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Home My WebLink AboutUntitled City of Arcadia, CA M - PermitNO 11.20 0598 S%1/174 Development Services Department1.-,----;,..':--,2--f.` : . '' P P ' D _ r ( Permit Type:°Tenant Improvement: # 240 West Huntington Drive,Post Office Box 60021 f c, di 1 Arcadia,CA 91066-6021 Work Classification Tenant Improvement. ,. (626)574 5416 , %‘‘,00'.,,. ...', wad.. _, 4,, . ....6„,„.1 ` x `, °: A °�.� � �new Permit 5tafus issued ARCADIA IssueDate:'11/05/20201 Expiration: 11/05/2021 Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number 140 Live Oak AVE Arcadia,CA 8573024031 Contacts MEEKER FAMILY PARTNERS LP Owner Jan Bustalino Applicant 368 LAMBERT RD,CARPENTERIA,CA 93013 (818)447-7402 Jan@permitadvisors.com A R MAYS CONSTRUCTION INC* Contractor 6900 INDIAN SCHOOL RD 200,SCOTTSDALE,AZ 85251 ._ (408)850-6900 582869 Description:T.I.FOR NEW GROCERY STORE,INCLUDES RACKS, ii.. Valuation: $ 650,000.00 Tenant WALK IN COOLERS,NEW DOOR SYSTEM.MEPS V Total Sq Feet: 0.00 Plan Check#20-598 Plan#358 Fees Amount Payments Amount Paid Accessibility Plan Check $489.36 Total Fees $12,263.70 Accessiblity Building Permit $501.90 Cash/Receipt#REC-05981-20 $6,901.95 Add/Alter Ducts $99.40 Cash/Receipt#REC-04356-20 $5,361.75 Air Handling Units<=10,000 cu ft per min. $29.92 Building Issuing Fee $47.01 Amount Due: $0.00 Building Permit Fees - $5,019.00 Building Plan Review Fee $3,262.35 Cal Green Plan Check $326.24 Commercial T.I.Fire Plan Chk. $280.00 Commercial service 200 to 1000amps $65.86 Distribution Panel $65.92 CALLS FOR INSPECTIONS Electrical Permit Issuance Fee $47.01 Request for inspection by telephone at 626-574-5450. Leave a message Energy Plan Review Fee $1,003.80 requesting the address,timeframe and what inspection item is needed. Fire Final Occupancy Fee $200.00 Floor Drain Fee $13.21 Floor Sink $13.21 This permit/plan review expires by time limitation and becomes null and Furnace or Burner<=100,000 BTU $59.58. void if the work authorized by the permit is not commenced within 180 days Furnace or Burner>100,000 BTU $49.80 from the date of issuance or if the permit is not obtained within 180 days Gas System(Outlets) $16.43 from the date of plan submittal.This permit expires and becomes null and Green Building Standard $26:00 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 Kitchen Sink $26.42 Arcadia building inspector fora period of 180 consecutive days. Total: $12,263.70 t COMPLETED November 05, 2020 Issued By: .Date November 05,2020 Page 1 of 1 AR U~44 oFF C4, ,, A' PERMIT/PLAN REVIEW APPLICATION it ,,i ,,,�, it j. 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: \jhapter 9(commencing with Section 7000,of Division 3 of the Business and ofessions Code and my license is in full force and effect. ❑ I have and will maintain a certificate of consent to self-insure for workers' cense Class 710-No2U( Exp. Date fI Z, compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. gnature of Contract°- " ��`� i1 I have and will maintain workers'compensation insurance,as required by Section WNER-BUILDER : RATION 3700 of the Labor Code,for the performance of the work for which this permit ❑ I hereby affirm under penalty of perjury that I am exempt from the Contractors is issue .My wor ers'compen a on insur. a carrier policy numbers are: License Law for the following reason(Section 7031.5,Business and Professions ll ,�,it j (�fj f a/+ Code.Any city or county which requires a permit to construct,alter,improve, Carrier s tl //�� VII vll�1 fW� l Cb demolish,or repair any structure,prior to its issuance,also required the applicant olicy Number �l� 2 v for such permit to file a signed statement that he or she is licensed pursuant to the s section need not be completed if the permit is for one hundred dollars or less) provisions of the Contractors License Law(Chapter 9(commencing with Section 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 L'l 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 Sectia-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 forQQ r� n n `A `'/ sale(Section 7044,Business and Professions Code:The Contractors License Date \ k "✓� !N 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 [I`&t 1A - \I. 1_ Title %May( PRINT N• r. I certify that I have read this application and state that the above information is c rrect and that I am the owner or duly authorized agent of the owner. I agree to compl with • City ordinances and State Laws relating to buildi g construction. I hereby authorize representatives of the City of Arcadia to enter • th\bovementioned- property for inspection purposes. Signatur:O' ,4,i 'k Date tr\YDVX NOTES Building Inspections Date Insp. Plumbing Inspections Date 0141Insp. 140 E 1_`f f� 1 V 100. Setbacks 210. Under ft./bldg.drain / ,1 i'2Q .114 ' L� Q' 101. Rough grade 211. Copper underslab LL --,, - ^�- 0�[ v 102. Figs.&forms 212. Rough plumbing 1R-3r2o QYV 103. Pre-slab (.Z 2-a0 213. Rough gas M 2 Tow:04 Floor joists 214. Shower pan 12-3?c0 a sAlfr 105. Steel 215. Water heater j g cMi � eF a ROOMS MD 106. Grout lift 216. Roof drains 4 !� 107. Shear nailing 217. Building sewer Lot-Wee r1 Al 108. Diaph nailing 218. Water service r_- (/ (St L " ' bb 109. Roof nailing 219. Final gas c61 �(� /^� �(s 110. Framing t.Z 3-� f 'V 220. Fixtures u""^� `'7 " 111. Occ./Area Sept.Wall 221. Final plumbing 1�2 L �� f c.. (J 1 112. Sound walls 222. Sewer cap/demo. �-V 113. T-bar grid • 114. Insulation-Flr. Pool Inspections Date Insp. 115. Insulation-Wall 240. Excavation/steel 116. Insulation-Cell. Nil� 241. Rough plumbing 117. Drywall nailing 12-I1� v V242. Light shell/bonding 118. Interior lath 243. Underground conduit 119. Exterior lath 244. P-trap 120. Finish grade 245. Gas line&test 121. Final building c7-1- I1113 246. Fence,gates&signs 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 conduitReroof Inspections Date I 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.bonding Sign Inspections Date Insp. 160. Service panel(IL611/+• (2,r3D.,2, 280. Setback/overhang 161. Final electric 281. Footing 282. Conduit/wiring Mechanical Inspections Date Insp. 283. Disconnect 180. Venting/flue 284. Final sign 181. Furnace/A.C. 182. Rouch HVAC 12.00 prirmffintmemirprimirtre 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. I Date I Insp. 191. Final mechanical I_)-i-)- 300. Lateral(main to P/L) 301. Saddle/Y Block Wall Inspections ' Date -Insp" 302. Cesspool filled 200. Footings ' 303. Sidewalk 201. Steel/rebar �'�+Zll 304. Driveway 202. Grout lift Z1`-'2( PN 305. Curb replacement 203. Final wall 306. Trash bin fl City of Arcadia, CA t .k; „ � 4a -" t rPermitNo TI`20 0688 N°• f. Development Services Department : f ' ` --N- ' 1 3 Permit Type Tenant Improvement a R� 4 240 West Huntington Drive,Post Office Box 60021 A U �� t ` j Arcadia,CA 91066-6021 7 , VYork CiasslficatiOn TI Interior Demolition ---� � i,,I,z 6 iF ; � (626)574-5416 � � a s xd r PelmltStctus Issued`' . CAD IA. , ,Issue Date 09 14 2020 P �. .• / 1 I Ex iration: 09 14 2021 Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number 140 Live Oak AVE Arcadia,CA 8573024031 F I Contacts MEEKER FAMILY PARTNERS LP Owner A R MAYS CONSTRUCTION INC* Contractor F 368 LAMBERT RD,CARPENTERIA,CA 93013 6900 INDIAN SCHOOL RD 200,SCOTTSDALE,AZ 85251 (408)850-6900582869 Description:INTERIOR DEMOLITION FOR FUTURE GROCERY ki Valuation: $ 22,300.00 4 Tenant OUTLET Total Sq Feet: 0.00 F Plan Check#• Plan#264 Fees Amount Payments Amount Paid Building Issuing Fee $47.01 Total Fees $839.73 Building Permit Fees $454.35 Cash/Receipt#REC-05465-20 $839.73 Building Plan Review Fee $295.33 Cal Green Plan Check $29.54 Amount Due: $0.00 Green Building Standard $1.00 Solid Waste Management Fee $6.25 Strong Motion Inst.Program Com $6.25 Total: I $839.73 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. v COMPLETED September 14, 2020 Issued By: Date September 14,2020 Page 1 of 1 of&R 4 Puroa,„0, °� �• ,' PERMIT/PLAN REVIEW APPLICATION • Development Services Department,240 West Huntington Drive,Post Office Box 60021 o\Y% 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. 0 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 performance of the work for which this permit is issued. Signature of Contractor 0 I have and will maintain workers'compensation insurance,as required by Section OWNER-BUILDER DECLARATION ❑ 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 Policy Number for such permit to file a signed statement that he or she is licensed pursuant to the (This section need not be completed if the permit is for one hundred dollars or less) provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is ❑ I certify that in the performance of the work for which this permit is issued,I shall exempt there from and the basis for the alleged exemption. Any violation of 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 penaltiesand 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 dik NO of Los,, COUNTY OF LOS ANGELES• DEPARTMENT OF PUBLIC HEALTH e`;• `� ENVIRONMENTAL HEALTH f til .)4 + ,{I IBi- + SPECIALIZED SURVEILLANCE AND ENFORCEMENT BRANCH PLAN CHECK PROGRAM-BALDWIN PARK Comm OF Los ANGELES "c�eIFORNp 5050 COMMERCE DR,BALDWIN PARK,CA 91706 Public Health PHONE:(626)430-5560 VWVVV.PU BLICHEALTH.LA000NTY.GOV/EH PLAN CHECK OFFICIAL INSPECTION REPORT DATE 02/16/2021 EHS TINA GRIGORIAN PLAN CHECK NUMBER SR0220864 PROGRAM ELEMENT 1713-FOOD MARKET RETAIL(6,000-19,999 SF) OWNER/REQUESTER NA BUSTALINO(PERMIT ADVISORS), PROJECT MANAGER DBA GROCERY OUTLET INC. ADDRESS 140 LIVE OAK,ARCADIA,CA 91006 FINAL REINSPECTION STATUS: APPROVED CORRECTIONS COMPLETED R ` CORRECTION CATEGORY DATE IDENTIFIED DATE CORRECTED PLAN SUBMITTAL/REMODEL 01/29/2021 02/16/2021 ADDITIONAL REQUIREMENTS. FACILITY IS APPROVED TO OPEN AND OPERATE. NO ADDITIONAL REQUIREMENTS. FINAL CITY OF ARCADIA BUILDING APPROVAL WAS RECEIVED VIA EMAIL ON 02/16/21. COMMENTS OFFICE APPROVAL: FACILITY IS APPROVED TO OPEN AND OPERATE. NO ADDITIONAL REQUIREMENTS. Help us serve you better by completing a short survey.Visit our website at www.publichealth.lacountv.00v/eh. EHS Signature Page 1 of 2 PLAN CHECK OFFICIAL INSPECTION REPORT DATE 02/16/2021 EHS TINA GRIGORIAN PLAN CHECK NUMBER SR0220864 PROGRAM ELEMENT 1713-FOOD MARKET RETAIL(6,000-19,999 SF) OWNER/REQUESTER NA BUSTALINO(PERMIT ADVISORS), PROJECT MANAGER- • DBA GROCERY OUTLET INC. ADDRESS 140 LIVE OAK,ARCADIA, CA 91006 DISCLOSURES It is a misdemeanor violation to begin operation without a valid Public Health Permit/License.The Public Health Permit/License will be issued by the Los Angeles County Department of Public Health Environmental Health Division(DPH-EH)Plan Check Program at the job site following final inspection and approval by all applicable agencies. Remodeledareas of an existing food facility/establishment must obtain a final inspection and approval from all applicable enforcement agencies prior to use. 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 DPH-EH Plan Check Program. Additional approvals may be required from other enforcement agencies. It is improper and illegal for any County officer,employee or inspector to solicit bribes,gifts or gratuities in connection with performing their official duties. Improper solicitations include requests for anything of value such as cash,discounts,free services,paid travel or entertainment,or tangible items such as food or beverages. Any attempt by a County employee to solicit bribes,gifts or gratuities for any reason should be reported immediately to either the County manager responsible for supervising the employee or the Fraud Hotline at(800)544-6861 or www.lacountyfraud.org. YOU MAY REMAIN ANONYMOUS Public Health Permit/License: A separate fee is required for the Public Health.Permit/License.A billing statement Will be sent to the permit/license holder. annually by the DPH-EH. The fee is required to be paid to perform or carry on,conduct or engage in any mobile food facility listed in Los Angeles County Code,Title 8,Section 8.04.720. State and Local Licenses and Permits: Contact the State of California and your local city hall regarding additional license and permit requirements. Restrooms: - Customer may use restroom facilities if they are located in a customer area.Customers may not enter the food preparation area,food storage area,or the utensils washing/storage areas in order to access the restrooms.All food,utensils and equipment must be protected from contamination. Routine Inspection:The DPH-EH conducts routine inspections of all food facilities in Los Angeles County. Following the issuance of your Public Health Permit by the Plan Check Program,an Environmental Health Specialist from your local district will conduct an inspection of your facility. If your Business is located in a city that has adopted the grading ordinance,the inspector will post a grade or score card at your facility. Grade/Score cards are not issued by the Plan Check Program. Help us serve you better by completing a short survey.Visit our website at www.publichealth.lacountv.00v/eh. EHS Signature Page 2 of 2 !_ 1<raZa T1 & ASSOCIATES , INC . GEOTECHNICAL ENGINEERING • ENVIRONMENTAL ENGINEERING CONSTRUCTION TESTING AND INSPECTIONS January 20,2021 KA Project No.: 116-20147 Ms.Tiffany Edwards Grocery Outlet,Inc. 5650 Hollis Street Emeryville,CA . tedwards@cfgo.com RE: Special Inspection Services—Progress Report 1 Proposed Grocery Outlet#2 140 E.Live Oak Arcadia,CA 91006 Dear Ms.Edwards: In accordancewith your request and authorization, our firm has provided construction observation and materials testing(special inspection)services for the above-referenced project. This report documents the services provided by our field personnel during the period of December 10th, 2020 through December 16th, 2020. Copies of our daily field reports documenting the work observed and our findings_ are attached. Special inspection tasks included: • Observation of the installation of drilled in anchors. • Observation of in-progress and completed reinforcing steel placement. . • Observation of concrete masonry unit("block")placement on an intermittent basis. • Sampling of grout and preparation of compressive strength test specimens. • Transportation'of compression test specimens to the laboratory for curing and testing. •- Review of welder's qualification papers. • Observation of structural steel welding at the jobsite. Basedon the observations of our technicians and the results of field testing services,it is our professional opinion that the construction observed and the materials tested during the identified time period were, to the best of our knowledge, in accordance with the approved project documents and the requirements of the Uniform or International Building Code,and/or A.C.I,AWS Structural Steel Code and/or A.I.S.C. Laboratory test results are reported under separate cover as the tests are completed. LIMITATIONS 1100 Olympic Drive# 103 •Corona,California.92881 •(951)273-1011 •FAX(951)273-1003 With Offices Serving The Western United States P:\116\2020\2020 Projects\11620147 Grocery Outlet Arcidia\Reports\11620147 PRI 012021.doc KA No. 116-20147 Page No.2 Construction observation, inspection and testing (special inspection) services are techniques used to check construction for conformance with the project requirements as the work progresses and to reduce the potential that construction elements are not in compliance with the project requirements as the work is completed. Even with diligent construction monitoring, some construction defects may be missed. .In all cases, the contractor retains sole responsibility for the quality of work, for adhering to plans and specifications and for repairing defects, deficiencies or omissions, regardless of when they are found. We have performed our services in a manner consistent with the standard of care and skill ordinarily exercised by firms of our type practicing under similar conditions at this same time and locality. However, we do not undertake the guarantee of construction or production of a completed project conforming to the project plans and specifications: No warranty or guarantee is expressed or implied. Our services during the identified period of time were limited to those documented in our attached reports. If you have any questions regarding the information contained in this cover letter or the attachedreports,or if we can be of further assistance,please contact our Corona office at(951)273-1011. Respectfully submitted, KRAZAN&ASSOCIATES,INC. ten James M.Kellogg,PE Managing Engineer RCE No. 65092 JMK\sk . Attachments:. Daily Field Reports - cc: Addressee Krazan&Associates,Inc. With Offices Serving The Western United States 1<raZarl SITE DEVELOPMENT ENGINEERS 1100 Olympic Drive,Suite#103, Corona,California,92881 Phone: (951)273-1003 C x PL ❑ NC ❑ FIX ❑ PAGE 1 OF 1 FIELD INSPECTION REPORT FOR: REINFORCED CONCRETE DREINFORCED MASONRY 0 WELDING❑FIREPROOFING ❑Q.C.CONCRETE ❑ROOFING/WATERPROOFING❑P.T.CONCRETE/STRESSM EPDXY ANCHORS ❑H.S.BOLTING SOILS PROJECT TITLE: PHASE#: DSA FILE NO.: DSA APP.NO.: Grocery Outlet PROJECT ADDRESS: PERMIT NO: KRAZAN JOB# 140 W Live Oak Ave TI-20-0598 ARCHITECT: ENGINEER: MBH VLMK GENERAL CONTRACTOR: SUB CONTRACTOR: Cajon Concrete Construction MATERIAL CLASSIFICATION: Simpson Set-XP (Expires 07/06/22) DATE: DESCRIPTION OF WORK INSPECTED: 11/17/20 Observed placement of 16" dowels with epoxy embedded 4 inches into concrete slab located along lines A.3/3-4;A.3/2.5;A.5/1-2. I toles were brushed and blown prior to installation No discrcpancics found Inspector Name(print) P.E.REVIEW: Jesus Mendoza CBC/UBC I hereby certify that I have inspected the above reported work. Unless noted otherwise, the work inspected is to the best of my knowledge in compliance with the approved plans,specifications and applicable sections of the governing building laws. Inspector Initials 8894528 DSA/OSHPD I hereby certify that I have inspected the above reported work in accordance with the requirements of DSA/OSHPD approved documents.Sampling and testing were conducted in INSPECTORS SIGNATURE REGISTRATION No. accordance with the requirements of the DSA/OSHPD approved documents. The work inspected corn lies with the DSA/OSHPD approved documents. Yes f No:]lnspector Initials J_A.M qL-„, 11/17/20 SIGNATURE DATE —MA Iran SITE DEVELOPMENT ENGINEERS 1100 Olympic Drive,Suite#103, Corona,California,92881 Phone: (951)273-1003 C x PL ❑ NC ❑ FIX ❑ PAGE 1 OF 1 FIELD INSPECTION REPORT FOR: REINFORCED CONCRETE ❑REINFORCED MASONRY 0 WELDING OFIREPROOFING ❑Q.C.CONCRETE ❑ROOFING/WATERPROOFING❑P.T.CONCRETE/STRESS®EPDXY ANCHORS ❑H.S.BOLTING SOILS PROJECT TITLE: PHASE#: DSA FILE NO.: DSA APP.NO.: Grocery Outlet#2 PROJECT ADDRESS: PERMIT NO: • •KRAZAN JOB# 140 W Live Oak Ave. Tl-20-0598 ARCHITECT: ENGINEER: MBH VLMK GENERAL CONTRACTOR: SUB CONTRACTOR: Cajon Concrete Construction MATERIAL CLASSIFICATION: DATE: DESCRIPTION OF WORK INSPECTED: 11/19/20 Arrived at job site at 1 to inspect epoxy placement. However, work was cancelled due to lack of material. Postponed till further notice. Inspector Name(print) P.E.REVIEW: Jesus Mendoza CBC/UBC I hereby certify that I have inspected