HomeMy WebLinkAboutUntitled ...1. 77,;,'-• Development Services Department
,
240 West Huntington Drive,Post Office Box 66021
-tPERMIT NO. BOO-058-663
�
;✓ Arcadia,CA 91066-6021
City of (626)574-5416,Fax(626)447-9173Permit Type: Tenant Improve w/energ:
Arcadia
PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS
12/26/2017 CM 10:33 3/5/2018 Issued
ADDRESS NO. Dir.Prefix Street Name Street Suffix UNIT BLG ASSESSORS PARCEL NO. GEO CODE
400 S Baldwin Ave T-387
OWNER MAILING ADDRESS
Westfield Corporation, Inc. 11601 Wilshire Blvd. 12th Floor PHONE NO. Plan Chk#: 17-481
Los Angeles,CA 90025- EMAIL ADDRESS
Plan#: 32460
APPLICANT MAILING ADDRESS
Barrett Building Company Inc PHONE NO.
EMAIL ADDRESS:
CONTRACTOR/PROFESSIONAL MAILING ADDRESS
PHONE NO. 531-1078 FAX NO.
Barrett Building Company Inc (808)
EMAIL ADDRESS:
,
License No. 898075 Type: B Expires: 3/31/2019 12:00:
TENANT MAILING ADDRESS
Lady M Confections PHONE NO. FAX NO.
DESCRIPTION
INTERIOR TI FOR LADY M CONFECTIONS.WITH EMP
Construction Type UOM I/of Units Value Construction Type UOM M of Units Value
Value Value 255,000.00 $255,000.00
41 COMPLETED
OCCUPANCY: Tenant Improve TOTAL VALUATION: $255,000.00
QTY I.IOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT
each Plan review 1,490.78 1,490.78 01-3103 37.00 each Ltg fixtures 47.80 47.80 01-3105
each Energy p/c fee 458.70 458.70 01-3103 10.00 Flat Add/Alter Ducts 93.80 93.80 01-3105
PC ADA 223.62 223.62 01-3103 1.00 each T.I.Fire Pkc 280.00 280.00 01-3109
PC Cal Green 149.08 149.08 01-3103 SMIP Com 71.40 71.40 14-2207
1.00 Flat Bldg Issue Auto 44.35 44.35 01-3104 gm bldg std 11.00 11.00 714-2203
each Bldg permit 2,293.50 2,293.50 01-3104 1.00 Flat SWMF Auto 6.25 6.25 88-3027
Bldg Issue ADA 229.35 229.35 01-3104 1.00 Flat SWMF 2 1.00 1.00 88-3027
1.00 flat Elec issue 44.35 44.35 01-3105 1.00 Flat SWIvIF 2 1.00 1.00 88-3027
1.00 Flat Mech issue 44.35 44.35 01-3105 1.00 Flat SWMF 2 1.00 100 88-3027
1.00 Flat Plmbgissuance 44.35 44.35 01-3105
1.00 each Distrib panel 15.55 15.55 01-3105 7- I.(8
3.00 each Kitchen sinks 37.38 37.38 01-3105 ////����
1.00 each Power I hp 7.62 7.62 01-3105 (4JA'. 0,6161, 67.).
1.00 each Dishwashers 12.46 12.46 01-3105 t 1
4.00 each Floor sink 49.84 49.84 01-3105
1.00 each Floor drain 12.46 12.46 01-3105
35.00 each Outlets 45.80 45.80 01-3105
Total Fees: $5,716.79 Balance Due: $0.00 Paid Today:
This permit/plan review expires by time limitation and becomes null and void if the work authorized by the cccip .:
permit is not commenced within 180 days from the date of issuance or if the permit is not obtained within 180 days from
the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit
is suspended or abandoned for 180 consecutive days or if no progressive work has been verified by a City of
Arcadia building inspector for a period of 180 consecutive days.
CALLS FOR INSPECTION INSPECTORS'OFFICE HOURS
Requests for inspection should be made at least Monday-Thursday Friday
one(1)business day in advance of the inspection 7:30 a.m.to 8:30 a.m. 7:30 a.m.to 8:30 a.m.
by telephone at(626)574-5416 for onsite work. 4:00 p.m.to 5:30 p.m. 4:00 p.m.to 4:30 p.m.
(Closed on alternate Fridays)
0A.trogv.I'. • -
k Ph,114 PERMIT/PLAN REVIEW APPLICATION
Mt
4,41*• Development Services Department,240 West Huntington Drive,Post Office Box 60021
, Arcadia, CA 91066-6021,(626) 574-5416,Fax(626)447-9173
City of
Arcadia
LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION
❑ I hereby affirm under penalty of perjury that I am licensed under provisions of I hereby affirm under penalty of perjury one of the following:
Chapter 9(commencing with Section 7000,of Division 3 of the Business and
Professions Code,and my license is in full force and effect. ❑ I have and will maintain a certificate of consent to self-insure for workers'
License Class License No. Exp. Date compensation, as provided for by Section 3700 of the Labor Code, for the
Signature of Contractor performance of the work for which this permit is issued.
OWNER-BUILDER DECLARATION 1:1I have and will maintain workers'compensation insurance,as required by Section
❑ I hereby affirm under penalty of perjury that I am exempt from the Contractors 3700 of the Labor Code,for the performance of the work for which this permit
License Law for the following reason(Section 7031.5,Business and Professions is issued.My workers'compensation insurance carrier and policy numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, Carrier
demolish,or repair any structure,prior to its issuance,also required the applicant
for such permit to file a signed statement that he or she is licensed pursuant to the Policy Number
provisions of the Contractors License Law(Chapter 9(commencing with Section (This section need not be completed if the permit is for one hundred dollars or less)
7000)of Division 3 of the Business and Professions Code)or that he or she is
exempt there from and the basis for the alleged exemption. Any violation of ❑ I certify that in the performance of the work for which this permit is issued,I shall
Section 7031.5 by any applicant for a permit subjects the applicant to a civil not employ any person in any manner so as to become subject to the workers'
penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree that if I should become subject to the
workers'compensation provisions of Section 3700 of the Labor Code,I shall
❑I, as owner of the property, or my employees with wages as their sole forthwith comply with those provisions.
compensation,will do the work,and the structure is not intended or offered for
sale(Section 7044,Business and Professions Code:The Contractors License Date Signature
Law does not apply to an owner of property who builds or improves thereon,
or who does such work himself or herself or through his or her own
employees,provided that such improvements are not intended or offered for WARNING: Failure to secure Workers'Compensation coverage is unlawful,
sale.If,however,the building or improvement is sold within one(1)year of and shall subject an employer to criminal penalties and civil fines up to one
completion,the owner-builder will have the burden of proving that he or she hundred thousand dollars($100,000),in addition to the cost of compensation,
did not build or improve for the purpose of sale). damages as provided for in Section 3706 of the Labor Code, interest, and
attorney's fees.
❑I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project(Section 7044, Business and Professions
Code:The Contractors License Law does not apply to an owner of property CONSTRUCTION LENDING AGENCY
who builds or improves thereon,and who contracts for such projects with a I hereby affirm under penalty of perjury that there is a construction lending agency
contractor(s)licensed pursuant to the Contractors License Law). for the performance of the work for which this permit is issued (Section 3097,
Civil Code).
❑ I am exempt under Section 7044,Business and Professions Code,for this reason:
Lender's Name
Date Signature Lender's Address
IMPORTANT: APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND
RESTRICTIONS SET FORTH ON THIS APPLICATION AND THE FOLLOWING:
1. The City's approved plans and permit inspection card must remain on the job site for use by City inspection personnel.
2. Final inspection of the work authorized by this permit is required.A Certificate of Occupancy must be obtained prior to use and occupancy of new buildings
and structures.
3. Per South Coast Air Quality Management District(AQMD)regulations,renovation and remodeling work that results in the removal,stripping,or altering
of asbestos containing materials requires an asbestos survey and removal prior to disturbing the asbestos.Please contact AQMD at(909)396-2000 for
further information.
Name Title
PRINT NAME
I certify that I have read this application and state that the above information is correct and that I am the owner or duly authorized agent of the owner.
I agree to comply with all City ordinances and State Laws relating to building construction. I hereby authorize representatives of the City of
Arcadia to enter upon the above-mentioned property for inspection purposes.
Signature Date
r - (0(.3 .Sc.,0 tA_s 1,4 460y 11
NOTES
Building Inspections Date Insp. Plumbing Inspections Date Insp. q,q,`s ?lee _/• Jn� i ','/` I
pc
100. Setbacks 210. Under flr./bldg.drain 77 (( �Jw.y,/`� /{ �f
101. Rough grade 211. Copper underslab P ' _ '5 ii‘c....;,..,
102. Figs.&forms 212. Rough plumbing .. es-tia,
103. Pre-slab 213. Rough gas 101.47Z-
// '/
104. Floor joists 214. Shower pan 4-(Z-it .crvt;� W.4�e1/ ./tr %
105. Steel 215. Water heater •
106. Grout lift 216. Roof drains
107. Shear nailing 217. Building sewer �3-I t44 G`
J$ GEG IC iii/47�rGC-S
108. Diaph nailing 218. Water service
109. Roof nailin. 19. Final'as
A.40A� ��M��G• K T�
/!
