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10-1080 (RC)P.O. BOX 1504 78-495 CALL•E TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 10-00001080 Property Address: 78590 HIGHWAY 111 APN: 604 -080 -999 - Application description: REMODEL - COMMERCIAL Property Zoning: COMMUNITY COMMERCIAL Application valuation: 100000 T41, �4'e4�Q" Applicant: Architect or Engineer: --------------- - - LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class: B License No.: 769556 �( Date:/I Z Contractor: • OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom 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 penalty of not more than five hundred dollars ($500).: (_) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). (_) I am exempt under Sec. , BAP.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY 1 hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: _ Lender's Address: LQPERnIIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner: WASHINGTON ADAM PARTNERSHIP 42620 CAROLINE CT 4102 PALM DESERT, CA 92211 r Contractor: KARMAN GENERAL CONTR, JON - 9375 ARCHIBALD AVENUE RANCHO CUCAMONGA, CA 91730 (909)944-5274 Lic. No.: 769556 Date: 11/23/10 ® t 1rs z • �;t�� 2 � 2a tib, a ------------------ WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 is issued. My workers' compensation insurance carrier and policy number are: Carrier SPARTA INS Policy Number 003WK06641 I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 700 of the Labor Code, I shall forthwith comply with those provisions. K Date Q Applicant: WARNING: FAILURE TO SECURE W RKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1 . Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to, building construction, and hereby authorize representatives of this county to nter upon the above-mentioned property for inspection purposes. Pate: Signature (Applicant or Agent): ^/91 LQPERMIT „Application Number . I . . 10-00001080 ------ Structure Information 1,580SF TI/VB/B-OCC/34-OL/SPRINKLED ----- Other struct info . . . . . CODE EDITION 2007/2008 FIRE SPRINKLERS FULLY MIXED -USE -OCCUPANCY B OCCUPANT LOAD 34.00 ---------------------------------------------------------------------------- 1ST FLOOR SQUARE FOOTAGE 1580.00 Permit 'BUILDING PERMIT Additional desc . Permit Fee 639.50 Plan Check Fee,. 415.68 Issue Date Valuation . . . . 100000 Expiration Date 5/22/11 • Qty Unit Charge Per Extension. BASE FEE 414.50 50.00 4.5000 ---------------------------------------------------------------------------- THOU BLDG 50,001-100,000 225.00 Permit . . . ELECT - ADD/ALT/REM ,Additional desc . Permit Fee . . . . 57.00 Plan Check Fee 14.25 Issue Date . . . . Valuation 0 Expiration Date 5/22/11 Qty Unit Charge Per Extension BASE FEE 15.00 20.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 15.00 60.00 .4500 -------------------------------------------------=-------------------------- EA ELEC DEVICE/FIXTURE >20 27.00 , Permit . . . MECHANICAL Additional desc . . HOOD AND MAKEUP AIR UNITS ONLY Permit Fee . . . . 43.50 Plan Check Fee 10.88 Issue Date Valuation . . . . 0 Expiration Date 5/22/11 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 4.5000 EA MECH VENT INST/ DUCT ALT 9.00 1.00 6.5000 EA MECH EVAP COOLER 6.50. 1.00 6.5000 EA MECH VENT FAN 6.50 1.00 6.5000 ---------------------------------------------------------------------------- EA MECH EXHAUST HOOD 6.50 Permit PLUMBING Additional desc . LQPERMIT Application Number _ 10.00001080 Permit PLUMBING Permit Fee 1 79.50 -•Plan Check Fee 19.88 Issue Date . . . . Valuation 0 Expiration Date 5/22/11. Qty Unit Charge Per - Extension BASE FEE 15:00 9.00 6.0000 EA PLB FIXTURE 54.00 1.00 7.5000 EA PLB WATER HEATER/VENT 7.50 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 -------------------------------------------------------------=-------------- Special Notes and Comments _ 1,580SF TI/B-OCC/34-OL/SPRINKLED [SUBWAY STORE #48246-01 THIS PERMIT DOES NOT' INCLUDE ADDITIONAL HVAC EQUIPMENT OR f OPTIONAL FEATURES SHOWN ON PLAN. 2007/2008 CALIFORNIA BUILDING CODES. November 23, 2010 4:56:38 PM AORTEGA. ----------- ------------------------------------- Other Fees . . . . . .