the above reported work. Unless noted otherwise, the work inspected is to the best of my knowledge in compliance with the approved plans,specifications and applicable sections of the governing building laws. Inspector Initials 8894528 DSA/OSHPD I hereby certify that I have inspected the above reported work in accordance with the requirements of DSA/OSHPD approved documents.Sampling and testing were conducted in INSPECTORS SIGNATURE REGISTRATION No. accordance with the requirements of the DSA/OSHPD approved documents. The work inspected corn lies with the DSA/OSHPD approved documents. Yes f1No: jnspector Initials J.A.M 11/19/20 SIGNATURE DATE **A Krazan =4;1=3 SITE DEVELOPMENT ENGINEERS 1100 Olympic Drive,Suite#103, Corona, California,92881 Phone: (951)273-1003 C x PL ❑ NC ❑ FIX ❑ PAGE 1 OF 1 FIELD INSPECTION REPORT FOR: REINFORCED CONCRETE DREINFORCED MASONRY 0 WELDING['FIREPROOFING ❑Q.C.CONCRETE ❑ROOFING/WATERPROOFINGP.T.CONCRETE/STRESS.EPDXY ANCHORS [H.S.BOLTING SOILS PROJECT TITLE: PHASE#: DSA FILE NO.: DSA APP.NO.: Grocery Outlet#2 PROJECT ADDRESS: PERMIT NO: KRAZAN JOB# 140 W Live Oak Ave. TI-20-0598 ARCHITECT: ENGINEER: MBH VLMK GENERAL CONTRACTOR: SUB CONTRACTOR: Cajon Concrete Construction MATERIAL CLASSIFICATION: Simpson Set XP (Expires 08/25/22) DATE: DESCRIPTION OF WORK INSPECTED: 11/20/20 Observed placement of 3/4 anchors with epoxy, embedded 5 1/2" into CMU wall @ 16" o.c located along lines A/3-4 All irI auuurdanue lu detail B/S2.0 and 8/S2.0 lincs 1/A.5 B according to dctail 7/S3.0 Holes were properly brushed and blown prior to placement No disrrPpancies found Inspector Name(print) P.E.REVIEW: Jesus Mendoza CBC/UBC I hereby certify that I have inspected the above reported work. Unless noted otherwise, the work inspected is to the best of my knowledge in compliance with the approved plans,specifications and applicable sections of the governing building laws. Inspector Initials 8894528 DSA/OSHPD I hereby certify that I have inspected the above reported work in accordance with the requirements of DSA/OSHPD approved documents.Sampling and testing were conducted in INSPECTORS SIGNATURE REGISTRATION No. accordance with the requirements of the DSA/OSHPD approved documents. The work inspected corn lies with the DSA/OSHPD approved documents. Yes;]No: nspector Initials J_A.M 11/20/20 SIGNATURE DATE • vtom' t sD r-Vr i@1 •1Mrc', gi SSI: LitVHC:PM Wi Plc INF 5 1100 Olympic Drive,Suite#103,Corona,California,92881 Phone: (951)273-1003 1-71-7-1c PL ❑ NC ❑ FIX ❑ PAGE 1 OF 1 FIELD INSPECTION REPORT FOR: REINFORCED CONCRETE ®REINFORCED MASONRY ❑WELDING❑FIREPROOFING ❑Q.C.CONCRETE ❑ROOFING/WATERPROOFING❑P.T.CONCR ETE/STRESS®EPDXY ANCHORS ❑H.S.BOLTING SOILS PROJECT TITLE: PHASE#: DSA FILE NO.: DSA APP.NO.: Grocery Outlet Arcadia#2. PROJECT ADDRESS: PERMIT NO: KRAZAN JOB# 140 E. Live Oak,Arcadia CA TI-20-0598 ARCHITECT: ENGINEER: MBH VLMK GENERAL CONTRACTOR: SUB CONTRACTOR: MATERIAL CLASSIFICATION: DATE: DESCRIPTION OF WORK INSPECTED: 12/10/2020 Task#1 1- i performed visual inspection for post installed rebars dowels in existing concreteand masonry , at the CMU wall infill As per details 1/S 3.0 ,4/S 3.0 2-the contractor used Epoxy Simpson strong-tie Set-XP 3- i verified embedment depth met job specification 4- i verified the holes diameter met lob specification 5- i verified the holes cleaning procedure met job specifications Task#2 1- i performed visual inspection for construction of 8"CMU wall infill-as per details A/S3.0 ,B/S3.O 2- the contractor used mortar type-S. 3-i verified rebars met job specifications 4-the infill walls were full grouted by pre-mix concrete 3000 psi inspector Name(print) Sarni Allakkis CBC/UBC I hereby certify that I have inspected the above reported work. Unless noted otherwise, the work inspected is to the best of my knowledge in compliance with the approved plans,specifications and applicable sections of the governing building laws. ICC 8786459 Inspector Initials SA. LADBS PO37122 DSAIOSHPD I hereby certify that I have inspected the above reported work in accordance with the requirements of DSAIOSHPD.approved documents.Sampling and testing were conducted in INSPECTORS SIGNATURE REGISTRATION No. accordance with the requirements of the DSA/OSHPD, approved documents. The work inspected complies with the DSA/OSHPD approved documents. Yes:,No: Inspector Initials 12/10/2020 SIGNATURE DATE 41.1E-PA-7"'" "(teaZan- SITE DEVELOPMENT ENGINEERS 1100 Olympic Drive, Suite#103,Corona,California,92881 Phone: (951)273-1003 • C x F21.71-17]-1 NC ❑ FIX ❑ PAGE 1 OF 1 FIELD INSPECTION REPORT FOR: REINFORCED CONCRETE ['REINFORCED MASONRY 0 WELDING❑FIREPROOFING ❑Q.C.CONCRETE ❑ROOFING/WATERPROOFING 0 P.T.CONCRETE/STRESS❑■ EPDXY ANCHORS ❑H.S.BOLTING SOILS PROJECT TITLE: PHASE#: DSA FILE NO.: DSA APP.NO.: Grocery Outlet Arcadia#2 PROJECT ADDRESS: PERMIT NO: KRAZAN JOB# 140 E.Live Oak Ave.,Arcadia,CA - TI-20-0598 ARCHITECT: ENGINEER: MBH VLMK GENERAL CONTRACTOR: SUB CONTRACTOR: A R MAYS CONSTRUCTION INC., BCM MATERIAL CLASSIFICATION: DATE: DESCRIPTION OF WORK INSPECTED: 12-11-20 EPDXY: Observed epoxying of#5 dowels into existing wall at N3.7 (ref., E and 3 on S3.0). Holes were spaced according to E on S3.0), brushed and blown clean, 4" embedment depths achieved, and Simpson Set-XP epoxy was used. MASONRY INFILLS: Observed CMU placement and grouting of the final courses of the CMU wall infill at B.3/1, and all the courses for the infill at N3.7. Workers used Spec Concrete 3000 for grout (from Pre-Mix Products, 2500 psi required), mixed grout in a mechanical mixer until achieving a flowable mix, used type S mortar, and filled CMU walls to the the top. I made 1 set of(4) grout cubes with corresponding location: wall infill at grid lines N3.7 bottom 4 courses. They used 8" block at the infill at A/B.7 and the Superintendent said that the engineer is approving 8" block at this location and will send over a confirmation RFI. Inspector Name(print) : pE.REVIEW: Jay Carson CBC/UBC I hereby certify that I have inspected the above reported work. Unless noted otherwise,the work inspected is to the best of my knowledge in compliance with the approved Y2- �)-Z,o plans,specifications and applicable sections of the governing building laws. Inspector Initials 5313293 DSAIOSHPD I hereby certify that I have inspected the above reported work in accordance with the requirements of DSA/OSHPD approved documents.Sampling and testing were conducted in INSPECTORS SIGNATURE REGISTRATION No. accordance with the requirements of the DSA/OSHPD approved documents. The work 4 �/f . /2..- inspected corn lies with the DSA/OSHPD approved documents. !/ YesCINo: jnspector Initials _ . 12=11-20 SIGNATURE DATE (A...AKra azain SITE DEVELOPMENT ENGINEERS 1100 Olympic Drive, Suite#103,Corona,California,92881 Phone: (951)273-1003 C x PL ❑ NC ❑ FIX ❑ PAGE 1 OF 1 FIELD INSPECTION REPORT FOR: REINFORCED CONCRETE ['REINFORCED MASONRY ❑■ WELDING['FIREPROOFING ❑Q.C.CONCRETE ❑ROOFING/WATERPROOFING 0 P.T.CONCRETE/STRESS]]EPDXY ANCHORS ['H.S.BOLTING SOILS PROJECT TITLE: PHASE#: DSA FILE NO.: DSA APP.NO.: Grocery Outlet Arcadia#2 PROJECT ADDRESS: PERMIT NO: KRAZAN JOB# 140 E. Live Oak, Arcadia, CA TI-20-0598 11620147 ARCHITECT: ENGINEER: MBH VLMK GENERAL CONTRACTOR: SUB CONTRACTOR: A.R. Mays Construction MATERIAL CLASSIFICATION: E71 T-8/FCAW process, ASTM A992 wide flange beams, ASTM A36 plate & bent plate DATE: DESCRIPTION OF WORK INSPECTED: 1 2/1 5/20 -Arrived onsite to perform visual inspection of welding. Reviewed approved plans, details and WPS's. Verified welder culifivaliuns. - Observed the fit-up and welding of angle reinforcing-to joists on grid lines 2/A.8-B.1 and 3/A.8-B.1 utilizing fillet welds Der detail 10/S3.0. - Observed the fit-up and welding of bent plates to joists utilizing 3/16"fillet welds and 3/16"flare bevel groove welds for beam on grid line B.1/2-3 per detail 13/S3.0. - Observed the tit-up and welding of shear plates to bent plates utilizing 3116"tlllet welds tor beam on grid line 13. 1/2-3 per detail 13/S3.0. backing bars for bpm on grid line B.1/2 3 per shop drawings. - nhcaniPri the fit-up and welding of four 3/8"stifffnPr platPS tO beam wPbc anri flangPS, on both sidPc of the hPam on both sides of the splice weld, utilizing fillet welds on grid line B.1/2-3 per shop drawings. - No deficiencies observed. Inspector Name(print) P.E.REVIEW: Kelly W. Klunk CBC/UBC I hereby certify that I have inspected the above reported work. Unless noted otherwise, the work inspected is to the best of my knowledge in compliance with the approved plans,specifications and applicable sections of the governing building laws. V6t/te,(44Inspector Initials AWS 12081001 DSA/OSHPD I hereby certify that I have inspected the above reported work in accordance with the requirements of DSA/OSHPD approved documents.Sampling and testing were conducted in INSSIGNATURE REGISTRATION No. accordance with the requirements of the DSA/OSHPD approved documents. The work inspected corn compdLes with the DSA/OSHPD approved documents. Yes0No:ll Inspector Initials _ 12/15/20 SIGNATURE DATE Krazan SITE DEVELOPMENT ENGINEERS 1100 Olympic Drive,Suite#103,Corona, California,92881 Phone: (951)273-1003 EC-7n P11-7171 NC ❑ FIX ❑ PAGE 1 OF 1 FIELD INSPECTION REPORT FOR: REINFORCED CONCRETE ['REINFORCED MASONRY ❑■ WELDING['FIREPROOFING ❑Q.C.CONCRETE ❑ROOFINGNVATERPROOFING❑P.T.CONCRETE/STRESS❑EPDXY ANCHORS OHS.BOLTING SOILS PROJECT TITLE: PHASE#: DSA FILE NO.: DSA APP.NO.: Grocery Outlet Arcadia#2 PROJECT ADDRESS: PERMIT NO: KRAZAN JOB# 140 E. Live Oak, Arcadia, CA Tl-20-0598 11620147 ARCHITECT: ENGINEER: MBH VLMK GENERAL CONTRACTOR: SUB CONTRACTOR: A.R. Mays Construction MATERIAL CLASSIFICATION: E71 T-8/FCAW process, ASTM A992 wide flange beams, ASTM A36 plate & bent plate DATE: DESCRIPTION OF WORK INSPECTED: 1 2/1 6/20 - Arrived onsite to perform visual inspection of welding. Reviewed approved plans, details and WPS's. Verified welder certifications. - Observed the fit up and welding of bent plates to joists utilizing 3/16"fillet welds and 3/16" flare bevel groove welds for beam on grid line A.8/2 3 per detail 13/S3.0. Observed the fit up and welding of shear plates to bent plates utilizing 3/16" fillet welds for beam on grid line A.8/2 3 per detail 13/S3.0. Observed the fit up and welding of beam to beam splice utilizing prequalified single bevel groove CJP welds with backing bars for boom on grid line A.8/2 3 per shop drawings. Observed the fit up and welding-of four 3/8" stiffener plates to beam webs and flanges, on both sides of the beam on both sides of the splice weld, utilizing fillet welds on grid line A.8/2 3 per shop drawings. deficiencies observed. Inspector Name(print) : P.E.REVIEW: Kelly W.Klunk CBC/UBC I hereby certify that I have inspected the above reported work. Unless noted otherwise, the work inspected is to the best of my knowledge in compliance with the approved plans,specifications and applicable sections of the governing building laws. va01,44 Inspector Initials AWS 12081001 DSA/OSHPD I hereby certify that I have inspected the above reported work in accordance with the requirements of DSA/OSHPD approved documents.Sampling and testing were conducted in INSSIGNATURE REGISTRATION No. accordance with the requirements of the DSA/OSHPD approved documents. The work inspected corn lies with the DSA/OSHPD approved documents. YesCINo: ,Inspector Initials _ 12/16/20 SIGNATURE DATE • SRE DEVEIOPMFtdT ENGItdEEIIS 1100 Olympic Drive,Suite#103,Corona,California,92881 Phone: (951)273-1003 • l O x PL ❑ NC ❑ FIX ❑ PAGE 1 OF 1 FIELD INSPECTION REPORT FOR: REINFORCED CONCRETE DREINFORCED MASONRY ®WELDINGDFIREPROOFING •LI Q.C.CONCRETE ❑ROOFINGANATERPROOFINGD P.T,CONCRETE/STRESSD EPDXY ANCHORS DH.S.BOLTING SOILS PROJECT TITLE: - PHASE#: DSA FILE NO.: OSA APP.NO.: Grocery Outlet Arcadia#2 PROJECT ADDRESS: PERMIT NO: KRAZAN JOB/3 140 E. Live Oak, Arcadia, CA ARCHITECT: ENGINEER: GENERAL CONTRACTOR: SUB CONTRACTOR: AR Mays construction • MATERIAL CLASSIFICATION: • DATE: DESCRIPTION OF WORK INSPECTED: • 12/21/2020 Arrived onsite to field : Shell Facade Remodel,Huntington Beach,CA for NDT UT testing. Reviewed approved project document,specifications , code requirements ,WPS and welder certification on file. 1. Performed calibration to UT scanning equipment. Calibrated index point, angle.beam , sensitivity and horizontal sweep per AWS D1.1 section 6 ,part F 2015 edition. 2. Performed NDT UT testing on WF support beam CP butt splice welds to WF support beam flanges+web See attach NDT UT testing page for details • • • Time in lam-Time out 11 am Irmna�Name twn+I P.E.REVIEW: Luc Bang,UT level 11 technician • CECIUBC I hereby certify that I have inspected the above reported work: Unless noted otherwise,the work inspected is tothe best of my knowledge in compliance with the approved plans,specifications and applicable sections of the governing building laws. Inspector Initials r ' DSA/OSHPD I hereby certify that I have inspected the above reported work in accordance with • INSPECTORS SIGNATURE REGISTRATION N . the requirements of DSA/OSHPD approved documents.Sampling and testing were conducted-In accordance with the requirements. of the DSA/OSHPD approved documents. The work inspected corn lies with the DSA/OSHPD approved documents. Yes0No: lnspector Initials 12/21/2020 SIGNATURE DATE l [:f Vf i( l r.4 ':r i=ira'Fr(s 1100 Olympic Drive,Suite#103,Corona,California,92881 Phone: (951)273-1003 EC-1-7-1t PL . ❑ NC ❑ FIX ❑ PAGE 1:OF 1 FIELD INSPECTION REPORT FOR: REINFORCED CONCRETE ❑REINFORCED MASONRY. IN WELDING❑FIREPROOFING 0 Q.C.CONCRETE ❑ROOFINGNVATERPROOFING❑P.T.CONCRETE/STRESS❑EPDXY ANCHORS ❑H:S.BOLTING SOILS PROJECT TITLE: PHASE#: DSA A FILE NO.: DSA APP.NO.: Grocery Outlet Arcadia#2 PROJECT ADDRESS: PERMIT NO: KRAZAN JOB# 140_E. Live Oak,Arcadia,CA TI-20-0598 11620147. ARCHITECT: ENGINEER: MBH VLMK GENERAL CONTRACTOR: SUB CONTRACTOR: A.R. Mays Construction MATERIAL CLASSIFICATION: E71T-8/FCAW process, ASTM A36 plate & angle, ASTM A501 HSS DATE: DESCRIPTION OF WORK INSPECTED: 12/23/20 Arrived onsite to perform visual inspection of welding. Reviewed approved plans, details and WPS's. Verified welder certifications.. -• _ -" _II ,11 - _ „ - per detail 9/S3.0 at grids C/3 and D/3. Verified the welding of angle to joists for wcbreinforcing utilizing 3/16"fillet welds.per dctail 10/S3.0 at grids C/3 and D/3. Verified the welding of 3"x2 112"x3/16 HSS blocking to angle utilizing 3/16"fillet welds and to joists utilizing 3/16"flare bevel groove welds 2" long every 24" per detail 11/S3.0 at grids C/3 and D/3:.' 4 doficicncics observed. Inapoctor Name(p,lntl P.E.REVIEw: Kelly W.Klunk CBC/UBC I hereby certify that I have inspected the above reported work. Unless noted otherwise,the work inspected is tothe best of my knowledge in compliance with the approved plans,specifications and applicable sections of the governing building laws. Inspector Initials // RS k 14. AWS 12081001 DSA/OSHPD I hereby certify that I have inspected the above reported work in accordance with the requirements of DSA/OSHPD approved documents.Sampling and testing were conducted in INSPEC SIGNATURE REGISTRATION No. accordance with the requirements of the DSA/OSHPD approved documents. The work inspected corxplil.es with the DSA/OSHPD approved documents. Yes:ONo: Inspector Initials _ • 12/23/20 SIGNATURE - • DATE,- �: , : ^E __: rn-. ._. 1100 Olympic Drive,Suite#103,Corona,California,92881 Phone: (951)273-1003 17-C-: 17-11( PL ❑ - 171C-1-151 FIX ❑ PAGE 1 OF 1 IFIELD INSPECTION REPORT FOR: REINFORCED CONCRETE ❑REINFORCED MASONRY 0 WELDING❑FIREPROOFING El Q.C.CONCRETE ❑ROOFING/WATERPROOFING❑P.T.CONCRETE/STRESS❑EPDXY ANCHORS ❑H.S.BOLTING SOILS PROJECT TITLE: PHASE#: DSA FILE NO.: DSA APP.NO.: Grocery Outlet Arcadia#2 PROJECT ADDRESS: PERMIT NO: KRAZAN JOB# 140 E. Live Oak,Arcadia CA TI-20-0598 ARCHITECT: ENGINEER: MBH VLMK GENERAL CONTRACTOR: SUB CONTRACTOR: MATERIAL CLASSIFICATION: DATE: DESCRIPTION OF WORK INSPECTED: 01/16/21 1- i performed visual inspection for torquing of expansion bolts for siesmic anchors of display fixtures as per details 2,31S3. 2-the contractor used expansion HILTI bolts ,3/8"diameter for wall and island display and 1/2"and 5/8" diameter for heavy duty racks 3- i verified the torquing force was 20 ft-lb for 3/8"bolts ,40ft-lb for 1/2"bolts and 60ft-Ib for 5/8"bolts • Inspector Name(print) - P.E.REVIEW: Sarni Allakkis CBC/UBC I.hereby certify that I have inspected the above reported work. Unless noted otherwise, the work inspected is to the best of my knowledge in compliance with the approved plans,specifications and applicable sections of the governing building laws. ICC 8786459 Inspector Initials SA LADBS P037122 DSA/OSHPD I hereby certify that I have inspected the above reported work in accordance with the requirements of DSA/OSHPD approved documents.Sampling and testing were conducted in INSPECTORS SIGNATURE REGISTRATION No. accordance with the requirements of the DSA/OSHPD approved documents. The work Inspected complies with the DSA/OSHPD approved documents. Yes: No: Inspector Initials _ 01/16/21 SIGNATURE DATE '' :. •• -..'. . � . . .�• �_'CRS'. PACIFIC ' . - 5 • .February 16;.202.1 :. . Arcadia.Buildrn De t 240'Huntington;Dr. :. : Arcadia;CA 91.007. :. Attn: Building and Safety : . To whom it may.concern, This letter of indemnification is to advise that the undersigned Electrical Contractor,Cal Pacific.Electric,takes full responsibility for the torque requirements of the-loadside of Main 1200ainp circuitbreaker installed in Main Switchboard and all interior panels located at 140 E.Live Oak and herby holds harmless the City of Arcadia'. :. Building Department. • • Sincerely, Brett.Johnson. . •..: President :.. .. . .. Cal Pacific.Electric'-.