag: EF-11 System location or Area Served: RR B. Functional Testing Results Step 1: Drive all VAV boxes to full design airflow. a. Refer to design documents and record system design airflow. 115 cfm b. Supply fan speed modulates to increase capacity. Yes (D No O C. Record fan frequency: 60 Hz d Supply fan maintains discharge static pressure t 10% of the current operating set point. If NA, indicate reason in Notes section. Yes O No ®NA O Note: If NOT performing this test in conjunction with MCH-02, other methods for verifying Variable Flow operation include increasing static pressure setpoint or putting all the VAV boxes into full cooling. Was one of these methods used? Due to diversity in system design, static pressure setpoint will likely not be achieved when all VAV boxes are in full cooling. If this occurs, verify fan speed is 60 Hz and indicate NA in Step 1.d. Yes O No e. Verify that supply fan controls stabilize within a 5 minute period. Yes O No Notes: Step 2: Drive all VAV boxes to reduced or minimum airflow a. Supply fan speed modulates to decrease capacity. Yes @ No b. Record fan frequency: Hz C. Current operating static pressure setpoint has decreased (for systems with DDC to the zone level). Yes@NoONAO d. Supply fan maintains discharge static pressure t 10% of the current operating setpoint. Yes Q No O e. Supply fan controls stabilize within a 5 minute period. Yes Q No Q Notes: Step 3: System returned to initial operating conditions Yes (D No O C. Testing Results Pass Fail Step 1: Drive all VAV boxes to achieve full design airflow (Pass if all answers are Yes and/ or NA) Q O Step 2: Drive all VAV boxes to minimum flow (Pass if all answers are Yes and/ or NA) O D. Evaluation PASS: All Construction Inspection responses are complete and all Testing Results responses are "Pass". Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January2016 J I A It Ur t.:ALIFUKNIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE At CEC-NRCA-MCH-07-A (Revised 01/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 3 of 3) Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identificationfrag: System Location or Area Served: EF-11 RR DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. j Documentation Author Name: Johnny Contreras Documentation Author Signature: — - DocumentationAuthorCompanyName: Christian Brothers Mechanical Services Date Signed: Address: 11140 Thurston Lane ATT Certification Identification (If applicable): city/state/zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with a building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: -- - Field Technician company Name: Christian Brothers Mechanical Services Position with company (Title): Techn k6an Address: 11140 Thurston Lane j ATT Certification Identification (If applicable): city/state/zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: Z lS, ZOZ RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical Position with Company (Title): Project Manager Address: 11140 Thurston Lane I CSLB License: 499547 city/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 Date Signed: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 JIHI -Ur UALItUKNIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE ror_rJorA_hArrw_rn_A ro-1—d nimri CAI IFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: I Permit Numher: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Lp Code: 92660 System Name or Identificetiontrag: EF-12 System Location or Area Served:. HSKP Note: Submit one Certificate of Acceptance for each system that must I Enforcement Agency Use: Checked by/Date demonstrate compliance. Intent: I Verify that the supply fan speed in a variable air volume system modulates to meet system airflow demand. A. Construction Inspection Note: MCH-07 can be performed in conjunction with MCH-02 Outdoor Air Acceptance since testing activities overlap. 1. Supporting documentation needed to perform test includes: a. As -built and/or Design Documents including Mechanical Equipment Schedules. b 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.6 Supply Fan Variable Flow Controls Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation to perform test includes: a. Calibrated differential pressure gauge. Date of calibration: 12/14/23 (must be within one year) b. Static Pressure Probe c. Drill d. Rubber Plugs 3. Installation: a. The static pressure location, setpoint, and reset control meets the requirements of 2016 Building Energy Efficiency Standards Section 140.4(c)2B and 140.4(c)2C: (check all the following that apply). ❑ If sensor is located downstream of major duct splits, multiple sensors are installed in each major branch with fan capacity controlled to satisfy the sensor furthest below its setpoint. ❑✓ Set point is no greater than one-third of the total design fan static pressure. Design TSP: 0.5 in. w.c. Setpoint: 0.42 ._in.w.c. ❑ If system has DDC to the zone level it has reset control complying with 2016 Building Energy Efficiency Standards Section 140.4(c) 2C. Reset is based on the zone requiring the most pressure; i.e., the set point is reset lower until one zone damper is nearly wide open. b. Supply fan includes a device for modulating airflow, such as variable speed drive or electrically commutated motor. 4. Field calibrate all discharge static pressure sensors: ❑ Performed field -calibration using calibrated differential pressure gauge and static pressure probe. ❑ Calibration complete, all pressure sensors ± 10% of calibrated reference sensor (provide supporting documentation). Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 J I A I t OF Wki-itUMMA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01116) - -f�V f VVIYI IYIIa7�l1 MY � CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: e Permit Number: X2021-2737 Project Address: 101 Bayview Place city: Newport Beach Zip Code: 92660 System Name or Identification rag: EF-12 System Location or Area Served: HSKP B. Functional Testing Results Step 1: Drive all VAV. boxes to full design airflow. a. Refer to design documents and record system design airflow. 70 cfm b. Supply fan speed modulates to increase capacity. Yes lD No O C. Record fan frequency: 60 Hz d Supply fan maintains discharge static pressure ± 10%of the burrent operating set point. If NA, indicate reason in Notes section. Yes O No O NA Note: If NOT performing this test in conjunction with MCH-02, other methods for verifying Variable Flow operation include increasing static pressure: setpoint or.putt(ng all the VAV boxes into full cooling. Was one of these methods used? Due to diversity in system design, static pressure setpoint will likely not be achieved when all VAV boxes are in full cooling. If this occurs, verify fan speed is 60 Hz and indicate NA in Step 1.d. Yes O No O e. Verify that supply fan controls stabilize within a 5 minute period. Yes (D No O Notes: Step 2: Drive all VAV boxes to reduced or minimum airflow a. Supply fan speed modulates to decrease capacity. Yes @ No O b. Record fan frequency: Hz C. Current operating static pressure setpoint has decreased (for systems with DDC to the zone level). es No Q NAQ d. Supply fan maintains discharge static pressure ± 10% of the current operating setpoint. Yes Q No O e. Supply fan controls stabilize within a 5 minute period. Yes Q No Q Notes: Step 3: System returned to initial operating conditions Yes Q No O C. Testing Results Pass / Fail Step 1: Drive all VAV boxes to achieve full design airflow (Pass if all answers are Yes and/ or NA) Q O Step 2: Drive all VAV boxes to minimum flow (Pass if all answers are Yes and/ or NA) O D. Evaluation ❑ PASS: All Construction Inspection responses are complete and all Testing Results responses are ..Pass Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 J I A I t Ut- UALIr VKN1A SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE xt '.�! k tmavlseo vino) CALIFORNIA ENERGY COMMISSION "%iW' CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 3 of 3) Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living X2021-2737 Project Address: 101 Bayview Place uty: Newport Beach Zip Code:92660 System Name or Identificationfrag: EF-12 System Location. or Area Served: HSKP DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation .is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: 2 Address: 11140 Thurston Lane ATT Certification Identification applicable): city/state/zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this ertificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available w h the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Te5#6cian Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/State/Zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: rJ/qDZ G G RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to t 'Iding owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical ^� Position with Company (Title): Project a r Address: 11140 Thurston Lane CSLB License: 499547 City/state/zip: Mira Loma, CA 91752 Phone: 951-241-5392 Date Signed: 202 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 J 1 H I t UI- UALIFUMIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/16) CAI IFORNIA FNFRrY CnMMIRRInKI CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach zip Code: ! 92660 System Name or Identification/Tag: EF-13 System Location or Area Served: Unisex Note: Submit one Certificate of Acceptance for each system.that most Enforcement Agency Use: Checked by/Date demonstrate compliance. Intent: I Verify that the supply fan speed in a variable air volume system modulates to meet system airflow demand. A. Construction Inspection Note: MCH-07 can be performed in conjunction with MCH-02 Outdoor Air Acceptance since testing activities overlap. 