- . . ACCESSIBILITY.PLAN REVIEW 41.57 BLDG STDS ADMIN (SB1473) 4.00 ENERGY REVIEW FEE 41.57 Fee,summary. Charged -.,.Paid Credited Due •Permit Fee Total 819.50 .00 .00 819.50 Plan.Check Total 460.69 .'00 .00 460.69 Other Fee Total 87.14 .00 .00 87.14 Grand Total 1367.33 .00. .00 1367.33 LQPERMIT Bin # �9 G City of La Quinta Building 8T Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quanta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # _ p Project Address: ,?S %D b�Aj Owner's Name: _ A. P. Number: U , Address: 15f1U1//- l Legal Description: City, ST, Zip: Contractor: -r b Address: Telephone: a f Project Description: L.V City, ST, Zip: &Ai-Z t Utop Telephone:IFA � • ;�. ri�,�J City Lic. #; State Lic. # : Arch., Engr., Designer. G Address: City., ST, Zip: &A ou." N OF Telephone: l 'Z f., y_ .� �7 3 b ,K ` § Construction Type: V-3 Occupancy State Lic. #: ' ' •:'•� � "`'F`�•"•�<.,r � ��.• Project type,circle one): New Add'n Alter Repair Demo Name of Contact Person: (EJ/, A Sq. Ft.: %59 # Stories: / # Units: Telephone # of Contact Person: ZS3 O3 Estimated Value of Project: 06> 0Q() APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACMG PERMIT FEES Plan Sets Plan Check submitted 0Item Amount Structural Cale& Reviewed, ready for corrections if Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance, Title 24 Calcs. p� Plans picked up j' Vta Construction Flood plain plan Pians resubmitted Mechanical Grading plan 21" Review, ready for correctionsfissuen Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- Review, ready for correctionstissue If Developer Impact Fee Planning Approval Called Contact Person A.I.P.P, Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees /ol ZD u �f�c �. "f' zK .d1�-�.e- i°/a7 /o/tel -11- Z- /a /Z*re 11 t`�co • 1JS � - s Jkf�P�l�taus f � �ss�� 4�6. rowllArsl,�i�L PROUDLY SERVING THE UNINCORPORATED AREAS OF RIVERSIDE COUNTY AND THE CITIES OF: BANNING BEAUMONT CALI M ESA CANYON LAKE COACHELLA DESERT HOT SPRINGS EASTVALE INDIAN WELLS INDIO . LAKE ELSINORE LA QUINTA MENIFEE MORENO VALLEY PALM DESERT PERRIS RANCHO MIRAGE RUBIDOUx CSD SAN JACINTO TEMECULA WILDOMAR BOARD OF SUPERVISORS: BOB BUSTER DISTRICT 1 JOHN TAVAGLIONE DISTRICT 2 JEFF STONE DISTRICT 3 JOHN BENOIT DISTRICT 4 MARION ASHLEY DISTRICT 5 IVERSI'DE Oouwy SIRE-DEPAR'l`11/1imr IN COOPERATION WITH THE CALIFORNIA DEPARTMENT OF FORESTRY AND FIRE PROTECTION 77-933 Las Montanas Rd., Ste. #201, Palm Desert, CA 92211-4131 • Phone (760) 863-8886 • Fax(760)863=7072 www.rvcfire.org Date: November 2, 2010 Case Number: LAQ-I0-TI-041 Project Name: Subway, 78-590 Hwy 1 I 1 Plan Type: Tenant Improvement You have been issued a release for a tenant improvement on an existing building. THIS IS NOT AN. OCCUPANCY PERMIT. - THE FOLLOWING CONDITIONS MUST BE MET PRIOR TO LNSPECTION: ➢ Fire sprinkler system plans for the tenant improvement area must be submitted to the Fire Department for review, along with a plan/inspection fee. A licensed C-1.6 contractor will have to submit plans for review and approval and modify the fire sprinkler system in accordance with NFPA 13, 2002 Edition. A licensed C-16 contractor shall do all sprinkler work and certification. The approved plans, with Fire Department Job card must be at the job site for all inspections. ➢ Provide keys to the tenant space for inclusion in the main building Knox Box. Key(s) shall have durable and legible tags affixed for identification of the correlating tenant space. ➢ Shelving, counters, etc., must be in place, however, no merchandise may be placed in the building prior to .inspection ➢ A minimum 2AIOBC