• 2432 N. Highwood , Orange, California 92867•-(714) 998.4881 • Fax (714) 998-4889 Krazan & ASSOCIATES , INC . GEOTECHNICAL ENGINEERING • ENVIRONMENTAL ENGINEERING CONSTRUCTION TESTING AND INSPECTIONS January 20,2021 KA Project No.: 116-20147 Ms.Tiffany Edwards Grocery Outlet,Inc. 5650 Hollis Street Emerville, CA 94608 RE: Compaction Testing—Final Report Proposed Grocery Outlet#2 140 E.Live Oak Arcadia,CA 91006 Dear Ms. Edwards: In accordance with your authorization, we have performed compaction testing on the fill associated with the paved areas and trenches at the above-referenced site. This report documents compaction tests performed on December 7th, 2020. Compaction or relative compaction is defined as the in-place dry density of the compacted soil divided by the laboratory-compacted maximum dry density as determined by ASTM Test Method D1557, expressed as a percentage. FINDINGS The results of the tests performed on the fill associated with the paved areas and trenches at the subject site indicated that the required relative compaction of 95 percent was met or exceeded where tested. The attached table presents the results of the in-place density tests performed. The depths cited are referenced from estimated finished subgrade. LIMITATIONS As scheduled,our services were limited to random compaction testing of the completed subgrade. The test results provided are valid only for the locations tested and could vary with time due to construction activities or weather • impacts. The engineering evaluation of the structural integrity of the entire section is beyond the scope of this work. As our client, please recognize that construction observation and testing services; are techniques employed to reduce the potential for deviations from the approved plans to become incorporated into the completed project without appropriate engineering review and approval. Performance of construction observation and/or testing 1100 Olympic:Drive# 103 •Corona,California 92881 •(951)273-1011 •FAX(951)273-1003 With Offices Serving The Western United States P:\116\2020\2020 Projects\11620147 Grocery Outlet Arcidia\Reports\11620147 Compaction-Final 021221.doc ti KA No. 116-20147 Page No.2 services by Krazan&Associates' field personnel is not insurance,nor does it guarantee construction of any type. Even with diligent observation and testing services, some construction defects may be missed. In all cases, the contractor shall retain sole responsibility for the quality of work, for adhering to plans and specifications and for repairing defects, deficiencies or omissions,regardless of when they are found. We have performed our services in a manner consistent with the standard of care and skill ordinarily exercised by firms of our type practicing under similar conditions at this same time and locality. However, we do not undertake theguarantee of construction or production of a completed project conforming to the project plans and specifications. No warranty is expressed or implied. We appreciate the opportunity to assist you on this project. If you have any questions regarding the reported test results or require additional information,please contact our Corona office at(951)273-1011. Respectfully submitted, KRAZAN&ASSOCIATES,INC. - gym a.14; Net!. James M.Kellogg,PE Project Engineer *Cy RCE No. 65092o CAt ° JMK\sk ' Krazan&Associates,Inc. With Offices Serving The Western United States Ili an & ASSOCIATES INC : GEOTECHNICAL ENGINEERING • ENVIRONMENTAL ENGINEERING CONSTRUCTION TESTING AND INSPECTIONS February 12,2021 KA Project No.: 116-20147 Ms.Tiffany Edwards Grocery Outlet,Inc. 5650 Hollis Street Emeryville,CA tedwards@cfgo.com RE: . Special Inspection Services-Final Report Proposed Grocery Outlet#2 140 E.Live Oak Arcadia,CA 91006 Dear Ms.Edwards: In accordance with your request and authorization, our firm has provided construction observation and materials testing(special inspection)services for the above-referenced project. This report documents the services provided by our field personnel during the period of December 10t,2020 through January 16th, 2021. Copies of our daily field reports documenting the work observed and our findings are attached. Special inspection tasks included: • Observation of the installation of drilled in anchors. • Observation of in-progress and completed reinforcing steel placement • Review of welder's qualification papers.. • Observation of structural steel welding at the jobsite. • Inspection of structural steel welding by way of Ultrasonic Testing. • Performance of bolt torque testing. • Observation of concrete masonry unit("block")placement on an intermittent basis. • Sampling of grout and preparation of compressive strength test specimens. • Transportation of compression test specimens to the laboratory for curing and testing. Based on the observations of our technicians and the results of field testing services,lit is our professional opinion that the construction observedand the materials tested duringthe identified time period were, to the best of our knowledge, in accordance with the approved project documents and the requirements of the Uniform or International Building Code,and/or A.C.I,AWS Structural Steel Code and/or A.I.S.C. Laboratory test results.are reported under separate cover as the tests are completed. LIMITATIONS 1100 Olympic Drive# 103•Corona,California 92881 •(951)273-1011 •FAX(951)273-1003:. With Offices Serving The Western United States P:\116\2020\2020 Projects\11620147 Grocery Outlet Arcidia\Reports\11620147 SI Final 021221.doc 3 • KA No.116-20147 Page No.2 Construction observation, inspection and testing (special inspection) services are techniques used to check construction for conformance with the project requirements as the work progresses and to reduce the potential that construction elements are not in compliance with the project requirements as the work is completed. Even with diligent construction monitoring, some construction defects may be missed. In all cases, the contractor retains sole responsibility for the quality of work, for adhering to plans and specifications and for repairing defects, deficiencies.or omissions, regardless of when they are found. We have performed our services in a manner consistent with the standard of care and skill ordinarily exercised by firms of our type practicing under similar conditions at this same time and locality. However, we do not undertake the guarantee of construction or production of a completed project conforming to the project plans and specifications. No warranty or guarantee is expressed or implied. Our services during the identified period of time were limited to those documented in our attached reports. If you have any questions regarding the information contained in this cover letter or the attached reports,or if we. can be of further assistance,please contact our Corona office at(951)273-1011. Respectfully submitted, KRAZAN&ASSOCIATES,INC.I itadir James M.Kellogg,PE Managing Engineer RCE No. 65092 JMK\sk Attachments: Daily Field Reports cc:. Addressee- Krazan&Associates,Inc. With Offices Serving The Western United States OF LOsA COUNTY OF LOS ANGELES• DEPARTMENT OF PUBLIC HEALTH I/#° Al ENVIRONMENTAL HEALTH } . plp SPECIALIZED SURVEILLANCE AND ENFORCEMENT BRANCH t_ ,1'j { PLAN CHECK PROGRAM-BALDWIN PARK 4COUNTY OF Los ANOEIES \ Lc uian��a 5050 COMMERCE DR,BALDWIN PARK,CA 91706 Public Health PHONE:(626)430-5560 WWW.PU BLICH EALTH.LACOUNTY.GOV/EH OFFICIAL PLAN REVIEW REPORT DATE 06/15/2020 EHS VERNY GRAJEDA PLAN CHECK NUMBER SR0220864 PROGRAM ELEMENT 1713-FOOD MARKET RETAIL(6,000-19,999 SF) OWNER/REQUESTER NA BUSTALINO(PERMIT ADVISORS), PROJECT MANAGER DBA GROCERY OUTLET INC. ADDRESS 140 LIVE OAK,ARCADIA, CA 91006 REVISED PLAN REVIEW STATUS: APPROVED , . _. ar + r� ; Lc" .. �t4 iCeRReeTTON fl 4E #c2i`V � 4'0 4,:r ,rt.6a�iyi? �i �-,Nc:ygfi„ a W �. " CORRECTION CATEGORY DATE IDENTIFIED DATE CORRECTED FLOOR BASE COVING 05/26/2020 06/15/2020 EQUIPMENT/STORAGE 05/26/2020 06/15/2020 PLAN SUBMITTAUREMODEL 05/26/2020 06/15/2020 /�^ g h ADDITIONAL. IR.EQUIRIyMEN 5 S.. 1, y x t.� +rt i �. 4�+-� 5•: 1 BEFORE SCHEDULING A FINAL INSPECTION, PROVIDE COPIES OF THE FOLLOWING DOCUMENTS: A. BUILDING AND SAFETY FIELD CARD WITH FINALS. B. SOLE PROPRIETORSHIP: 1.DRIVER LICENSE.2, SELLER PERMIT.3. BUSINESS LICENSE. C. CORPORATION: 1.SELLER PERMIT,2. BUSINESS LICENSE,3. FEDERAL EMPLOYEE IDENTIFICATION NUMBER (IRS LETTER).4.ARTICLES OF INCORPORATION(INC), OR ARTICLES OF ORGANIZATION(LLC). 5.STATEMENT OF INFORMATION INC/LLC. D. PUBLIC HEALTH APPLICATION(PROVIDED). E. MAINTAIN APPROVED PLANS AT THE SITE, ;i COMMENTSr}P 1 ; 4 cr # K k t U 7t x t d CALL(262)430-4450 TO SCHEDULE A FINAL INSPECTION. PROVIDE ALL THE DOCUMENTS OF OWNER PRIOR TO SCHEDULE A FINAL INSPECTION. • Help us serve you better by completing a short survey.Visit our website at www.publichealth.lacountv.gov/eh. EHS Signature Page 1 of 2 • OFFICIAL PLAN REVIEW REPORT DATE 06/15/2020 EHS VERNY GRAJEDA PLAN CHECK NUMBER SR0220864 PROGRAM ELEMENT 1713-FOOD MARKET RETAIL(6,000-19,999 SF) OWNER/REQUESTER NA BUSTALINO(PERMIT ADVISORS), PROJECT MANAGER DBA GROCERY OUTLET INC. ADDRESS 140 LIVE OAK,ARCADIA, CA 91006 • ISCL �l�RE 7 li a y 7 M5 G� i 7 ,t til t •+, 5 f r # Y 3 i 7 s �> �. +•1 y,.7 1k vc}.{�� x t F-y. � 1 v,t �7 �' t 'Y. t t ... -... ..,. , .,#;L.,.,.�,f.,.. •��:t'^��.....r......n�..,.t. ,_t .,.i.:°r�a::`�,(�-.F. ... t,..,n)r?s F��1 .f<�;#. i. ,.;i.�a_# � x# ..,,7...._. .. a....c;�'�.... 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. - i • • • Help us serve you better by completing a short survey.Visit our website at www.publichealth.lacountv.gov/eh. • EHS Signature Page 2 of 2 • • lila IKrazan. SITE DFVEIO?MF.PJT ENGINEERS 1100 Olympic Drive,Suite#103,Corona,California,92881 Phone: (951)273-1003 1-71-71c PL ❑ NC ❑ FIX ❑ PAGE 1 OF 1 FIELD INSPECTION REPORT FOR: REINFORCED CONCRETE DREINFORCED MASONRY ®WELDING❑FIREPROOFING ❑Q.C.CONCRETE ❑ROOFINGIWATERPROOFING❑P.T.CONCRETE/STRESSD EPDXY ANCHORS DI-LS.BOLTING SOILS PROJECT TITLE: PHASE fi: DSA FILE NO.: USA APP.NO.: Grocery Outlet Arcadia#2 PROJECT ADDRESS: PERMIT NO: KRAZAN JOB 140 E. Live Oak, Arcadia, CA ARCHITECT: ENGINEER: GENERAL GENERAL CONTRACTOR: SUB CONTRACTOR: AR Mays construction MATERIAL CLASSIFICATION: DATE: DESCRIPTION OF WORK INSPECTED: 12/21/2020 Arrived onsite to field : Shell Facade Remodel,Huntington Beach, CA for NDT UT testing. Reviewed approved project document, specifications, code requirements ,WPS and welder certification on file. 1. Performed calibration to UT scanning equipment. Calibrated index point, angle beam , sensitivity and horizontal sweep per AWS D1.1 section 6 ,part F 2015 edition. 2. Performed NDT UT testing on WF support beam CJP butt splice welds to WF support beam flanges+web Sec attach NDT UT testing page for details • Time in lam-Time out 11 am ImpMoNsma{p!M}I - P.E.REVIEW: Luc Bang,UT level 11 technician CBCIUBC I hereby certify that I have inspected the above reported work. Unless noted otherwise,the work inspected Is to the best of my knowledge in compliance with the approved plans,specifications and applicable sections of the governing building laws. , Inspector Initials DSA/OSHPD I hereby certify that I have Inspected the above reported work in accordance with INSPECTORS SIGNATURE REGISTRATION Na. the requirements of DSA/OSHPD approved documents.Sampling and testing were conducted In accordance with the requirements of the DSA/OSHPD approved documents. The work Inspected corn Iles with the DSA/OSHPD approved documents. Yes0No:,Iinspector Initials 12/21/2020 SIGNATURE DATE _"_ �1 'k ._ 1.• _. e' ti..4'- - 1100 Olympic Drive,Suite#103, Corona,California,92881 Phone: (951)273-1003 rC x 1-1;171-1=11 NC ❑ 1-7171711 PAGE 1 OF 1 FIELD INSPECTION REPORT FOR: REINFORCED CONCRETE ❑REINFORCED MASONRY ❑� WELDING['FIREPROOFING ❑Q.C.CONCRETE ❑ROOFING/WATERPROOFINGP.T.CONCRETE/STRESS❑EPDXY ANCHORS ❑H.S.BOLTING SOILS PROJECT TITLE: 'PHASE#: DSA FILE NO.: DSA APP.NO.: Grocery Outlet Arcadia#2 PROJECT ADDRESS: PERMIT NO: KRAZAN JOB# 140 E. Live Oak, Arcadia, CA TI-20-0598 11620147 ARCHITECT: ENGINEER: MBH VLMK GENERAL CONTRACTOR: SUB CONTRACTOR: A.R. Mays Construction MATERIAL CLASSIFICATION: E71T-8/FCAW process, ASTM A36 plate & angle, ASTM A501 HSS DATE: DESCRIPTION OF WORK INSPECTED: 12/23/20 Arrived onsite to perform visual inspection of welding. Reviewed approved plans, details and WPS's. Verified welder certifications. per detail 9/S3.0 at grids C/3 and D/3. Verified the welding of angle to joists for web reinforcing utilizing 3/16"fillet welds per detail 10/S3.0 at grids C/3 and D/3. Verified the welding of 3"x2 1/2"x3/16 HSS blocking,to angle utilizing 3/16" fillet welds and to joists utilizing 3/16"flare bevel groove welds 2" long every 21" per detail 11/S3.0 at grids C/3 and D/3. deficiencies observed. Inspector Neo (print) P.E.REVIEW: Kelly W.Klunk CBCIUBC I hereby certify that I have Inspected the above reported work. Unless noted otherwise,the work inspected is to the best of my knowledge in compliance with the approved plans,specifications and applicable sections of the governing building laws. Inspector Initials //�e 4/1:414 AWS 12081001 DSA/OSHPD I hereby certify that I have inspected the above reported work in accordance with 1 the requirements of DSA/OSHPD approved documents.Sampling and testing were conducted in INSPEc RS SIGNATURE REGISTRATION No. accordance with the requirements of the DSA/OSHPD approved documents. The work inspected corn ies with the DSA/OSHPD approved documents. Yes_❑No:lInspector Initials 12/23/20 SIGNATURE DATE 1100 Olympic Drive,Suite#103,Corona,California,92881 Phone: (951)273-1003 1—T1-7-11c PL ❑ NC ❑ FIX ❑ PAGE 1 OF 1 IFIELD INSPECTION REPORT FOR: REINFORCED CONCRETE ❑REINFORCED MASONRY 0 WELDING OFIREPROOFING ❑Q.C.CONCRETE ❑ROOFING/WATERPROOFINGP.T.CONCRETE/STRESS❑EPDXY ANCHORS ❑H.S.BOLTING SOILS PROJECT TITLE: PHASE#: DSA FILE NO.: DSA APP.NO.: Grocery Outlet Arcadia#2 PROJECT ADDRESS: PERMIT NO: KRAZAN JOB# 140 E. Live Oak,Arcadia CA TI-20-0598 ARCHITECT: ENGINEER: MBH VLMK GENERAL CONTRACTOR: SUB CONTRACTOR: MATERIAL CLASSIFICATION: DATE: DESCRIPTION OF WORK INSPECTED: 01/16/21 1- i performed visual inspection for torquing of expansion bolts for siesmic anchors of display fixtures as per details 2,3/S3.' 2-the contractor used expansion HILTI bolts , 318"diameter for wall and island display and 1/2"and 5/8" diameter for heavy duty racks 3- i verified the torquing force was 20 ft-lb for 3/8"bolts ,40ft-lb for 1/2"bolts and 60ft-lb for 5/8"bolts Inspector Name(pnnt) ` Sami Allakkis P.E.REVIEW: CBC/UBC I hereby certify that I have inspected the above reported work. Unless noted otherwise,the work inspected is to the best of my knowledge in compliance with the approved plans,specifications and applicable sections of the governing building laws. ICC 8786459 Inspector Initials SA LADES P037122 DSA/OSHPD I hereby certify that I have inspected the above reported work iri accordance with the requirements of DSA/OSHPD approved documents.Sampling and testing were conducted in INSPECTORS SIGNATURE REGISTRATION No. accordance with the requirements of the DSA/OSHPD approved documents. The work Inspected complies with the DSA/OSHPD approved documents. Yes: No: Inspector Initials 01/16/21 SIGNATURE DATE Krazan UUtvEsc::c'AFI;i =r•:;-IIJ [ .. 1100 Olympic Drive,Suite#103,Corona,California,92881 Phone: (951)273-1003 C xPL I=1 NC ❑ 1—FIX-1-171 PAGE 1 OF 1 FIELD INSPECTION REPORT FOR: REINFORCED CONCRETE ►.REINFORCED MASONRY ❑WELDING['FIREPROOFING ❑Q.C.CONCRETE ❑ROOFINGNJATERPROOFING❑P.T.CONCRETE/STRESS121 EPDXY ANCHORS ❑H.S.BOLTING SOILS PROJECT TITLE: PHASE#: DSA FILE NO,: DSA APP.NO,: Grocery Outlet Arcadia#2 PROJECT ADDRESS: PERMIT NO: KRAZAN JOB# 140 E. Live Oak,Arcadia CA TI-20-0598 ARCHITECT: ENGINEER: MBH VLMK GENERAL CONTRACTOR: SUB CONTRACTOR: MATERIAL CLASSIFICATION: DATE: DESCRIPTION OF WORK INSPECTED: 12/10/2020 Task#1 1- i performed visual inspection for post installed rebars dowels in existing concreteand masonry , at the CMU wall infill As per details 1/S 3.0 ,4/S 3.0 2-the contractor used Epoxy Simpson strong-tie Set-XP 3- i verified embedment depth met job specification 4- i verified the holes diameter met lob specification . 5- i verified the holes cleaning procedure met job specifications Task#2 1- i performed visual'inspection for construction of 8"CMU wall infill-as per details A/S3.0 , B/S3.0 2- the contractor used mortar type-S 3-i verified rebars met job specifications 4-the infill walls were full grouted by pre-mix concrete 3000 psi Inspector Name(print) ` Sami Allakkis P.E.REVIEW: CBC/UBC I hereby certify that I have inspected the above reported work. Unless noted otherwise, the work inspected is to the best of my knowledge in compliance with the approved plans,specifications and applicable sections of the governing building laws. ICC 8786459 Inspector Initials SA LADBS P037122 DSAIOSHPD I hereby certify that I have inspected the above reported work in accordance with the requirements of DSA/OSHPD approved documents.Sampling and testing were conducted in INSPECTORS SIGNATURE REGISTRATION No. accordance with the requirements of the DSA/OSHPD approved documents. The work inspected complies with the DSA/OSHPD approved documents. Yes: No: Inspector Initials _ 12/10/2020 SIGNATURE DATE hYd ! WNW. IN *Neap 5: trYf(c)/.'f •ll frt,,IrJFr%5. 1100 Olympic Drive,Suite#103,Corona,California,92881 Phone: (951)273-1003 C x PL ❑ NC ❑ F1-7171-71 PAGE 1 OF 1 FIELD INSPECTION REPORT FOR: REINFORCED CONCRETE MIREINFORCED MASONRY 0 WELDING❑FIREPROOFING 0 Q.C.CONCRETE ❑ROOFINGNVATERPROOFING❑P.T.CONCRETE/STRESSIJ EPDXYANCHORS. ❑H.S.BOLTING SOILS PROJECT TITLE: PHASE#: DSA FILE NO.: DSA APP.NO.: Grocery Outlet Arcadia#2 PROJECT ADDRESS: PERMIT NO: KRAZAN JOB# 140 E.Live Oak Ave.,Arcadia, CA TI-20-0598 ARCHITECT: ENGINEER: MBH VLMK GENERAL CONTRACTOR: SUB CONTRACTOR: A R MAYS-CONSTRUCTION INC., BCM MATERIAL CLASSIFICATION: DATE: DESCRIPTION OF WORK INSPECTED: 12-11-20 EPDXY: Observed epoxying of# 5 dowels.into existing wall at A/3.7 (ref., E and 3 on S3.0). Holes were spaced according to E on S3.0), brushed and blown clean, 4" embedment depths achieved, and Simpson Set-XP epoxy was used. MASONRY INFILLS: Observed CMU placement and grouting of the final courses of the CMU wall infill at B.311, and all the courses for the infill at N3.7. Workers used Spec Concrete 3000 for grout (from Pre-Mix Products, 2500 psi required), mixed grout in a mechanical mixer until achieving a flowable mix, used type S mortar, and filled CMU walls to.the the top. I made 1 set of(4)_grout cubes with corresponding location: wall infill at grid lines N3.7 bottom 4 courses. They used 8" block at the infill at A/B.7 and the - Superintendent said that the engineer is approving 8" block at this location and will send over a. confirmation RFI. • 'Inspector Name(print) : - P.E.REVIEW: .. Jay Carson CBC/UBC I hereby certify that I have inspected the above reported work. Unless noted otherwise,the work inspected is to the best of my knowledge in compliance with the approved plans,specifications and applicable sections of the governing building laws. Inspector Initials 5313293 DSA/OSHPD I hereby certify that I have inspected the above reported work in accordance with the requirements of DSA/OSHPD approved documents.Sampling and testing were conducted in INSPECTORS SIGNATURE REGISTRATION No. accordance with the requirements of the DSA/OSHPD approved documents. The work �v �!// /2.- inspected corn lies with the DSA/OSHPD approved documents. / Yesf No: inspector Initials ^ 12-11-20 SIGNATURE DATE [.(Vf..r,n'i•2T �b�GMFF'".5 . 