110. Framing 6-i-l 8 ' j '220. Fixtures Ayer1 SWG 6%- LJ o.u.--S�t
111. 0cc./Area Sept.Wall 221. Final plumbing 7. .a �rt
112. Sound walls 22. Sewer cap/demo.
113. T-bar grid 6-42't& 5'45-tt8 f 67/4- Euysgr,i4 fSp jI
114. Insulation Flr. ll Pool Inspections Date Insp. DOir/off F-4.0(sok SirIK /71(c...,/115. Insulation-Wall 240. Excavation/steel ✓
116. Insulation-Ceil. ,241. Rough plumbing d
117. Drywall nailing Co'/"i`8 .►��/242. Light shell/bonding ,5 301
118. Interior lath 243. Underground conduit C�/G/,v� fe frA1/4#
119. Exterior lath 244. P-trap V R'1►�
120. Finish grade245. Gas line&test b•W/g
121. Final building 7148r- 246. Fence,gates&signs ri(�/C' % 5glerlett-,?• OPDgi
122. Final demo/lot clear 247. Pool heater
248. Final electric
Electrical Inspections Date Insp. 249. Final.lumbin.
150. Power pole 250. Pool cover
151. Sales lot lighting 251. Pool final
152. Underground conduit
153. Underslab conduit Reroof Inspections Date Insp.
154. UFER ground 270. Pre-reroof insp.
155. Water ground 271. Roof framing
156. Rough electrical 272. Sheathing nailing
157. Fixtures 273. Final reroof
158. G.F.C.I.
159. E..t.bondin. Sign Inspections I Date I Insp.
160. Service panel 280. Setback/overhang
161. Final electric 7.2{8 7 281. Footing
282. Conduitlwirin.
Mechanical Inspections Date Insp. 283. Disconnect _
180. Venting/flue 284. Final sign
181. Furnace/A.C.
182. Rouch HVAC Miscellaneous Insp. I Date Insp.
183. Fire dampers 290. Fire alarm
184. Furnace compartment 291. Underground supply
185. Combustion air 292. Fire sprinklers
186. Smoke detectors 293. Monitor system
187. Metal F.P.rough 294. Hood dry chem.
188. Compressor setback 295. Final
189. Commercial hood
190. Duct shaft Sewers&Offsite Insp. Date Insp.
191. Final mechanical 'Z{: dr 300. Lateral(main to P/L)
301. Saddle/Y
Block Wall Inspections Date Insp. 302. Cess...l filled
200. Footings 303. Sidewalk
201. Steel/rebar 304. Driveway
202. Grout lift 305. Curb replacement
203. Final wall 306. Trash bin
City o
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..�:_' f Community Development Department INSPECTION RECORD D
•j _ tBuilding Division
r,
240 W.Huntington Drive - P.O. Box 60021
(-.., ._`t � Arcadia.CA 91066-6021 Permit No. BOO-058-663
"roR•=F)= (626)574-5416 Permit Type: Tenant Improve wlenergy
POOLS t SPAS Date Insp.
"""mg 400 S Baldwin Ave
Address Alarms
Owner Name
Westfield Corporation,Inc- Phone: Excavation/Steel
and Address 11601 Wilshire Blvd. 12th Floor Fax: Rough Plumbing
Los Angeles,CA 90025-
Light Shell/Bonding
Contractor Barrett Building Company Inc Phone:(805)531-1078 Underground Conduit
Name and Fax:
Address P-Trap
State Lie. 898075 City Lie.# 061786 Gas Line&'fest
CIassif. B Fence,Gates&Signs
Proposed Construction Pool Heater .
INTERIOR TI FOR LADY M CONFECTIONS.WITH EMP Final Electrical
Final Plumbing
Pool Cover
Final Pool
SIGNS Date Insp.
LJv Gas Rmdl Porch Patio Setback/Overhang
Sq.Ft.
Size Footing
Sq.Ft Conduit i Wiring
Size Disconnect
❑ New ❑ Add ❑ Alteration p Repair ❑ Demolition Final Sign
BUILDING Date Insp. ELECTRICAL Date Insp, MECHANICAL Date Insp.
Setbacks Power Pole Venting /Flue
Rough Grade Underground Conduit Furnace/A.C.
!-ormstt-preUnderslab Conduit Rough HVAC
i-ic-.,iab UFER Ground Fire Dampers
Floor Joists Water Ground Furnace Compartments
Grout Lift Rough Electrical Combustion Air
Shear Nailing Fixtures/T-Bar Metal F.P.Rough
Diaph Nailing Service Panel Release Compressor Setback
Root Nailing Smoke Detector Commercial Flood
Framing Utility ClearanceDuct Shall
Occ,/Area Sep, Wall Final Electrical t'213. Final Mechancial 72,1r
7i-0--
T-Bar Grid FIRE - Date Insp. PLUMBING Date Insp.
Insulation-fir. Fire Sprinkler Rough yorUnder Flr./Bldg.Drain
Insulation-wall Fire Sprinkler Final — Copper Underslab
Insulation-ceiling , Fire Alarm Final �� 1IC1j Rough Plumbing
Drywall Nailing6iyikiii, Fire Sprinkler UG Hydro Rough Gas
Interior Lath Fire Sprinkler UG Flush Shower Pan
Exterior Lath Kitchen Ext Water Heater
Final Dcmo lot clear ' Occupancy Final Roof Drains
Final Building "'J.fig -Dti- Building Sewer
REROOF Date 1 Insp. BLOCK WALL Date Insp. Water Service
Pre-retool Inspection Footings Sewer Cap/Demo.
Roof Framing Steel/Rebar Miscellaenous
Sheathing Nailing Grout Lift Final Gas
Final Rcroof - Final Wall Final Plumbing 7 24 8 '''''A-s,.
L__...MENTS: 4t`...'t,{--I� �- e f`9 L+' 4 i, /7-. '
,�` . j - 6-21'17' f7 /r I/ lwr-, 0
POT,'
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NO INSPECTIONS ON L TERNA TE FRIDAYS.
DA 1E CORRECTIEDNS EHSINInALs: PLAN CHECK OFFICIAL INSPECTION REPORT
COUNTY OF LOS ANGELES:•DEPARTMENT OF PUBLIC HEALTH
ENVIRONMENTAL HEALTH
OPERATOR INITIALS: RETAIL INSPECTION ■ WHOLESALE INSPECTION
SECTION I: TYPE OF INSPECTION
Preliminary Inspection 90-Day Evaluation
0
o iii
Follow Up Inspection Equipment Evaluation
id
m a
Final Inspection-NEW Revocation Evaluation
1-
1- Final Inspection-REMODEL Other:
di
SECTION II: STATUS OF PERMIT I LICENSE
T
APPROVED:The facility/establishment is approved to operate pursuant to the following contingencies: I
co
ca
X_ DENIED:The facility/establishment is NOT approved to operate.To obtain approval,the requirements needed are:
e �,,' 44 IiraM-4 -clot. app rd, ox
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-�v Iffo c< am d -Ira' n . Opp rn va," to Aper 7te
`� AA CACIK n j ri 4- 4prrku d i�o -tai-r 6 Joi ci n a l
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•
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...,:i tu - 5 ( �! 1644 1/4 " ,g )-
N 0a W Submit 3 sets of detailed plans: Se Construction Requirement Guidelines at www.publichealth.lacountv.00v/eh
zObtain local Building&Safety, Fire Department and other agency permits and approvals
..*-,,,4 i
a. SECTION III: LIMITS & RESTRICTIONS
• J ? w The approved facility/establishment may engage in the processes/activities marked below:
44) LU
v CO aTrain EmployeesUse Multiservice Utensils
15 p S. •g• •. •• .•• Serve Alcoholic Beverages
J
Stock .• •• •• Foods May NOT Serve Alcoholic Beverages For On-Site Consumption
Vw CCIO Food• •. . • Food Demonstration
Z
. v m o t� •••Preparation •FOOD • Wholesale Food Processing
W Y
iii�Q- cn 0 Food• •.. . . • •• • Food Market,Wholesale
1- y x
Z Q cr 0 V 0 + ••• Prepackaged ••• • Other:
O Z
o . �t aa- . CC a. ri c�7 SECTION IV: FEES/ADMINISTRATIVE ACTIONS
A fee in the amount of$ must be paid prior to the next field inspection.
I Ei
J2 z CLOSURE:Operating without final approval and/or without Public Health Permit OR License
Q V( Q 0 Administrative Review/Office Hearing has been scheduled on: ,at a.m./p.m.(Provide Valid Photo Identification)
W 0
I 0 -. r" o SECTION V: DISCLOSURES
...irz ( Q
Q a. Q S U It is a misdemeanor violation to begin operation without a valid Public Health permit/license.The Public Health permit/license will be
I—• , o issued by the Plan Check Inspector at the job site following final inspection and approval by all applicable agencies.Remodeled areas of
Z Y Nan existing food facility/establishment must obtain a final inspection and approval from all applicable enforcement agencies prior to use.
0
Any future alteration,construction,building,renovation,repair,change of equipment,change of the operation of a food facility/
establishment or change of menu may require plans to be submitted to the Health Department Plan Check Program.Additional approvals
Z 02 may be required from other enforcement agencies.