Fire Extinguisher, (State Fire Marshal Approved) must be mounted in a visible location within 75' walking distance from any point in your building or suite. Fire extinguishers can be installed by a licensed extinguisher company with a State Fire Marshal service tag attached to the extinguisher, or purchased from a retail store with a sales receipt attached. A licensed fire extinguisher company must service extinguisher yearly. ➢ All breakers must be labeled and a clearance of 36 inches must be maintained around the panel at all times. Applicant/installer shall be responsible to contact the Fire Department to schedule inspections: A re- inspection fee will be required if more than one (1) inspection is necessary. Requests for inspections are to be made at least 72 hours in advance and may be arranged by calling (760) 863-8886. All questions regarding the meaning of these conditions should be referred to the Fire Department Planning & Engineering Staff at (760) 863-8886. ICM Jason Walsh Fire Safety Specialist RIVERSIDE COUNTY COMMUNITY HEALTH AGENCY DEPARTMENT OF ENVIRONMENTAL HEALTH FOOD ESTABLISIIMENT PLAN APPROVAL NOTICE SR# 20723 Date 1.0/25/10 Project Name Subway Address 75890 Highway 111, La Quinta Plans Submitted by Pedro Garcia Phone 619-253-0340 Owner Don Sowle Address 78664 Como Ct. La Quinta Phone None listed The plans are now approved subject to the conditions listed below and the attached compliance sheet. 1. Provide a grease interceptor letter from the sewer agency. 2. Page F-2, P2 eggshell finish is not approved, must use semi gloss or gloss paint finish. 3. Page F4, the floor sink.located under.6'e'soda fountain must be half exposed under the soda cabinet, with the back of the flooc?sirik enclosed with a 3/8" radius cove base. 4. Provide a water heat6r., . ith minimum capacity of 70 gallons with a rating of at least 12.5kW (electric) or 55000 BTU's (gas). 5: Sneeze guards are to be evaluated during on-site inspections. CONSTRUCTION INSPECTIONS: Contact the Plan Checker for a Preliminary Inspection when construction is approximately 80% complete, with plumbing, rough ventilation, and rough equipment installed. Request for inspection should be made at least five (5) working days in advance. A FINAL INSPECTION MUST be made upon completion of ALL work including finished details. APPROVAL to operate shall not be granted, or remodeled areas approved to operate, until the facility has passed the FINAL INSPECTION, and "APPLICATION TO OPERATE" has been completed and PERMIT FEES have been paid. Request for inspection should be made at least five (5) working days in advance. PLANS CHECKED BY Tracey Ford, EHS III Phone (760) 863-8287 I .acknowledge the corrections noted herein and as indicated on the plans and agree to incorporate them during construction: Signature Company Name. DEH -SAN -178 (Rev 2/06) Date Corona Hemet Indio Murrieta 2275 S. Main St 800 S. Sanderson 47-950 Arabia St ; 38740 Sky Canyon Suite 204 (951) 766-2824 "A" Dr (951) 273-9140 Fax(951)766- (760) 863-8287 (951) 461-0284 Fax (951) 520-8319 7874 Fax(760)863- Fax (95 1) 461-0245 8303 Department Web Site — www.rivcoeh.org Palm Springs 554 S. Paseo Dorotea (760) 3207,1048 Fax (760) 320-1470 Riverside 4065 County Cir (951) 358-5172 Fax(951)358- 5017 ax(951)358- 5017 COACHELLA VALLEY WATER DISTRICT ASSESSOR'S PARCEL NUMBER 85-995 Avenue 52 Coachella, California 92236 (760) 399-2651 APPLICATION FOR WASTEWATER INTERCEPTORISEPARATOR APPROVAL APPLICANT: Submit this form with a copy ora SCALED plot plan (1"= 20' to I"= 4(y SCALE) drawn to District specifications. A nonrefundable filing fee is required when the application is submitted. Check must be made payable to the Coachella Valley Water District. Approval of this application shall remain valid for a period not to exceed one (1) year from date of payment. Plan Check No. Agent. Contractor, Contact