1100 Olympic Drive,Suite#103,Corona,California,92881 Phone: (951)273-1003 1-7 1-71 .PL ❑ NC ❑ FIX ❑ PAGE 1 OF 1 FIELD INSPECTION REPORT FOR: REINFORCED CONCRETE ['REINFORCED MASONRY ®WELDING OFIREPROOFING ❑Q.C.CONCRETE ❑ROOFING/WATERPROOFING❑P.T.CONCRETE/STRESS❑EPDXY ANCHORS ❑H.S.BOLTING SOILS PROJECT TITLE: PHASE#: DSA FILE NO.: DSA APP.NO.: Grocery Outlet Arcadia#2 PROJECT ADDRESS: PERMIT NO: KRAZAN JOB# 140 E. Live Oak, Arcadia, CA TI-20-0598 11620147 ARCHITECT: ENGINEER: MBH VLMK GENERAL CONTRACTOR: SUB CONTRACTOR: A.R. Mays Construction MATERIAL CLASSIFICATION: E71T-8/FCAW process, ASTM A992 wide flange beams, ASTM A36 plate & bent plate DATE: DESCRIPTION OF WORK INSPECTED: 12/15/20 -Arrived onsite to perform visual inspection of welding. Reviewed approved plans, details and WPS's.. Verified welder uurtiflea tiuris. • -Observed the fit-up and welding of angle reinforcing to joists on grid lines 2/A.8-B.1 and 3/A.8-B.1 utilizing fillet welds per detail 10/S3.0. -Observed the fit-up and welding of bent plates to joists utilizing 3/16"fillet welds and 3/16"flare bevel groove welds for beam on grid line B.1/2=3 per detail 13/S3.0. -Observed the tit-up and welding of shear plates to bent plates utilizing 3/16"fillet welds for beam on grid line B. 1/2-3 per detail -13/53.0. - - _ - . - _ - - -c B.112 3 per shop drawings. -CIhgervAd the fit-up and welding of four 118"stifffnPr piatPs to hpam webs and flang-as, nn hnth sirtas of the hem on both sides of the splice weld, utilizing fillet welds on grid line B.112-3 per shop drawings. - No deficiencies observed. Inspector Name(print) P.E.REVIEW: Kelly W. Klunk CBC/UBC I hereby certify that I have inspected the above reported work. Unless noted otherwise, the work inspected is to the best of my knowledge in compliance with the approved /f� I� plans,specifications and applicable sections of the governing building laws. I,-1 '' Inspector Initials 4 !/� AWS 12081001 DSA/OSHPD I hereby certify that I have inspected the above reported work in accordance with the requirements of DSA/OSHPD approved documents.Sampling and testing were conducted in INSPEC RS SIGNATURE REGISTRATION No. accordance with the requirements of the DSA/OSHPD approved documents. The work inspected corn lies with the DSA/OSHPD approved documents. Yes❑No: inspector Initials _ 12/15/20 SIGNATURE DATE e-s—n a^.MNfriNl'�A--s KrC:s zv . L07:, E NGlN Ny 1100 Olympic Drive,Suite#103, Corona,California,92881 Phone: (951)273-1003 1-71-71c PL ❑ NC ❑ FIX ❑ PAGE 1 OF 1 FIELD INSPECTION REPORT FOR: REINFORCED CONCRETE DREINFORCED MASONRY 0 WELDING❑FIREPROOFING ❑Q.C.CONCRETE El ROOFING/WATERPROOFING❑P.T.CONCRETE/STRESS❑EPDXY ANCHORS ❑H.S.BOLTING SOILS PROJECT TITLE: PHASE#: DSA FILE NO.: DSA APP.NO.: Grocery Outlet Arcadia#2 PROJECT ADDRESS: PERMIT NO: KRAZAN JOB# 140 E. Live Oak, Arcadia, CA TI-20-0598 11620147 ARCHITECT: ENGINEER: MBH VLMK • GENERAL CONTRACTOR: SUB CONTRACTOR: A.R. Mays Construction MATERIAL CLASSIFICATION: E71 T-8/FCAW process, ASTM A992 wide flange beams, ASTM A36 plate & bent plate DATE: DESCRIPTION OF WORK INSPECTED: 12/16/20 -Arrived onsite to perform visual inspection of welding. Reviewed approved plans, details and WPS's. Verified welder certifications. e_ - . -- - - - - - -- - - - - - - - - - : - - ' ' - _ -11 - :,, 7 . - groove welds for beam on grid linc A.8/2 3 per detail 13/83.0. linc A.8/2 3 per detail 13/S3.0. welds with backing bars for beam on grid linc A.8/2 3 per chop drawings. • --- -- - - - - - - - - .11 •- - - - '- - - , - -- - deficioncies obsorved. Inspector Name(print) P.E.REVIEW: Kelly W.Klunk CBC/UBC I hereby certify that I have inspected thea above reported work. Unless noted otherwise, the work inspected is to the best of my knowledge in compliance with the approved plans,specifications and applicable sections of the governing building laws. Inspector Initials // 4,44 AWS 12081001 DSA/OSHPD I hereby certify that I have inspected the above reported work in accordance with the requirements of DSA/OSHPD approved documents.Sampling and testing were conducted in INSPEC RS SIGNATURE REGISTRATION No. accordance with the requirements of the DSA/OSHPD approved documents. The work inspected corn lies with the DSA/OSHPD approved documents. Yes,❑No:jinspector Initials _ 12/16/20 SIGNATURE DATE • Krazan 1100 Olympic Drive, Suite#103,Corona,California,92881 Phone: (951)273-1003 FTE171 rNC LII 171371-11 PAGE 1 OF 1 FIELD INSPECTION REPORT FOR: REINFORCED CONCRETE NREINFORCED MASONRY 0 WELDING['FIREPROOFING EQ.C.CONCRETE Li ROOFING/WATERPROOFING P.T.CONCRETE/STRESSEI EPDXY ANCHORS OHS.BOLTING SOILS PROJECT TITLE: PHASE#: DSA FILE NO.: DSA APP.NO.: Grocery Outlet Arcadia#2 PROJECT ADDRESS: PERMIT NO: KRAZAN JOB# 140 E.Live Oak Ave.,Arcadia,CA TI-20-0598 ARCHITECT: ENGINEER: MBH VLMK GENERAL CONTRACTOR: SUB CONTRACTOR: A R MAYS CONSTRUCTION INC., BCM MATERIAL CLASSIFICATION: DATE: DESCRIPTION OF WORK INSPECTED: 12-11-20 EPDXY: Observed epoxying of# 5 dowels into existing wall at N3.7 (ref., E and 3 on S3.0). Holes were spaced according to E on S3.0), brushed and blown clean, 4" embedment depths achieved, and Simpson Set-XP epoxy was used. MASONRY INFILLS: Observed CMU placement and grouting of the final courses of the CMU wall infill at B.3/1, and all the courses for the infill at N3.7. Workers used Spec Concrete 3000 for grout (from Pre-Mix Products, 2500 psi required), mixed grout in a mechanical mixer until achieving a flowable mix, used type S mortar, and filled CMU walls to the the top. I made 1 set of (4) grout cubes with corresponding location: wall infill at grid lines A/3.7 bottom 4 courses. They used 8" block at the infill at A/B.7 and the Superintendent said that the engineer is approving 8" block at this location and will send over a confirmation RFI. Inspector Name(print) P.E.REVIEW: Jay Carson CBC/UBC I hereby certify that I have inspected the above reported work. Unless noted otherwise, the work inspected is to the best of my knowledge in compliance with the approved plans,specifications and applicable sections of the governing building laws. Inspector Initials 5313293 DSAIOSHPD I hereby certify that I have inspected the above reported work in accordance with the requirements of DSA/OSHPD approved documents.Sampling and testing were conducted in INSPECTORS SIGNATURE REGISTRATION No. accordance with the requirements of the DSAIOSHPD approved documents. The work 9'v4,7- /2..- //- —7 c. inspected corn lies with the DSA/OSHPD approved documents. C. Yes{ ]No: Inspector Initials 12-11-20 SIGNATURE DATE • • Yr( DIVE;!)'"/iNT F-IJGINFER 1100 Olympic Drive,Suite#103,Corona, California,92881 Phone: (951)273-1003 C . x PL ❑ NC ❑ FIX ❑ PAGE 1 OF:1 FIELD INSPECTION REPORT FOR: REINFORCED CONCRETE ❑REINFORCED MASONRY ®WELDING OFIREPROOFING ❑Q.C.CONCRETE ❑ROOFING/WATERPROOFING❑P.T.CONCRETE/STRESS❑EPDXY ANCHORS DHS.BOLTING SOILS PROJECT TITLE: PHASE#: DSA FILE NO.: DSA APP.NO.: Grocery Outlet Arcadia#2 PROJECT ADDRESS: PERMIT NO: KRAZAN JOB# 140 E. Live Oak, Arcadia, CA Tl-20-0598 11620147 ARCHITECT: ENGINEER: MBH VLMK GENERAL CONTRACTOR: SUB CONTRACTOR: A.R. Mays Construction MATERIAL CLASSIFICATION: E71T-8/FCAW process, ASTM A992 wide flange beams, ASTM A36 plate & bent plate DATE: DESCRIPTION OF WORK INSPECTED: 12/15/20 -Arrived onsite to perform visual inspection of welding. Reviewed approved plans, details and WPS's. Verified welder eertificaliuris. -Observed the fit-up and welding of angle reinforcing to joists on grid lines 2/A.8-B.1 and 3/A.8-B.1 utilizing fillet welds per detail 10/S3.0. -Observed the fit-up and welding of bent plates to joists utilizing 3/16"fillet welds and 3/16"flare bevel groove welds for beam on grid line B.1/2-3 per detail 13/S3.0. -Observed the lit-up and welding of shear plates to bent plates utilizing :i116-fillet welds for Deam on grid line 13. 1/2-3 per detail 13/53.0. backing bars for beam on grid line B.1/2 3 per shop drawings. • -C1hserveri the fit-lip and welding of four R/8" stiffener plates to ham wabc and flanges, no both since of the beam on both sides of the spline weld, utilising fillet welds on grid line B.1/2-3 per shop drawings. - No deficiencies observed. Inspector Name(print) P.E.REVIEW: Kelly W. Klunk. CBC/UBC .I hereby certify that I have inspected the above reported work. Unless noted otherwise, the work inspected is to the best of my knowledge in compliance with the approved /�� plans,specifications and applicable sections of the governing building laws. i /%�/�� "V\ Inspector Initials // (,f/ G/, AWS 12081001 DSA/OSHPD I hereby certify that I have inspected the above reported work in accordance with the requirements of DSA/OSHPD approved documents.Sampling and testing were conducted in INSPEC RS SIGNATURE REGISTRATION No. accordance with the requirements of the DSA/OSHPD approved documents. The work inspected complies with the DSA/OSHPD approved documents. YesFNoJ Inspector Initials _ 12/15/20 SIGNATURE - DATE ArLalefit • - r _ . 1100 Olympic Drive,Suite#103, Corona, California,92881 Phone: (951)273-1003 1-71-71c PL ❑ NC ❑ FIX ❑ PAGE 1 OF 1 FIELD INSPECTION REPORT FOR: REINFORCED CONCRETE ❑REINFORCED MASONRY ©WELDING❑FIREPROOFING ❑Q.C.CONCRETE El ROOFING/WATERPROOFING❑P.T.CONCRETE/STRESS❑ EPDXY ANCHORS ❑H.S.BOLTING SOILS PROJECT TITLE: PHASE* DSA FILE NO.: DSA APP.NO.: Grocery Outlet Arcadia#2 PROJECT ADDRESS: PERMIT NO: KRAZAN JOB# 140 E. Live Oak, Arcadia, CA Tl-20-0598 11620147 ARCHITECT: ENGINEER: MBH VLMK GENERAL CONTRACTOR: SUB CONTRACTOR: A.R. Mays Construction MATERIAL CLASSIFICATION: E71 T-8/FCAW process, ASTM A992 wide flange beams, ASTM A36 plate & bent plate DATE: DESCRIPTION OF WORK INSPECTED: 12/16/20 Arrived onsite to perform visual inspection of welding. Reviewed approved plans, details_and WPS's. Verified welder certifications. - - groovc welds fer Iacam en grid line A.8/2 3 per detail 13/83.0. line A.8/2 3 per detail 13/83.0. welds with backing bars for beam on grid line A.8/2 3 per shop drawings. A • e. - . • - 1 1 . - a deficiencies obsorvod. Inspector Name(print) : P.E.REVIEW: Kelly W.Klunk CBC/UBC I hereby certify that I have inspected the above reported work. Unless noted otherwise, the work inspected is to the best of my knowledge in compliance with the approved plans,specifications and applicable sections of the governing building laws. Inspector Initials // AWS 12081001 DSA/OSHPD I hereby certify that I have inspected the above reported work in accordance with the requirements of DSA/OSHPD approved documents.Sampling and testing were conducted in ' INSPEC RS SIGNATURE REGISTRATION No. accordance with the requirements of the DSA/OSHPD approved documents. The work inspected corn lies with the DSA/OSHPD approved documents. YesGNo:�inspector Initials _ 12/16/20 SIGNATURE DATE_ KraZarl SITE DEVELOPMENT ENGINEERS 1100 Olympic Drive,Suite#103,Corona, California,92881 Phone: (951)273-1003 C x PL ❑ NC ❑ FIX ❑ PAGE 1 OF 1 FIELD INSPECTION REPORT FOR: REINFORCED CONCRETE ❑REINFORCED MASONRY ❑■ WELDING❑FIREPROOFING ❑Q.C.CONCRETE ❑ROOFING/WATERPROOFINGP.T.CONCRETE/STRESS❑EPDXY ANCHORS ❑H.S.BOLTING SOILS PROJECT TITLE: PHASE#: DSA FILE NO.: DSA APP.NO.: Grocery Outlet Arcadia#2 PROJECT ADDRESS: PERMIT NO: KRAZAN JOB# 140 E. Live Oak, Arcadia, CA Tl-20-0598 11620147 ARCHITECT: ENGINEER: MBH VLMK GENERAL CONTRACTOR: SUB CONTRACTOR: A.R. Mays Construction MATERIAL CLASSIFICATION: E71 T-8/FCAW process, ASTM A992 wide flange beams, ASTM A36 plate & bent plate DATE: DESCRIPTION OF WORK INSPECTED: 1 2/1 6/20 -Arrived onsite to perform visual inspection of welding. Reviewed approved plans, details and WPS's. Verified welder certifications. Observed the fit up and welding of bent plates to joists utilizing 3/16"fillet welds and 3/16" flare bevel groove welds for beam on grid line A.8/2 3 per detail 13/S3.0. e - - - - - - - „ - line A.8/2 3 per detail 13/S3.0. - - - . - • . - welds with backing bars for beam on grid line A.8/2 3 per shop drawings. a - - - - ',, • - - - - tl the boom on both sides of the splice weld, utilizing fillet welds on grid line A.8/2 3 per shop drawings. - - A 1 • - A - , deficiencies observed. Inspector Name(print) P.E.REVIEW: Kelly W.Klunk CBC/UBC I hereby certify that I have inspected the above reported work. Unless noted otherwise, the work inspected is to the best of my knowledge in compliance with the approved plans,specifications and applicable sections of the governing building laws. / ��, Inspector Initials // 6. ,x.,44 AWS 12081001 DSA/OSHPD I hereby certify that I have inspected the above reported work in accordance with the requirements of DSA/OSHPD approved documents.Sampling and testing were conducted in INSPEC RS SIGNATURE REGISTRATION No. accordance with the requirements of the DSA/OSHPD approved documents. The work inspected corn lies with the DSA/OSHPD approved documents. Yes;❑No: iinspector Initials _ 12/16/20 SIGNATURE DATE H - r-`. C `l 1 naire . . . . .. . . .. .. . . .CERTIFIED TEST, ADJUST, AND BALANCE REPORT - . . ..DATE- : .. - • January 19,2021 .- • . . : • •• . . • . PROJECT GROCERY OUTLET-ARCADIA .• . : ADDRESS - .140..LIVE OAK . . -__'. . • . • • • • • .. . -ARCADIA;-CA 91106. . . - ARCHITECT N/A : . - -.. : ADDRESS • . - • . . • - .. ., PHONE/.FAX ' : . - - • . • . . ENGINEER- . -COOL-SYS ENERGY DESIGN CONSULTING ENGINEERS ADDRESS 4275.N..PALM STREET;SUITE.100 - . : :. FULLERTON,r.CA 92835` .. `:PHONE/FAX• .• •714-578-2300. . HVAC . . 'CONTRACTOR `REESE MECHANICAL; INC._ • . : : : • . ' . : • • ADDRESS. . .42309 WINCHESTER.RD,.SUITE I. • : : • : : . - . :. • TEMECULA;CA 92590- .. • • . ' • :PHONE/FAX/CELL 951-719-1175 • • : . TAB FIRM • . HARTMANAIRE. • . :- - ADDRESS 12 GARDENIA - - • • . - LAKE FOREST, CA-92630. • • • • • . �,Lpmforti . IONE/FAX 951-479-6855 /.949-215-1001 �o�s1 Cewn��jo;� ._ a .0C. CC, . - • ci s �^ rcClanansn Inc.DBA Nartrtunalz IO. ieoscwnE• E - _ Neev�idunbu sipn.e - . H manaire CERTIFICATION PROJECT GROCERY OUTLET-ARCADIA ADDRESS 140 LIVE OAK ARCADIA, CA 91106 1 1 THE DATA PRESENTED IN THIS REPORT IS AN EXACT RECORD OF SYSTEM PERFORMANCE AND WAS OBTAINED IN ACCORDANCE WITH TABB-ICB STANDARD PROCEDURES. ANY VARIANCES FROM DESIGN QUANTITIES WHICH EXCEED TABB TOLERANCES ARE NOTED THROUGHOUT THIS REPORT. .THE AIR DISTRIBUTION SYSTEMS HAVE BEEN TESTED&BALANCED AND FINAL ADJUSTMENTS HAVE BEEN MADE IN ACCORDANCE WITH TABB-ICB PROCEDURAL STANDARDS FOR TESTING, ADJUSTING BALANCING OF ENVIRONMENTAL SYSTEMS AND THE PROJECT SPECIFICATIONS. TABB TAB FIRM REG. NO. TB0690817C CERTIFIED BY Mario Covarrubias DATE .1/19/2021 (Air Tat;Supervisor) THE HYDRONIC DISTRIBUTION SYSTEMS HAVE BEEN TESTED&BALANCED AND FINAL ADJUSTMENTS HAVE BEEN MADE IN ACCORDANCE WITH TABB-ICB PROCEDURAL STANDARDS FOR TESTING,ADJUSTING BALANCING OF ENVIRONMENTAL SYSTEMS AND THE PROJECT SPECIFICATIONS. TABB TAB FIRM REG. NO. TB0690817C CERTIFIED BY DATE (Hydronic Tab Supervisor) Certificati 00 SUBMITTED&CERTIFIED BY: 1 TM'r-CP8c?, , cClanahan Inc.DBA Hartmann! TABB TAB FIRM HARTMANAIRE 150.5912617C N7I Valid Unice.Slimed TAB SUPERVISOR Mario Covarrubias :SIGNATURE 0 .0.0./,0/2011 ,co "4.ed conVP 1 H part ire TABLE OF CONTENTS SECTION I-PROJECT INFORMATION CERTIFICATES 1 WARRANTY 6 CALIBRATION 7 ABBREVIATION 8 SECTION II -UNIT REPORTS UNIT DATA-AC-2 THRU AC-2 AND FC-1 THRU FC-2 9 INOUT DATA-AC-1 THRU AC-2 10 UNIT DATA-FC-3 11 EXHAUST DATA EF-1 THRU EF-3 12 UNIT DATA-TF-1 THRU TF-3 13 SECTION III -OTHER DATA MECHANICAL PLANS 14 • I .. INERT METAL I AIR I.RAIL I TRANSPORTATION 11LILI- il Fir D - . : SMACHA r �i m ` �,, ►„/I' D D . INTERNATIONAL cJ3/ T ADJUSTING AND.BALANCING BUREAUCERTIFICATION BOARD 'THE PROFESSIONAL'S CHOICE"' This certi es that !McC• ana � �an Inc. X DBJ4 has complete) the requirements of cert4cation as a Testing, Adjusting and:Balancing Contractor on My 21 2019 4111W' 4-114 --- j91111,VA : ' NEMIC Labo� Chairman. ,�1ageI11Et NEMIC Ma gement Co-Chairman ,,ti,„blis/Ico. 44) t 0 ,46'&_t__ -_____ :P I It, it 1 ilociaiHitwati. ICB Labor Co-Chairma• ICB Management Co Chairman a d..Nl�ilrffIlC ro Ori lrlet Of CoNu�. ' A k °ft1� a t lune 30. 2021 : . TIC30F90R�7(' a��. � Certification No. 4 ExpirationDate ■NETT METAL I AIR.;I.RAIL 1 TRANSPORTATION -- - Cp SMACNA D D INTERNATIONAL. TESTING,ADJUSTING AND.BALANCING BUREAU CERTIFICATION BOARD 'THE PROFESSIONAL'S CHOICE" l This certifies that fMcCl2inafian Inc. Mil gfartmanaire hascompkted the requirements of certification as a Nesting, Adjusting and Balancing Contractor on May 11 2019 ..411'' - ,,f/TiplA A<__. oti, 4:101L-- NEMIC Labo 1 hairman. ' �,1ame 11 NEMIC Man gement Co-Chairman �c\abiishco, ✓, 1 .,,,,,„ ..4. ' It' 1983lettocii , ICB Labor Co-Chairman - 0 co / ICB Management Co-Chairman , ash .f.co�,��, 0.A ZI�i � 0690R77(' ° rrr1P an's lune 30. 2021 Certification No. 4 Expiration Date e ms . s ® ACCREDITED J , #0728. INTERNATIONAL .. ' .: TESTING,ADJUSTING AND BALANCING BUREAU ISO/IEC 17024 CERTIFICATION BOARD ' THE PROFESSIONALS CHOICE'"• • • - . ' Personnel.Certification Program• ac to, .7i, o Certflc1, . . . , . . . . . . . . . . . , to, Sheet 1t4 e ta!; encu .Conditio-'n ng Indus try This -cert fies that • . yzo: COvarru bias . . .. Has successfuffycompeted the requirements for'IABc.Supervisor. ' 'June- 2 . • . , Ju ,. . ., ®19' 2'B97677SS Certification.# _ ,1 Y i • Labor Co-Chairman .: Renewed:June•28, 2019 -• 74.- ' - r i.) -1 , Valid Date . ' . . : ,-• f -- R. : Management Co-Chairman : : ii Expiration Date - - - J - Administrator of ICB/TABB " . Valid iinring qualified empin e't • I ® ACCREDITED INTERNATIONAL • : TESTING;ADJUSTING AND.BALANCING BUREAU. • ' • ISO/IEC 17024' CERTIFICATION BOARD THE PROFESSIONAL'S CHOICE.' Personnel Certification Program t72 ..z, o : . : : . Sheet .Metal 'ands: it Conitition ngIndustr . • This =certi .les that :: : .. f . , . , ,.: :. . , . , J-las success CG`. om� letecl the:requirement.. or ZA.Bc Technician . • • October. 1T,..,20 20 07,,,..z, ...4 a.__...., . �811�9.80907. . ��,�a�� . : .. • : Certification# : .. , Labor Co-Chairman . Octo6er-17, 2020 : - 4 PI°. 11 , ` wi Valid Date. 4 •^ �-�--•—• „ ManagementCo-Chairman December 31 2022. : ` ' , / . : . • : :Expiration Date . - . : - 7:-.SIT: Administrator of ICB/TABB Valid during qualified employment. w - - = i ® o ACCREDITED #0728. . INTERNATIONAL TESTING,ADJUSTING AND BALANCING BUREAU. • 'ISO/IEC 17024 CERTIFICATION BOARD THE PROFESSIONAL'S CHOICE`"' .Personnel Certification Program 1!La Eck Sheet Metat and .Ir Conditioning Industry This `certi lies that nest cFscareno xas success f uy tt com feted.tiie requirements. or ZABB:.�Iechnician :• p 31 " 202.0 "( .'" :: , . _.• .. 8310718522'. ,u�y .. �. Certiti atioii# i'r ,-ti Labor Co-Chairman Rneu d jury 31; 2020 " Valid Date Management Co-Chairman Septemder 30, 2022 � . Expiration Date. : Administrator of ICB/TABS. Valid"during qualified employment. • in • I - ® o ACCREDITED #0728, INTERNATIONAL TESTING,ADJUSTING AND BALANCING BUREAU 10/1E6:17024 CERTIFICATION BOARD , THE PROFESSIONAL'S CHOICE.' Personnel Certification Program .'. : .; .'. : ..:: ':. i: .tey: -.. .. : . . . ... . - . -. : . --. .. -, .. .. .- e . f.. . '.. .... r ... ,._ -. ::: : . : ::. : : . :: :. 00... -. ..-± : . - : . - . . : : Sheet fit4etatand Air Condit on nnc ustry . . .. . . .. ... . . . phis.cern tes thiat. . f rzc re o f Jfas successfully.completed•the requireme s for cIycBc:Technician ' : `: ' ��j1S002S7 October 19,: 2020 •Certification# Oft-,,c,-.1,'= ; Labor Co-Chairman : Renewed October 19, 2020 . 7`� 4 f�^ t Valid Date: Management Co-Chairman : : Ii 'w --�-�i . ecemter 31, 2022 . . , r.i.