O Z It is improper and illegal for any County officer,employee or inspector to solicit bribes,gifts or gratuities in connection with performing
Ce their official duties.Improper solicitations include requests for anything of value such as cash,discounts,free services,paid travel or
• Q J U M entertainment,or tangible items such as food or beverages.Any attempt by a County employee to solicit bribes,gifts or gratuities for any
Z a o: 0) reason should be reported immediately to either the County manager responsible for supervising the employee or the Fraud Hotline at
LU `) co (800) 544—6861 or www.lacountvfraud.orq.YOU MAY REMAIN ANONYMOUS
0 SEE REVERSE SIDE FOR ADDITIONAL CRITERIA Page 1 of
H-3086 (1-09) ORIGINAL
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City of Arcadia, CA
SIGN-18-1034
Development Services Department Permit Type:Sign
240 West Huntington Drive,Post Office Box 60021
Arcadia,CA 91066-6021 Work Classification:Sign-Illuminated
(626)574-5416 Permit Status:Issued
A RCA 1)1 A Issue Date:06/18/2018 ( Expiration: 12/15/2018
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
400 S Baldwin AVE Arcadia,CA 5775031043
Contacts
SANTA ANITA BORROWER LLC C/0 Owner PINOY CREATIONS SIGNS Contractor
WESTFIELD SANTA ANITA 422 MILFORD ST A,GLENDALE,CA 91203
400 (818)567-0045
Description:LED ILLUMINATED SIGN FOR LADY M Valuation: $ 3,500.00 Tenant LADY M
Total Sq Feet: 0.00 Plan Check# Plan#
Fees Amount Payments Amount Paid
Building Issuing Fee $44.35 Total Fees $379.20
Building Permit Fees $137.05 Cash/Receipt#REC-001469-2018 $379.20
Electrical Permit Issuance Fee $44.35
Amount Due: $0.00
Sign and Branch Circuit $62.13
Sign Connection $15.55
Sign Plan Review $68.52
Solid Waste Management Fee $6.25
Solid Waste Management Fee 2 $1.00
Total: $379.20
CALLS FOR INSPECTIONS
Request for inspection by telephone at 626-574-5450. Leave a message
71-f C requesting the address,timeframe and what inspection item is needed.
7D-\
F(A1 10447,710 .
This permit/plan review expires by time limitation and becomes null and
void if the work authorized by the permit is not commenced within 180 days
from the date of issuance or if the permit is not obtained within 180 days
from the date of plan submittal.This permit expires and becomes null and
lit void if any work authorized by this permit is suspended or abandoned for 180
COMPLETED consecutive days or if no progressive work has been verified by a City of
Arcadia building inspector for a period of 180 consecutive days.
June 18, 2018
Issued By: Date
June 18,2018 Page 1 of 1
i‘oguPORnt,',
kil 001's, 1 . M PERMIT/PLAN REVIEW APPLICATION
E4ib' Development Services Department,240 West Huntington Drive,Post Office Box 60021
�,e m° Arcadia, CA 91066-6021, (626) 574-5416,Fax(626)447-9173
City of
Arcadia
LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION
❑ I hereby affirm under penalty of perjury that I am licensed under provisions of I hereby affirm under penalty of perjury one of the following:
Chapter 9(commencing with Section 7000,of Division 3 of the Business and
Professions Code,and my license is in full force and effect. ❑ I have and will maintain a certificate of consent to self-insure for workers'u
License Class C 1 S
Signature of Contractor License No.IO\$5S S Exp. Date�'j 0 f� compensation, as provided for by Section 3700 of the Labor Code, for the
���yv
performance of the work for which this permit is issued.
OWNER-BUILDER DECLARATION ❑ I have and will maintain workers'compensation insurance,as required by Section
❑ I hereby affirm under penalty of perjury that I am exempt from the Contractors 3700 of the Labor Code,for the performance of the work for which this permit
License Law for the following reason(Section 7031.5,Business and Professions is issued.My workers'compensation insurance carrier and policy numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, Carrier
demolish,or repair any structure,prior to its issuance,also required the applicant
for such permit to file a signed statement that he or she is licensed pursuant to the Policy Number
provisions of the Contractors License Law(Chapter 9(commencing with Section (This section need not be completed if the permit is for one hundred dollars or less)
7000)of Division 3 of the Business and Professions Code)or that he or she is rs_
exempt there from and the basis for the alleged exemption. Any violation of 4u.1 certify that in the performance of the work for which this permit is issued,I shall
Section 7031.5 by any applicant for a permit subjects the applicant to a civil not employ any person in any manner so as to become subject to the workers'
penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree that if I should become subject to the
workers'compensation provisions of Section 3700 of the Labor Code,I shall
❑I, as owner of the property, or my employees with wages as their sole forthwith comply with those provisions.
compensation,will do the work,and the structure is not intended or offered for , �1
sale(Section 7044,Business and Professions Code:The Contractors License Date —) Signature W
Law does not apply to an owner of property who builds or improves thereon,
or who does such work himself or herself or through his or her own
employees,provided that such improvements are not intended or offered for WARNING: Failure to secure Workers'Compensation coverage is unlawful,
sale.If,however,the building or improvement is sold within one(1)year of and shall subject an employer to criminal penalties and civil fines up to one
completion,the owner-builder will have the burden of proving that he or she hundred thousand dollars($100,000),in addition to the cost of compensation,
did not build or improve for the purpose of sale). damages as provided for in Section 3706 of the Labor Code, interest, and
attorney's fees.
❑I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors License Law does not apply to an owner of property CONSTRUCTION LENDING AGENCY
who builds or improves thereon,and who contracts for such projects with a I hereby affirm under penalty of perjury that there is a construction lending agency
contractor(s)licensed pursuant to the Contractors License Law). for the performance of the work for which this permit is issued (Section 3097,
Civil Code).
❑ I am exempt under Section 7044,Business and Professions Code,for this reason:
Lender's Name
Date Signature Lender's Address
IMPORTANT: APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND
RESTRICTIONS SET FORTH ON THIS APPLICATION AND THE FOLLOWING:
1. The City's approved plans and permit inspection card must remain on the job site for use by City inspection personnel.
2. Final inspection of the work authorized by this permit is required.A Certificate of Occupancy must be obtained prior to use and occupancy of new buildings
and structures.
3. Per South Coast Air Quality Management District(AQMD)regulations,renovation and remodeling work that results in the removal,stripping,or altering
of asbestos containing materials requires an asbestos survey and removal prior to disturbing the asbestos. Please contact AQMD at(909)396-2000 for
further information.
Name �`^c�� � ' O V1 (Title
PRINT NAME
I certify that I have read this application and state that the above information is correct and that I am the owner or duly authorized agent of the owner.
I agree to comply with all City ordinances and State Laws relating to building construction. I hereby authorize representatives of the City of
Arcadia to enter upon the above-mentioned property for inspection purposes.
Signature \.) 3.J Date t o _'
� •„� City of Arcadia, CA
FIRE-18-0613
Development Services Department Permit Type:Fire
240 West Huntington Drive,Post Office Box 60021
Arcadia,CA 91066-6021 Work Classification:Fire Sprinkler
(626)574-5416 Permit Status:Issued
ARCAD I A Issue Date:04/19/2018 I Expiration: 10/16/2018
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
400 S Baldwin AVE Arcadia,CA 5775031043
Contacts
SANTA ANITA BORROWER LLC C/0 Owner HYDRO-MATIC FIRE PROTECTION INC* Fire Contractor(C-16)
WESTFIELD SANTA ANITA 1161 Rosedale,Glendale,CA 91208
400 (818)247-9812
Description:FIRE SPRINKS FOR LADY M 16 HEADS Valuation: $ 2.000.00 Tenant LADY M
Total Sq Feet: 0.00 Plan Check#OTC Plan#
Fees Amount Payments Amount Paid
Fire Issuance $44.35 Total Fees $849.00
Fire Permit Fees $103.65 Cash/Receipt#REC-000918-2018 $849.00
Solid Waste Management Fee 2 $1.00
Sprinkler Heads $700.00 Amount Due: $0.00
Total: $849.00
COMPLETE') CALLS FOR INSPECTIONS
Request for inspection by telephone at 626-574-5450. Leave a message
requesting the address,timeframe and what inspection item is needed.
This permit/plan review expires by time limitation and becomes null and
void if the work authorized by the permit is not commenced within 180 days
from the date of issuance or if the permit is not obtained within 180 days
from the date of plan submittal.This permit expires and becomes null and
void if any work authorized by this permit is suspended or abandoned for 180
consecutive days or if no progressive work has been verified by a City of
Arcadia building inspector for a period of 180 consecutive days.
April 19, 2018
Issued By: Date
April 19,2018 Page 1 of 1
4 "'ow PERMIT/PLAN REVIEW APPLICATION
.+ t ~ Development Services Department,240 West Huntington Drive,Post Office Box 60021
,.11"
1 e. Arcadia, CA 91066-6021,(626) 574-5416,Fax(626)447-9173
City of
Arcadia
LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION
0 I hereby affirm under penalty of perjury that I am licensed under provisions of I hereby affirm under penalty of perjury one of the following:
Chapter 9(commencing with Section 7000,of Division 3 of the Business and
Professions Code,and my license is in 1 force and effect. 0 I have and will maintain a certificate of consent to self-insure for workers'
License Class C-1 G Leii Exp. Da• compensation, as provided for by Section 3700 of the Labor Code, for the
/6i/J/ performance of the work for which this permit is issued.
Signature of Contractor
OWNER-BUILDER DEC ARATION ❑ I have and will maintain workers'compensation insurance,as required by Section
I hereby affirm under penalty of perjury that I am exempt from the Contractors 3700 of the Labor Code,for the performance of the work for which this permit
License Law for the following reason(Section 7031.5,Business and Professions is issued.My workers'compensation insurance carrier and policy numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, Carrier _ _ItSELF_____REIMais
demolish,or repair any structure,prior to its issuance,also required the applicant
Policy Number
for such permit to file a signed statement that he or she is licensed pursuant to the
provisions of the Contractors License Law(Chapter 9(commencing with Section (This section need not be completed if the permit is for one hundred dollars or less)
7000)of Division 3 of the Business and Professions Code)or that he or she is
exempt there from and the basis for the alleged exemption. Any violation of 0 I certify that in the performance of the work for which this pe,' 't is issued,I shall
Section 7031.5 by any applicant for a permit subjects the applicant to a civil not employ any person in any manner so as to become .jest to • e workers'
penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree t. I shod rbeco• e.ubject to the
workers'compensation provisions of Sec'. 700 ., the •b. Code,I shall
0 I, as owner of the property, or my employees with wages as their sole forthwith comply with those provisions.
compensation,will do the work,and the structure is not intended or offered for Date -1�- Signa
sale(Section 7044,Business and Professions Code:The Contractors License 'Fr Law does not apply to an owner of property who builds or improves thereon,
or who does such work himself or herself or through his or her own
employees,provided that such improvements are not intended or offered for WARNING: Failure to secure Workers'Compensation coverage is unlawful,
sale.If,however,the building or improvement is sold within one(1)year of and shall subject an employer to criminal penalties and civil fines up to one
completion,the owner-builder will have the burden of proving that he or she hundred thousand dollars($100,000),in addition to the cost of compensation,
did not build or improve for the purpose of sale). damages as provided for in Section 3706 of the Labor Code, interest, and
attorney's fees.