Person Owner U 60 W Lf' Job Propert Add� y ?8�Y t�r• ,;N;-1 Address J, City Legal Description `4 DBA PLEASE COMPLETE THIS SECTION FOR REVIEW OF FOOD EST, NOTRe Pr enrcwrr..,.,r... -- _--. r y.. -o Zip 76p Telephor Zip Z� - - -- ti arta r� uvry ra wMP4ETE AND THE PLANCHECK GENERAL CONSTRUCTION: FEE IS PAID. Type of Construction:7Aernal Seating with Mist + I P r New Food FacilityAS— Remodel of Exist- g Food Establishment Ext ers or Heaters 9m of Operation ting Capacity: internal Service: �Z External Bar with Food Service Bar Nonfood Service Water Softener Multiservice (reusable) Single Service (disposable) L� OWNER/REPRESENTATIVEDEClARATION: paid I certify that I have read the entire application and state that all information is correct. I understand that the amount of fee is based on my declaration of information on this form and that incorrect information is grounds for denial of the submitted plana. I also understand that plans will be discarded if not picked up within sixty (60) days of approval or denial and that no inspection Proper information requested has been received and plans have been apved establishment will be conduct " . �+ or approval granted to operate, until all Signature �� !.-•• a— �Z Date Type of System(s) No. Dwelling Fixture units E3Ssnd/OiI fiqGremw interceptor Waived [3New ■ [3Grease Interceptor ■Replacement[3Addition ■ ■Connect to Sewer I ■ wl / Of �,�(( u Approved ❑Denied ❑Conditional Approval* 'See Remarks Date Fee $ - & jj Check No. Date (nidal CVWD-921 t P.O. Box 1504 78-495 CALLE TAMPICO LA OUINTA, CALIFORNIA 92253 To: Greg Butler, Building & Safety Manager From: Les Johnson, Director -Planning Permit #: BUILDING & SAFETY DEPARTMENT (760) 777-7012 FAX (760).777-7011 To CDD: /0- -90-/0 Due Date: /0 - a7 -%D Status:, 45-64 Building Plans Approval (This is an approval to issue a Building Permit) The Planning Department. has reviewed the Building Plans for the following project: o � Description: Address or General Location: n Applicant Contact:. edto. 6/q - a 23 - 0 0#0 The Planning Department finds that: ❑ ...these Building Plans .do not require Planning Department approval. ...these Building Plans are approved by the Planning Department. ❑ ...these Building Plans require corrections. Please forward a copy of the attached corrections to the applicant. When the corrections are made please return them to the Planning Department for review. Les Johnso , Director -Planning receiveucl OCT 2 0 2010 City of La Quin,?a Nanning Departmer+i to/f,it 0 Date 4 Certificate of Occupancy Ihaoown� � . oF�9�. Building & Safety Department This Certificate is issued pursuant to the requirements of Appendix Chapter 1 Section 110 of the California Building Code, certifying that, at the time of issuance, this structure was in compliance with the provisions of the Building Code and the various ordinances of the City regulating building construction and/or use. BUILDING ADDRESS: 78-590 HIGHWAY 111 Use classification: COMMERCIAL —SUBWAY RESTAURANT Building Permit No.: 10-1080 Occupancy Group: B Type of Construction: VB Land Use Zone: CR Code Edition: 2007/2008 Sprinkler Installed: YES Occupant Load: 34 Owner of Building: WASHINGTON ADAMS PARTNERSHIP Address: 42-620 CAROLINE CT #102 City, ST, ZIP: PALM DESERT, CA 92211 By: AJ ORTEGA Building Official Date: JANUARY 5. 