� . . Expiration Date Administrator of'ICBITABB . CTalid duffing quali5ed einplppmegt' .. Ha4maonawe 12 Gardenia Lake Forest, CA 92630 951-479-6855 Warranty Warranty of Services Hartmanaire warranties the TAB work for one year from the date of this report.Hartmanaire reserves the right to correct errors or omissions in the collection of data. The Warranty covers Balancing Issues. Off Season Testing: Typical balance report covers testing and balancing of all scheduledequipment, regardless of the outside air temperature.An Off Season test will generally cover temperature measurements Balancing Issues:Any balancing issues or concerns that arise,Hartmanaire will return to the site any time duringthe warranty period.Systems will be rechecked and verified that tested items adhere with the reported test date,AT NO CHARGE. . Warranty Procedures For all warranty items Balancing Issues,Hartmanaire requires a written request. The written request should be specific on the areas of concern, such rooms, or equipment, and the type of issue the occupants are having. Once written notification is received Hartmanaire will schedule a Technician.It is recommended that an Owner, or Architect,or Engineer be on site at that time. Voided Warranty and Additional Charges. If a complaint issue is due to a mechanical equipment failure, control or maintenance related,the return trip maybe subject to a service charge, not covered under warranty.Hartmanaire reserves the right to resolve any TAB issues.If a third party or competing Test &Balance/Commissioning firm test or adjust any equipment, all project warranty is voided.:(This is typical standard for the Mechanical industry, as Manufacture,Mechanical and Control Contractor voids all warranty when a competing firm test or. manipulates their systems.)Any return trip to the job,site is subject to a service charge and a purchase order will be required before returning to the job site. Document Archiving An electric file of all test documentswill be kept on file until the end of the Warranty period.During that time an electronic,copy of the test date will be provided a no charge.Any additional hard bound copies requested will be subject to a fee. Building owner should retain all documentation for future reference. All documentation pertaining to this project will be destroyed in accordance with our record retention schedule. 5 • • Fi atr`tJ a n itre • INSTRUMENT CALIBRATION FUNCTION MINIMUM'RANGE ACCURACY'• RESOLUTION• INSTRUMENT INFORMATION' •Calibration interval date• Rotation'measurement 0 to 5000 rpm • ±2%of reading : t 5 rpm- Name/Type ' Digital Tachometer (6 Months)' Manufacture&Model Extec Instuments Serial No. L735549 4/30/2021 Temperature Measurement .Air-. -•-40 to 240°F ±1%of reading _ 0:2°F• Name/Type- Digital Tachometer • • (6 Months) Manufacture&Model Extec/421307 Serial No. 631249 4/30/2021-. Immersion -40 to 240°F - ±1%of reading • .0.2°F • Name/Typpe Digital Tachometer (6 Months). Manufacture&Model' Extec/-39240 • Serial No. 3034 ' 4/30/2021- Contact:- -40 to 240°F' ±1%of reading 0.2°F Name/Type Digital Tachometer (6 Months) Manufacture&Model Extec/421307' Serial No. 631249 4/30/2021 Electrical Measurement • Voits AC. 0 to 600•VAC• • . • ±2%of reading 1.0 Volt- Name/.Type. Fluke/Volt-Amp Meter • -(6 Months)- ', Amperes- 0 to 100 Amps - ±2%-of reading . 0.1 Ampere- Manufacture&Model 333 Serial No. 8.9E+07 4/30/2021. • 'Air Pressure Measurement •'0 to 10.00 in-w.g. t 2%-of reading -0.01 in.w.g.51 in.w.g. Name/Type • Air Flow Meter• (6-Months) Manufacture&Model Shortridge/850 •Serial No. M00187- 4/30/2021' Air Velocity Measurement 50 to 2500 fpm . t'5%of reading 20 fpm Name/Type Vain Anemometer - .(6 Months). (Not For Pitot.tube traverses) Manufacture'&Model Airflow/LCA6000- Serial No. A13562 4/30/2021 Humidity.Measurement 10 to 90%RH• 2%RH 1% • Name/.Type. Check-it.Superheat-Humidity Set (6 Months) Manufacture 8 Model CHECK-IT 0628- Serial No. 40950 4/30/2021- Direct Reading Hood 100 to 2000 cfm ±5%-of reading Digital-1-dm - Name/Type Air Flow Meter (6-Months) . Analog-Not applicable Manufacture&Model Shortridge/850 -Serial No: M00187' 4/30/2021' . Pitot Tubes(2 required) , . . '.18"minimum '. not applicable- �Not applicable. Name/Type, Dwyer Not•Required • .adequate length for.intended use Manufacture'&Model 18"/36"1 50" Serial No. NA Hydronic Pressure Measurement ' -30"hg to 60 psi. ±2%dreading 0.5 psi -• Name/Type .Compound.&Pressure.Gage (6 Months). (Pressure Gauges) Manufacture-&Model USG-190/1500.03 1X587 Serial No. 1771 4/30/2021 0 to 100 psi ±2%of reading 1.0 psi Name/Type Pressure Gage 0 to 100 (6 Months) • ' ' 'Manufacture'&Model USG 190/ 1X599 Serial No. 3452 4/30/2021` 0 to.200 psi ±2%of reading 2.5 psi Name/Type Pressure Gage 0 to 200 (6 Months) Manufacture &Model USG 190/150003 1X630 Serial No. 1774 4/30/2021' Hydronic Differential Pressure 0 to 100 in.w.g. ±2%of reading . 1.0 in.w.g. Name/.Type Water Meter/Differential Manometer (6 Months) . Measurement 0 to 100.ft.w.g. ±2%of reading 1.0 ft:w.g. • Manufacture &Model Turb-O-Flow/DP2 Serial No. 2973. 4/30/2021 • H maria 12 Gardenia Lake Forest, CA 92630 951-479-6855 ABBREVIATIONS ACT .. Actual. AK - Free Area Factor AHU Air Handling Unit CD - Ceiling Diffuser CER - Ceiling Exhaust Register CFM - Cubic.Feet per Minute CR - Ceiling Return Register D.B. - Dry Bulb DD Direct Drive DDC - Direct Digital Controls: EMS.Control System for the HVAC DL - Drum Louver DNL - Data Not Listed. EF - Exhaust Fan EMS - Energy Management System ERU - Energy Recovery Unit ENT - Entering FH - Flowhood(Measures CFM Directly SO FPM and AK factors are not required). FPM - Feet per Minute GPM - . Gallons per Minute H.P. - Horsepower LVG - - Leaving MBH - 1,000 BTUH NA -. Not Available/No Access NVL - No Valid Location O.S.A. Outside Air P.D. - Pressure Drop R.A. - Return Air REQ - Required RPM - Revolutions.per.Minute RTU - Roof Top.Unit S.A. Supply Air S.F. - Service Factor S.P. - Static Pressure SWS - Side Wall Supply SWR - Side Wall Return TAB - Test,Adjust, and Balance TSP - Total Static Pressure Traverse - CFM readings take in at a point in the ductwork VAV - Variable Air Volume;box that contains a motorized damper that modulates airflow W.B. - Wet Bulb W.G. - Water Gauge 7 • H ' antaire 1rfr.-t,„0 • PACKAGE ROOFTOP / HEATPUMP / AC UNIT REPORT PROJECT GROCERY OUTLET-ARCADIA LOCATION 140 LIVE OAK ARCADIA, CA 91106 FAN NAME AC-1 AC-2 FC-1 FC-2 SERVICE SALES SALES FRONT OFFICE BACK OFFICE LOCATION ROOF ROOF p WALL MOUNT WALL MOUNT MANUFACTURER MON MON .LG LG MODEL# RN-013-8-0-EB09 .. RN-013=8-0-EB09 LSNO90H5V5 LSNO90H5V5 SERIAL# 202012-ANGK89239 202012-ANGK89238 . 007KABF1N98.1 811KABFO1A01 . CFM DESIGN ACTUAL DESIGN ACTUAL DESIGN ACTUAL DESIGN ACTUAL TOTAL FAN 4500 4412 4500 4593 307 310 307 308 • P RETURN AIR . 3050 3102 3050 3278 . 307 310 307 308. OUTSIDE AIR 1450 ' 1310 1450 1315 - ' - - O DAMPER POS OSA.% - 20% - 20% - - - - STAT PRES DISCHARGE . .32 .35 .08 . ..09. SUCTION -.64 . . -.69 -.02 . .02 ESP 1.0 .96 1.0 1.04 NL .10 NL .11 . . MOTOR FAN P. MANUFACTURER •WEG . WEG LG JG HORSEPOWER . 5 : . 5 NL NL VOLTAGE .. 200 221 200 218 208 207 208 207 AMPERAGE 14.6 12.8 . ' 14.6 12.7 ' A .26 .4 . .24. PHASE 3 3 1 1 DIRECT DIRECT RPM/SPEED . - 1760 . 59 HZ 1760 57 HZ • DRIVE HIGH DRIVE. HIGH SERVICE FACTOR T.P. T.P. T.P. T.P. DRIVE MOTOR SHEAVE SIZI DIRECT DRIVE DIRECT DRIVE . .DIRECT DRIVE DIRECT DRIVE % CLOSED DIRECT DRIVE DIRECT DRIVE DIRECT DRIVE DIRECT DRIVE FAN SHEAVE SIZE DIRECT DRIVE . . DIRECT DRIVE DIRECT DRIVE DIRECT DRIVE FAN RPM DIRECT DRIVE DIRECT DRIVE DIRECT DRIVE DIRECT DRIVE BELT SIZE/#OF DIRECT DRIVE DIRECT DRIVE DIRECT DRIVE DIRECT DRIVE CENTER TO CENTER DIRECT DRIVE DIRECT DRIVE DIRECT DRIVE DIRECT DRIVE NOTES: . M CC cc 0 0 a z a. LI — w IX • • ... • • . • Ce i e .1.-- ° 'a- l',• 'a- •6••• 0 c.1- ;i14'2 11)) • •co 8 (v) P CD C° I:13 0, .02)) a a Is- o co c, a ,....7., o) c n ci, cp a) cs) cr, ,-- %-• .- %- , , 13. Li- -i N- 0 < .1 1.0 0) CO CO cDCNI ,CD LC) CO CO LO 0 o) co Lo 0.,'") Z co NI- •-• 0) 0) CV v. ,- 01 CO 01 0 CV co co in cv LT- r*. N. OZ) co. Co r's NI. or) s- N. N. CO N. 1`... r•- v. CO • I I a. . . . . 000000 0 •• • • • - • 00.. . 000 O 0 0 0 0 0 0 P • 0 0 0 C1 0 0 0 0 0 .. • 0 LO to 1.0 to 0 0 10000 0 0 U) 1.0 0 0 GI Nt0 I`s. CO f`• h. N- co . ILI r•-• co r-- N. r-... co to a Tr • I F3.1171 0 I'' \ Se • 0 0 0 0 0 0 0 0 • 0 0 0 0 0 0 • 0 • 0 ,--,--/ 0 0 0 0 a a 11 •v.) %- a a a a a a 11• m •,- co ._ •.1 p < •C 1' C) (O a• I-' Cei co . • 0 •• • • 0 • • • • • • • • 0 9 000 < Cr) = = = = UJ .95.sletiau GI C%1 el ISI tS1 GI .•- c\i < 0 co `-x-,, x ;;I. ;4. ;,r :t :4- ;-4- A c< c, c, r , r r r r ,– — — ,- r — w CC 'Cr .cr .< a • • . • • . . • 00 .• 4, 000 000 000 000 < 0 (.) Z 0 0 0 0 0 0 0 0 CI 0 0 CI 0 0 0 0 . • LU re 2 0 0 0 0 0 0 x o 0 0 0 0 0 0 cc o = H • 0 y e 0 < . , < , 0 0 ;6= , c•1 c) •gl" I.0 CD R — u) — — CN1 CO Nr to co s- < Cl) 1-• co 410 LLI > • • • . . . . • . • • • • • • • • • 900 0 W C3 .4. IV ... ..i.'".1 CO CD CO CO (0 CO ,t ‘ WL.LJWLLILLJLIJ 1- ell (1)W 2 Wu) Luu) Wu) Luu) C c4 LLI t_j -J J -.1 -I -J -I 6 6 • 0 _1 _1 -J J J -J 0 -..e- <t <C < < <C < < < cc < < < <C < <L <U) (0 CI) U) U) U) W I= i ." 4 i/i 1 0 re 0 0 0 M z Han�aare rG4 � PACKAGE ROOFTOP / HEATPUMP / AC UNIT REPORT PROJECT GROCERY OUTLET-ARCADIA LOCATION 140 LIVE OAK ARCADIA, CA 91106 FAN NAME FC-3 SERVICE BREAK ROOM LOCATION WALL MOUNT MANUFACTURER LG MODEL# LSNO90H5V5 SERIAL# 006KATMO3H53 CFM : DESIGN ACTUAL DESIGN ACTUAL DESIGN ACTUAL DESIGN ACTUAL TOTAL FAN 307 312 RETURN AIR 307 . . 312. OUTSIDE AIR STAT PRES DISCHARGE . .09 P . SUCTION -.03 ESP NL .12 . . MOTOR FAN MANUFACTURER LG. HORSEPOWER NL VOLTAGE .. 208. 207 AMPERAGE .4 .29: . . PHASE 1: DIRECT . RPM/SPEED DRIVE : HIGH. SERVICE.FACTOR T.P. DRIVE MOTOR SHEAVE SIZE DIRECT DRIVE. %CLOSED DIRECT DRIVE FAN SHEAVE SIZE DIRECT DRIVE FAN RPM DIRECT.DRIVE BELT SIZE/#OF DIRECT DRIVE. CENTER TO CENTER DIRECT DRIVE NOTES: AL H 1 a a irre r L )r- EXHAUST FAN REPORT PROJECT GROCERY OUTLET-ARCADIA LOCATION 140 LIVE OAK ARCADIA; CA 91106 FAN DATA FAN NUMBER EF-1 FAN NUMBER EF-2 FAN NUMBER EF-3 Location CEILING CEILING ROOF Service RESTROOM 1 RESTROOM 2 ELECTRIC ROOM Manufacturer COOK COOK- COOK Model Number GEMINI 140- GEMINI 140 90 ACEH 90C15DH Motor Mfr. QUEACE QUEACE US MOTORS Motor H.P./RPM 15 W/1550 1 5 W/1550 .25/1550 Volts/Phase 115.- 1 115= 1 : . 115- 1 . F.L.Amps/S.F. :4/T.P. .4 I.T.P. .7/T.P. Motor Sheave Diam x Bore DIRECT DRIVE DIRECT DRIVE . DIRECT DRIVE. % Closed DIRECT DRIVE DIRECT DRIVE DIRECT DRIVE. .. Fan Sheave Diam x Bore DIRECT DRIVE DIRECT DRIVE DIRECT DRIVE No. Belts/Size. DIRECT DRIVE DIRECT DRIVE DIRECT DRIVE TEST DATA DESIGN I ACTUAL DESIGN I ACTUAL DESIGN I ACTUAL CFM 100 109 100 110 300 310 DIRECT DIRECT DIRECT DIRECT DIRECT Fan RPM DRIVE DRIVE . . DRIVE DRIVE 1550. DRIVE . . Motor RPM 1550 LOW 1550 LOW 1550 . VARIABLE E.S.P. 0.125 .0.127 0.125 0.13 0.25 0.26 Voltage 115 117 115 117 115 117 Amperage 0.4. . . T.P. : . 0.4 . .T.P. . 1.7 REMARKS airtAH 1 ainaire 0.64 1-.-:,-,, ,; -,-:,)`,,)). ! j--L uni);i•-:) EXHAUST FAN REPORT PROJECT GROCERY OUTLET-ARCADIA LOCATION 140 LIVE OAK ARCADIA, CA 91106 FAN DATA FAN NUMBER TF-1 FAN NUMBER[ TF-2 FAN NUMBER! TF-3 Location CEILING CEILING CEILING Service FRONT OFFICE BACK OFFICE BREAK ROOM Manufacturer COOK COOK COOK Model Number GEMINI-GN146 GEMINI-GN146 GEMINI-GN146 Motor Mfr. QUEACE QUEACE QUEACE Motor H.P./RPM 56 W/DIRECT DRIVE 56 VV/DIRECT DRIVE 56 W/DIRECT DRIVE •Volts/Phase 115- 1 115- 1 115- 1 F.L.Amps!S.F. DIRECT DRIVE/T.P. DIRECT DRIVE/T.P. DIRECT DRIVE/T.P. Motor Sheave Diam x Bore • DIRECT DRIVE DIRECT DRIVE • DIRECT DRIVE. %Closed DIRECT DRIVE DIRECT DRIVE DIRECT DRIVE Fan Sheave Diam x Bore DIRECT DRIVE DIRECT DRIVE DIRECT DRIVE No. Belts/Size DIRECT DRIVE DIRECT DRIVE DIRECT DRIVE TEST DATA DESIGN ACTUAL DESIGN 1 ACTUAL DESIGN I ACTUAL CFM 100 105 100 108 100 110 DIRECT DIRECT DIRECT DIRECT DIRECT Fan RPM DRIVE DRIVE • DRIVE DRIVE 1550 • DRIVE Motor RPM 1550 LOW 1550 LOW 1550 VARIABLE E.S.P. 0.125 0.13 0.125 0.135 0.125 0.14 Voltage 115 117 115 118 115 117 Amperage NVL T.P. NVL T.P. NVL T.P. REMARKS t t Project Status Report— Lighting Controls Acceptance Testing `''LcA 0 • ❑ National Lighting Contractors Association of America iN `k .. (Revised 04/2020) 1.34 - - -NAs•«agono9CA«e+cdo :• PROJECT INFORMATION Code Cycle:. 2019 Energy Code Project Name: .. Grocery Outlet-Arcadia NLCAA Project Number: 2101-00035." Project Address: 140 Live Oak Avenue,Arcadia,CA,91006-5239 Permit Number 20-598 Enforcement Agency: City of Arcadia Acceptance Test Employer: Kevin White-ATE-1.412-00008 Acceptance Test Technician: Kevin White;.ATT=1501-00024 FORMS INCLUDED Q✓NRCA-LTi-02-A O✓NRCA-LTI-03-A 2 NRCA-LTI-04-A _ 0 NRCA-LTI-05-A QQ NRCA-LTO-02-A TESTED AREAS FORM" BUILDING FLOOR NAME Automatic Scheduling Controls Not Used in Conjunction with Motion Sensors 1 1 Exterior Occupant Sensing Lighting Controls . 1 1 Front Office. Occupant Sensing Lighting Controls 1 1 Back Office Automatic Time Switch Lighting Controls 1 1 Back of.House Occupant Sensing Lighting Controls 1 1 Employee Lounge. Occupant Sensing Lighting Controls 1 1 Women Restroom Occupant Sensing Lighting Controls 1 1 Men Restroom, Automatic Time Switch Lighting Controls "".. 1 1 .. Hallway Automatic Time Switch Lighting Controls 1 1 Sales Daylighting Continuous Dimming Control Systems 1 1 "" Sales • Demand Responsive.Illuminance Measurement STATE OF CALIFORNIA r'f:. .', NLc'.W P • SHUT-OFF LIGHTING CONTROL ACCEPTANCE DOCUMENT �,� y �. CEC-NRCA-CTI-02-A(Revised 01/21) — —1:1..r.am NeQo o Lighting C tr1ct re 0 O California Energy Commission CERTIFICATE:OF ACCEPTANCE NR CA=LTI=02-A Occupant Sensing Lighting Controls Project Name:Grocery Outlet-Arcadia . Enforcement Agency:City of Arcadia. Permit Number:20-598 . Project Address:..140 Live Oak Avenue City:Arcadia Zip Code:91006-5239. Building:1 Floor 1, Room:Front Office Occupant Sensing Lighting Controls A-2.Occupant Sensing Lighting Control Construction Inspection(NA7:6:2.2) ID a. Occupant sensors have been located to minimize false signals.(NA7.6:2.2(a)) O. . ✓O : b.: Occupant sensors are located no closer than four(4)feet from any HVAC diffuser:(NA7.6.2:2(b)) r0.. c.. Passive infrared sensor pattern does not enter into adjacent zones.(NA7.6.2.2(c)) O : d.- .Occupant sensors do not encounter any obstructions that could adversely affect desired performance.(NA7.6.2.2(d)) 2 . Ultrasonic occupant sensors do not emit audible sound:(NA7.6.2:2(e),.§110.9(b)6Bii) Construction.Inspection Compliance:D Complies O.Does Not Comply B-2:Occupant Sensing Lighting Control Functional Testing(NA7.6.2.3) Confirm compliance(Y-yes/.N-no)for the control being tested.. . . Step 1:Simulate an unoccupied condition.(NA7.6.2.3(a)) a.. Lights controlled by occupant sensing control turn off or partially off,if applicable,within a maximum of 20 minutes from start of an Yes unoccupied condition:(NA7.6.2.3(a)1,§110.9(b)4A) In the partial off state,partial-OFF.occupant sensors automatically reduce lighting power by at least 50%(§130.1(c)6AC, ' §130.1(c)7A);OR: For metal halide or high pressure sodium lighting in warehouses,automatically reduce lighting power by at least 40% (EXCEPTION 2 to§130.1(c)6A). • In aisle ways and open areas in warehouses in which the installed lighting power is 80%or less of the value allowed under the Area Category Method,automatically reduce lighting power by at least 40%(EXCEPTION 1 to§130.1(c)6A). • In corridors and stairwells in which the installed lighting power is 80%or less,of the value allowed under the Area Category Method,automatically reduce lighting power by at least 40%(EXCEPTION to§130.1(c)7A). Occupant sensing controls in parking garages,parking areas,and loading and unloading areas have at least one control step between 20 to 50%of design lighting power(§130.1(c)7B).OR Occupant sensing controls for metal halide luminaires with a lamp plus ballast meansystem efficacy of 75 lumens per watt in parking garages,parking areas;and loadingand unloading areas have at least one control step between 20 to 60%of design lighting power(EXCEPTION to§130.1(c)7B). b. The occupant sensing controldoes not trigger a false"on"from movement in an area adjacent to the controlled space or,from : Yes HVAC operation.(NA7.6.2.3(a)2) c. Signal sensitivity is adequate to achieve desired control.(NA7.62.3(a)3)For library book,stacks or warehouse aisles,activity Yes beyond the stack or aisle shall not activate the lighting in the stack or aisle.(§130.1(c)6A,§130.1(c)6B) Step 2:Simulate an occupied condition:(NA7.6.2.3(b)) a. Status indicator or annunciatoroperates correctly:(NA7.6.2.3(b)1,§110.9(b)4C) Yes b: . Immediately upon an occupied condition(NA7.6.2.3(b)2): Yes • Lights controlled by an occupant sensor or a partial-OFF occupant sensor turn on;OR • A vacancy sensor indicates a space is"occupied and lights may be turned on manually;OR • The first stage of a partial-ON occupant sensor automatically activates between 50 to 70%of the lighting..(§130.1(c)5A) - After the first stage occurs for partial-ON occupant sensors,manual switches allowan occupant to activate the alternate set of lights,:activate 100%of the lighting power,and manually deactivate all of the lights. Functional Testing Compliance:OO Complies 0 Does Not Comply. Page 1 of 9 - . • • STATE OF CALIFORNIA f t. ❑ {i❑ SHUT-OFF LIGHTING CONTROL ACCEPTANCE DOCUMENT. N\LCAA,' 4 r } • CEGNRCA-CTI-02-A(Revised 01/21) California Energy.Commission .. National Am ire,• ❑ - CERTIFICATE OF ACCEPTANCE • • - NRCA LTI=02-A Occupant Sensing Lighting Controls Project Name:Grocery Outlet-Arcadia . Enforcement Agency:City of Arcadia Permit'Number.20-598 . • Project Address:140 Live Oak Avenue • : City:Arcadia Zip Code:91006-5239 • • Building.'1 Floor 1 Room..Back Office Occupant Sensing Lighting Controls A-2.Occupant Sensing Lighting Control Construction Inspection(NA7:6.2.2) • 0 a Occupant sensors have been located to minimize false signals:(NA7.6:2.2(a)) • D b. Occupant sensors are located no closer than four(4)feet from any HVAC diffuser:(NA7.6.2:2(b)) • c:- Passive infrared sensor pattern does not enter into adjacent zones..(NA7.6.2.2(c)) d. Occupant sensors do not encounter any obstructions that could adversely affect desired performance.(NA7.6.2.2(d)) 2 e: Ultrasonic occupant sensors do not emit audible sound.(NA7.6.2:2(e),§110.9(b)6Bii) Construction Inspection Compliance:0 Complies O.Does Not Comply B-2:Occupant Sensing Lighting Control Functional Testing(NA7.6.2.3) • • Confirm compliance(Y-yes/.N-no)for the control being tested.. Step 1:Simulate an unoccupied condition.(NA7.6.2.3(a)) a - Lights controlled by occupant sensing control turn off or partially off,if applicable;within a maximum of 20 minutes from start of an Yes unoccupied condition:(NA7.6.2.3(a)1,§110.9(b)4A) In the partial off state,partial-OFF.occupant sensors automatically reduce lighting power by at least 50%(§130.1(c)6AC, - §130.1(c)7A),OR:. • For metal halide or high pressure sodium lighting in warehouses,automatically reduce lighting power by at least 40% (EXCEPTION 2 to.§130.1(c)6A). • In aisle ways and open areas in warehouses in which the installed lighting power is 80%or less of the value allowed under the Area Category Method,automatically reduce lighting power by at least 40%(EXCEPTION 1.to§130.1(c)6A). • In corridors and stairwells in which the installed lighting power is 80%or less of the value allowed under the Area Category Method,automatically reduce lighting power by at least 40%(EXCEPTION to§130.1(c)7A). ' Occupant sensing controls in parking garages,parking areas,and loading and unloading areas have at least one control step between 20 to 50%of design lighting power(§130.1(c)7B).OR Occupant sensing controls for metal halide luminaires with a lamp plus ballast mean system efficacy of 75 lumens per watt in parking garages,parking areas,and loading and unloading areas have • at least one control step between 20 to 60%of design lighting power(EXCEPTION to§130.1(c)7B). • b. The occupant sensing control does not trigger a false"on"from movement in an area adjacent to the controlled space or.from Yes HVAC operation.