❑I, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors License Law does not apply to an owner of property CONSTRUCTION LENDING AGENCY
who builds or improves thereon,and who contracts for such projects with a I hereby affirm under penalty of perjury that there is a construction lending agency
contractor(s)licensed pursuant to the Contractors License Law). for the performance of the work for which this permit is issued (Section 3097,
Civil Code).
❑ I am exempt under Section 7044,Business and Professions Code,for this reason:
Lender's Name
Date Signature Lender's Address
IMPORTANT: APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND
RESTRICTIONS SET FORTH ON THIS APPLICATION AND THE FOLLOWING:
1. The City's approved plans and permit inspection card must remain on the job site for use by City inspection personnel.
2. Final inspection of the work authorized by this permit is required.A Certificate of Occupancy must be obtained prior to use and occupancy of new buildings
and structures.
3. Per South Coast Air Quality Management District(AQMD)regulations,renovation and remodeling work that results in the removal,stripping,or altering
of asbestos containing materials requires an asbestos survey and removal prior to disturbing the asbestos.Please contact AQMD at(909)396-2000 for
further information.
Name oiiiGv_ rika ,takQ (Fitic �� .
PRINT NAME
certify that I have read this application and state at the . 'ove information is correct and that I am the owner or duly authorized agent of the owner.
I agree to comply 't all C ordinances . d .tate aws relating to building construction. I hereby authorize representatives of the City of
Arcadia to enter u thea e-mentio •. pro . • f 1 inspection purposes.
ignature 7 D 4 Qate -1 l-'8
�►:� City of Arcadia, CA AV/ FIRE-18-0449
• Development Services Department Permit Type:Fire
240 West Huntington Drive,Post Office Box 60021
Arcadia,CA 91066-6021 Work Classification:Fire Alarm
- (626)574-5416 Permit Status:Issued
,A R('.1 I)[A Issue Date:04/05/2018 I Expiration: 10/02/2018
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
400 5 Baldwin AVE Arcadia,CA 5775031043
Contacts
Building Electronic Controls Inc. Applicant SANTA ANITA BORROWER LLC C/0 Fire Contractor(C-16)
2246 Lindsay WAY,Glendora,CA 91740 WESTFIELD SANTA ANITA
(909)305-1600 ext 100 400
Description:FIRE ALARMS FOR LADY M CONFECTIONS. 5 Valuation: S 6.000.00 Tenant LADY M CONFECTIONS
DEVICES
Total Sq Feet: 0.00 Plan Check#18-449 Plan#
Fees Amount Payments Amount Paid
Fire Alarm Plan Check $280.00 Total Fees $495.80
Fire Issuance $44.35 Cash/Receipt#REC-000703-2018 $280.00
Fire Permit Fees $170.45
Amount Due: $215.80
Solid Waste Management Fee 2 $1.00
Total: $495.80
CALLS FOR INSPECTIONS
Request for inspection by telephone at 626-574-5450. Leave a message
re uestin the address timeframe and what ins ection item is needed.
tOtAKEIED
requesting p
This permit/plan review expires by time limitation and becomes null and
void if the work authorized by the permit is not commenced within 180 days
from the date of issuance or if the permit is not obtained within 180 days
from the date of plan submittal.This permit expires and becomes null and
void if any work authorized by this permit is suspended or abandoned for 180
consecutive days or if no progressive work has been verified by a City of
Arcadia building inspector for a period of 180 consecutive days.
April 05, 2018
Issued By: Date
April 05,2018 Page 1 of 1
4 ! i PERMIT/PLAN REVIEW APPLICATION
•+ p'
tt Development Services Department,240 West Huntington Drive,Post Office Box 60021
/.
, Arcadia,CA 91066-6021,(626)574-5416,Fax (626)447-9173
City of
Arcadia
LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION
❑ I hereby affirm under penalty of perjury that I am licensed under provisions of I hereby affirm under penalty of perjury one of the following:
Chapter 9(commencing with Section 7000,of Division 3 of the Business and
Professions Code,and my license is in full force and effect. ❑ I have and will maintain a certificate of consent to self-insure for workers'
License Class Cl. d License No. 72-1CID�Exp. Date 84ircompensation, as provided for by Section 3700 of the Labor Code, for the
//// performance of the work for which this permit is issued.
Signature of Contractor
OWNER-BUILDER DECLARA I ❑ I have and will maintain workers'compensation insurance,as required by Section
❑ I hereby affirm under penalty of perjury that I am exempt from the Contractors 3700 of the Labor Code,for the performance of the work for which this permit
License Law for the following reason(Section 7031.5,Business and Professions is issued. �My workers'compensation insurance carand policy numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, Carrier hu rakers- et 1 yrierQ9-I--
demolish,or repair any structure,prior to its issuance,also required the applicant
Policy Number �D 5038 40/4 est)
for such permit to file a signed statement that he or she is licensed pursuant to the
provisions of the Contractors License Law(Chapter 9(commencing with Section (This section need not be completed if the permit is for one hundred dollars or less)
7000)of Division 3 of the Business and Professions Code)or that he or she is
exempt there from and the basis for the alleged exemption. Any violation of IDI certify that in the performance of the work for which this permit is issued,I shall
Section 7031.5 by any applicant for a permit subjects the applicant to a civil not employ any person in any manner so as to become subject to the workers'
penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree that if I should become subject to the
workers'compensation provisions of Section 3700 of the Labor Code,I shall
❑I, as owner of the property, or my employees with wages as their sole forthwith comply with those provisions.
compensation,will do the work,and the structure is not intended or offered for
sale(Section 7044,Business and Professions Code:The Contractors License Date I S a Signature
Law does not apply to an owner of property who builds or improves thereon,
or who does such work himself or herself or through his or her own
employees,provided that such improvements are not intended or offered for WARNING: Failure to secure Workers'Compensation coverage is unlawful,
sale.If,however,the building or improvement is sold within one(1)year of and shall subject an employer to criminal penalties and civil fines up to one
completion,the owner-builder will have the burden of proving that he or she hundred thousand dollars($100,000),in addition to the cost of compensation,
did not build or improve for the purpose of sale). damages as provided for in Section 3706 of the Labor Code, interest, and
attorney's fees.
❑ I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors License Law does not apply to an owner of property CONSTRUCTION LENDING AGENCY
who builds or improves thereon,and who contracts for such projects with a I hereby affirm under penalty of perjury that there is a construction lending agency
contractor(s)licensed pursuant to the Contractors License Law). for the performance of the work for which this permit is issued (Section 3097,
Civil Code).
❑ I am exempt under Section 7044,Business and Professions Code,for this reason:
Lender's Name
Date Signature Lender's Address
IMPORTANT: APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND
RESTRICTIONS SET FORTH ON THIS APPLICATION AND THE FOLLOWING:
1. The City's approved plans and permit inspection card must remain on the job site for use by City inspection personnel.
2. Final inspection of the work authorized by this permit is required.A Certificate of Occupancy must be obtained prior to use and occupancy of new buildings
and structures.
3. Per South Coast Air Quality Management District(AQMD)regulations,renovation and remodeling work that results in the removal,stripping,or altering
of asbestos containing materials requires an asbestos survey and removal prior to disturbing the asbestos.Please contact AQMD at(909)396-2000 for
' further information.
\lame PElt ,W.. S N 4, Title /
PRINT NAME I
I certify that I have read this application and state that the above information is correct and that I am the owner or duly authorized agent of the owner.
I agree to comply with all City ordinances and State Laws relating to building construction. I hereby authorize representatives of the City of
Arcadia to enter upon the above-mentioned property for inspection purposes.
Signature Date
tf- S 18
1
9)111'.
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•
B 3. IAETAL POST MICHAEL R. BLACK,AIA
2225 E.RANDOL MILL RD.,SUITE 300
ARLINGTON,TEXAS 76011
817.701.4819
ion CAUFORNIA UCENSE NO.:C26839
_ ,e,......„.4. ...........A.4-es iy
ki I t e"14.t-C-1-1:‘?‘j 1"-- kQ--- lo.e-L''d _.----------
4- 4-,....__ 0_,...,,_ 0( 4 ' 4f • <9 11,
I .2-" -Z-B /45 4 C-26839
FINAL INSPECTION AND APPROVAL
i 4 •L"
N N.
are required prior to beginning operating. edA
The Department requires AT LEAST THREE l'i' 9.• 1.%\.
WORKING DAYS PRIOR notice to arrange
for final inspection.