1. Supporting documentation needed to perform test includes: a. As -built and/or Design Documents including Mechanical Equipment Schedules. b 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.6 Supply Fan Variable Flow Controls Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation to perform test includes: a. Calibrated differential pressure gauge. Date of calibration: 12/14/23 _ (must be within one year) b. Static Pressure Probe c. Drill d. Rubber Plugs 3. Installation: a. The static pressure location, setpoint, and reset control meets the requirements of 2016 Building Energy Efficiency Standards Section 140.4(c)2B and 140.4(c)2C: (check all the following that apply). ❑ If sensor is located downstream of major duct splits, multiple sensors are installed in each major branch with fan capacity controlled to satisfy the sensor furthest below its setpoint. ❑✓ Set point is no greater than one-third of the total design fan static pressure. Design TSP: 0.5 in. w.c. Setpoint: 0.42 in.w.c. ❑ If system has DDC to the zone level it has reset control complying with 2016 Building Energy Efficiency Standards Section 140.4(c) 2C. Reset is based on the zone requiring the most pressure; i.e., the set point is reset lower until one zone damper is nearly wide open. b. Supply fan includes a device for modulating airflow, such as variable speed drive or electrically commutated motor. 4. Field calibrate all discharge static pressure sensors: ❑ Performed field -calibration using calibrated differential pressure gauge and static pressure probe. ❑ Calibration complete, all pressure sensors t 10% of calibrated reference sensor (provide supporting documentation). Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 J I A It Ur IiALIt-UKNI/i SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/161 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: PermR Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach zip Code: 92660 System Name or Identification/Tag: EF-13 System Location or Area Served: Unisex B. Functional Testing Results Step 1: Drive all VAV boxes to full design airflow. a. Refer to design documents and record system design airflow. 90 cfm b. Supply fan speed modulates to increase capacity. Yes Q No Q C. Record fan frequency: 60 Hz d Supply fan maintains discharge static pressure ± 10% of the current bperating-set point. If NA, indicate reason in Notes section. Yes Q No Q NA Q Note: If NOT performing this test in conjunction with MCH-02, other methods for verifying Variable Flow operation include increasing static pressure setpoint or putting all the VAV boxes into full cooling. Was one of these methods used? Due to diversity in system design, static pressure setpoint will likely not be achieved when all VAV boxes are in full cooling. If this occurs, verify fan speed is 60 Hz and indicate NA in Step 1.d. Yes Q No Q e. Verify that supply fan controls stabilize within a 5 minute period. Yes Q No Q Notes: Step 2: Drive all VAV boxes to reduced or minimum airflow a. Supply fan speed modulates to decrease capacity. Yes Q No b. Record fan frequency: Hz C. Current operating static pressure setpoint has decreased (for systems with DDC to the zone level). Yes@NoONA0 d. Supply fan maintains discharge static pressure ± 10% of the current operating setpoint. Yes IS No O e. Supply fan controls stabilize within a 5 minute period. Yes @ No Q Notes: Step 3: System returned to initial operating conditions Yes Q No O C. Testing Results Pass Fail Step 1: Drive all VAV boxes to achieve full design airflow (Pass if all answers are Yes and/ or NA) G Step 2: Drive all VAV boxes to minimum flow (Pass if all answers are Yes and/ or NA) D. Evaluation E] PASS: All Construction Inspection responses are complete and all Testing Results responses are "Pass". Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 JIAIt: Ur UALIrUrMIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CFC-NRCA-MCH-07-A (Revised 01/161 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: EF-13 System Location or Area Served: Unisex DOCUMENTATION AUTHOR'S DECLARATION STATEMENT' 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: 2 Address: 11140 Thurston Lane ATT Certification Identification (If a plicable): City/State/Zip: Mira Loma, CA 91752 � Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT. I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available Lh the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Tec .1Cian Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/State/Zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical Position with Company (Title): - Project MaR.a�ex Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 Date Signed: -MA/�Z CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 J I A I t Ul- UAurUMMAk SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CFC-NRCA-MCH-W-A (Revised 01/161 Apwtk .1411 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 " System Name or Identiflcationfrag: - GEF-D3 System Location or Area Served: Garage :71 I Note: Submit one Certificate of Acceptance for each system that must Enforcement Agency Use: Checked by/Date demonstrate compliance. Intent: I Verify that the supply fan speed in a variable air volume system modulates to meet system airflow demand. A. Construction Inspection Note: MCH-07 can be performed in conjunction with MCH-02 Outdoor Air Acceptance since testing activities overlap. 1. Supporting documentation needed to perform test includes: a. As -built and/or Design Documents including Mechanical Equipment Schedules. 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.6 Supply Fan Variable_ Flow Controls b' Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation to perform test includes: a. Calibrated differential pressure gauge. Date of calibration: 12/14/23 (must be within one year) b. Static Pressure Probe c. Drill d. Rubber Plugs 3. Installation: a. The static pressure location, setpoint, and reset control meets the requirements of 2016 Building Energy Efficiency Standards Section 140.4(c)2B and 140.4(c)2C: (check all the following that apply). ❑ If sensor is located downstream of major duct splits, multiple sensors are installed in each major branch with fan capacity controlled to satisfy the sensor furthest below its setpoint. ❑✓ Set point is no greater than one-third of the total design fan static pressure. Design TSP: 0.5 in. w.c. Setpoint: 0.42 in.w.c. ❑ If system has DDC to the zone level it has reset control complying with 2016 Building Energy Efficiency Standards Section 140.4(c) 2C. Reset is based on the zone requiring the most pressure; i.e., the set point is reset lower until one zone damper is nearly wide open. b. Supply fan includes a device for modulating airflow, such as variable speed drive or electrically commutated motor. 4. Field calibrate all discharge static pressure sensors: ❑ Performed field -calibration using calibrated differential pressure gauge and static pressure probe. ❑ Calibration complete, all pressure sensors ± 10% of calibrated reference sensor (provide supporting documentation). Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 AS I A I t OF L;ALIFUKNIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE l; t C:-N KC:A-M L; K-U /-A CALIFORNIA ENERGY COMMISSION •r' CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 2 of 3) Project Name: Enforcement Agency: Permit Number. Clearwater Harbor Point Senior Living _ X2021-2737 Project Address: city: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identi irationfrag: System Location or Area Served: GEF-01 Garage B: Functional. Testing Results Step 1: Drive all VAV boxes to full design airflow. a. Refer to design documents and record system design airflow. 17000 cfm b. Supply fan speed modulates to increase capacity. Yes (D No O C. Record fan frequency: 60 Hz d Supply fan maintains discharge static pressure ± 10% of the current operating set point. If NA, indicate reason in - Notes section. Yes O No O NA Q Note: If NOT performing this test in conjunction with MCH-02, other methods for verifying Variable Flow operation Include increasing static pressure setpoint or putting all the VAV boxes into full cooling. Was one of these methods used? Due to diversity in system design, static pressure setpoint will likely not be achieved when all VAV boxes are in full cooling. If this occurs, verif yfan speed is 60 Hz and indicate NA in Step 1.d. Yes ® No O e. Verify that supply fan controls stabilize within a 5 minute period. Yes O No Notes: Step 2: Drive all VAV boxes to reduced or minimum airflow a. Supply fan speed modulates to decrease capacity. Yes (D No O b. Record fan frequency: Hz C. Current operating static pressure setpoint has decreased (for systems with DDC to the zone level). Yes .� No O NAO d. Supply fan maintains discharge static pressure ± 10% of the current operating setpoint. Yes Q No O e. Supply fan controls stabilize within a 5 minute period. Yes Q No Q Notes: Step 3: System returned to initial operating conditions Yes 0 No O C. Testing Results Pass Fail Step 1: Drive all VAV boxes to achieve full design airflow (Pass if all answers are Yes and/ or NA) Q O Step 2: Drive all VAV boxes to minimum flow (Pass if all answers are Yes and/ or NA) 0 D. Evaluation ❑ PASS: All Construction Inspection responses are complete and all Testing Results responses are "Pass". Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 J I A i t Ur- URI-1 r-UM I/i SUPPLY FANVARIABLE FLOW CONTROLS ACCEPTANCE CALIFORNIAENERGYCCIMMISSInN CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 ProjectAddress: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: GEF-Ol System Location or Area Served: Garage DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: Address: 11140 Thurston Lane ATT Certification Identifica on plicable): City/State/Zip: Mira. Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this C rtificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Te nician Address: 11140 Thurston Lane ATT Certification Identification [0 applicable): city/state/ZIp:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: b RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. I am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical' Position with Company (Title): ProjectM r Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 Date Signed: �4002{ CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 J I A I t OF L:ALIFUMI/k SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/16) CERTIFICATE OF ACCEPTANCE Supply Fan Variable Flow Controls Acceptance Project Name: Enforcement Agency: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System Name or identification/Tag: MAU-Ol Note: Submit one Certificate of Acceptance for each system that must demonstrate compliance. City: Newport Beach System Location orArea Served: Kitchen IA ENERGY COMMISSION NRCA-MCH-07-A (Page 1 of.3) Permit Number: X2021-2737 Zip Code: 92660 Enforcement Agency'Use: Checked by/Date Intent: Verify that the supply fan speed in a variable air volume system modulates to meet system airflow demand. A. Construction Inspection Note: MCH-07 can be performed in conjunction with MCH-02 Outdoor Air Acceptance since testing activities overlap. 1. Supporting documentation needed to perform test includes: a. As -built and/or Design Documents including Mechanical Equipment Schedules. b 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.6 Supply Fan Variable Flow Controls C. 2016 Building Energy Efficiency Standards. 2. Instrumentation to perform test includes: a. Calibrated differential pressure gauge. Date of calibration: 12/14/23 (must be within one year) b. Static Pressure Probe c. Drill d. Rubber Plugs 3. Installation: a. The static pressure location, setpoint, and reset control meets the requirements of 2016 Building Energy Efficiency Standards Section 140.4(c)2B and 140.4(c)2C: (check all the following that apply). ❑ If sensor is located downstream of major duct splits, multiple sensors are installed in each major branch with fan capacity controlled to satisfy the sensor furthest below its setpoint. ❑✓ Set point is no greater than one-third of the total design fan static pressure. Design TSP: 0.5 in. w.c. Setpoint: 0.42 in.w.c. ❑ If system has DDC to the zone level it has reset control complying with 2016 Building Energy Efficiency Standards Section 140.4(c) 2C. Reset is based on the zone requiring the most pressure; i.e., the set point is reset lower until one zone damper is nearly wide open. b. Supply fan includes a device for modulating airflow, such as variable speed drive or electrically commutated motor. 4. Field calibrate all discharge static pressure sensors: ❑ Performed field -calibration using calibrated differential pressure gauge and static pressure probe. ❑ Calibration complete, all pressure sensors ± 10% of calibrated reference sensor (provide supporting documentation). Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 b I H I t Ur- UKLI1-V KN IH SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01116) CERTIFICATE OF ACCEPTANCE Supply Fan Variable Flow Controls Acceptance Project Name: ` Enforcement Agency: Clearwater Harbor Point Senior Living jl Project Address: Cam' 101 Bayview Place NewportBeach System Name or Identification/Tag: System Location or Area Served: MAU-01 Kitchen IA ENERGY COMMISSION B. Functional Testing Step 1: Drive all VAV boxes to full design airflow. a. Refer to design documents and record system design airflow. b. Supply fan speed modulates to increase capacity. C. Record fan frequency: d Supply fan maintains discharge static pressure t 10% of the current operating set point. If NA,_indicate reason in Notes section. Note: If NOT performing this test in conjunction with MCH-02, other methods for verifying Variable Flow operation include increasing static pressure setpoint or putting all the. VAV boxes into full cooling. Was one of these methods used? Due to diversity in system design, static pressure setpoint will likely not be achieved when all VAV boxes are in full cooling. If this occurs, verifyfan speed is 60 Hz and indicate NA in Step 1.d. e. Verify that supply fan controls stabilize within a 5 minute period. Notes: Step 2: Drive all VAV boxes to reduced or minimum airflow a. Supply fan speed modulates to decrease capacity. b. Record fan frequency: C. Current operating static pressure setpoint has decreased (for systems with DDC to the zone level). d. Supply fan maintains discharge static pressure t 10% of the current operating setpoint. e. Supply fan controls stabilize within a 5 minute period. Notes: Step 3: System returned to initial operating conditions C. Testing Results Step 1: Drive all VAV boxes to achieve full design airflow (Pass if all answers are Yes and/ or NA) Step 2: Drive all VAV boxes to minimum flow (Pass if all answers are Yes and/ or NA) D. Evaluation PASS: All Construction Inspection responses are complete and all Testing Results responses are "Pass".. Notes: N RCA-MCH-07-A (Page 2 of 3) Permit Number: X2021-2737 zip Code: 92660 Results 4600 cfm Q No O 60 Hz ONoONAO Yes O No O Yes O No O Yes @ No 0 Hz es@ NoO NAQ Yes O No O Yes 0 No Q Yes Q No O Pass / Fail O +---020 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 J I A I t Ur- UALIr'VKNIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/16) CERTIFICATE OF ACCEPTANCE Supply Fan Variable Flow Controls Acceptance Project Name: Enforcement Agency: Clearwater Harbor Point Senior Living Project Address: City: 101 Bayview Place Newport Beach System Name or Identification rag: 1 System Location or Area Served: MAU-01 + Kitchen DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certifv that this Certificate of Acceptance documentation is accurate and complete. CALIFORNIA tNtKUY GOMMIsbIUN � N RCA-MCH-07-A (Page 3 of 3) Permit Number: X2021-2737 Zip Code: 92660 Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: 2/-5/ wZ Address: ATTCertification ldenntificatio applicable): 11140 Thurston Lane City/state/zip: Mira Loma, CA 91752 Phone: 951-241-5392. I FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available building permit(s) issued for the buildine. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Tech ian S SSS Address: ATT Certification Identification (if a(plicable): 11140 Thurston Lane City/State/Zip: Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: / 1 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building nwnPr at nccunancv. Responsible Acceptance Person Name: Johnny Contreras { Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical Position with Company (Title): Project ager Address: 11140 Thurston Lane CSLB License: 499547 city/state/zip: Mira Loma, CA 91752 Phone: 951-241-5392 Date Signed: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 J I A I t Ul- KALIFVM IA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identlfication/Tag: MAU-01/Kitchen Hood-01 System Location or Area Served: - Kitchen. Note: Submit one Certificate of Acceptance for each system that must Enforcement Agency Use: Checked by/Date demonstrate compliance. Intent: I Verify that the supply fan speed in a variable air volume system modulates to meet system airflow demand. A. Construction Inspection Note: MCH-07 can be.performed in conjunction with MCH-02 Outdoor Air Acceptance since testing activities overlap. 1. Supporting documentation needed to perform test includes: a. As -built and/or Design Documents including Mechanical Equipment Schedules. b 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.6 Supply Fan Variable Flow Controls Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation to perform test includes: a. Calibrated differential pressure gauge. Date of calibration: 12/14/23 (must be within one year) b. Static Pressure Probe c. Drill d. Rubber Plugs 3. Installation: a. The static pressure location, setpoint, and reset control meets the requirements of 2016 Building Energy Efficiency Standards Section 140.4(c)2B and 140.4(c)2C: (check all the following that apply). ❑ If sensor is located downstream of major duct splits, multiple sensors are installed in each major branch with fan capacity controlled to satisfy the sensor furthest below its setpoint. ❑✓ Set point is no greater than one-third of the total design fan static pressure. Design TSP: 0.5 in. w.c. Setpoint: 0.42 in.w.c. ❑ If system has DDC to the zone level it has reset control complying with 2016 Building Energy Efficiency Standards Section 140.4(c) 2C. Reset is based on the zone requiring the most pressure; i.e., the set point is reset lower until one zone damper is nearly wide open. b. Supply fan includes a device for modulating airflow, such as variable speed drive or electrically commutated motor. 4. Field calibrate all discharge static pressure sensors: ❑ Performed field -calibration using calibrated differential pressure gauge and static pressure probe. ❑ Calibration complete, all pressure sensors t 10% of calibrated reference sensor (provide supporting documentation). Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 J I A I t Ur UALIFUMIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/161 r eI MnOKIIA FnlCor--v rnnAnAlcclnnl CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 2 of 3) Project Name: - Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number. X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/rag: MAU-01/Kitchen Hood-Ol System Location or Area Served: Kitchen B.functional Testing Results Step 1: Drive all VAV boxes to full design airflow. a. Refer to design documents and record system design airflow. 4750 efm b. Supply fan speed modulates to increase capacity. Yes (D No O C. Record fan frequency: 60 Hz d,' Supply fan maintains discharge static pressure ± 10% of the current operating set point. If NA, indicate reason in Notes section. Yes ® No ® NA Note: If NOT performing this test in conjunction with MCH-02, other methods for verifying Variable Flow operation include increasing static pressure setpoint or putting all the VAV boxes into full cooling. Was one of these methods used? Due to diversity in system design, static pressure setpoint will likely not be achieved when all VAV boxes are in full cooling. !L this occurs, verifyfan speed is 60 Hz and indicate NA in Step 1.d. Yes O No O e. Verify that supply fan controls stabilize within a 5 minute period. Yes Q No Notes: Step 2: Drive all VAV boxes to reduced or minimum airflow a. Supply fan speed modulates to decrease capacity. Yes G) No O b. Record fan frequency: Hz C. Current operating static pressure setpoint has decreased (for systems with DDC to the zone level). Yes@NoONA0 d. Supply fan maintains discharge static pressure ± 10% of the current operating setpoint. Yes Q No e. Supply fan controls stabilize within a 5 minute period. Yes Q No 0 Notes: Step 3: System returned to initial operating conditions Yes 0 No O C. Testing Results IPass Fail Step 1: Drive all VAV boxes to achieve full design airflow (Pass if all answers are Yes and/ or NA) Q O Step 2: Drive all VAV boxes to minimum flow (Pass if all answers are Yes and/ or NA) Q D. Evaluation ❑ PASS: All Construction Inspection responses are complete and all Testing Results responses are "Pass". Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 A' I A I L Vr UALIt-UMIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/16) HIA CERTIFICATE OF ACCEPTANCE Supply Fan Variable Flow Controls Acceptance Project Name: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System Name or Identification/rag: MAU-01/Kitchen Hood-01 Enforcement Agency: City: Newport Beach System Location or Area Served: Kitchen DOCUMENTATION AUTHOR'S DECLARATION STATEMENT I. I certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras I Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services = Z/5, Address: 11140 Thurston Lane I ATT Certification Identifil Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT N RCA-MCH-07-A (Page 3 of 3) Permit Number: X2021-2737 Zip Code: 92660 I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. I am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with a building permi issued for the building. Field Technician Name: Field Technician Signature: Todd Alpert I Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Tech cian Address: 11140 Thurston Lane ATT Certification Identification ('If a plicable): City/State/Zip:Mira Loma, CA 91752 Phone: Date Signed: 951-361-2247 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to tiab-uildins owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Company Name: Address: 11140 Thurston Lane City/State/Zip: Mira Loma, CA 91752 Christian Brothers Mechanical ` Responsible Acceptance Person Signature: Position with Company (Title): Project �p alter CSLB License: 499547 Phone: 951-241-5392 - Date signed: 2 7 6-Z CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 W A I t Ul- I.:ALIt-VKNIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/161 CALIFORNIA ENERGY COMMISSION �& CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach zip Code: 92660 System Name or IdentifIcation/Tag: MAU-01/Kitchen Hood-01/K-EF-01 System Location or Area Served: Kitchen )Vote: Submit one Certificate of Acceptance for each system that must f Enforcement Agency Use: Checked by/Date demonstrate compliance. Intent: I Verify that the supply fan speed in a variable air volume system modulates to meet system airflow demand. A. Construction Inspection Note: MCH-07 can be performed in conjunction with MCH-02 Outdoor Air Acceptance since testing activities overlap. 1. Supporting documentation needed to perform test includes: a. As -built and/or Design Documents including Mechanical Equipment Schedules. b 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.6Supply Fan Variable Flow Controls Acceptance At A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation to perform test includes: a. Calibrated differential pressure gauge. Date of calibration: 12/14/23 (must be within one year) b. Static Pressure Probe c. Drill d. Rubber Plugs 3. Installation: a. The static pressure location, setpoint, and reset control meets the requirements of 2016 Building Energy Efficiency Standards Section 140.4(c)2B and 140.4(c)2C: (check all the following that apply). ❑ If sensor is located downstream of major duct splits, multiple sensors are installed in each major branch with fan capacity controlled to satisfy the sensor furthest below its setpoint. ❑✓ Set point is no greater than one-third of the total design fan static pressure. Design TSP: 0.5 in. w.c. Setpoint: 0.42 in.w.c. ❑ If system has DDC to the zone level it has reset control complying with 2016 Building Energy Efficiency Standards Section 140.4(c) 2C. Reset is based on the zone requiring the most pressure; i.e., the set point is reset lower until one zone damper is nearly wide open. b. Supply fan includes a device for modulating airflow, such as variable speed drive or electrically commutated motor. 4. Field calibrate all discharge static pressure sensors: ❑ Performed field -calibration using calibrated differential pressure gauge and static pressure probe. ❑ Calibration complete, all pressure sensors t 10% of calibrated reference sensor (provide supporting documentation). Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 J I A I t U!" UAL11-VII V IA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/161 r-Ai =^MKIIA or.ir=on_v ^^KARA 1-1 4Z CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A 4 Supply Fan Variable Flow Controls Acceptance (Page 2 of 3) Project Name: 11 Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 10I Bayview Place City: Newport Beach Zip Code:92660 System Name or Identification/Tag: - MALI-01/Kitchen Hood-01/K-EF-01 System Location or Area Served: Kitchen R. Functional Testing Results Step 1: Drive all VAV boxes to full design airflow. a. Refer to design documents and record system design airflow. 4750 cfm b. Supply fan speed modulates to increase capacity. Yes O No O C. Record fan frequency: 60 Hz d. Supply fan maintains discharge static pressure t 10% of the current operating set point. If NA, indicate reason in Notes section. Yes ® No Q NA O Note: If NOT performing this test in conjunction with MCH-02, other methods for verifying Variable Flow operation include increasing static pressure setpoint or putting all the VAV boxes into full cooling. Was one of these methods used? Due to diversity in system design, static pressure setpoint will likely not be achieved when all VAV boxes are in full cooling, If this occurs, verify fan speed is 60 Hz and indicate NA in Step I.d. Yes O No e. Verify that supply fan controls stabilize within a 5 minute period. Yes 0 No 0 Notes: Step 2: Drive all VAV boxes to reduced or minimum airflow a. Supply fan speed modulates to decrease capacity. Yes @ No O b. Record fan frequency: Hz C. Current operating static pressure setpoint has decreased (for systems with DDC to the zone level). Yes @ No O NAO d. Supply fan maintains discharge static pressure t 10% of the current operating setpoint. Yes O No O e. Supply fan controls stabilize within a 5 minute period. Yes Q No O Notes: Step 3: System returned to initial operating conditions Yes Q No C. Testing Results Pass / Fail Step 1: Drive all VAV boxes to achieve full design airflow (Pass if all answers are Yes and/ or NA) Q Step 2: Drive all VAV boxes to minimum flow (Pass if all answers are Yes and/ or NA) D. Evaluation ❑ PASS: All Construction Inspection responses are complete and all Testing Results responses are "Pass". Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 '*)I A It UP UALIrVMIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/161 CERTIFICATE OF ACCEPTANCE )MMISSION Supply Fan Variable Flow Controls Acceptance Project Name: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System Name or ldentifr.tionrra MAU-01/Kitchen Hood-Ol/K-EF-01 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT Enforcement Agency: City: Newport Beach System Location or Area Served: Kitchen 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: ZZ`l�'s Address: ATi Certification Identi .5 11140 Thurston Lane City/State/Zip: Mira Loma, CA 91752 Phone:951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT N RCA-MCH-07-A (Page 3 of 3) Permit Number: X2021-2737 Zip Code: 92660 I certify the following under penalty of perjury, under the laws of the State of California: I. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with t uilding permit(s) issued for the building. Field Technician Name: Field Technician Signature: Todd Alpert Field Technician Company Name: � Christian Brothers Mechanical Services Position with Company (Title): Technicia Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/state/zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: I RESPONSIBLE PERSON'S DECLARATION STATEMENT` Z�Z I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides�t the building owner at occupancy. Responsible Acceptance Person Name: Responsible Acceptance Person Signature: Johnny Contreras Responsible Acceptance Person Company Name: Christian Brothers Mechanical', Position with Company (Title): Project 11140 Thurston Lane CSLB License: 499547 �Zlp. Mira Loma, CA 91752 Phone: 951-241-5392 Date signed: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 A' I A I t VF I:AL11-UMIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/16) CAI IFORNIA FNFRr;V CAMMI.CStIr1N CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 ProjectAddress: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: MAU-01/Kitchen Hood-01/K-EF-02 System location or Area Served: - ' Kitchen Note: Submit one Certificate of Acceptance for each system that must Enforcement Agency Use: Checked by/Date demonstrate compliance. Intent: I Verify that the supply fan speed in a variable air volume system modulates to meet system airflow demand. A. Construction Inspection Note: MCH-07 can be performed in conjunction with MCH-02 Outdoor Air Acceptance since testing activities overlap. 1. Supporting documentation needed to perform test includes: a. As -built and/or Design Documents including Mechanical Equipment Schedules. b 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.6Supply Fan Variable Flow Controls Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation to perform test includes: a. Calibrated differential pressure gauge. Date of calibration: 12/14/23 (must be within one year) b. Static Pressure Probe c. Drill d. Rubber Plugs 3. Installation: a. The static pressure location, setpoint, and reset control meets the requirements of 2016 Building Energy Efficiency Standards Section 140.4(c)2B and 140.4(c)2C: (check all the following that apply). ❑ If sensor is located downstream of major duct splits, multiple sensors are installed in each major branch with fan capacity controlled to satisfy the sensor furthest below its setpoint. ❑✓ Set point is no greater than one-third of the total design fan static pressure. Design TSP: 0.5 in. w.c. Setpoint: 0.42 in.w.c. ❑ If system has DDC to the zone level it has reset control complying with 2016 Building Energy Efficiency Standards Section 140.4(c) 2C. Reset is based on the zone requiring the most pressure; i.e., the set point is reset lower until one zone damper is nearly wide open. b. Supply fan includes a device for modulating airflow, such as variable speed drive or electrically commutated motor. 4. Field calibrate all discharge static pressure sensors: ❑ Performed field -calibration using calibrated differential pressure gauge and static pressure probe. ❑ Calibration complete, all pressure sensors ± 10% of calibrated reference sensor (provide supporting documentation). Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 b I A It: Uf- tiALIF V KN IA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/16) is CALIFORNIA ENERGY COMMISSION -41111111F- CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: PermItNumber: X2021-2737 Project Address: 101 Bayview Place City: - Newport Beach ApCode: 92660 System Name or Identification/rag: - MAU-01/Kitchen Hood-01/K-EF-02 System Location or Area Served: Kitchen B. Functional Testing Results Step 1: Drive all VAV boxes to full design airflow. a. Refer to design documents and record system design airflow. 1400 cfm b. Supply fan speed modulates to increase capacity. Yes O No O C. Record fan frequency: 60 Hz d Supply fan maintains discharge static pressure ± 10%.of the current operating set point. If NA, indicate reason in Notes section. Yes 0 No ® NA 0 Note: If NOT performing this test in conjunction with MCH-02, other-methods.for verifying Variable Flow operation include increasing static pressure setpointbr putting all the VAV boxes into full cooling. Was one of these methods used? Due to diversity in system design, static pressure setpoint will likely not be achieved when oil VAV boxes are in full cooling. If this occurs, verify fan speed is 60 Hz and indicate NA in Step 1.d. Yes O No e. Verify that supply fan controls stabilize within a 5 minute period. Yes Q No O Notes: Step 2: Drive all VAV boxes to reduced or minimum airflow a. Supply fan speed modulates to decrease capacity. Yes @ No O b. Record fan frequency: Hz C. Current operating static pressure setpoint has decreased (for systems with DDC to the zone level). Yes@No0NA0 d. Supply fan maintains discharge static pressure t 10% of the current operating setpoint. Yes A No O e. Supply fan controls stabilize within a 5 minute period. Yes Q No Q Notes: Step 3: System returned to initial operating conditions Yes Q No O C. Testing Results Pass / Fail Step 1: Drive all VAV boxes to achieve full design airflow, (Pass if all answers are Yes and/ or NA) O Step 2: Drive all VAV boxes to minimum flow (Pass if all answers are Yes and/ or NA) 0 D. Evaluation ❑ PASS: All Construction Inspection responses are complete and all Testing Results responses are "Pass". Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 J I Alt Ur' UALIFUKNIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/16) CAI IFT)RNIA FNFRr,V r-nMMIRRInN1 CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: MAU-01/Kitchen Hood-01/K-EF-02 System location or Area Served: Kitchen DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: 2As) Address: 11140 Thurston Lane ATT Certification Idennti/ficatio p icable): City/State/zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available wEtf the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Technid Address: 11140 Thurston Lane ATT Certification Identification (if appl' ble): City/State/Zip: Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder pro ' e building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical Position with Company (Title): Project Ma r Address: 11140 Thurston Lane CSLa License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 Date Signed: 4, CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 b I A It: V F KALIF V KIV IA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place city: Newport Beach zip Code: 92660 System Name or IdeMificatlon/Tag: RF-1-01 System Location or Area Served: Corridor Note: Submit one Certificate of Acceptance for each system that must Enforcement Agency Use: Checked by/Date demonstrate compliance. Intent: I Verify that the supply fan speed in a variable air volume system modulates to meet system airflow demand. A. Construction Inspection Note: MCH-07 can be performed in conjunction with MCH-02 Outdoor Air Acceptance since testing activities overlap. 1. Supporting documentation needed to perform test includes: a. As -built and/or Design Documents including Mechanical Equipment Schedules. b 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.6 Supply Fan Variable Flow Controls Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation to perform test includes: a. Calibrated differential pressure gauge. Date of calibration: 12/14/23 (must be within one year) b. Static Pressure Probe c. Drill d. Rubber Plugs 3. Installation: a. The static pressure location, setpoint, and reset control meets the requirements of 2016 Building Energy Efficiency Standards Section 140.4(c)2B and 140.4(c)2C: (check all the following that apply). ❑ If sensor is located downstream of major duct splits, multiple sensors are installed in each major branch with fan capacity controlled to satisfy the sensor furthest below its setpoint. ❑✓ Set point is no greater than one-third of the total design fan static pressure. Design TSP: 0.5 in. w.c. Setpoint: 0.42 in.w.c. ❑ If system has DDC to the zone level it has reset control complying with 2016 Building Energy Efficiency Standards Section 140.4(c) 2C. Reset is based on the zone requiring the most pressure; i.e., the set point is reset lower until one zone damper is nearly wide open. b. Supply fan includes a device for modulating airflow, such as variable speed drive or electrically commutated motor. 4. Field calibrate all discharge static pressure sensors: ❑ Performed field -calibration using calibrated differential pressure gauge and static pressure probe. ❑ Calibration complete, all pressure sensors t 10% of calibrated reference sensor (provide supporting documentation). Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 IAIt: UI- I:AiLIrUMIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/16) Cal IF:nPMIA FMr-W-W Cn1,AKAI.CSInrI CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 ProjectAddress: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: RF-1-Ol System Location or Area Served: Corridor B. Functional Testing Results Step 1: Drive all VAV boxes to full design airflow. a. Refer to design documents and record system design airflow. 595 cfm b. Supply fan speed modulates to increase capacity. Yes 0 No C. Record fan frequency: 60 Hz d Supply fan maintains discharge static pressure ± 10% of the current operating set point. If NA, indicate reason in Notes section. Yes ® No 0 NA O Note: If NOT performing this test in conjunction with MCH-02, other methods for verifying Variable Flow operation include increasing static pressure setpoint or putting'all the VAV boxes into full cooling. Was one of these methods used? Due to diversity in system design, static pressure setpoint will likely not he achieved when all VAV boxes are in full cooling. (f this occurs, verify fan speed is 60 Hz and indicate NA in Step I.d. Yes ® No e. Verify that supply fan controls stabilize within a 5 minute period. Yes Q No Notes: Step 2: Drive all VAV boxes to reduced or minimum airflow a. Supply fan speed modulates to decrease capacity. Yes @ No O b. Record fan frequency: Hz C. Current operating static pressure setpoint has decreased (for systems with DDC to the zone level). es (F) No O NAO d. Supply fan maintains discharge static pressure ± 10% of the current operating setpoint. Yes Q No O e. Supply fan controls stabilize within a 5 minute period. Yes Q No O Notes: Step 3: System returned to initial operating conditions Yes O No C. Testing Results Pass Fail Step 1: Drive all VAV boxes to achieve full design airflow (Pass if all answers are Yes and/ or NA) Q Step 2: Drive all VAV boxes to minimum flow (Pass if all answers are Yes and/ or NA) 0 D. Evaluation ❑ PASS: All Construction Inspection responses are complete and all Testing Results responses are "Pass". Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 J I A I t Vr' U/-.LIFVKNIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/16) IA ENERGY COMMISSION I CERTIFICATE OF ACCEPTANCE Supply Fan Variable Flow Controls Acceptance rrolett name: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System Name or Identification rag: RF-1-01 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT. Enforcement Agency: City: Newport Beach System Location or Area Served: Corridor 1. I certity that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras i Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: Address: AT7 Certification 11140 Thurston Lane City/State/Zip: Mira Loma, CA 91752 FIELD TECHNICIAN'S DECLARATION STATEMENT Phone: 951-241-5392 NRCA-MCH-07-A (Page 3 of 3) Permit Number: X2021-2737 Zip Code: 92660 I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available wit the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician signature: Field Technician Company Name: Christian BrOtherS M2ChanlCal $erVILeS Position with Company (Title): Techni an Address: 11140 Thurston Lane ATT Certification Identification (if applicable): City/state/Zip: Mira Loma, CA 91752 Phone: Date Signed: 951-361-2247 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Position with Company (Title): Christian Brothers Mechanical " Project MaW r Address: 11140 Thurston Lane CSLB License: 499547. City/State/Zip: Phone: Date Signed: Mira Loma, CA 91752 951-241-5392 g 2 ZOL- CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 J IAr r- Vr UALIFVKNIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE GtG-NKGA-MGH-ut-A wevisea uin n CERTIFICATE OF ACCEPTANCE Supply Fan Variable Flow Controls Acceptance Project Name: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System Name or Identification/Tag: RF-1-02 Enforcement Agency: City: Newport Beach System location or Area Served: Patio Note: Submit one Certificate of Acceptance for each system that must. Enforcement Agency Use: Checked by/Date demonstrate compliance. NRCA-MCH-07-A (Page 1 of 3) Permit Number: X2021-2737 Zip Code: 92660 Intent: I Verify that the supply fan -speed in a variable air volume system modulates to meet system airflow demand. A. Construction Inspection Note: MCH-07 can be performed in conjunction with.MCH-02 Outdoor Air Acceptance since testing activities overlap. 1. Supporting documentation needed to perform test includes: a. As -built and/or Design Documents including Mechanical Equipment Schedules. b 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.S.6 Supply Fan Variable Flow Controls Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation to perform test includes: a. Calibrated differential pressure gauge. Date of calibration: 12/14/23 (must be within one year) b. Static Pressure Probe c. Drill d. Rubber Plugs 3. Installation: a. The static pressure location, setpoint, and reset control meets the requirements of 2016 Building Energy Efficiency Standards Section 140.4(c)2B and 140.4(c)2C: (check all the following that apply). ❑ If sensor is located downstream of major duct splits, multiple sensors are installed in each major branch with fan capacity controlled to satisfy the sensor furthest below its setpoint. ❑✓ Set point is no greater than one-third of the total design fan static pressure. Design TSP: 0.5 in. w.c. Setpoint: 0.42 in.w.c. ❑ If system has DDC to the zone level it has reset control complying with 2016 Building Energy Efficiency Standards Section 140.4(c) 2C. Reset is based on the zone requiring the most pressure; i.e., the set point is reset lower until one zone damper is nearly wide open. b. Supply fan includes a device for modulating airflow, such as variable speed drive or electrically commutated motor. 4. Field calibrate all discharge static pressure sensors: ❑ Performed field -calibration using calibrated differential pressure gauge and static pressure probe. ❑ Calibration complete, all pressure sensors ± 10% of calibrated reference sensor (provide supporting documentation). Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 J I A I F Ut• UALIFUMIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE PCr`JU97L`A_KA1'W—n7_A 10—A ei rNHRI CI' S. mil•. CAI IFORNIA ENERGY COMMISSION _ CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A l Supply Fan Variable Flow Controls Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/rag: - RF-1-02 System Location or Area Served: Patio B. Functional Testing Results .. Step 1: Drive all VAV boxes to full design airflow. a. Refer to design documents and record system design airflow. 100 cfm b. Supply fan speed modulates to increase capacity. Yes Cs No O C. Record fan frequency: 60 Hz d Supply fan maintains discharge static pressure ± 10% of the current operating -set point. If NA, indicate reason in Notes section. Yes ® No O NA O Note: If NOT performing this test in conjunction with MCH-02, other methods for verifying Variable Flow operation include increasing static pressure setpoint or putting all the VAV boxes into full cooling. Was one of these methods used? Due to diversity in system design, static pressure setpoint will likely not be achieved when all VAV boxes are in full coolin . I this occurs, verify fan speed is 60 Hz and indicate NA in Step 1.d. Yes ® No e. Verify that supply fan controls stabilize within a 5 minute period. Yes IQ No Q Notes: Step 2: Drive all VAV boxes to reduced or minimum airflow a. Supply fan speed modulates to decrease capacity. Yes @ No O b. Record fan frequency: Hz C. Current operating static pressure setpoint has decreased (for systems with DDC to the zone level). Yes (F) No O NAO d. Supply fan maintains discharge static pressure ± 10% of the current operating setpoint. Yes Q No O e. Supply fan controls stabilize within a 5 minute period. Yes @ No O Notes: Step 3: System returned to initial operating conditions Yes Q No O C. Testing Results Pass Fail Step 1: Drive all VAV boxes to achieve full design airflow (Pass if all answers are Yes and/ or NA) O Step 2: Drive all VAV boxes to minimum flow (Pass if all answers are Yes and/ or NA) O D. Evaluation ❑ PASS: All Construction Inspection responses are complete and all Testing Results responses are "Pass". Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 SUA I t.iHLIFUKNIH ^„ SUPPP LY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 011161 ^ A l CERTIFICATE OF ACCEPTANCE V NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: RF-1-02 -System Location or Area Served: Patio DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: ry Address: 11140 Thurston Lane ATTCertification Identificatia ca le): City/State/Zip: Mira Loma, CA 91752 Phone: "951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certi icate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with t building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician signature: Field Technician company Name: Christian Brothers Mechanical Services Position with company (Title): Technicia Address: 11140 Thurston Lane ATT Certification Identification (if applica le): city/state/zip: Mira Loma, CA 91752 Phone: Date Signed: 951-361-2247 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to ng owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical Position with Company (Title): Project Man Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 Date Signed: r'�/Z�Z CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 JIAI t Vt• UALIFVKIVUi SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01116) (:AI IF:nRNIA FNFR(:V C(NUMICCIYIAI Me CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 !I Project Address: 101 Bayview Place City: - Newport Beach Zip Code: 92660 System Name or Identification/Tag: RF-2-02 System Location or Area Served:_ - Corridor Note: Submit one Certificate of Acceptance for each system that must ` Enforcement Agency Use: Checked by/Date demonstrate compliance. Intent: I Verify that the supply fan speed in a variable air volume system modulates to meet system airflow demand. A. Construction Inspection Note: MCH-07 can be performed in conjunction with MCH-02 Outdoor Air Acceptance since testing activities overlap. 1. Supporting documentation needed to perform test includes: a. As -built and/or Design Documents including Mechanical Equipment Schedules. b 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.6 Supply Fan Variable Flow Controls Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation to perform test includes: a. Calibrated differential pressure gauge. Date of calibration: 12/14/23 (must be within one year) b. Static Pressure Probe c. Drill d. Rubber Plugs 3. Installation: a. The static pressure location, setpoint, and reset control meets the requirements of 2016 Building Energy Efficiency Standards Section 140.4(c)2B and 140.4(c)2C: (check all the following that apply). ❑ If sensor is located downstream of major duct splits, multiple sensors are installed in each major branch with fan capacity controlled to satisfy the sensor furthest below its setpoint. ❑✓ Set point is no greater than one-third of the total design fan static pressure. Design TSP: 0.5 in. w.c. Setpoint: 0.42 in.w.c. ❑ If system has DDC to the zone level it has reset control complying with 2016 Building Energy Efficiency Standards Section 140.4(c) 2C. Reset is based on the zone requiring the most pressure; i.e., the set point is reset lower until one zone damper is nearly wide open. b. Supply fan includes a device for modulating airflow, such as variable speed drive or electrically commutated motor. 