(NA7.6:2.3(a)2) c. - Signal sensitivity is adequate to achieve desired control.(NA7.6.2.3(a)3)For library book stacks or warehouse aisles,activity - Yes beyond the stack or aisle shall not activate the lighting in the stack or aisle. 130.1 c 6A,§130.1(c)6B) ; .. Step 2;Simulate an occupied condition:(NA7.6:2.3(b)) a. Status indicator or annunciatoroperates correctly:(NA7.6.2.3(b)1,§110.9(b)4C) Yes b: . Immediately upon an occupied condition(NA7.6.2.3(b)2): • Yes.: • Lights controlled by an occupant sensor or a.partial=OFF occupant sensor turn on;OR • A vacancy sensor indicates a space is"occupied"and lights may be turned on manually;OR • The first stage of a partial-ON occupant sensor automatically activates between 50 to 70%of the lighting. the first stage occurs for partial-ON occupant sensors,manual switches allowan occupant to activate the alternate set of • lights,:activate 100%of the lighting power,and manually deactivate all of the lights. • Functional Testing Compliance:' I Complies 0 Does Not Comply • • • Page 2 of 9 • • STATE OF CALIFORNIA �;. 0"..4j, ❑.. • SHUT-OFF LIGHTING CONTROL ACCEPTANCE DOCUMENT :NLCAA° ti94 CEC=NRCA=LTI-02-A(Revised 01/21) t•I Association i oof AmarIfo F• California Energy Commission Na,oaoan aadro 0 . ca CERTIFICATE OF ACCEPTANCE NRCA-LTI-02-A Automatic Time Switch Lighting Controls. Project Name:Grocery Outlet-Arcadia Enforcement Agency:City of Arcadia . • Permit Number 20-598 Project Address:.140 Live Oak Avenue City:Arcadia - Zip Code:91006-5239. Building:1 Floor:1 '. Room:Back of House Automatic Time Switch Lighting Controls A-1.Automatic Time Switch Lighting Control Construction Inspection(NA7.6.2;4) O a. Automatic time switch controls are programmed with acceptable weekday,weekend,and holiday(if applicable)schedules.(NA7.6.2.4(a), §110.9(b)1Aii,§130.1(c)1A„§130.1(c)4) O b. Document for the owner weekday,weekend,and holidays schedules,as well as all set-up and preference program settings. (NA7.6.2.4(b)) • c. The correct time and date are properly set in the time switch.(NA7.6.2:4(c)) • d. The battery backup(if applicable)is installed and energized.(NA7.6.2.4(d),§110.9(b)1) • e. Override time limit is no more than 2 hours.(NA7:6.2.4(e),§110.9(b)1Ai,§130.1(c)3B)OR The automatic time switch control's override time is exempt from the 2-hour limit.(EXCEPTION to§130.1(c)3B) • f. Override switches remote from area with controlled luminaires have annunciator lights.(NA7.6.2.4(f),§130.1(c)3A,§130.1(a))OR The manual override switch isexempt from being in the same enclosed area with the lighting it controls.(EXCEPTION1 to§130.1(a)2) Construction Inspection Compliance:ID Complies 0 Does Not Comply B-1:Automatic Time Switch Lighting Control Functional Testing(NA7.6.2.5) Confirm compliance(Y-yes/.N-no)for the control being tested.. Step 1:Simulate occupied condition.(NA7.6.2.5(a)) a. All lights can be turned on and:off by their respective area control switch.(NA7.6:2.5(a)1) - Yes b. The switch only operates lighting in the enclosed space(ceiling-height partitioned area)in which the switch is located.(NA7.6.2.5(a)2; Yes §130.1(c)1C) . c. For the area controlled by an automatic time switch control with a time override located in and for the area,the lighting can be turned' Yes on manually by initiating the time override.The lighting is configured to remain on for no more than 2 hours,unless the area is exempt from the 2-hour time override limit.(NA7.6.2.5(a)3,'§110.9(b)1Ai,§130.1(c)3B,EXCEPTION to§130.1(c)3B) d. For the area'controlled by an automatic time switch control with an automatic holiday shut-off feature,the lighting in the area can be Yes turned off automatically by initiating the holiday shut-off.(NA7.6.2.5(a)4,§110.9(b 1Aii,§130.1((c)4)OR The automatic time switch control is exempt from incorporating an.automatic holiday shut-off feature:(EXCEPTION to§130.1(c)4).. e. For the area controlled by an automatic time switch control with manual-on mode configured,the lighting in the area can be turned on Yes manually when it is manually activated.(NA7.6.2.5(a)5;§130.1(c)1 E)OR The automatic time switch control does not include or utilize a manual,on mode.(§130.1(c)1 E) Step 2:Simulate unoccupied condition..(NA7.6.2.5(b)) a. All non-exempt lighting turns off in accordance with the programmed time switch schedules:(NA7:6.2.5(b)1,§130.1(c)1A) • Yes, b. Manual override switch allows only the lights in the enclosed space(ceiling height partitioned)where the override switch is located to Yes turn on or remain on until the next scheduled shut off occurs.(NA7.6.2.5(b)2,§130.1(c)1 C,§130.1(c)3) .. Functional Testing Compliance:O✓Complies 0 Does Not Comply • • • Page 3 of 9 STATE OF CALIFORNIA f._ ❑•. . ' ❑ SHUT-OFF LIGHTING CONTROL ACCEPTANCE DOCUMENT rlLcAa CEC-NRCA-LTI-02-A(Revised 01/21) National on"a Cm;,t".: } California Energy Commission Association of Amdtic9 • CERTIFICATE OF ACCEPTANCE NRCA-LTI-02-A Occupant Sensing Lighting Controls • Project Name:Grocery Outlet-Arcadia Enforcement Agency:City of Arcadia Permit Number 20-598 Project Address:140 Live Oak Avenue City:Arcadia Zip Code:91006-5239 Building:1 Floor:1 • Room:Employee Lounge Occupant Sensing Lighting Controls A-2.Occupant Sensing Lighting Control Construction Inspection(NA7.6.2.2) . 0. a. Occupant sensors have been located to minimize false signals.(NA7.6.2.2(a)) • b. Occupant sensors are located no closer than four(4)feet from any HVAC diffuser.(NA7.6.2.2(b)) • c. Passive infrared sensor pattern does not enter into adjacent zones.(NA7.6.2.2(c)) O d. Occupant sensors do not encounter any obstructions that could adversely affect desired performance.(NA7.6.2.2(d)) ▪ e. Ultrasonic occupant sensors do not emit audible sound.(NA7.6.2.2(e),§110.9(b)6Bii) Construction Inspection Compliance:2 Complies 0 Does Not Comply B-2.Occupant Sensing Lighting Control Functional Testing(NA7.6.2.3) Confirm compliance(Y-yes/N-no)for the control being tested:. • Step 1:Simulate an unoccupied'condition.(NA7.6.2.3(a)) a. Lights controlled by occupant sensing control turn off or partially off,if applicable,within a maximum of 20 minutes from start of an Yes unoccupied condition.(NA7.6.2.3(a)1,§110.9(b)4A) In the partial off state,partial-OFF occupant sensors automatically reduce lighting power by at least 50%(§130.1(c)6AC, §130.1(c)7A),OR: • For metal halide or high pressure sodium lighting in warehouses,automatically reduce lighting power by at least 40% (EXCEPTION 2 to§130.1(c)6A). • In aisle ways and open areas in warehouses in which the installed lighting power is 80%or less of the value allowed under the Area Category Method,automatically reduce lighting power by at least 40%(EXCEPTION 1 to§130.1(c)6A). • In corridors and stairwells in which the installed lighting power-is 80%or less of the value allowed under the Area Category Method,automatically reduce lighting power by at least 40%(EXCEPTION to§130.1(c)7A). Occupant sensing controls in parking garages,parking areas,and loading and unloading areas have at least one control step between 20 to 50%of design lighting power(§130.1(c)7B).OR Occupant sensing controls for metal halide luminaires with a lamp plus ballast mean system efficacy of 75 lumens per watt in parking garages,parking areas,and loading and unloading areas have at least one control step between 20 to 60%of design lighting power(EXCEPTION to§130.1(c)7B). b. The occupant sensing control does not trigger a false"on"from movement in an area adjacent to the controlled space or from Yes HVAC operation.(NA7.6.2.3(a)2) c. Signal sensitivity is adequate to achieve desired control.(NA7.6.2.3(a)3)For library book stacks or warehouse aisles,activity Yes beyond the stack or aisle shall not activate the lighting in the stack or aisle.(§130.1(c)6A,§130.1(c)6B) Step 2:Simulate an occupied condition:(NA7.6.2.3(b)) 2 ' a. Status indicator or annunciator operates correctly.(NA7.6.2.3(b)1,§110.9(b)4C) Yes b: Immediately upon an occupied condition(NA7.6.2.3(b)2): Yes • Lights controlled by an occupant sensor or a.partial-OFF occupant sensor turn on;OR • A vacancy sensor indicates a space is"occupied"and lights may be turned on manually;OR • The first stage of a partial-ON occupant sensor automatically activates between 50 to 70%of the lighting.(§130.1(c)5A) • After the first stage occurs for partial-ON occupant sensors,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.. Functional Testing Compliance:0 Complies 0 Does Not Comply • Page 4 of 9 • • STATE OF CALIFORNIA �' L fA';+ ❑ �i o SHUT-OFF LIGHTING CONTROL ACCEPTANCE DOCUMENT NLC • -=`kr. CEC-NRCA-LTI-02-A(Revised 01/21) National LantinaConta«o. _ California Energy Commission - Kswtel*"°"'"ce . ❑; CERTIFICATE OF ACCEPTANCE NRCA-LTI-02-A Occupant Sensing Lighting.Controls - • Project-Name:Grocery Outlet-Arcadia " Enforcement Agency:City of Arcadia • Permit Number 20-598 Project Address:..140 Live Oak Avenue City:Arcadia Zip Code:91006-5239.. • Building 1 • Floor 1 Room:Women Restroom Occupant Sensing Lighting Controls A-2.Occupant Sensing Lighting Control Construction Inspection(NA7:6.2.2) " O✓. a. Occupant sensors have been located to minimize false signals.(NA7.6:2.2(a)) O✓ b.: Occupant sensors are located no closer than four(4)feet from any HVAC diffuser:(NA7.6.2.2(b)) • c. Passive infrared sensor pattern does not enter into adjacent zones.(NA7.6.2.2(c))" • d.: Occupant sensors do not encounter any obstructions that could'adversely affect desired performance.(NA7.6.2.2(d)) 2 e. Ultrasonic occupant sensors do not emit audible sound.(NA7.6.2:2(e),.§110:9(b)6Bii) Construction Inspection Compliance:n Complies 0 Does Not Comply B-2:Occupant Sensing Lighting Control Functional Testing(NA7.6.2.3) Confirm compliance(Y'-yes'/N-no)for the control being tested.. Step 1:Simulate an unoccupied condition,(NA7.6.2.3(a)) • a. Lights controlled by occupant sensing control turn off or partially off,if applicable,within a maximum of 20 minutes from start of an • Yes unoccupied condition.(NA7.6.2.3(a)1,§110.9(b)4A) In the partial off state,partial-OFF,occupant sensors automatically reduce lighting power by at least 50%•( 130.1(c)6AC, §130.1(c)7A),OR: • • For metal halide or high pressure sodium lighting in warehouses,automatically reduce lighting power by at least 40% (EXCEPTION 2 to.§130.1(c)6A).. - " - • In aisle ways and open areas in warehouses in which the installed lighting power is.80%or lessof the value allowed under the Area Category Method,automatically reduce lighting"power by at least 40%(EXCEPTION 1 to§130.1(c)6A).= • In corridors and stairwells in which the installed lighting power is 80%or less of the value allowed under the Area Category Method,automatically reduce lighting power by at least 40%(EXCEPTION to§130.1(c)7A). . Occupant sensing controls in parking garages,parking areas,and loading and unloading areas have at least one control step • between 20 to 50%of design lighting power(§130.1(c)7B).OR Occupant sensing controls for metal halide luminaires with a lamp plus ballast mean system efficacy of 75 lumens per watt in parking garages,parking areas,and loading and unloading areas have at least one control,step between 20 to 60%of design lighting power(EXCEPTION to-§130.1"(c)7B). b. The occupant sensing control does not trigger a false"on"from movement in an area adjacent to the controlled space or from Yes HVAC operation.(NA7.6.2.3(a)2) • c.. Signal sensitivity is adequate to achieve desired control.(NA7,6.2.3(a)3)For library book stacks or warehouse aisles;activity Yes •=beyond the stack or aisle shall not activate the lighting in the stack or aisle.(§130.1(c)6A,§130.1(c)6B) ' Step 2:Simulate an occupied condition:(NA7.62.3(b)) a." Status indicator or annunciator operates correctly:(NA7:6.2.3(b)1,§110.9(b)4C) Yes b: . Immediately upon an occupied condition(NA7.6.2.3(b)2): • Yes • Lights controlled by an occupant sensor or a.partial-OFF occupant sensor turn on;OR • A vacancy sensor indicates a space is'occupied"and lights may be turned on manually;OR • The first stage of a partial-ON occupant sensor automatically activates between 50 to 70%of the lighting.(§130.1(c)5A) After the first stage occurs for partial-ON occupant sensors,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. Functional Testing Compliance:0 Complies 0 Does Not Comply. " • • • • • Page5of9 STATE OF CALIFORNIA r . , p a: p SHUT-OFF LIGHTING CONTROL ACCEPTANCE DOCUMENT N,�cA , IF.y ,, CEC=NRCA-CTI-02=A(Revised 01/21) -¢ NatioLlyhtlp•contrx3 — contract.. California Energy Commission .. ONIeuenuIAm,,ka- -E _• CERTIFICATE OF ACCEPTANCE NRCA LTI=02-A Occupant Sensing Lighting Controls Project Name:Grocery Outlet=Arcadia . Enforcement Agency:City of Arcadia Permit Number.20-598 Project Address:140Live Oak,Avenue - City:Arcadia Zip Code:91006-5239 Building:'1 Floor 1 Room Men Restroom Occupant Sensing Lighting Controls A-2.Occupant Sensing Lighting Control Construction Inspection(NA7:6.2.2) • O. . a. Occupant sensors have been located to minimize false signals.(NA7.6:2.2(a)) • b.= Occupant sensors are located no closer than four(4)feet from any HVAC diffuser.(NA7.6.2:2(b)) c Passive infrared sensor pattern does not enter into-adjacent zones.(NA7.6.2.2(c)) • • d. Occupant sensors do not encounter any obstructions that could adversely affect desired.performance.(NA7.6.2.2(d)) • e: Ultrasonic occupant sensors do not emit audible sound'.(NA7.6.2:2(e),.§110.9(b)6Bii) Construction Inspection Compliance:EO Complies 0 Does Not Comply B-2.Occu ant SensinLighting Control Functional TestinNA7.6.2.3 Confirm'compliance(Y- es'/. -no)for the control being sted.. .). . . . . Step 1:Simulate an unoccupied condition.(NA7.6.2.3(a)) a. Lights controlled by occupant sensing control turn off or partially off,if applicable;within a maximum of 20 minutes from start'of an Yes unoccupied condition:(NA7.6.2.3(a)1,§110.9(b)4A) In the partial off state,partial-OFF.occupant sensors automatically reduce lighting power by at least 50%(§130.1(c)6AC, §130.1(c)7A),OR: • • For metal halide or high pressure sodium lighting in warehouses,automatically reduce lighting power by at least 40% (EXCEPTION 2 to§130.1(c)6A).' • In aisle ways and open areas in warehouses in which the installed lighting.power is.80%or lessof the value allowed under the Area Category Method,automatically reduce lighting power by at least 40%(EXCEPTION 1 to§130.1(c)6A). • • In corridors and stairwells in which the installed lighting power is 80%or less of the value allowed under the Area Category Method,automatically reduce lighting power by at least 40%(EXCEPTION to§130.1(c)7A). Occupant sensing controls in parking garages,parking areas;and loading and unloading areas have at least one control step between 20 to 50%of design lighting power(§130.1(c)7B).OR Occupant sensing controls for metal halide luminaires with a lamp. ' plus ballast mean system efficacy of 75 lumens per watt in parking.garages,parking areas;and loading and unloading areas have at least one control,step between 20 to 60%of design lighting power(EXCEPTION to§130.1(c)7B). - b. The occupant sensing control,does not trigger a false"on"from movement in an area adjacent to the controlled space or from Yes • HVAC operation.(NA7.6.2.3(a)2) ' c. Signal sensitivity is adequate to achieve desired control.(NA7.6.2.3(a)3)For library bookstacks or warehouse aisles;activity Yes beyond the stack or aisle shall not activate the lighting in the stack or aisle.(§130.1(c)6A,§130.1(c)6B) Step 2:Simulate an occupied condition:(NA7.6.2.3(b)) a. Status indicator or annunciatoroperates correctly:(NA7.6.2.3(b)1,§110.9(b)4C) " : : Yes b: . Immediately upon an occupied condition(NA7.6.2:3(b)2):' • Yes • Lights controlled by an occupant sensor or a partial-OFF occupant sensor turn on;OR • A vacancy sensor indicates a space is'occupied"and lights may be turned on manually;OR • The first stage of a partial-ON occupant sensor automatically activates between 50 to 70%of the lighting.(§130.1(c)5A) . After the first stage occurs for partial-ON occupant sensors,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. ' • Functional Testing Compliance:CI Complies 0 Does Not Comply • • • • Page 6of9. , STATE OF CALIFORNIA ;, - ❑ SHUT-OFF LIGHTING CONTROL ACCEPTANCE DOCUMENT N�cAn � ,�.: CEC-NRCA-LTI-02-A(Revised 01/21) '' "� Nallonal Llghting Contractors 4 Asia I tlonofAmerica California Energy Commission 0 �..• CERTIFICATE OF ACCEPTANCE :. NRCA-LTI=02-A Automatic Time Switch Lighting Controls Project Name:Grocery Outlet-Arcadia . Enforcement Agency:City of Arcadia Permit Number 20-598 Project Address:,.140 Live Oak Avenue City:Arcadia Zip Code:91006-5239 Building:1 Floor 1, Room:Hallway Automatic Time Switch Lighting Controls . A-1.Automatic Time Switch Lighting Control Construction Inspection(NA7.6.2.4) • a. Automatic time switch controls are programmed with acceptable weekday,weekend,and holiday(if applicable)schedules.-(NA7.6.2.4(a), §110.9(b)1Aii,§130.1(c)1A,§130.1(c)4) ▪ b: Document for the owner weekday,weekend,and holidays schedules,as well as all set-up and preference program settings. (NA7.6.2.4(b)) • c. The correct time and date are properly set in the time switch.(NA7.6.2.4(c)) • d. The battery backup(if applicable)is installed and energized.(NA7.6.2.4(d),§110.9(b)1) O e. Override time limit is no more than 2 hours.(NA7.6.2.4(e),§110.9(b)1Ai,§130.1(c)3B)OR The automatic time switch control's override time is exempt from the 2-hour limit.(EXCEPTION to§130.1(c)3B) 2 f. Override switches remote from area with controlled luminaires have annunciator lights.(NA7.6.2.4(f),§130.1(c)3A,§130.1(a))OR The manual override switch is,exempt from.being in the same enclosed area with the lighting it controls.(EXCEPTION 1 to§130.1(a)2) • Construction Inspection Compliance:0 Complies 0 Does Not Comply B-1.Automatic Time Switch Lighting Control Functional Testing(NA7.6.2.5) Confirm compliance(Y-yes/N-no)for the control being tested. . • Step 1:Simulate occupied condition:(NA7.6:2.5(a)) • • • a. All lights can be turned on and:off by their respective area control switch.(NA7.6.2.5(a)1) • Yes b. The switch only operates lighting in the enclosed space(ceiling-height partitioned area)in which the switch is located.(NA7.6.2.5(a)2, Yes §130.1(c)1C). c. For the area controlled by an automatic time switch control with a time override located in and for the area,the lighting can be turned Yes on manually by initiating the time override.The lighting is configured to remain on for no more than 2 hours,unless the area is exempt from the 2-hour time override limit.(NA7:6.2.5(a)3,§110.9(b)1Ai,§130.1(c)3B,EXCEPTION to§130.1(c)3B) d. For the area controlled by an automatic time switchcontrol with an automatic holiday shut-off feature,the lighting in the area can be Yes turned off automatically by initiating the holiday shut-off.