IMMIIIMINIMMI.1.111.11.1.1.1.1.1.
jkeiri Job Number
17020B
--------
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S'SQ X 3/8' SJV
PLATEw/ (4) --------_
EXPANSION 441IM N MRB
ms -----_
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x 3*
AN .. •• .. ..w.vol.'s I4€1;16txri
r -,"1'''''"-",',1 .7"E Equipment Plan
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Sheet Number
,orci Es,r,`V.NTY
----- 1c0c:"..:t.,-:,EIALTH
Al 04
. ,
c,of S,gNO COUNTY OF LOS ANGELES• DEPARTMENT OF PUBLIC HEALTH
4(-
;oJ LOI ' ENVIRONMENTAL HEALTH
SPECIALIZED SURVEILLANCE AND ENFORCEMENT BRANCH
PLAN CHECK PROGRAM- BALDWIN PARK
4- • COUNTY Of SOS ANGELES
cqufoaN�' 5050 COMMERCE DR, BALDWIN PARK, CA91706 Public Health
PHONE: (626) 430-5560
`\` V�MAV.PUBLICHEALTH.LA000NTY.GOV/EH
\
\ OFFICIAL PLAN REVIEW REPORT
DATE 02/28/2018 EHS VIVIAN TAN
PLAN CHECK NUMBER SR0129781
PROGRAM ELEMENT 1772 - EXPEDITED - RESTAURANT(501-1999 SF)
OWNER I REQUESTER SCOTT DAVES, AGENT
DBA LADY M CAKE BOUTIQUE
ADDRESS 400 S BALDWIN E-21, ARCADIA, CA 91007
REVISED PLAN REVIEW STATUS: APPROVED PF06
CORRECTIONS COMPLETED
CORRECTION CATEGORY DATE IDENTIFIED DATE CORRECTED
WAREWASHING FACILITIES 01/19/2018 02/28/2018
FOOD PREPARATION SINKS 01/19/2018 02/28/2018
HANDWASHING FACILITIES 01/19/2018 02/28/2018
JANITORIAL FACILITIES 01/19/2018 02/28/2018
TOILET FACILITIES 01/19/2018 02/28/2018
WATER SUPPLY 01/19/2018 02/28/2018
EQUIPMENT/STORAGE 01/19/2018 02/28/2018
FOOD PROTECTION/FOOD STORAGE 01/19/2018 02/28/2018
VENTILATION 01/19/2018 02/28/2018
EMPLOYEE FACILITIES 01/19/2018 02/28/2018
VERMIN EXCLUSION/ENCLOSURE 01/19/2018 02/28/2018
PLAN SUBMITTAL/REMODEL 01/19/2018 02/28/2018
•
Help us serve you better by completing a short survey.Visit our website at www.oublichealth.lacounty.gov/eh.
V
FHS Sinnaturp Page 1 of 3
OFFICIAL PLAN REVIEW REPORT •
DATE 02/28/2018 EHS VIVIAN TAN
PLAN CHECK NUMBER SR0129781
PROGRAM ELEMENT 1772 - EXPEDITED - RESTAURANT(501-1999 SF)
OWNER/ REQUESTER SCOTT DAVES, AGENT
DBA LADY M CAKE BOUTIQUE
ADDRESS 400 S BALDWIN E-21, ARCADIA, CA 91007
ADDITIONAL REQUIREMENTS
THE REVISED PLANS ARE APPROVED, SUBJECT TO ON-SITE INSPECTION PRIOR TO OPERATION OR STOCKING
FOOD ON THE PREMISES. APPROVAL IS CONTINGENT UPON THE FOLLOWING:
1) OBTAIN LOCAL BUILDING DEPARTMENT PERMITS AND APPROVALS.
2) SUBJECT TO ON-SITE INSPECTION AND APPROVAL. ALL EQUIPMENTS MUST BE CERTIFIED OR CLASSIFIED
FOR SANITATION BY AN AMERICAN NATIONAL STANDARDS INSTITUTE(ANSI)ACCREDITED CERTIFICATION
PROGRAM OR AN ACCREDITED TESTING AGENCY.
3) ALL USED AND/OR EXISTING EQUIPMENT AND FINISHES SHALL BE IN GOOD REPAIR AND ARE SUBJECT TO
ON-SITE INSPECTION AND APPROVAL.
4) ENSURE THAT THE COMMERCIAL HOOD AND MECHANICAL EXHAUST AND MAKE UP AIR SYSTEMS MEET THE
UNIFORM MECHANICAL CODE.
5) READ AND COMPLY WITH THE FOLLOWING ATTACHMENTS REGARDING:
A) FINAL INSPECTION NOTICE
B) PLAN APPROVAL CHECK LIST
C) CERTIFIED FOOD HANDLERS CERTIFICATE
6) HEALTH DEPT. APPROVED SET OF PLANS SHALL BE MADE AVAILABLE-SITE AT THE TIME OF FINAL
INSPECTION.
7) THE MOSAIC TILES AND PROPOSED PORCELAIN TILES ARE APPROVED SUBJECT TO ON-SITE INSPECTION.
THE FLOORS, WALLS AND CEILING SHALL BE SMOOTH, WASHABLE AND DURABLE (EXCEPT IN THE DINING AREA).
THE DISHWASHER SHALL BE LOW TEMP. IFA TYPE II HOOD IS NOT BEING PROVIDED.
COMMENTS
CONTACT VIVIAN TAN AT 626 430-5546/VTAN@PH.LACOUNTY.GOV TO SCHEDULE A FINAL INSPECTION.
PROVIDE AT LEAST 3 WORKING DAYS PRIOR NOTICE FOR A FINAL INSPECTION.
A FINAL INSPECTION SHALL BE CONDUCTED AND A PUBLIC HEALTH PERMIT SHALL BE OBTAINED PRIOR TO
OPENING AND OPERATING THIS FOOD ESTABLISHMENT.
Help us serve you better by completing a short survey.Visit our website at www.publichealth.lacounty.gov/eh.
FHS Sinnaturp Page 2 of 3
OFFICIAL PLAN REVIEW REPORT
DATE 02/28/2018 EHS VIVIAN TAN
PLAN CHECK NUMBER SR0129781
PROGRAM ELEMENT 1772 - EXPEDITED - RESTAURANT(501-1999 SF)
OWNER/ REQUESTER SCOTT DAVES,AGENT
DBA LADY M CAKE BOUTIQUE
ADDRESS 400 S BALDWIN E-21, ARCADIA, CA 91007
DISCLOSURES
Prior to construction and approval from the Los Angeles County Department of Public Health Environmental Health Division
(DPH-EH) Plan Check Program, final inspections must be obtained from Building and Safety (mechanical, plumbing, electrical)
and all other enforcement agencies.
Failure to obtain a Public Health Permit/License prior to operation of the facility/establishment is a misdemeanor violation.
Construction of the food facility/ establishment must be completed and approved within twelve (12) months from the date of
approval to avoid submitting new plans.
A copy of the approved plans must be available at the time of the field construction review.
All utilities must be on and operational at the time of the field construction review.
Please contact your plan check inspector at least 3 days prior to the field construction review.
Two field inspections will be covered under the Plan Check fees assessed upon plan submission.
A charge will be assessed for each subsequent field construction review.
Help us serve you better by completing a short survey.Visit our website at www.publichealth.lacounty.gov/eh.
EHS Sianature Page 3 of 3
.t.
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A 400%
Equal Air Balance Company
/1 V
LadyM Cake Boutique
Westfield Santa Anita
CERTIFIED TEST; ADJUST; BALANCE REPORT
Project Name: LadyM Cake Boutique Westfield Santa Anita
Address: 400 S. Baldwin Avenue, Space E21
City: Arcadia, CA 91007
Architect: N/S
Engineer: PDMS Design Group
HVAC Contractor: Pro West Mechanical
NEBB Certified TAB Firm: Equal Air Balance Company
Address: 357 East Arrow Highway, Suite 206
City: San Dimas, CA 91773
EAB Job#: 18301
Certification Number: 2910
License#: 1006492 galance C
Date: 6/18/2018 ;m�� r-. °•
N.E23D
Technician: Adele Collins
IRENEUSZ M.DLUGAJCZYK
CERTIFICATION
2910
Exp. 31119
Q/kitir- e,10
AIR BALANCE REPORT IS NOT VALID WITHOUT NEBB STAMP ABOVE
A •l.'111 Oft
Equal Air Balance Company
r1 V V
REPORT CERTIFICATION
Project Name: LadyM Cake Boutique
Westfield Santa Anita
Certifying NEBB Qualified
TAB Supervisor: Erik Dlugajczyk
Firm License Number: 1006492
Expiration Date: 8/31/2019
Firm Certification Number: 2910
Expiration Date: 3/31/2019
"THE DATA PRESENTED IN THIS REPORT IS A RECORD OF SYSTEM
MEASUREMENTS AND FINAL ADJUSTMENTS THAT HAVE BEEN OBTAINED IN
ACCORDANCE WITH THE CURRENT EDITION OF THE NEBB PROCEDURAL
STANDARDS FOR TESTING, ADJUSTING, AND BALANCING OF ENVIRONMENTAL
SYSTEMS.ANY VARIANCES FROM DESIGN QUANTITIES, WHICH EXCEED NEBB
TOLERANCES, ARE NOTED IN THE TEST-ADJUST- BALANCE REPORT PROJECT
SUMMARY."
357 E. Arrow Hwy. Suite 206
San Dimas, CA 91773
Phone(714)637-3500
Fax (714) 637-3050
Web:www.equalairbalance.com
Specializing in testing and balancing of environmental systems
A rims oft
- Equal Air Balance Company
am%_ - V
Table of Contents
LadyM Cake Boutique Westfield Santa Anita
Certification 4-6
Symbol Sheet: 7
Outlet Sheet: Existing RTU-1 8
Coded Drawing
JLT:JL:
Trrtif ration
THIS IS TO CERTIFY THAT
Equal BaCance., Inc.
HAS MET ALL REQUIREMENTS FOR NEBB CERTIFICATION
IN THE FOLLOWING DISCIPLINE
V esting Adjusting and ,Balancing o/envi'tonmenta`Systems
FOR THE NEBB BOARD OF DIRECTORS
March 31, 2019
Expiration Date NEBBBresident
2910 hed(94;:,
NEBB Certification Number NEBB President-Elect
iL
} NEBB Certification Board
NEBB Certified Professional
Ireneusz .M. D lugajczyk
HAS MET ALL THE NEBB REQUIREMENTS FOR
NEBB CERTIFIED PROFESSIONAL STATUS IN
Testing, .adjusting and Balancing of2nvironmenta(Systems
This Certificate,as well as individual affiliation with a NEBB Certified Firm and associated NEBB Certification
Stamp are REQUIRED to provide a NEBB Certified Report. Participation in the NEBB Quality Assurance
Program requires the Certificant be affiliated with a NEBB Certified Firm.