4. Field calibrate all discharge static pressure sensors: ❑ Performed field -calibration using calibrated differential pressure gauge and static pressure probe. ❑ Calibration complete, all pressure sensors t 10% of calibrated reference sensor (provide supporting documentation). Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 .1.' I H 1 - Ut' U1kLIt VKNIH SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/161 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 2 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: - 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identificationtrag: RF-2-02 System Location or Area Served: Corridor B. Functional Testing - Results Step 1: Drive all VAV boxes to full design airflow. a. Refer to design documents and record system design airflow. 780 cfm b. Supply fan speed modulates to increase capacity. Yes O No Q C. Record fan frequency: 60 Hz d Supply fan maintains discharge static pressure ± 10% of the current operating set point. If NA, indicate reason in Notes section. Yes Q No Q NA Q Note: If NOT performing this test in conjunction with MCH-02, other methods for verifying Variable Flow operation include increasing static pressure setpoint or putting all the VAV boxes into full cooling. Was one of these methods used? Due to diversity in system design, static pressure setpoint will likely not be achieved when all VAV boxes are in full cooling. if this occurs, verify fan speed is 60 Hz and indicate NA in Step I.d. Yes Q No Q e. Verify that supply fan controls stabilize within a 5 minute period. Yes O No Q Notes: Step 2: Drive all VAV boxes to reduced or minimum airflow a. Supply fan speed modulates to decrease capacity. Yes Q No 0 b. Record fan frequency: Hz C. Current operating static pressure setpoint has decreased (for systems with DDC to the zone level). Yes i@ No Q NAO d. Supply fan maintains discharge static pressure ± 10% of the current operating setpoint. Yes Q No e. Supply fan controls stabilize within a 5 minute period. Yes @ No 0 Notes: Step 3: System returned to initial operating conditions Yes A No C. Testing Results Pass / Fail Step 1: Drive all VAV boxes to achieve full design airflow (Pass if all answers are Yes and/ or NA) e Step 2: Drive all VAV boxes to minimum flow (Pass if all answers are Yes and/ or NA) D. Evaluation PASS: All Construction Inspection responses are complete and all Testing Results responses are "Pass". Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 J I A 1 1- Uh UAL1I-UM Ii1 SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE GtG-NKGA-MGr1-U1-A fKeVlSeC U111 I't�-,1!'7 CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 3 of 3) Project Name: Enforcement Agency: Permit Number: Clearwater Harbor Point Senior Living I X2021-2737 ProjectAddress: City: Zip Code: 101 Bayview Place Newport Beach 92660 System Name or Identification/Tag: System Location or Area Served: RF-2-02 Corridor DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: _ F' Address: 11140 Thurston Lane A17 Certification Identificati (If a le): City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Ce ficate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available with' a buildin ermit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: Position with Company (Title): Technlc Field Technician Company Name: Christian Brothers Mechanical Services Address: 11140 Thurston Lane ATT Certification Identification (if applieable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provsdo the buildin owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical " Position with Company (Title): Project anage Address: 11140 Thurston Lane CSiB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone: Date Signed: 2/5 ?C3Z 951-241-5392 L( CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 J IAIt Vt I;ALIPVKNIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/16) CERTIFICATE OF ACCEPTANCE Supply Fan Variable Flow Controls Acceptance Project Name: Enforcement Agency: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System NameorIdentification/Tag: RF-3-01 Note: Submit one Certificate of Acceptance for each system that must demonstrate compliance. City: Newport Beach System location or Area Served: Corridor Enforcement Agency Use: Checked by/Date 3Y COMMISSION N RCA-MCH-07-A (Page 1 of 3) Permit Number: X2021-2737 Zip Code: 92660 Intent: I Verify that the supply fan speed in a variable air volume system modulates to meet system airflow demand. A. Construction Inspection Note: MCH-07 can be performed in conjunction with MCH-02 Outdoor Air Acceptance since testing activities overlap. 1. Supporting documentation needed to perform test includes: a. As -built and/or Design Documents including Mechanical Equipment Schedules. b 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.6 Supply Fan Variable Flow Controls C. 2016 Building Energy Efficiency Standards. 2. Instrumentation to perform test includes: a. Calibrated differential pressure gauge. Date of calibration: 12/14/23 (must be within one year) b. Static Pressure Probe c. Drill d. Rubber Plugs 3. Installation: a. The static pressure location, setpoint, and reset control meets the requirements of 2016 Building Energy Efficiency Standards Section 140.4(c)2B and 140.4(c)2C: (check all the following that apply). ❑ If sensor is located downstream of major duct splits, multiple sensors are installed in each major branch with fan capacity controlled to satisfy the sensor furthest below its setpoint. ❑✓ Set point is no greater than one-third of the total design fan static pressure. Design TSP: 0.5 in. w.c. Setpoint: 0.42 in.w.c. ❑ If system has DDC to the zone level it has reset control complying with 2016 Building Energy Efficiency Standards Section 140.4(c) 2C. Reset is based on the zone requiring the most pressure; i.e., the set point is reset lower until one zone damper is nearly wide open. b. Supply fan includes a device for modulating airflow, such as variable speed drive or electrically commutated motor. 4. Field calibrate all discharge static pressure sensors: ❑ Performed field -calibration using calibrated differential pressure gauge and static pressure probe. ❑ Calibration complete, all pressure sensors ± 10% of calibrated reference sensor (provide supporting documentation). Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 b IAIt VI' UALII-UKNIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/16) CERTIFICATE OF ACCEPTANCE Supply Fan Variable Flow Controls Acceptance Project Name: Enforcement Agency: Clearwater Harbor Point Senior Living Project Address: Cm'' 101 Bayview Place Newport Beach System Name or Identification rag: System Location or Area Served: RF-3-Ol Corridor rF� ENERGY COMMISSION NRCA-MCH-07-A (Page 2 of 3) Permit Number: X2021-2737 Zip Code: 92660 B. Functional Testing Step 1: Drive all VAV boxes to full design airflow. a. Refer to design documents and record system design airflow. b. Supply fan speed modulates to increase capacity. C. Record fan frequency: d Supply fan maintains discharge static pressure t 10% of the current operating set point. If NA, indicate reason in Notes section. Note: If NOT performing this test in conjunction with MCH-02, other methods for verifying Variable Flow operation include increasing static pressure setpoint or putting all the VAV boxes into full cooling. Was one of these methods used? Due to diversity in system design, static pressure setpoint. will likely not be achieved when all VAV boxes are in full cooling. If this occurs, verify fan speed is 60 Hz and indicate NA in Step I.d. e. Verify that supply fan controls stabilize within a 5 minute period. Notes: Step 2: Drive all VAV boxes to reduced or minimum airflow a. Supply fan speed modulates to decrease capacity. b. Record fan frequency: C. Current operating static pressure setpoint has decreased (for systems with DDC to the zone level). d. Supply fan maintains discharge static pressure t 10% of the current operating setpoint. e. Supply fan controls stabilize within a 5 minute period. Notes: Step 3: System returned to initial operating conditions C. Testing Results Step 1: Drive all VAV boxes to achieve full design airflow (Pass if all answers are Yes and/ or NA) Step 2: Drive all VAV boxes to minimum flow (Pass if all answers are Yes and/ or NA) D. Evaluation ❑ PASS: All construction Inspection responses are complete and all Testing Results responses are "Pass". Notes: Results 125 cfm Q No O 60 Hz ONaONAO Yes O No O Yes 0 No O Yes Q No O Hz es @ No O NAQ Yes Q No O Yes @ No O Yes 0 No O Pass / Fail O O O CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 J 1 H 1 t OF UALI FUM IA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/16) r`AI IFARMIA FMFRr;V r:AMMICRIAM 4e CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 3 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/Tag: RF-3-01 System Location or Area Served: Corridor DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Johnny