(NA7.6.2.5(a)4,§110.9(b)1Aii,§130.1(c)4)OR The automatic time switch control is exempt from incorporating an automatic holiday shut-off feature.(EXCEPTION to§130.1(c)4).. e. For the area controlled by an automatic time switch control with manual-on mode configured,the lighting in the area can be turned on Yes manually when it is manually activated:(NA7.6.2.5(a)5,§130.1(c)1 E)OR The automatic time switch control does not include or utilize a manual-on mode.(§130.1(c)1 E) Step 2 Simulate unoccupied condition.(NA7.6:2.5(b)) a. All non-exempt lighting turns off in accordance with the programmed time switch schedules.(NA7:6.2.5(b)1,§130.1(c)1A) . •Yes b. Manual override-switch allows only the lights in the enclosed space(ceiling height partitioned)where the override switch is-located to - Yes turn on or remain on until the next scheduled shut off occurs.(NA7.6.2.5(b)2,§130.1(c)1C,§130.1(c)3) . Functional Testing Compliance:ll Complies 0 Does Not.Comply Page 7 of 9 • STATE OF CALIFORNIA :. ,'.• ❑.. ❑. SHUT-OFF LIGHTING CONTROL ACCEPTANCE DOCUMENT NLCAA4 _ : �� • CEC-NRCA-LTI-02-A(Revised 01/21) Noorail LIghtlog «6.cto,; o . California Energy Commission Association of AmO"CB ❑�r • • CERTIFICATE OF ACCEPTANCE - NRCA-LTI-02-A Automatic Time Switch Lighting Controls Project Name:Grocery Outlet-Arcadia Enforcement Agency:City of Arcadia Permit Number 20-598 Project Address:..140 Live Oak Avenue City:Arcadia Zip Code:91006-5239. Building:1 Floor:1 Room:Sales Automatic Time Switch Lighting Controls A-1.Automatic Time Switch Lighting Control Construction Inspection(NA7.6.2.4) • a. Automatic time switoh controls are programmed with acceptable weekday,weekend,and holiday(if applicable)schedules.(NA7.6.2.4(a), §110.9(b)1Aii,§130.1(c)1A,.§130.1(c)4) - 2 b. Document for the owner weekday,weekend,and holidays schedules,as well as all set-up and preference program settings. (NA7.6.2.4(b)) • c. The correct time and date are properly set in the time switch.(NA7.6.2.4(c)) O✓ d. The battery backup(if applicable)is installed and energized.(NA7.6.2.4(d),§110.9(b)1) • e. Override time limit is no more than 2 hours.(NA7.6.2.4(e),§110.9(b)1Ai,§130.1(c)3B)OR The automatic time switch control's override time is exempt from the 2-hour limit.(EXCEPTION to§130.1(c)3B) • f. Override switches remote from area with controlled luminaires have annunciator lights.(NA7.6.2.4(f),§130.1(c)3A,§130.1(a))OR The manual override switch is,exempt from being in the same enclosed area with the lighting it controls.(EXCEPTION 1 to§130.1(a)2) Construction Inspection Compliance:D✓Complies 0 Does Not Comply B-1.Automatic Time Switch Lighting Control Functional Testing(NA7.6.2.5) Confirm compliance(Y-yes/N-no)for the control being tested.. Step 1:Simulate occupied condition.(NA7.6.2.5(a)) a. All lights can be turned on and:off by their respective area control switch.(NA7.62.5(a)1) Yes b. The switch only operates lighting in the enclosed space(ceiling-height partitioned area)in which the switch is located.(NA7.6.2.5(a)2, Yes §130.1(c)1C). c. For the area controlled by an automatic time switch control with a time override located in and for the area,the lighting can be turned , Yes on manually by initiating the time override.The lighting is configured to remain on for no more than 2 hours,unless the area is exempt from the 2-hour time override limit:(NA7:6.2.5(a)3,§110.9(b)1Ai,§130.1(c)3B,EXCEPTION to.§130.1(c)3B) d. For the area controlled by an automatic time switch control with an automatic holiday shut-off feature,the lighting in the area can be Yes. turned off automatically by initiating the holiday shut-off.(NA7.6.2.5(a)4,§110.9(b)1Aii,§130.1(c)4)OR The automatic time switch control is exempt from incorporating anautomatic holiday shut-off feature.(EXCEPTION.to§130.1(c)4) e. For the area controlled by an automatic time switch control with manual-on mode configured,the lighting in the area can be turned on Yes manually when it is manually activated.(NA7.6.2.5(a)5,§130.1(c)1 E)OR The automatic time switch control does not include or utilize a manual-on mode.(§130.1(c)1 E) . Step 2 Simulate unoccupied condition.,(NA7.6.2.5(b)) a. Allnon-exempt lighting turns off in accordance with the programmed time switch schedules.(NA7.6.2.5(b)1,§130.1(c)1A) Yes b. Manual override switch allows only the lights in the enclosed space(ceiling height partitioned)where the override switch is located to Yes - tum on or remain on until the next scheduled shut off occurs.(NA7.6.2:5(b)2,§130.1(c)1C,§130.1(c)3) Functional Testing Compliance:O Complies D Does Not Comply . • Page 8 of 9 • STATE OF CALIFORNIA f ❑. o SHUT-OFF LIGHTING CONTROL ACCEPTANCE DOCUMENT NLCAA" ,- +i , • •71 • CEC-NRCA-LTI-02-A(Revised 01/21) -i National Lighting Contractors 0: California Energy Commission Association of Americo - ❑ • CERTIFICATE OF ACCEPTANCE NRCA=LTI-02-A • Shut-Off Lighting Control Acceptance Document Project Name:Grocery Outlet-Arcadia •Enforcement Agency:City of Arcadia Permit Number:20-598 Project Address:140 Live Oak Avenue City:Arcadia Zip Code:91006-5239 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT I certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Kevin White Documentation Author Company Name: Date Signed:January 21,2021 Emmaus Electric,Inc. Address:451 West Lambert Road,Suite 207 CEA/ATT Certification Identification(If applicable)::. City/State/Zip:Brea,CA 92821 :- - Phone:1 (714)853-3744 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 ade available with the building permit(s)issued for the building. Field Technician Name: Field Technician Signature: Kevin White • Field Technician Company Name: Position with Company(Title): Emmaus Electric,Inc. • Acceptance Test Technician • Address:451.West Lambert Road,Suite 207 ATT Certification Identification(if applicable):ATT-1501-00024 City/State/Zip:Brea,CA,92821 Phone:.1(714)853-3744 • Date Signed:January 21,2021.. 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 onmy 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 identifiedon 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 buil er rovides to the building owner at occupancy. Responsible Person Name:: Responsible Person Signature: Kevin White Responsible Person Company Name:: Position with Company(Title): Emmaus Electric,Inc. Acceptance Test Employer Address:451 West Lambert Road,Suite 207 CSLB License:991307 • City/State/Zip:Brea,CA,92821 • Phone:1 (714)853-3744 Date Signed:January 21,2021 Page 9 of 9 STATE OF CALIFORNIA 74'73❑ AUTOMATIC DAYLIGHTING CONTROL.ACCEPTANCE DOCUMENT ;NizAk, CEC-NRCA=LTI-03-A(Revised.01/21) - * i+'t72`moon,`.7::— ❑ +11'7 ti 7 California Energy Commission As, tJO,u!Amun� CERTIFICATE OF ACCEPTANCE NRCA-LTI=03-A Daylighting Continuous Dimming Control Systems Project Name:Grocery Outlet-Arcadia . Enforcement Agency:City of Arcadia Permit Number 20-598 Project Address:.140 Live Oak Avenue City:Arcadia Zip Code:91006-5239. Building:"1 Floor:1 Room:Sales A.ConstructionInspection(NA7.6:1.1) • a. The general lighting in skylit and primary sidelit daylit zones,or the general lighting in the combined primary and secondary sidelit daylit zones in parking garages;is controlled by automatic daylighting controls.(§130.1(d)). ✓D b. The daylit zones are shown on page(s) E2.0 of plans; OR The daylit zones are drawn in on page(s) . of as-built plans(attached).(§130.1(d)1) O c. The automatic daylighting controls provide separate control for luminaires in each type of daylit zone.Luminaires that fall in both a skylit and primary sidelit daylit zone are controlled as part of the skylit zone.(§130.1(d)2). • d. For photosensors located within a daylit zone,at least one photosensor is not readily accessible to unauthorized personnel. (§130.1(d)4) • e. The location where calibration adjustments:are made to the automatic daylighting controls is readily accessible to authorized personnel,includinginside a locked case or.under a cover that requires a tool for access.(§130.1(d)5) Construction Inspection Compliance:OO Complies 0 Does Not Comply Page 1 of 4 • STATE OF CALIFORNIA . ,/-:,,f-;` : : AUTOMATIC DAYLIGHTING CONTROL ACCEPTANCE DOCUMENT - : t"LcAA i,=.'} CECGNRCA-LTI-03-A(Revised.01/21) ;,Ei„�,t,3h��9�*�;P«o ti__o Assxlatc.7 I America- ” ❑: .California Energy Commission .. � - CERTIFICATE OF ACCEPTANCE - .• :. • NRCA=LTI-03-A DaylightingContinuous Dimming Control.Systems- .• - :. - :• • Project Name:Grocery Outlet.-Arcadia. - Enforcement Agency:City ofArcadia_ Permit Number:20-598 . Project Address:.140 Live Oak Avenue _ : City:Arcadia -.- Zip Code:91006-5239- - - • Building.'1 . : Floor 1.. - - Room:Sales. • • B.-1:Continuous Dimming Control.Systems•FunctionalTesting(NA7.6.1.2.1) • -- - • : Step 1:Identify the reference location(the minimum daylighting location in the controlled zone).(NA7.6.1:2.1(a))For parking garages;illuminance ' levels should be measured at the farthestedge_of the:secondary sidelit zone.away from the glazing or opening:_(§130.1(0)3D). . .. .. _ : . - • a. Specify the power estimation method to be used:default ratio of power to light(Dfc);cut sheet ratio of power to light(CSfc)-cut : Dfc - sheet must be attached,measured Amps multiplied by Volts(VA),or measured watts(W). . • • - . Step 2:No daylight test:Simulate_or provideconditione without daylight,(NA7.6:1:2.1(d)) . . . b. : . Indicate the method used to simulate or provide conditions without daylight night time manual measurement(Night),night time illuminance logging(Log),cover.fenestration(CF),or cover photosensor(CP). . . . -. . Night • .. • c. Enter the reference illuminance value in footcandles(fc),es measured at.the reference location.(NA7.6:1.2.1(d)2)This is the electric • - 97 'lighting illuminance without any daylight. .. .. . d: Enter the measured full load power in Volt-Amps(VA)if power estimation method(line:a)=VA or in watts(W)if power estimation ' N/A • . . method=W.OR Indicate not applicable(NIA)if power estimation method(line a).=Dfc or CSfc. e: Automatic daylight control:system provides appropriate control so that the electric lighting system is providing full light output unless :- - Yes otherwise specified by design.documents.(NA7.6.1.2.1(d)1):Enter yes(Y)or no(N). . :. . .. • - : .'f. •Light output is stable with no discemable.flicker.(NA7.6.1.2:1(d)3)Enter yes(Y)or.no(N): Yes Step 3'Full daylight test.Simulate or provide bright conditions where the daylight illuminance is greater than 150%of the reference illuminante - - measured in Step 2.(NA7.6.1:2.1(e),_.§130.1(d)3C,§130.1(d)3D) .• . ._ . . _ . . _ . . : g. -Enter the daylight illuminance(light level with the electric lighting turned off)value in footcandles(fc)measured at the reference-:.• : 147 location, - h. •Calculate the ratio of daYlight illuminance:to the reference illuminance in%.([line g/line c]x 100) : .•151. • 55% : is The ratio of:daylight illuminanceto the reference•illuminance(line h)is greater than 150%.(§130.1(d)3C;§130.1(d)3D): .. Yes Enter yes(Y)or no(N): : : I ' I - ]. Enter the total illuminance(combined daylight and electric light illuminance)in footcandles(fc)measured.at the reference location if 181 powerestimation.method(line a)=Dfc or CSfc.OR Enter the measured power in.Volt-Amps(VA)if power estimation method(line a) =VA,or in watts(W)if powerestimation method(line a)=W. . k. Calculate the electric lighting:illuminance in.footcandles(fc)-at the reference location if power estimation method(line a)=.Dfc orCSfc: . 34 (line j-line9)O. PPeble.(N/A R indicate nota licpower estimation method_(linea =VA or W: . )if ..' :: I. . . Calculate the fraction of rated light output in%.if_power estimation method(line a)=Dfc or CSfc ([line k/line c]x 100)OR Indicate_ ' :. notapplicable(N/A)if power estimation method(linea)=VA or W. • 35.05 . • • - . m. Enter the dimmed luminaire.fraction of rated power in%iif power estimation method(line a)=Did or CSfc;and label the control . . 32% . - . •- system being tested on the manufacturer's cut sheet or the default graph on page 3.OR Indicate not applicable(N/A)if power : • estimation method(line a)=VA or W. .. • . . . - . :. n.• • Calculate the system power reduction in%. . .. - 68% OR wer estimation method(line:a)=Dfc or CSfc,system power reduction=[1-dimmed luminaire fraction of rated power(line m)]. • :. If power estimation method(line a)a VA or W,,•system power reduction=•[1-measured power(line j)/full load power(line d)]: : .- . . • • • • Page 2 of 4 STATE OF CALIFORNIA f ti',,., o ,Y--, o AUTOMATIC DAYLIGHTING CONTROL ACCEPTANCE DOCUMENT ',tdLcAAi CEC-NRCA-LTI-03-A(Revised 01/21) He po•,c,ahupsoontaat ❑ '} California Energy Commission M,00IPonoinmm,m° .•-. CERTIFICATE OF ACCEPTANCE NRCA-LTI-03-A Daylighting Continuous Dimming Control Systems Project Name:Grocery Outlet?Arcadia . Enforcement Agency:City of Arcadia Permit Number:20-598 Project Address:140 Live Oak Avenue : City:Arcadia Zip Code:91006-5239. Building:1 Floor:1 Room:Sales o. For areas other than parking garages,the system lighting power reduction of controlled luminaires(line o)is at least 65%: Yes (NA7.6.1.2.1(e)1,§130.1(d)3C)OR For parking garages,the controlled lighting power consumption is zero. (§130.1(d)3D)Enter yes(Y)or no(N). p.• Dimmed lamps are stable with no discernable flicker.(NA7.6.1.2.1(e)1)Enter yes(Y)or no(N): Yes q. Only theluminaires in the daylit zones are affected by daylight control.(NA7.6.1.2.1(e)2)Enter yes(Y)or no(N). Yes r. If a PAF is claimed for daylight dimming plus OFF controls,the system automatically turns off the luminaires that are receiving this - N/A credit.(NA7.6.1.2.1(e)3,§140.6(a)2H)Enter yes(Y),no(N),or not applicable(N/A). . Step 4:Partial daylight test.Simulate or provide daylight conditions where illuminance(fc)from daylight only at the reference location is between 60 and 95%of the reference illuminance measured in Step 2.(NA7.6.1.2.1(f)) There are 0 control steps between ON and OFF.(Indicate,not applicable(N/A)for lines s through aa.) s. Indicate method used to simulate or provide conditions with partial daylight:natural daylight manual measurement(ND),light logging PCF (Log),partiallycover fenestration(PCF),open loop setpoint adjustment(OLSA). t. _ Enter the daylight illuminance(light level without electric light)in footcandles(fc)measured at the reference location. 72 U. Calculate the ratio of daylight illuminance to the reference illuminance in%.([line t/line c]x 100) 74.23 v. The ratio of daylight illuminance to the reference illuminance(line u)is between 60 and 95%.(NA7.6.1.2.1(f))Enter yes(Y)or no(N). Yes w. Enter the total illuminance(combined daylight and electric light illuminance)in footcandles(fc).measured at the reference location... 112 x. The total illuminance(line w)is greater than or equal to the reference illuminance(line c):(NA7.6:1.2.1(f)1,§130.1(d)3B)Enter yes(Y) Yes or no(N). y. Calculate the ratio of total illuminance to the reference illuminance in%.([line w/linen]x 100) 115. 46% z. The ratio of total illuminance to the reference illuminance(line y)is less than or equal to 150%.(NA7.6.1.2.1(f)2)Enter yes(Y)or no Yes aa. The light output is stable with no discernable flicker.(NA7.6.1.2.1(f)3)Enter yes(Y)or no(N). Yes Functional Testing ComplianceComplies 0 Does Not Comply Page3of4 . STATE OF CALIFORNIA • �. , ❑•:}:� 0 AUTOMATIC DAYLIGHTING CONTROL ACCEPTANCE DOCUMENT 'NLCAA; CEC-NRCA-LTI-03-A(Revised 01/21) a„on,, o t;neCon„«o.s D�. California Energy Commission Assooktbn of America • CERTIFICATE OF ACCEPTANCE - NRCA-LTI-03-A Automatic Daylighting Control Acceptance Document . • - Project Name:Grocery Outlet-Arcadia Enforcement Agency:City of Arcadia Permit Number:20-598 Project Address:140 Live Oak Avenue : City:Arcadia Zip Code:91006-5239. • DOCUMENTATION AUTHOR'S DECLARATION STATEMENT • • I certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Kevin White. Documentation Author Company Name: Date Signed:January 21,2021 Emmaus Electric,.Inc. • Address:451 West Lambert Road,Suite 207 CEA/ATT Certification Identification(If applicable): City/State/Zip:Brea,CA 92821 Phone::1 (714)853=3744 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 ade available with the building permit(s)issued for the building. Field Technician Name: Field Technician Signature: Kevin White Field Technician Company Name: Position with Company(Title): • Emmaus Electric,Inc. Acceptance Test Technician Address:451.West Lambert Road,Suite 207 ATT Certification Identification(if applicable):ATT-1501-00024 City/State/Zip:Brea,CA,92821 Phone:1(714)853-3744 Date Signed:January 21,2021 •. 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 buil er rovides to the building owner at occupancy. . Responsible Person Name:: Responsible Person Signature: - Kevin White Responsible Person Company Name:: Position with Company(Title): Emmaus Electric,Inc. Acceptance Test Employer Address:451 West Lambert Road,Suite 207 - CSLB License:991307 City/State/Zip:Brea,CA,92821 Phone:1 (714)853-3744 Date Signed:January 21,2021 . Page 4 of 4 STATE OF CALIFORNIA . C.`'\.'1,. . . 0 0 DEMAND RESPONSIVE LIGHTING CONTROL ACCEPTANCE DOCUMENT << a • CEC=NRCA=LTI-04=A(Revised.01/21) y'=• } r . Notional Lighting contractor. ` .D California Energy Commission ." ns.aceuanarna�rka- ❑ A.Construction Inspection(NA7.6.3.1) . 0 a. The demand responsive control is capable of receiving a demand responsive signal directly or indirectly through another device.. (NA7.6:3.1(a)) O✓.. b. The demandresponsive control is a certified OpenADR 2.0a or OpenADR 2.0b Virtual End Node(VEN),as specified under Clause 11, • Conformance,in the applicable OpenADR 2.0 Specification.(NA7.6.3.1(a),§110.12(a)1A) OR The demand responsive control is certified by the manufacturer to the Energy Commission as being capable of responding to a demand response signal from a certified OpenADR 2.0b VEN by automatically implementing the control functions requested by the VEN for the equipment it controls.(NA76.3.1(a),§110.12(a)1B) • c. The demand responsive control is capable ofcommunicating using one or more of the following:Wi-Fi,ZigBee,BACnet;Ethemet,or hard-wiring.(NA7.6.3.1(a),§110.12(a)2) • d. The demandresponsive control continues to perform all other functions provided by the control when communications are disabled or unavailable.(NA7.6.3.1(a),§110.12(a)4) . O✓ e. If the demand response signal is received from another device(such as an EMCS),that system must itself be capable of receiving a demand response signal from a'utilitymeter or other external source:(NA7.6.3.1(b)) ( ( )) Construction Inspection Compliance:2 Complies 0 Does Not Comply. . Page 1 of 3 • • STATE OF CALIFORNIA • - ❑ D DEMAND RESPONSIVE LIGHTING CONTROL ACCE PTANCE.DOCUMENT t",1- A4, {� y. CEC=NRCA-LTI-04-A(Revised 01/21) • California Energy Commission • Naoio�nai �nrr,cro,. o A l Lighting gon of(unzrlu . - — • CERTIFICATE OF ACCEPTANCE :. - • - - NRCA=LTI=04-A Demand Responsive Illuminance Measurement . • Project Name:Grocery Outlet=Arcadia Enforcement Agency:City of Arcadia Permit Number 20-598 . • Project Address:.140 Live Oak Avenue • City:Arcadia Zip Code:91006-5239. B-1:Functional Testing using Illuminance Measurement(NA7.6.3.2,Method 1) - . .