►,larch 31, 2019
Expiration Date NEBB Certification Board Chairman
23720mtiva ctcfft_
NEBB Certificant Number NEBB Certification Director
The NEBB Certification Board retains sole ownership of all certificates.The NEBB Certifieation Board Policy Manual governs use of this certificate.
l 1.
R [31GK MUiIVNES COMPANY ISO
LIQUID6;. CGAS 1-_OW CALIBRATION I-(R�i .•..
ACCREDITED
I1,1„
CER I'IFICA'I'E OF CALII;RRATION
Customer Name: EQUAL AIR BALANCE Calibration Date: 12 -07-2017
Reference Number: Calibration Due: 12-07-2018
Instrument Manufacturer: ALNOR Calibration Fluid: AIR @ 14.7PSIA 70F
Instrument Description: AIR FLOW TESTER Standard(s)Used: A220 DUE 1-2018
Model Number: EBT-723 & ACCESORIES NIST Traceability Per: 1390386562,1329407628
Serial Number: 90447006 Ambient Conditions: 765 mmHGA, 30% RH 70F
Rated Accuracy: +/- 3% RD + 5FPM Procedure Number: T.0.33K6-4-1769-1
Accuracy Given: +1- .53% RD. ; K=2 Certificate/File Number: 452304.2017
AS REC./AS LEFT WITHIN SPECS.
** CALIBRATED WITH D.M. ACCESORIES **
INDICATED —ACTUAL INDICATED AC'TUA1. INDICATED ACTUAL
AIRFOIL AIRFOIL GRID GRID HOOD HOOD
FPM FPM FPM IPM CFM CFM
99 J 100 101 - — 100 99 _ 100
495 500 504 500 495 500
991 1000 1007 1000 792 800
1485 1500 1511 1500 1188 1200
1980 2000 2018 - 2000 1485 1500
3977 4000 2420 2400 1980 2000
_,t-=
AL72-TI "1120 1120
1.00 1.00
DEG.F DEG.F 10.00 10.00
69.8 70.1 20.00 20.00
90.5 90.9 60.00 60.00
PITOT TUBE PITOT TUBE '4 RI-It AL72-TII I.1 '4 RI
1000 TO 10000 1000 TO 10000 32.3 33.1
2510 2500 34.6 35.4
6025 6000 76.3 77.3
\II 11.11uutenl• u.ed in the pcllinnt:utcc .RI Ilse •hn%tii ralihr:uinn have ua.eahihn In the \tuumal In.11till. uI Slutd:ud• and Ie.Intulue\
I NIS I I the u'cerlainr\ ?alio heta“ee' the eallhi:uiun da'dard.III\I I II I u•ed and the will tinder Ic•l It I I I n.I nnuim m ul I I unic.,
ulhenit.c 'iled t ,Ihlaatrun ha. hc.•n petlw11ned pct the .111.‘‘ii prrrcedwc uuurhel. in A:cntd:flux a„h IStI 111111'_'101 1SII I'10_5 2110.
\\•t\( SI -/•541 1.mid ni \111 -'11/-15(62\ I..I m.IhuRd. \1'12510-9'a\ \S\II \11 l -1\I-Il))4)
(lick %loons C. puny • 1 1 1 1 3 \\inner.firsts• IRR. \I:unitu.,( \111172tI
Phone 17141 8-27-1_2 15• I a\17141827-0823
It;we \ppnn.1It. I aldrnal.nt I.duu.rui
17 - }- tl 4A:,
.) Pace ltit
Equal Air Balance Company
Air Symbol Sheet
ACU Air Conditioning Unit LAT Leaving Air Temperature
AK F• ree Area Factor LD Linear Diffuser
ATM Atmosphere LSD Linear Slot Diffuser
BHP B• rake Horse Power LWT Leaving Water Temperature
CAV C• onstant Air Volume MAT Mixed Air Temperature
CD Ceiling Diffuser MB Mixing Box
CER Ceiling Exhaust Register NA Not Applicable
CFM Cubic Feet per Minute NI Not Installed
CHWR Chilled Water Return NL Not Listed
CHWS Chilled Water Supply NVL No Valid Location
CO Cooling Only NM Not Measured
CRR Ceiling Return Register NR Not Read
CSG Ceiling Supply Grille NS Not Specified
CWR Condensor Water Return OSA Outside Air
CWS Condensor Water Supply R.A Reverse Acting
D.A. Direct Acting RA Return Air
DNA Data Not Available RAG Return Air Grille
DO Duct Opening RAR Return Air Register
DT D• uct Traverse RD Round Diffuser
EAG Exhaust Air Grill RH Re-Heat
EAR Exhaust Air Register RPM Revolutions per Minute
EAT Entering Air Temperature SA Supply Air
EF Exhaust Fan SAG Supply Air Grille
EG Exhaust Grill SAR...... Supply Air Register
ESP External Static Pressure SAV Supply Air Valve
EWT Entering Water Temperature SEF Smoke Evac Fan
EXH Exhaust SP Static Pressure
FC Fan Coil SW Sidewall
FLA Full Load Amps SWG Sidewall Grill
FP Fan Powered TBD To Be Determined
FPM Feet per Minute TSP
Total Static Pressure
GEX General Exhaust T-STAT Thermostat
GF Grease Filter UA ULPA Filter
HF H• epa Filter V Volts
HP Horse Power VAV Variable Air Volume
HWR Hot Water Return VP Velocity Pressure
HWS Hot Water Supply WER Wall Exhaust Register
7
_ A 1"11 Oft TEST AND BALANCE REPORT
Equal Air Balance Company DIFFUSER AND GRILLE TEST
r'1 -1160 V
LadyM Cake Boutique Westfield Santa Anita
Date: 6/18/2018
Readings by: Adele Collins Job No.: 18301
ZONE ROOM OUTLET TYPE SIZE DESIGN ACTUAL %Of NOTES
CFM CFM Design
Existing RTU-1 B.O.H. 103 1 CD 24x24 250 259 104%
Supply B.O.H. 103 2 CD 24x24 275 282 103%
Office 104 3 CD 12x12 75 71 95%
Main Retail 101 4 LD 48x3 250 246 98%
Main Retail 101 5 LD 48x3 250 258 103%
Main Retail 101 6 LD 48x3 250 270 108%
Main Retail 101 7 LD 48x3 250 266 106%
Total 1600 1652 103%
Existing RTU-1 Roof 1 Open 29x10 250 257 103%
OSA Total 250 257 103%
Notes:
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(CERTIFICATE OF ACCEPTANCE INRCA-L11-02-A
'Lighting g Control
'Project Name:Lady M-Arcadia Enforcement Agency CITY OF ARCADIA IlPermit Number B00-058-663
'Project Address:400 South Baldwin ('City:Arcadia I Zip Code:91007
Enforcement Agency Use: Checked by/Date
LIGHTING CONTROL ACCEPTANCE DOCUMENT
Automatic Shut-off Controls: Automatic Time Switch Control and Occupant Sensor
Intent: Lights are turned off or set to a lower level when not needed per Section 110.9(a)& 130.1(c).
A. Construction Inspection
Fill out Section A to cover spaces 1 through 3 that are functionally tested under Section B.
Instruments needed to perform tests include, but are not limited to: hand-held amperage meter, power meter, or light meter
1:Automatic Time Switch Controls Construction Inspection—confirm for all listed in Section 0
a.All automatic time switch controls are programmed for(check all):
P Weekdays F Weekend P Holidays
b. Document for the owner automatic time switch programming (check all):
F Weekday settings F Weekend settings F Holidays settings F Set-up settings
F Preference program setting F Verify the correct time and date is properly set in the time switch
F Verify the battery is installed and energized F Override time limit is no more than 2 hours
F Occupant Sensors and Automatic Time Switch Controls have been certified to the Energy Commission in accordance with
the applicable provision in Section 110.9 of the Standards, and model numbers for all such controls are listed on the Commission
database as Certified Appliance and Control Devices
2.Occupancy Sensor Construction Inspection—confirm for all listed in Section B
F Occupancy sensors are not located within 4 feet of any HVAC diffuser
F Ultrasonic occupancy sensors do not emit audible sound 5 feet from source
CAL TP California Advanced Lighting
Controls Training Program
This is page 1 of 15
CERTIFICATE OF ACCEPTANCE INRCA-LTI-02-A
'Lighting Control
'Project Name.Lady M-Arcadia ''Enforcement Agency.CITY OF ARCADIA 'Permit Number:B00-058-663
Project Address:400 South Baldwin 'City.Arcadia 'Zip Code:91007
B. Functional Testing of Lighting Controls
For every space in the building, conduct functional tests 1 through 5 below if applicable. If there are several geometrically similar spaces
that use the same lighting controls, test only one space and list in the cells below which"untested spaces"are represented by that
• tested space. EXCEPTION: For buildings with up to seven (7) occupancy sensors, all occupancy sensors shall be tested. (NA7.6.2.3)
Representative Spaces Selected
Tested space/room name: Sales
Space Type (office, corridor, etc)
Sales
Untested areas/rooms
Confirm compliance for all control system types (1-5) present in each space:
1. Automatic Time Switch Controls
Step 1:Simulate occupied condition
a. All lights can be turned on and off by their respective area control switch
b. Verify the switch only operates lighting in the ceiling-height partitioned area in
which the switch is located.