2011 , ' POST IN A CONSPICUOUS PLACE 4 Certificate of Occupancy Ihaoown� � . oF�9�. Building & Safety Department This Certificate is issued pursuant to the requirements of Appendix Chapter 1 Section 110 of the California Building Code, certifying that, at the time of issuance, this structure was in compliance with the provisions of the Building Code and the various ordinances of the City regulating building construction and/or use. BUILDING ADDRESS: 78-590 HIGHWAY 111 Use classification: COMMERCIAL —SUBWAY RESTAURANT Building Permit No.: 10-1080 Occupancy Group: B Type of Construction: Riverside County Fire Department Fire Protection Planning Section ' � T Riverside Office: 2300 Market St., Ste. 150, Riverside, CA 92501 Ph. (951) 955.4777 Fax (951) 955.4886 Murrieta Office: 39493 Los Alamos Rd., Ste A, Murrieta, CA 92563 Ph. (951) 600-6160 Fax (951) 600.6164 + Palm Desert Office: 77.933 Las Montahas Rd., A 201 Palm Desert, CA 92 21 1-41 31 Ph. (760) 863-8886 (760) 863-7072 Fire Department Clearance/Release Date: December 29, 2010 To: City of La Quinta Building Dept. .Fax: Tract/Parcel Map #: Permit/Lot #: LAQ-10-TI-041 (Subway) Job Site Address: 78-590 Hwy 111 Final For Recordation Release For Building Permit(s) Shell Final Only (No Tenant) Approved Final For Occupancy Building Plan Check Fees Paid Building Plan Check Fees Not'Paid Other Fees Fees Not Required 'If you should have any questions, please contact the appropriate Riverside County Fire Protection Planning office for further assistance. Au orizing Signature For Release Jason Walsh Print Name Form C — Revised 12/29/2010 �- BUILDING ENERGY ANALYSIS REPORT PROJECT: Subway 48246-0 78590 H ig hway 111 La Quinta, CA 92253 Project Designer: G Design Report Prepared by: Michael Dell DELL CO. 1629 York Drive Vista, Ca 92084 760-940-0064 RECEIV1FI:) OCT 20 2010 BY. CITY OF LA QUINTA Job Number: BUILDING & SAFETY DEPT. APPROVED nr10-1410m FOR CONSTRUCTION Date: DATE BY 10/14/2010 The EnergyPro computer program has been used to perform the calculations summarized in this compliance report. This program has approval and is authorized by the California Energy Commission for use with both the Residential and Nonresidential 2008 Building Energy Efficiency Standards. This program developed by EnergySoft, LLC — www.energysoft.com. EnergyRo 5.1 by Ener Soft User Number: 1712 RunCode: 2010-10.14719:56:19 /D: nr10-1410m J.,;r4 {i1QUlMD Cr.AQjUWq {3X EUQtaaGjj' -,,-C - //1` A"611g1� �4G1: CQ;Si' T n(jjo,.'-iq Na 1pof 4. (OtUIJ cmd) C'-'ll;w;2,eou (JL MO : rp qow (Na Lqc—m3UUPVI VIA SOOa RMAll%6 E0901A F;(i(_ IV Fui:lb :6to r wbr.(El b,,Odi!'W P5a POW Urq 10 bullnuu CII Mcnipow 2'auu;7Us- w ccWbyfjcN E1.7CU ,11'2 b14Qt9Ll iin Jt1'nrl/:'l 7.:q f? J 01.1141504 0 !ALJ 0-J,4•1 ULU Lois come.Lunc-Ltoo `l 1 i4 i; �e� • neo-aqo-ooel Mfg' 09 a5O9.4• J P.',Sa AOLK D1.1 AS DErf- CO" Al!('PS-1 Dbli blbbOLI bLrbaLcq ph: 1 C p%--elau bLOISCI Us2liUUGL: rs -onmo, c4' a5sn inn H!aPMSA J J J bUOIECI: TABLE OF CONTENTS Cover Page Table of Contents Form LTG -1-C Certificate of Compliance Form LTG -3-C Indoor Lighting Power Allowance Form LTG -MM Lighting Mandatory Measures EnergyPro 5.1 by EnergySoft Job Number. ID• nr10-1410m User Number. 1712 1 2 3 7 8 CERTIFICATE OF COMPLIANCE Part 1 of 4) LTG -1 C Project Name Date Subway 48246-0 10/14/2010 Project Address Climate Zone Total Cond. Floor Area Unconditioned Floor Area 78590 Highway 111 La Quinta 15 1,580 0 GENERAL INFORMATION Building Type: m Nonresidential ❑ High -Rise Residential ❑ HoteVMotel Guest Room ❑ School ❑ Relocatable Public m Conditioned Spaces ❑ Unconditioned Spaces School Phase of Construction: ❑ New Construction ❑ Addition m Alteration Method of Compliance: ❑ Complete Building m Area Category ❑ Tailored Documentation Author's Declaration Statement I certify that this Certificate of Compliance documentation is accurate and complete. Signature Name Michael Dell Date Company DELL CO. 10/1412010 Address CEA # 1629 York Drive CEPE # NR08-90-3530 City/State2ip Phone Vista, Ca 92084 760-940-0064 The Principal Lighting Designer's Declaration Statement • I am eligible under Division 3 of the California Business and Professional Code to accept responsibility for the lighting design. • This Certificate of Compliance identifies the lighting features and performance specifications required for compliance with Title 24, Pages 1 and 6 of the California Code of Regulations. • The