- • - Step 1:Select one location for illuminance measurement.The chosen location must not be a skylit or primary sidelit area and the illuminance meter must not have a direct view ofa window or skylight:.If this is not possible,perform the test at a time and location at which daylight illuminance • provides less than halfof the design illuminance.(NA7.6.3.2,Method 1(a)) a.. _ Enter the design illuminance value in footcandles(fc). 100 fc Step 2:Full output test(NA7.6:3.2,Method 1(b)) . - b. Using the manual switches/dimmers;set the lighting system to full output.:The lighting in areas with photo controls or occupant/vacancy sensors may be at less than full output or may be off.(NA7.6.3.2,Method.1(b)1) - . c: Measure the illuminance at the selected location and enter the value in footcandles(fc).(NA7.6.3.2,Method 1(b)2) 100 fc: • d.' Simulate a demand response condition using the demand responsive control.(NA7.6.3.2;Method 1(b)3). e. Measure the illuminance at the selected location with the electric lighting system in the demand response condition andenter the 60 fc. value in footcandles(fc)..(NA7.6:3.2,Method 1(b)4). f. Calculate the percent reduction in illuminance from the full output condition to the demand response condition and enter the.value -: 40% in%:(Percent reduction=[(line c-line e)/line c]x 100%) • g. Enter-the area of the controlled space.in square feet(ft2). • 10571 f h.. Calculate the area-weighted average reduction in illuminance from the full output condition to the demand response condition for 40% the building using the givenformula and enter the value in%.(NA7.6:3.2,Method 1(b)5) : . Area-weighted average reduction= f1..' t + f2''g2)+ f3 g3).+.:. / 1+g2.+. 3+:... x 100% L. The area-weighted average reduction:(line h)is.at least 15%.(NA7.6.3.2,Method.1(b)5,.§110.12(c))Enter yes(Y)or no(N).• : Yes • j: The combined electric light and daylight illuminance is not reduced to less than 50%of the design illuminance in the tested space: Yes (NA7.6.3.2,Method_1.(b)5)([line e./line a]>=50%)Enter yes(Y)or no'(N): Step 3:Minimum output test. NA7.6:3:2,Method 1(c)). k. Using the manual switches/dimmers in each space,set the lighting systemto minimum output(but not.off).The lighting in areas with photo controls or occupant/vacancy sensors may be at more than minimum output or may be off.(NA7.6;3.2,Method 1(c)1). I. •Measure the illuminance at the selected location and enter the value in footcandles(fc)..(NA7.6.3.2,:Method 1(c)2) - - I •50 fc• m: Simulate a demand response condition using the demand responsive'control.(NA7.6.3.2,Method I(c)3) ' n. Measure the illuminance at the selected location with the electric lighting system in the demand response condition and enter the 50 fc • • :value'in footcandles(fc).(NA7.6.3.2,Method l(c)4) •. o. The illuminance in the demand respond condition(line n)isnot reduced to below the lesser of:the illuminance in the minimum Yes output condition(line I)or 50%of the design illuminance(line a).(NA7.6.3.2;Method 1(c)5)Enter yes(Y)or no(N). • • Exception:In daylit spaces,the illuminance in the demand response condition(linen)may reduce below the illuminance in the minimum output condition.However,the combined electric light and daylight illuminance in the.demand response condition must still beat least 50%of the design:illuminance(line a):(NA7.6.3.2,Method 1(c)5 EXCEPTION). . Functional Testing Compliance:12 Complies 0 Does Not Comply.. • • • • • • • • • • Page2of3 • STATE OF CALIFORNIA ❑WI❑ DEMAND RESPONSIVE LIGHTING CONTROL ACCEPTANCE DOCUMENT NLCAA o- CEC-NRCA-LTI-04-A(Revised 01/21) r+auo�iwnim®ewu.e�m.; ❑ California Energy Commission "°•«'°�'°n°'ATe"°a CERTIFICATE OF ACCEPTANCE NRCA-LTI-04-A Demand Responsive Lighting Control Acceptance Document Project Name:Grocery Outlet-Arcadia Enforcement Agency:City of Arcadia Permit Number:20-598 • Project Address:.140 Live Oak Avenue City:Arcadia Zip Code:91006-5239. • DOCUMENTATION AUTHOR'S DECLARATION STATEMENT I certify that this Certificate of Acceptance documentation is accurate and complete. • Documentation Author Name: Documentation Author Signature: 1\5rwa::::. • Kevin White Documentation Author Company Name: Date Signed:January 21,2021 Emmaus Electric,Inc. - Address:451 West Lambert Road,Suite 207 CEA/ATT Certification Identification(If applicable):." City/State/Zip:Brea,CA 92821 Phone:1(714)853-3744 • • 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 ade available with the building permit(s)issued for the building. - Field Technician Name: • Field Technician Signature: Kevin White Field Technician Company Name: Position with Company(Title): • Emmaus Electric,Inc. Acceptance Test Technician " Address:451:West Lambert Road;Suite 207 ATT Certification Identification(if applicable):ATT-1501-00024 City/State/Zip:Brea,CA,92821. Phone:1 (714)853-3744 Date Signed:January 21,2021. 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 withthe 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 buil er rovides to the building owner at occupancy. Responsible Person Name:: Responsible Person Signature: Kevin White Responsible Person Company Name:: Position with Company(Title): Emmaus Electric,Inc. Acceptance Test Employer • Address:451 West Lambert Road,Suite 207 CSLB License:991307 City/State/Zip:Brea,-CA,92821 Phone:1-(714)853-3744 - Date Signed:January 21,2021 • Page 3 of 3 STATE OF CALIFORNIA ,,-"q,:,,. o.:ixi, ❑. OUTDOOR LIGHTING ACCEPTANCE DOCUMENT . irii-cAA' CEC=NRCA-LTO-02-A(Revised 01/21) 0-• � F• National Lighting Conlrecl°rs ❑ ,, California Energy Commission CERTIFICATE OF ACCEPTANCE NRCA-LTO-02=A Automatic Scheduling Controls Not Used in Conjunction with Motion Sensors Project-Name:Grocery Outlet-Arcadia Enforcement Agency:City of Arcadia Permit Number:20-598 . Project Address:140 Live Oak Avenue City:Arcadia Zip Code:91006-5239. Building 1 Floor 1 Room:Exterior Automatic Scheduling Controls A-2.Automatic Scheduling.Control Construction Inspection(NA7:8.7) a. The automatic scheduling control is installed.(NA7.8.7(a)) c b.: The automatic scheduling control is programmed with ON and OFF schedules that match the schedules in the construction documents. OR If the schedule is unknown,the programmed schedule matches the default schedule where the OFF schedule is from 12:00 A.M.to 6:00 A.M.and the-ON schedule is all other night time hours,7 days per week.(NA7.8.7(b)) 2 c. Demonstrate and document the lighting control programming including ON and OFF schedules for weekdays,weekends,and holidays(if applicable):(NA7.8.7(c))'. . 0.. d.: The correct time and date are properly set in the control.(NA7.8.7(d)) Construction Inspection Compliance:2 Complies 0 Does.Not Comply B-2.Automatic Scheduling Control Functional Testing(NA7.8.8) Confirm.compliance(Y yes/N no)for the control being tested a. During daytime simulation,_all controlled outdoor lighting is turned off.(NA7.8.8(a),§130.2(c)1) Yes b. During nighttime simulation,all controlled outdoor lighting is turned on in accordance with the programmed schedule. Yes (NA7.8.8(b),§130.2(c)2B) c. During nighttime simulation,the power of controlled outdoor lights is turned off or reduced by at.least 50%in accordance with .Yes the programmed schedule.(NA7.8.8(c),§130.2(c)2A,§130.2(c)2B) Functional Testing Compliance:OO Complies 0 Does Not Comply • Page 1 of 2 STATE OF CALIFORNIA f . ❑ ,r. 0 OUTDOOR LIGHTING ACCEPTANCE DOCUMENT NBCA a CEC-NBCA-LTO-02-A(Revised 01/21) NationalLightingCon[pctcrs 0 r d:o California Energy.Commission Association of Americo • CERTIFICATE OF ACCEPTANCE NRCA-LTO-02-A Outdoor Lighting Acceptance Document Project-Name:Grocery Outlet-Arcadia Enforcement Agency:City of Arcadia Permit Number:20-598 Project Address:140 Live Oak Avenue City:Arcadia :Zip Code:91006-5239.. DOCUMENTATION AUTHOR'S DECLARATION STATEMENT I certify that this Certificate of Acceptance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Kevin White Documentation Author Company Name: Date Signed:January 21,2021 Emmaus Electric,Inc. Address:.451 West Lambert Road,Suite 207 CEA/ATT Certification.Identification(If applicable):.• City/State/Zip:Brea,CA 92821 Phone:1(714)853-3744 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 ade available withthe building permit(s)issued for the building: Field Technician Name: Field Technician Signature: Kevin White Field Technician Company Name: Position with Company(Title): Emmaus Electric,Inc.. Acceptance Test Technician Address:451 West Lambert Road,Suite 207 ATT Certification Identification(if applicable):ATT-1501-00024 City/State/Zip:Brea,CA,92821. Phone:1(714)853-3744 Date Signed:January 21,2021.. 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 reviewedthe 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 withthe 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 Acceptancehas 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 buil er rovides to the.building owner at occupancy. Responsible Person Name:: Responsible Person Signature: Kevin White Responsible Person Company Name:: Position with Company(Title): Emmaus Electric,Inc. Acceptance Test Employer .. - .. ._ Address:451 West Lambert Road,Suite 207 CSLB License:991307 City/State/Zip:Brea,CA,92821 Phone:1(714)853-3744 I Date Signed:January 21,2021 Page2of2 f _. Untested Areas Sheet LC A o- .� = f National Lighting Contractors Association of America • (Revised 04/2020) National Lighting Contractors ;o' - - - -- .,Association of AmerIce , - SAMPLE UNTESTED SPACE AREAS Building:1,Floor 1,Space:.Front Office 1 I 1 I.Janitor Closet I.Occupant Sensing Lighting Controls • City of Arcadia, CA �� Prm,t No FIRE4•20',20 6`3 ) Development Services Department y ` s Perm t Type Fire 1 240 West Huntington Drive,Post Office Box 60021 j Arcadia,CA 91066-6021 .� � &L work(elasslftcat?on>Flre Sprinkler., -) (626)574-5416 i '4r " ' 'P2rrllltStptus (SSU!?d a' A RCADA Issue Date 12/23/2020'I Expiration:N 12/23/2021 Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number 140 W Live Oak AVE Arcadia,CA 91007-8519 8573010013 Contacts MONROVIA MYRTLE PROPERTY LLC Owner A&D FIRE SPRINKLERS* Contractor 1430 Santa Anita Ave,Arcadia,CA 91006 1601 W ORANGE WOOD AVE,ORANGE,CA 92868 (562)405-5136 1069002 Description:FIRE SPRINKS FOR Ti.69 HEADS Valuation: $ 12,400.00 Tenant Total Sq Feet: 0.00 Plan Check#20-2063 Plan# Fees Amount Payments Amount Paid Fire Issuance $47.01 Total Fees $1,035.36 Fire Permit Fees $287.35 Cash/Receipt#REC-06387-20 $1,035.36 Solid Waste Management Fee 2 $1.00 Amount Due: $0.00 Sprinkler Heads $700.00 Total: $1,035.36 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. • COMPLETED December 23, 2020 Issued By: Date December 23,2020 Page 1 of 1 V~4��Fc9�9 ,• ' PERMIT/PLAN REVIEW APPLICATION wit; rip 44./.20 Development Services Department,240 West Huntington Drive,Post Office Box 60021 \Y 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. 0 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 performance of the work for which this permit is issued. Signature of Contractor 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 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 0 I certify that in the performance of the work for which this permit is issued,I shall exempt there from and the basis for the alleged exemption. Any violation of 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 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 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). 0 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 • • i • . . ,r,), PERMIT/PLAN -REVIEW APPLICATION . . -, /, `iiI . r-�' ;. • Development Services Department, 240 West Huntington Drive, Post Office Box 60021 ' - ja i Arcadia;CA 91066-6021, (626) 574-5416, Fax (626) 447-9173 ",f"`" ONLINE PERMIT/PLAN REVIEW APPLICATION cITY pr " ARGADIA • Job Site Address: 140 LIVE OAK AVE LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION" 0 l'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.Id the Business and . Professions.Code,and my license is in full force'and effect. . 0 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 �a performance of the work for which.this permit is issued. - Signature of Contractor ____—"- --2:—fig x=` —� OWNER=BUILDER DECLARATION. El I have and will maintain:workers'compensation insurance,as required by Section • 3700 of the Labor Code,for the performance of the work for which this permit • 0 I hereby affirm under penalty of perjury that lam exempt from the Contractors is issued.My workers'.compensation insurance carrier and policy numbers-are: License Law for the following reason(Section-70.31.5, Business and Professions 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).of 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,(shall Section 7031.5 by any applicant for a perrrrit 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.shalt • I, as owner of the property, or my employees with wages as their sole - forthwith comply with thoseprovisions. • compensation,will do the Work,and the structure is notintended or offered for12/23/2020. , 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.($1(10,000),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. . Ell, as owner of the property, ain 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 lendingagency contractors)licensed pursuant to the Contractors License Law): for the performance of the work for which this permit is issued (Section 3097; Civil Code). 0 Ilam 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. 1 Signature - � �� ------- -B,,,,:,..-:, -Date .2/23/2020. - .. . l o w"r City of Arcadia, CAf Pein�tNo FIRE 204707 .E y9 Y d x � Development Services Department � � p u a � � � ��, �� °�` � ax�.�� Per rr�i Type Ffire� tf 240 West Huntington Drive,Post Office Box 60021 ` a _ ° ` mg Arcadia,CA 91066-6021 '� WOCk Cla55lf coition FirefAlarm f (626)574-5416 ` 1 ,.P0.0.1t5tatrs Issued:' ARCA DIA "'° lssuepate 11/17/20201 Expiration: 11/17/2021 Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number 140 E Live Oak AVE Arcadia,CA 91007-8519 8573010013 Contacts MEEKER FAMILY PARTNERS LP Owner BAKER SYSTEMS INC* Contractor 368 LAMBERT RD,CARPENTERIA,CA 93013 P 0 BOX 1710,UPLAND,CA 91785 (909)985-5504 ext 302 818786 Ti Description:FIRE ALARM FOR TI 23 DEVICES t Valuation: $ 10,000.00 I Tenant Total Sq Feet: 0.00 k Plan Check#20-1707 Plan# Fees Amount payments Amount Paid Fire Alarm Plan Check $840.00 Total Fees $1,125.26 Fire Issuance $47.01 Cash/Receipt#REC-05802-20 $840.00 Fire Permit Fees $237.25 Cash/Receipt#REC-06058-20 $285.26 Solid Waste Management Fee 2 $1.00 Amount Due: $0.00 Total: $1,125.26 - 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 fora period of 180 consecutive days. 44( COMPLETED November 17, 2020 Issued By: Date November 17,2020 Page 1 of 1 of ARc �, PERMIT/PLAN REVIEW APPLICATION Development Services Department,240 West Huntington Drive,Post Office Box 60021 Y% Arcadia, CA 91066-6021, (626) 574-5416,Fax(626) 447-9173 City of Arcadia ICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION 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 fort and a ect. �/� ❑ I have and will maintain a certificate of consent to self insure for workers' License Class C`) V j ce .e No. Exp. Date-ill ate 6 Z compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. oi Signature of Contractor OWNER-B '`�ER DECLARATION &►"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 is issued.My workers'compensa n insurance carrier and policy numbers are: License Law for the following reason(Section 7031.5,Business and Professions .61t/ (1.—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 Policy Number for such permit to file a signed statement that he or she is licensed pursuant to the (This section need not be completed if the permit is for one hundred dollars or less) provisions of the Contractors License Law(Chapter 9(commencing with Section 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 Y 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 0 I, as owner of the property, or my employees with wages as their sole forthwith comply with��t(/jhosse i provisions. compensation,will do the work,and the structure is not intended or offered for Date 1� Signature / 1 "G sale(Section 7044,Business and Professions Code:The Contractors License ! — 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 inform�atio�n.� y( Name / lr/IT � Title / ^ PRINT NAME r 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 City ordinances and State Laws relating to buildi g construction. I hereby authorize representatives of the City of rcadia to enter o e above-mentioned property for inspection purposes. l Signature — Date IF ` 2i �o�Ft`9�ti ,,...11 -.1 "#.0. ll ,. i corp [cd A ryR S,1903 c'iliP MEMORANDUM Fire Department DATE January 19, 2021 TO: BUILDING DEPARTMENT INSPECTOR Jeff Wang FROM: FIRE DEPARTMENT SUBJECT: FIELD INSPECTION ADDRESS: 140 E. Live Oak Avenue THE FOLLOWING ITEMS WERE CHECKED FOR CONFORMANCE WITH APPLICABLE FIRE DEPARTMENT REQUIREMENTS: TYPE OF INSPECTION DATE/ INITIAL . FINAL INSPECTION FIRE SPRINKLERS (PC# 20-2063) 1-19-2021 Jill Perumean FIRE ALARMS (PC# 20-1707) 1-19-2021 Jill Perumean HOOD & DUCT KNOX BOX OCCUPANCY (PC# 20-598) 1-19-2021 Jill Perumean : . COMMENTS: Emailed Bldg. Dept. 1-19-2021 Rita • . . • ' . . . . . . • ' • . . . . . . . • • 0 • 0 . . - . • . -- Mr.a. . W.0- . . . . . • •. Kw ca.erE-, F WO.MO FUJAP 1 vA Ep . . . . .1-- EOLIIIVENT PUTFORIA . ) ee NEW MI WALL WILLI > ) ... 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' . • • • •• • 2 051351010 MAN OW(1 - . . . . , : 3 07.3030 WIMP 10/11 IIEVLSOI . . • . • • ' 5 02.25/2020 DEStll REVIEW 1,C1 • 1 101:57020 ISSUED FOR CONSTRUCTION. • . • • . . i PLAN :' • • .• . . . FOUNDATION LEGEND: • FOUNDATION NOTES: • . . CRAMS DESCRPTION • • F=F (11)SCUD GRO111.011i 1. 00MR.T011 TO VERIFY ALL MIMIC.MD ELEVAT1OKS NMI ARCNTECIIIR.DRAWN. .7.......±',... (E).NOW.L 2 CONOUCTOR TO VER.,EnSTIM Muer.WM CONDITIMS SHOWN OR NOTED PRJOR TO BEONNINO WORK.NOTIFY ENGINEER'S FOUNDATION PLAN . i!. On 030.401 Kit PAN COSCREPANCIESCCCON. • • . (WIPE COLUMN a REPLACENENI SUR5 TO LIATEN METING SUSI-MANESS (r NINILIUN)WITII ta RAMSAY MO C.EX:1MM%WSW.UNLESS , ,• . . , (N,CoNCRETE PCOTINa PER PUN OTHERWISE NOTED ON PUN DOWEL NEW SUBSTO EXISTING PER . • . •. . DETAIL(IWO) • • • • • ,. . 4 SEE oacNrrEcTum imAwmas FoR LocmoN oP PALLET • • • . ENEL.NO.GONCO.A ExELVINO.IWO WALL SYELVINS.PROME . AWNORACIE PER DETAIL(Iran 7JS1n ANDO.I 1.RESPECTIVELY. . . . . - . . . • . • . . . • •. • , . - • . . . . . . . . . . . - . . . . • - . . . . . . . - . . - • • . . . . . . . . . . . . . . . • . . . . - ' - . . • . . • . 0 " • NEW OVEMEA, DOOR OPE MO• 0 7-7 • CITY OF ARCADIA • • Development Services Department A P PROVED This set of plans and specifications must be kept on the job at tdi tiin:s and no changes or alterations 0 -• shall be made es,e!..p h the Building Division. • The Stamping of lhk p!ao and specification shall not. . . be held to permil or to he an approval,of the violOtion of any pnwisions of:any city ordinance or,state law • /12"21 \ • 0 • 7 • FOUNDA S. . -