Step 2:Simulate unoccupied condition
a. All lighting, including emergency and egress lighting,turns off. Exempt lighting may
remain on per Section 130.1(c)1 and 130.1(a)1.
b. Manual override switch controls only the lights in the selected ceiling height
partitioned space where the override switch is located and the lights remain on no
longer than 2 hours (unless serving public areas and override switch is captive key
type).
Step 3:
System returned to initial operating conditions F�
2. Occupancy Sensors
Step 1:Simulate an unoccupied condition .
a. Lights controlled by occupancy sensors turn off within a maximum of 20 minutes
from start of an unoccupied condition per Standard Section 110.9(b)
b.The occupant sensor does not trigger a false 'on'from movement in an area
adjacent to the controlled space or from HVAC operation. r
Step 2:Simulate an occupied condition
a. Status indicator or annunciator operates correctly r
b. Lights controlled by occupancy sensors turn on immediately upon an occupied
condition OR sensor indicates space is 'occupied'and lights may be turned on
manually
CAL. TP California Advanced Lighting
Controls Training Program
This is page 2 of 15
CERTIFICATE OF ACCEPTANCE NRCA-LTI-02-A
'Lighting Control
'Project Name:Lady M-Arcadia "Enforcement Agency:CITY OF ARCADIA JPennit Number:B00-058-663
'Project Address:400 South Baldwin ''City:Arcadia "Zip Code:91007
Step 3:
System returned to initial operating conditions r
3. Partial Off Occupancy Sensor
Step 1:Simulate an unoccupied condition
a. Lights go to partial off state within a maximum of 20 minutes from start of an
unoccupied condition per Standard Section 110.9(a) r
b.The occupant sensor does not trigger a false 'on'from movement in an area
adjacent to the controlled space or from HVAC operation. For library book stacks or
warehouse aisle, activity beyond the stack or aisle shall not activate the lighting in
the aisle or stack. r
c.In the partial off state, lighting shall consume no more than 50%of installed lighting
power,or:
No more than 60%of installed lighting power for metal halide or high pressure
sodium lighting in warehouses.
No more than 60%of installed lighting power for corridors and stairwells in which
the installed lighting power is 80%or less of the value allowed under the Area
Category Method.
Light level may be used as a proxy for lighting power when measurements are taken r
Step 2:Simulate an occupied condition
The occupant sensing controls shall turn lights fully ON in each separately controlled
areas, Immediately upon an occupied condition r
4. Partial On Occupancy Sensors
Step 1.-Simulate an occupied condition.Verify partial on operation.
a. Immediately upon an occupied condition, the first stage activates between 50 to
70% of the lighting automatically. r
b. After the first stage occurs, manual switches allow an occupant to activate the
alternate set of lights, activate 100%of the lighting power, and manually
deactivate all of the lights. r
Step 2.Simulate an unoccupied condition
a. Both stages(automatic on and manual on) lights turn off within a maximum of 20
minutes from start of an unoccupied condition per Standard Section 110.9(a) r
b. The occupant sensor does not trigger a false 'on'from movement in an area
adjacent to the controlled space or from HVAC operation. r
C,►L TP California Advanced Lighting
Controls Training Program
This is page 3 of 15
'CERTIFICATE OF ACCEPTANCE ONRCA-LTI-02-A
'Lighting Control
IProlect frame Lady M-Arcadia UEnforcement Agency CITY OF ARCADIA IIPertnitNwnber B00-058-663
'Project Address.400 South Baldwin 'City:Arcadia Op Code:91007
5. Additional test for Occupancy Sensors Serving Small Zones in Office Spaces Larger than
250 ft , to Qualify for a Power Adjustment Factor (PAF)
Step 0:First,complete Functional Test 2(above)for each controlled zone.
Step 1:Verify area served and compare actual PAF with claimed PAF.Refer to Functional Test 2.
a. Area served by controlled lighting ft2
h. Enter PAF corresponding to controlled area from line (a) above (<125 ft2 for
PAF=0.4, 126-250 ft2 for PAF=0.3, 251-500 ft2 for PAF=0.2).
c. Enter PAF claimed for occupant sensor control in this space from the Certificate of
Compliance.
d. The PAF corresponding to the controlled area (line b), is greater than or equal to
the PAF claimed in the compliance documentation (line c).
e. Sensors shall not trigger in response to movement in adjacent walkways or
workspaces
f. All steps are conducted in Functional Test 2 'Occupancy Sensor (On Off Control)'
and all answers are Yes.
CAL TP California Advanced Lighting
Controls Training Program
This is page 4 of 15
CERTIFICATE OF ACCEPTANCE NRCA-LTI-02-A
Lighting Control - -
'Project Name Lady M-Arcadia I Enforcement.Agency:CITY OF ARCADIA Permit Number.800-058-653
'Project Address:400 South Baldwin I City:Arcadia 'kip Code:91007
C. Testing Results
1. Automatic Time Switch Controls (all answers must be Yes).
2. Occupancy Sensor(On Off Control) (all answers must be Yes). r
3. Partial Off Occupancy Sensor(all answers must be Yes). For warehouses, library
book stacks, corridors,stairwells in nonresidential buildings must also be
accompanied by passing Test 1 or Test 2.
4. Partial On Occupant Sensor for PAF (all answers must be Yes). r
5. Occupant Sensor serving small zones for PAF (all answers must be Yes). Also must
pass Test 2.
Representative Spaces Selected
Tested space/room name: Office
Space Type (office, corridor, etc) Office
Untested areas/rooms
Confirm compliance for all control system types (1-5) present in each space:
1. Automatic Time Switch Controls
Step 1:Simulate occupied condition
a. All lights can be turned on and off by their respective area control switch
b. Verify the switch only operates lighting in the ceiling-height partitioned area in
which the switch is located.
Step 2:Simulate unoccupied condition
a. All lighting, including emergency and egress lighting,turns off. Exempt lighting may
remain on per Section 130.1(c)1 and 130.1(a)1.
b. Manual override switch controls only the lights in the selected ceiling height
partitioned space where the override switch is located and the lights remain on no
longer than 2 hours (unless serving public areas and override switch is captive key
type).
Step 3:
System returned to initial operating conditions r
2. Occupancy Sensors
Step 1:Simulate an unoccupied condition
a. Lights controlled by occupancy sensors turn off within a maximum of 20 minutes
CAL TP California Advanced Lighting
Controls Training Program
This is page 5 of 15
•
CERTIFICATE OF ACCEPTANCE NRCA-LTI-02-A
'Lighting Control
'Project Name.Lady M-Arcadia Enforcement Agency:CITY OF ARCADIA ''Permit Number.B00-058-663
'Project Address:400 South Baldwin "City:Arcadia pip Code:91007
from start of an unoccupied condition per Standard Section 110.9(b) I W
b. The occupant sensor does not trigger a false 'on'from movement in an area
adjacent to the controlled space or from HVAC operation.
Step 2:Simulate an occupied condition
a. Status indicator or annunciator operates correctly r
b. Lights controlled by occupancy sensors turn on immediately upon an occupied
condition OR sensor indicates space is 'occupied'and lights may be turned on
manually F
Step 3:
System returned to initial operating conditions
3. Partial Off Occupancy Sensor
Step 1:Simulate an unoccupied condition
a. Lights go to partial off state within a maximum of 20 minutes from start of an
unoccupied condition per Standard Section 110.9(a) r
b.The occupant sensor does not trigger a false 'on'from movement in an area
adjacent to the controlled space or from HVAC operation. For library book stacks or
warehouse aisle, activity beyond the stack or aisle shall not activate the lighting in
the aisle or stack. r
c. In the partial off state, lighting shall consume no more than 50%of installed lighting
power,or:
No more than 60%of installed lighting power for metal halide or high pressure
sodium lighting in warehouses.
No more than 60%of installed lighting power for corridors and stairwells in which
the installed lighting power is 80%or less of the value allowed under the Area
Category Method.
Light level may be used as a proxy for lighting power when measurements are taken r
Step 2:Simulate an occupied condition
The occupant sensing controls shall turn lights fully ON in each separately controlled
areas, Immediately upon an occupied condition r
4. Partial On Occupancy Sensors
Step 1.-Simulate an occupied condition.Verify partial on operation.
a. Immediately upon an occupied condition, the first stage activates between 50 to
70%of the lighting automatically. r
b. After the first stage occurs, manual switches allow an occupant to activate the
alternate set of lights, activate 100% of the lighting power, and manually
deactivate all of the lights. r
Step 2.Simulate an unoccupied condition
l � 1
Com.. TP California Advanced Lighting
Controls Training Program
This is page 6 of 15
CERTIFICATE OF ACCEPTANCE NRCA-LTI-02-A
'Lighting Control
(Project Name.Lady M-Arcadia 'Enforcement Agency:CITY OF ARCADIA 'Permit Number BOO-058-663
Project Address:400 South Baldwin 'City:Arcadia I Zip Code:91007
a. Both stages (automatic on and manual on) lights turn off within a maximum of 20
minutes from start of an unoccupied condition per Standard Section 110.9(a) r
b.The occupant sensor does not trigger a false 'on' from movement in an area
adjacent to the controlled space or from HVAC operation. r
CALE>
TP California Advanced Lighting
Controls Training Program
This is page 7 of 15
•
CERTIFICATE OF ACCEPTANCE NRC.A-LTI-02-A
'Lighting Control
'Project Name.Lady M-Arcadia [[Enforcement Agency.CITY OF ARCADIA [[Permit Number B00-058-663
'Project Address:400 South Baldwin [[City:Arcadia '[Zip Code:91007
5. Additional test for Occupancy Sensors Serving Small Zones in Office Spaces Larger than
250 ft , to Qualify for a Power Adjustment Factor (PAF)
Step 0:First,complete Functional Test 2(above)for each controlled zone.