design features represented on this Certificate of Compliance are consistent with the information provided to document this design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. Name Signature Pedro Garcia Company Phone G Design Address License # City/State/Zip Date Lighting Mandatory Measures Indicate location on building plans of Mandatory Measures Note Block: LIGHTING COMPLIANCE FORMS & WORKSHEETS check box if worksheets is Included For detailed instructions on the use of this and all Energy Efficiency Standards compliance forms; please refer to the Nonresidential Manual published by the California Energy Commission. m LTG -1 C Pages 1 through 4 Certificate of Compliance. All Pages required on plans for all submittals. m LTG -2C Lighting Controls Credit Worksheet 0 LTG -3C Indoor Lighting Power Allowance ❑ LTG -4C Pages 1 through 4 Tailored Method Worksheet ❑ LTG -5C Pages 1 and 2 Line Voltage Track Lighting Worksheet EnergyPro 5.1 by EnergySoftUser Number: 1712 RunCode: 2010-10-14719:56:19 ID: nr10-1410m Page 3 of 8 CERTIFICATE OF COMPLIANCE Part 2 of 4) LTG -1 C Project Name Subway 48246-0 Date 11011412010 INDOOR LIGHTING SCHEDULE and FIELD INSPECTION ENERGY CHECKLIST Installation Certificate, LTG -1- INST (Retain a copy and verify form is completed and signed.) Field Inspector ❑ Certificate of Acceptance, LTG -2A Retain a copy and verity form is completed and signed.) Field Inspector ❑ A separate Lighting Schedule Must Be Filled Out for Conditioned and Unconditioned Spaces Installed Lighting Power listed on this Liahtinq Schedule is only for: ® CONDITIONED SPACE ❑ UNCONDITIONED SPACE ® The actual indoor lighting power listed below includes all installed permanent and portable lighting systems in accordance with §146(a). Only for offices: Up to the first 0.2 watts per square foot of portable lighting shall not be required to be included in the ® calculation of actual indoor lighting power density in accordance with the Exception to §146(a). All portable lighting in excess of 0.2 watts per square foot is totaled below. Luminaire (Type, Lams Ballasts Installed Watts A B C D E F G H None or Item Ta Complete Luminaire Description' (Le, 3 lamp fluorescent troffer, F32T8, one dimmable electronic ballasts m 3 li a m m a ; -J How wattage Was determined 2 2 (D Cd E E > > Z � X C3 m 42 `0 3:a Field Ins actor' CEC Default From NA8 d c E- o � 8 o ¢ F- H m m u. A (2) 4 ft Fluorescent T8 ❑ 62.0 ® 1 ❑ 2 124 ❑ ❑ 8 2 ft PL -40W L ❑ 45.0 ® ❑ 9 405 ❑ ❑ C 2 ft PL -40W L ❑ 45.0 ® ❑ 3 135 ❑ ❑ D (1) 45w D ❑ 49.0 ® ❑ 5 245 ❑ ❑ G (2) 4 ft Fluorescent T8 Rapid Start ❑ 70.0 ® ❑ 7 490 ❑ ❑ P P 15w MAXLIGHT MLS15 ❑ 16.0 ® ❑ 9 144 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ [313 11 1:10 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Installed Watts Page Total: 11543 Building total number of pages: Installed Watts Building Total Sum of alla es 1,543 Enter into LTG -1C Page 4 of 4 1. Wattage shall be determined according to Section 130 (d and e). Wattage shall be rating of light fixture, not rating of bulb. 2 . If Fail then describe on Page 2 of the Inspection Checklist Form and take appropriate action to correct. Verify building plans if necessary. Ener Pro 5.1 by Ener Soft User Number: 1712 RunCode: 2010-10-14719:56:19 ID: nr10-1410m Page 4 of 8 CERTIFICATE OF COMPLIANCE Part 3 of 4 LTG-1C Project Name Subway 48246-0 Date 10/14/2010 INDOOR LIGHTING SCHEDULE and FIELD INSPECTION ENERGY CHECKLIST Fill in controls for all spaces: a) area controls, b) multi-level controls, c) manual daylighting controls for daylit areas > 250 ftz, automatic daylighting controls for daylit areas > 2,500 ftp, d) shut-off controls, e) display lighting controls, f) tailored lighting controls — general lighting controlled separately from display, ornamental and display case lighting and g) demand responsive automatic controls for retail stores > 50,000 ftz, in accordance with Section 131. MANDATORY LIGHTING CONTROLS — FIELD INSPECTION ENERGY CHECKLIST Field Ins for Number Special Type/ Description of Units Location in Building Features Pass Fail Auto Time Switch T.I. ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 1 ❑ ❑ ❑ ❑ ❑ .❑ ❑ ❑ ❑ ❑ SPECIAL FEATURES INSPECTION CHECKLIST See Page 2 of 4 of LTG-1C The local enforcement agency should pay special attention to the items specified in this checklist. These items require special written justification and documentation, and special verification. The local enforcement agency determines the adequacy of the justification, and may reject a building or design that otherwise complies based on the adequacy of the special justification and documentation submitted. Field Inspector's Notes or Discrepancies: Ener Pro 5.1 by Ener Soft User Number: 1712 RunCode: 2010-10-14719:56:19 ID: nr10-1410m Pae 5 of 8 CERTIFICATE OF COMPLIANCE Part 4 of 4 LTG -1 C Project Name Date Subway 48246-0 10/14/2010 CONDITIONED AND UNCONDITIONED SPACE LIGHTING MUST NOT BE COMBINED FOR COMPLIANCE Indoor Lighting Power for Conditioned S ces Indoor Lighting Power for Unconditioned S ces Watts Watts Installed Lighting 1,543 Installed Lighting 0 from Conditioned LTG -1 C, Page 2 from Unconditioned LTG -1 C, Page 2 Lighting Control Credit _ 0 Lighting Control Credit _ 0 Conditioned Spaces from LTG -2C Unconditioned Spaces from LTG -2C Adjusted Installed 1 543 Adjusted Installed = 0 Lighting Power Lighting Power Complies if Installed 5 Allowed Complies if Installed:5 Allowed Allowed Lighting Power Allowed Lighting Power Conditioned Spaces from LTG -3C or PERF -1 2,074 Unconditioned Spaces from LTG -3C)0 Required Acceptance Tests Designer: This form is to be used by the designer and attached to the plans. Listed below is the acceptance test for the Lighting system, LTG -2A. The designer is required to check the acceptance tests and list all control devices serving the building or space shall be certified as meeting the Acceptance Requirements for Code Compliance. If all the lighting system or control of a certain type requires a test, list the different lighting and the number of systems. The NA7 Section in the Appendix of the Nonresidential Reference Appendices Manual describes the test. Since this form will be part of the plans, completion of this section will allow the responsible party to budget for the scope of work appropriately. Forms can be grouped by type of Luminaire controlled. Enforcement Agency: Systems Acceptance. Before Occupancy Permit is granted for a newly constructed building or space or when ever new lighting system with controls is installed in the building or space shall be certified as meeting the Acceptance Requirements. The LTG -2A form is not considered a complete form and is not to be accepted by the enforcement agency unless the boxes are checked and/or filled and signed. In addition, a Certificate of Acceptance forms shall be submitted to the enforcement agency that certifies plans, specifications, installation certificates, and operating and maintenance information meet the requirements of §10-103(b) of Title 24 Part 6. The field inspector must receive the properly filled out and signed forms before the building can receive final occupancy. A copy of the LTG -2A for each different lighting luminaire control(s) must be provided to the owner of the building for their records. Controls for Credits LTG -2A Controls and Sensors and Automatic Number of Daylighting Luminaire Controls Equipment Re uirin Testing Description controls Location Acceptance 13 13 13 13 13 13 ❑ 13 Ener Pro 5.1 by Ener Soft User Number: 1712 RunCode: 2010-10-14T19:56:19 ID.