Contreras Documentation Author Signature: Documentation Author Company Name: Christian Brothers Mechanical Services Date Signed: 21 Address: 11140 Thurston Lane ATT Certifications Idenntifi lion (If a le): city/state/zip: Mira Loma, CA 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on t s Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available ith the building permit(s) issued for the building. - - Field Technician Name: Todd Alpert Field Technician Signature: Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title): Tec ician Address: 11140 Thurston Lane ATT Certification Identification (if pplicable): City/State/Zip: Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: to RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. S. I will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to ding owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: Responsible Acceptance Person Company Name: Christian Brothers Mechanical �_ = Position with Company (Title): Project Mana r Address: 11140 Thurston Lane CSLB License: 499547 City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 Date Signed: 2/5ZOZ CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 J I A I t= VI- IiALIrVKrv1A SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE CEC-NRCA-MCH-07-A (Revised 01/16) rel WnDKIIA CnICD _V rneleA1eC1nK1 CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 1 of 3) Project Name: Clearwater Harbor Point Senior Living Enforcement Agency: Permit Number: X2021-2737 Project Address: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identification/rag: RF-3-02 System Location or -Area Served: Corridor 1 Note: Submit one Certificate of Acceptance for each, system that must Enforcement Agency Use: Checked by/Date demonstrate compliance. Intent: I Verify that the supply fan speed in a variable air volume system modulates to meet system airflow demand. A. Construction Inspection Note: MCH-07 can be performed in. conjunction with MCH-02 Outdoor Air Acceptance since testing activities overlap. 1. Supporting documentation needed to perform test includes: a. As -built and/or Design Documents including Mechanical Equipment Schedules. b 2016 Building Energy Efficiency Standards Nonresidential Compliance Manual (NA7.5.6Supply Fan Variable Flow Controls Acceptance At -A -Glance). C. 2016 Building Energy Efficiency Standards. 2. Instrumentation to perform test includes: a. Calibrated differential pressure gauge. Date of calibration: 12/14/23 (must be within one year) b. Static Pressure Probe c. Drill d. Rubber Plugs 3. Installation: a. The static pressure location, setpoint, and reset control meets the requirements of 2016 Building Energy Efficiency Standards Section 140.4(c)2B and 140.4(c)2C: (check all the following that apply). ❑ If sensor is located downstream of major duct splits, multiple sensors are installed in each major branch with fan capacity controlled to satisfy the sensor furthest below its setpoint. ❑✓ Set point is no greater than one-third of the total design fan static pressure. Design TSP: 0.5 in. w.c. Setpoint: 0.42 in.w.c. ❑ If system has DDC to the zone level it has reset control complying with 2016 Building Energy Efficiency Standards Section 140.4(c) 2C. Reset is based on the zone requiring the most pressure; i.e., the set point is reset lower until one zone damper is nearly wide open. b. Supply fan includes a device for modulating airflow, such as variable speed drive or electrically commutated motor. 4. Field calibrate all discharge static pressure sensors: ❑ Performed field -calibration using calibrated differential pressure gauge and static pressure probe. ❑ Calibration complete, all pressure sensors ± 10% of calibrated reference sensor (provide supporting documentation). Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 b I A It: OF k;AL It*UK NIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE r'Cr^_pI01'A-KAr'N-n7-A IRcviend fNHRI CAI IFC]RNIA FNFRr,Y rOMMIRRIr1N CERTIFICATE OF ACCEPTANCE NRCA-MCH-07-A Supply Fan Variable Flow Controls Acceptance (Page 2 of 3) Project Name: Enforcement Agency: Clearwater Harbor Point Senior Living Permit Number: X2021-2737 ProjectAddress: 101 Bayview Place City: Newport Beach Zip Code: 92660 System Name or Identiflcation/Tag: RF-3-02 System Location or Area Served: Corridor B. Functional Testing Results Step 1: Drive all VAV boxes to full design airflow. a. Refer to design documents and record system design airflow. 170 cfm b. Supply fan speed modulates to increase capacity. Yes O No O C. Record fan frequency: 60 Hz d Supply fan maintains discharge static pressure f 10% of the current operating set point. If NA, indicate reason in Notes section. Yes ®No NA ®. Note: If NOT performing this test in conjunction with MCH-02, other methods for verifying Variable Flow operation include increasing static pressure setpoint or putting all the VAV boxes into full cooling. Was one of these methods used? Due to diversity in system design, static pressure setpoint will likely not be achieved when all VAV boxes are in full cooling. If this occurs, verify fan speed is 60 Hz and indicate NA in Step 1.d. Yes O No 0 e. Verify that supply fan controls stabilize within a 5 minute period. Yes Q No Q Notes: Step 2: Drive all VAV boxes to reduced or minimum airflow a. Supply fan speed modulates to decrease capacity. Yes (D No O b. Record fan frequency: Hz C. Current operating static pressure setpoint has decreased (for systems with DDC to the zone level). Yes@No0NA0 d. Supply fan maintains discharge static pressure t 10% of the current operating setpoint. Yes 0 No O e. Supply fan controls stabilize within a 5 minute period. Yes @ No 0 Notes: Step 3: System returned to initial operating conditions Yes A No C. Testing Results Pass 1 Fail Step 1: Drive all VAV boxes to achieve full design airflow (Pass if all answers are Yes and/ or NA) Step 2: Drive all VAV boxes to minimum flow (Pass if all answers are Yes and/ or NA) O D. Evaluation ❑ PASS: All Construction Inspection responses are complete and all Testing Results responses are "Pass". Notes: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 J I A It OF t.:ALII-UKNIA SUPPLY FAN VARIABLE FLOW CONTROLS ACCEPTANCE litl,-NnLA-muri-uf-A (Kevisea u7/l CALIFORNIA ENERGY COMMISSION �- CERTIFICATE OF ACCEPTANCE Supply Fan Variable Flow Controls Acceptance Project Name: Clearwater Harbor Point Senior Living Project Address: 101 Bayview Place System Name or Identification/rag: RF-3-02 Enforcement Agency: City: Newport Beach System Location or Area Served: Corridor NRCA-MCH-07-A (Page 3 of 3) Permit Number: X2021-2737 Zip Code: 92660 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Acceptance documentation is accurate and complete. - Documentation Author Name: Johnny Contreras Documentation Author Signature: ofDocumentation Author Company Name: Christian Brothers Mechanical Services Date Signed: -7-5 2 Address: 11140 Thurston Lane ATT Certification Wentificati (If app' le): City/state/zip: Mira Loma, CA . 91752 Phone: 951-241-5392 FIELD TECHNICIAN'S DECLARATION STATEMENT�� �I I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Acceptance is true and correct. 2. 1 am the person who performed the acceptance verification reported on this Certificate of Acceptance (Field Technician). 3. The construction or installation identified on this Certificate of Acceptance complies with the applicable acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and signed by the responsible builder/installer and has been posted or made available w h the building permit(s) issued for the building. Field Technician Name: Todd Alpert Field Technician Signature: -� Field Technician Company Name: Christian Brothers Mechanical Services Position with Company (Title):Technl Ian Address: 11140 Thurston Lane ATT Certification Identification (if applicable): city/state/Zip:Mira Loma, CA 91752 Phone: 951-361-2247 Date Signed: z� RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 1 am the Field Technician, or the Field Technician is acting on my behalf as my employee or my agent and I have reviewed the information provided on this Certificate of Acceptance. 2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Acceptance and attest to the declarations in this statement (responsible acceptance person). 3. The information provided on this Certificate of Acceptance substantiates that the construction or installation identified on this Certificate of Acceptance complies with the acceptance requirements indicated in the plans and specifications approved by the enforcement agency, and conforms to the applicable acceptance requirements and procedures specified in Reference Nonresidential Appendix NA7. 4. 1 have confirmed that the Certificate(s) of Installation for the construction or installation identified on this Certificate of Acceptance has been completed and is posted or made available with the building permit(s) issued for the building. 5. 1 will ensure that a completed, signed copy of this Certificate of Acceptance shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Certificate of Acceptance is required to be included with the documentation the builder provides to t ng owner at occupancy. Responsible Acceptance Person Name: Johnny Contreras Responsible Acceptance Person Signature: '" Responsible Acceptance Person Company Name: Christian Brothers Mechanical ; -, Position with Company (Title): Project Ma Address: 11140 Thurston Lane CSLB License: 499547 I City/State/Zip: Mira Loma, CA 91752 Phone: 951-241-5392 Date Si Signed: CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016