Step 1:Verify area served and compare actual PAF with claimed PAF.Refer to Functional Test 2.
3. Area served by controlled lighting ft2
b. Enter PAF corresponding to controlled area from line (a) above (<125 ft2 for
PAF=0.4, 126-250 ft2 for PAF=0.3, 251-500 ft2 for PAF=0.2).
c. Enter PAF claimed for occupant sensor control in this space from the Certificate of
Compliance.
d.The PAF corresponding to the controlled area (line b), is greater than or equal to
the PAF claimed in the compliance documentation (line c). C.
c. Sensors shall not trigger in response to movement in adjacent walkways or
workspaces r
f. All steps are conducted in Functional Test 2 'Occupancy Sensor(On Off Control)'
and all answers are Yes. r
CAL \` TP California Advanced Lighting
Controls Training Program
This is page 8 of 15
CERTIFICATE OF ACCEPTANCE NRCA-LTI-02-A
!Lighting Control I
!Project Name:Lady M-Arcadia '!Enforcement Agency.CITY OF ARCADIA Permit Number:BOO-058-663
!Project Address:400 South Baldwin IICity:Arcadia kip Code:91007
C. Testing Results
1. Automatic Time Switch Controls (all answers must be Yes). r
2. Occupancy Sensor(On Off Control) (all answers must be Yes).
3. Partial Off Occupancy Sensor(all answers must be Yes). For warehouses, library
book stacks, corridors,stairwells in nonresidential buildings must also be
accompanied by passing Test 1 or Test 2. r
4. Partial On Occupant Sensor for PAF (all answers must be Yes). r
5. Occupant Sensor serving small zones for PAF (all answers must be Yes). Also must
pass Test 2. r
Representative Spaces Selected
Tested space/room name: BOH
Space Type (office, corridor, etc) BOH
Untested areas/rooms
Confirm compliance for all control system types (1-5) present in each space:
1. Automatic Time Switch Controls
Step 1:Simulate occupied condition
a. All lights can be turned on and off by their respective area control switch r
b. Verify the switch only operates lighting in the ceiling-height partitioned area in
which the switch is located. r
Step 2:Simulate unoccupied condition
a. All lighting, including emergency and egress lighting,turns off. Exempt lighting may
remain on per Section 130.1(c)1 and 130.1(a)1. r
b. Manual override switch controls only the lights in the selected ceiling height
partitioned space where the override switch is located and the lights remain on no
longer than 2 hours (unless serving public areas and override switch is captive key
type).
r
Step 3:
System returned to initial operating conditions r
2. Occupancy Sensors
Step 1:Simulate an unoccupied condition
a. Lights controlled by occupancy sensors turn off within a maximum of 20 minutes
CALE>TP California Advanced Lighting
Controls Training Program
This is page 9 of 15
CERTIFICATE OF ACCEPTANCE NRCA-LTI-02-A
'Lighting Control
'Project Name.Lady M-Arcadia IIEnforcement Agency.CITY OF ARCADIA IJPennit Number.B00-058-663
'Project Address:400 South Baldwin IjCity:Arcadia Pip Code:91007
from start of an unoccupied condition per Standard Section 110.9(b) I 1
b. The occupant sensor does not trigger a false 'on' from movement in an area
adjacent to the controlled space or from HVAC operation. r
Step 2:Simulate an occupied condition
a. Status indicator or annunciator operates correctly
b. Lights controlled by occupancy sensors turn on immediately upon an occupied
condition OR sensor indicates space is'occupied' and lights may be turned on
manually r
Step 3:
System returned to initial operating conditions
3. Partial Off Occupancy Sensor
Step 1:Simulate an unoccupied condition
a. Lights go to partial off state within a maximum of 20 minutes from start of an
unoccupied condition per Standard Section 110.9(a) r
b. The occupant sensor does not trigger a false 'on' from movement in an area
adjacent to the controlled space or from HVAC operation. For library book stacks or
warehouse aisle, activity beyond the stack or aisle shall not activate the lighting in
the aisle or stack. r
c. In the partial off state, lighting shall consume no more than 50%of installed lighting
power,or:
No more than 60%of installed lighting power for metal halide or high pressure
sodium lighting in warehouses.
No more than 60%of installed lighting power for corridors and stairwells in which
the installed lighting power is 80%or less of the value allowed under the Area
Category Method.
Light level may be used as a proxy for lighting power when measurements are taken r
Step 2:Simulate an occupied condition
The occupant sensing controls shall turn lights fully ON in each separately controlled
areas, Immediately upon an occupied condition r
4. Partial On Occupancy Sensors
Step 1.-Simulate an occupied condition.Verify partial on operation.
a. Immediately upon an occupied condition, the first stage activates between 50 to
70%of the lighting automatically. r
b. After the first stage occurs, manual switches allow an occupant to activate the
alternate set of lights, activate 100% of the lighting power, and manually
deactivate all of the lights. r
Step 2.Simulate an unoccupied condition
1 � 1
CAL TP California Advanced Lighting
Controls Training Program
This is page 10 of 15
CERTIFICATE OF ACCEPTANCE NRCA-LTl-02-A
'Lighting Control
'Project Name Lady M-Arcadia IIEnforcement Agency.CITY OF ARCADIA IIPermit Number 800-058-663 I
(Project Address:400 South Baldwin "City:Arcadia IIZip Code:91007 I
1a. Both stages (automatic on and manual on) lights turn off within a maximum of 20
minutes from start of an unoccupied condition per Standard Section 110.9(a) p
b.The occupant sensor does not trigger a false 'on' from movement in an area
adjacent to the controlled space or from HVAC operation.
CALGTP TP California Advanced Lighting
Controls Training Program
This is page 11 of 15
'CERTIFICATE OF ACCEPTANCE NRCA-LTI-02-A
'Lighting Control
'Protect Name.Lady M-Arcadia IlEnforcement Agency CITY OF.ARCADI A !Permit Number B00.058-663
'Protect Address.400 South Baldwin Itchy.Arcadia Zip Code:91007
5. Additional test for Occupancy Sensors Serving Small Zones in Office Spaces Larger than
250 ft , to Qualify for a Power Adjustment Factor (PAF)
Step 0:First,complete Functional Test 2(above)for each controlled zone.
Step 1:Verify area served and compare actual PAF with claimed PAF.Refer to Functional Test 2.
a. Area served by controlled lighting ft2
b. Enter PAF corresponding to controlled area from line (a) above (<125 ft2 for
PAF=0.4, 126-250 ft2 for PAF=0.3, 251-500 ft2 for PAF=0.2).
c. Enter PAF claimed for occupant sensor control in this space from the Certificate of
Compliance.
d.The PAF corresponding to the controlled area (line b), is greater than or equal to
the PAF claimed in the compliance documentation (line c).
Sensors shall not trigger in response to movement in adjacent walkways or
workspaces
f. All steps are conducted in Functional Test 2 'Occupancy Sensor (On Off Control)'
and all answers are Yes.
CAL.6 TP California Advanced Lighting
Controls Training Program
This is page 12 of 15
CERTIFICATE OF ACCEPTANCE NRCA-LTI-02-A
'Lighting Control
!Project Name Lady M-Arcadia (Enforcement Agency CITY OF ARCADIA I Permit Number.BW-058-663
!Project Address 400 South Baldwin !City:Arcadia IQZ.ip Code.91007 _J
C. Testing Results
1. Automatic Time Switch Controls (all answers must be Yes).
2. Occupancy Sensor(On Off Control) (all answers must be Yes). r
3. Partial Off Occupancy Sensor(all answers must be Yes). For warehouses, library
book stacks, corridors,stairwells in nonresidential buildings must also be
accompanied by passing Test 1 or Test 2.
4. Partial On Occupant Sensor for PAF (all answers must be Yes). r
5. Occupant Sensor serving small zones for PAF (all answers must be Yes). Also must
pass Test 2.
D. Evaluation :
17 PASS: All applicable Construction Inspection responses are complete and all applicable
Equipment Testing Requirements responses are positive.
CAL TP California Advanced Lighting
Controls Training Program
This is page 13 of 15
CERTIFICATE OF ACCEPTANCE INRCA-LTI-02-A
Lighting Control
'Project Name Lady M-Arcadia 'Enforcement Agency:CITY OF ARCADIA IlPemtit Number:BO0-058-663
'Project Address:400 South Baldwin City.Arcadia IIZip Code:91007
DOCUMENTATION AUTHOR'S DECLARATION STATEMENT
I certify that this Certificate of Acceptance documentation is accurate and complete.
Documentation Author Company Name
Name Tracy Beattie Renovise, Inc.
Address City
5968 Joshua Trail Camarillo
Zip Code Phone
93012 (805)236-7260
CEA/ATT Certification Author Signature
Identification(if TC-A813710
applicable)
0 Illigr IIIIIIp
'4.. e A ri.AI ..„,..,
I.•
Date of Signature.
a. • r 8
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 the building permit(s)issued for the building.
Field Technician Name Company Name
Tracy Beattie Renovise, Inc.
Address: City
5968 Joshua Trail Camarillo
Zip Code Phone
93012 (805)236-7260
ATT Certification TC-A813710 Position with Company Vice President
Identification (Title)
Field Technic' Si. ature
4 . A Ad to:..iLl I...
iv4_ I
Date of Signature: 06/28/2w
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. I 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. 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 Company Name
Person Name Bonnie Beattie Renovise, Inc.
Address: City
5968 Joshua Trail Camarillo
Zip Code Phone
93012 (805)236-7260
CSLB License Position with Company
995038 (Title) President
Responsibl.pr
ce Person Signature
Vir rip' • gillno
1 11,
of Sian
06/28/2016
-A..
CAL TP California Advanced Lighting
Controls Training Program
This is page 14 of 15