- nr10-1410m Pae 6 of 8 INDOOR LIGHTING POWER ALLOWANCE LTG-3C' Project Name Subway 48246-0 Date 10/14/2010 ALLOWED LIGHTING POWER Chose One Method A Separate LTG-3C must be filled out for Conditioned and Unconditioned Spaces. Indoor Lighting Power Allowances listed on this page are only for: 0 CONDITIONED SPACES ❑ UNCONDITIONED SPACES COMPLETE BUILDING METHOD BUILDING CATEGORY From §146 Table 146-E WATTS PER (fe) X TOTALS COMPLETE BLDG. AREA = ALLOWED WATTS AREA WATTS AREA CATEGORY METHOD BUILDING CATEGORY From §146 Table 146-F WATTS PER (ft2) X Area ft2 = ALLOWED WATTS Dining 1.10 659 725 Kitchen, Food Preparation 1.60 796 1,274 Con'idor/Restroom/Support 0.60 125 75 TOTALS 1,580 2,074 AREA WATTS TAILORED METHOD Total Allowed Watts using the Tailored Method taken from LTG-4C Pae 1 of 4 Row 3 0 The indoor lighting power allowance using the Tailored Method of compliance shall be determined using the LTG-4C set of forms. A separate set of LTG- 4C forms shall be filled out for CONDITIONED and UNCONDITIONED spaces EnergyPro 5.1 by Ener Soft User Number: 1712 RunCode: 2010.10-14T19:56:19 ID: nr10-1410m Pae 7 of 8 LIGHTING MANDATORY MEASURES: NONRESIDENTIAL LTG -MM Project Name Date Subway 48246-0 10/14/2010 Indoor Lighting Measures: §131(d): Shut-off Controls For every floor, all interior lighting systems shall be equipped with a separate automatic control to shut off the lighting. 1. This automatic control shall meet the requirements of Section 119 and may be an occupancy sensor, automatic time switch or other device capable of automatically shutting off the lighting. 2 Override for Building Lighting Shut-off: The automatic building shut-off system is provided with a manual, accessible override switch in sight of the lights. The area of override is not to exceed 5,000 square feet. §119(h): Automatic Control Devices Certified: All automatic control devices specified are certified, all alternate equipment shall be certified and installed as directed by the manufacturer. §111: Fluorescent Ballast and Luminaires Certified: All fluorescent fixtures specified for the project are certified and listed in the Directory. All installed fixtures shall be certified. §131(a): Individual Room/Area Controls: Each room and area in this building is equipped with a separate switch or occupancy sensor device for each area with floor -to -ceiling walls. Uniform Reduction for Individual Rooms: All rooms and areas greater than 100 square feet and more than 0.8 watts §131(b): per square foot of lighting load shall be controlled with bi-level switching for uniform reduction of lighting within the room. Daylight Area Control: All rooms with windows and skylights that are greater than 250 square feet and that allow for §131(c): the effective use of daylight in the area shall have 50% of the lamps in each daylit area controlled by a separate switch; or the effective use of daylight cannot be accomplished because the windows are continuously shaded by a building on the adjacent lot. Diagram of shading during different times of the year is included on plans. §131(c): Display Lighting. Display lighting shall be separately switched on circuits that are 20 amps or less.6. Outdoor Lighting Measures: §130(c)1: Mandatory lighting power determination for medium base sockets without permanently installed ballasts §132(a): All permanently installed luminaires with lamps rated over 100 Watts either have a lamp efficacy of at least 60 lumens per Watt or are controlled by a motion sensor. §132(b): All Luminaires with lamps rated greater than 175 Watts in hardscape area, including parking lots, building entrances, canopies, and all outdoor sales areas meet the Cutoff Requirements. §132(c)1: All permanently installed outdoor lighting meets the control requirements listed. §132(c): Building facades, parking lots, garages, canopies, and outdoor sales areas meet the Multi -Level Lighting Requirements listed. Ener Pro 5.1 by Ener Soft User Number: 1712 RunCode: 2010.10-14719:56:19 ID: nr10-1410m Pae 8 of 8