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10-0381 (RC)4 P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 7/28/10 Application Number: 10-00000381 Owner: Property Address: 78822 HIGHWAY 111 WALSH JANET CURCI APN: 643-080-052-12-000000- 17300 17TH ST #J ; Application description: REMODEL - COMMERCIAL TUSTIN, CA 92780 r 1 Property Zoning: REGIONAL COMMERCIAL r Application valuation: 150000 JUL 2 9 2gl0 Contractor CdTY �3F Lg C,i(iINYA Applicant: Architect or Engineer: GREEN&NE INC FiivF_milE 1.)�►TP.O. B3981 PALM DT, CA 92255 Iv(760)6701 Lic. No.:43108 --------------------------------------------------------------------------------------=---------- LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Class: B IseNo.: 343108 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is p issued. Date: Z—t ontractor: 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 OWNER -BUILDER DECLARATION - insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier GRANITE STATE Policy Number WC19745351 following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, permit to file a signed statement that he or she -is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor het G with<eecQply with those provisions. - 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).: ate: /, pplicant: 1 _) 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. - 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.). APPLICANT ACKNOWLEDGEMENT , (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application, (_) I am exempt under Sec. , B.&P.C. for this reason the owner, and the applicant, each agrees to, and shalt defend, indemnify and hold harmless the City O' ff' d I f t n related to the work bein Date: Owner: CONSTRUCTION LENDING AGENCY I 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: of La umta, its o icers, agents an emp ogees or any ac or omission g 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 ;ofthi co my to enter upon the above -mentioned prop s action70ses, Ye� 1te: (Applicant or Agent �7 ems_, M LQPERMIT Application Number. . . . . . 10-00000381' ------ Structure Information EMC PT&OT TI/VB/B-OCC/112-OL/SPRINKLED ----- Other struct info . . . . . CODE EDITION 2007/2008 FIRE SPRINKLERS FULLY MIXED -USE OCCUPANCY B OCCUPANT LOAD 112.00 ---------------------------------------------------------------------------- 1ST FLOOR SQUARE FOOTAGE 8489.00 Permit . . . ELECT - ADD/ALT/REM Additional desc . Permit Fee . . . . 32.70 Plan Check Fee 8.18 Issue Date Valuation 0 Expiration Date 1/18/11 Qty Unit Charge Per Extension BASE FEE 15.00 20.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 15.00 6.00 .4500 --------------------------------- EA ELEC DEVICE/FIXTURE >20 =---------------------------- 2.70 -------------- .Permit . . . BUILDING PERMIT Additional desc . . Permit Fee . . . . 814.50 Plan Check Fee 529.43 Issue Date . . . . Valuation . . . . 150000 Expiration Date 1/18/11 Qty Unit Charge Per Extension BASE FEE 639.50 50.00 3.5000 ---------------------------------------------------------------------------- THOU BLDG 100,001-500,000 175.00 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 26.00 Plan Check Fee 6.50 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 1/18/11 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 4.5000 EA MECH VENT INST/ DUCT ALT 4.50 1.00 6.5000. ---------------------------------------------------------------------------- EA MECH VENT FAN 6.50 Permit . . . PLUMBING Additional desc . Permit Fee . . . . 36.00 Plan Check Fee 9.00 Issue Date . . . . Valuation . . . . 0 LQPERMIT Application Number . . . . . 10-00000381 Permit . . . . PLUMBING Expiration -Date 1/18/11 Qty Unit Charge Per Extension BASE FEE 15.00 3.00 6.0.000 EA PLB FIXTURE 18.00 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 ----------------- ------------------------------------------------------ Special Notes and Comments 8,489SF TI/VB/B-OCC/112-OL/SPRINKLED [EISENHOWER MEDICAL CENTER PHYSICAL THERAPY AND OCCUPATIONAL THERAPY TENANT IMPROVEMENT) THIS PERMIT DOES NOT INCLUDE ALTERATIONS TO THE EXTERIOR OF THE BUILDING OR SIGNAGE. 2007/2008 CALIFORNIA BUILDING CODES. July 22, 2010.2:42:24 PM AORTEGA ---------------------------------------------------------------------------- Other Fees . . . . . . . . ACCESSIBILITY PLAN REVIEW 52.94 BLDG STDS ADMIN (SB1473) 6.00 ENERGY REVIEW -FEE 52.94 Fee summary Charged Paid Credited --------------------------------------------------------- Due Permit Fee Total 909.20 .00 .00 909.20 Plan Check Total 553.11 .00 .00 553.11 Other Fee Total 111.88 .00 .00 111.88 Grand Total 1574.19 00 .00 1574.19 LQPERMIT ' Bin # 4L 0t of LaQuint'a Y Building &r Safety Division P.O. Box 1504, 78.495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # �� Project Address: WA Owner's Name:A. P. Number: '. Address: C%j o Legal Description: City, ST, Zip: Contractor: T Telephone: Address: Project Description: City, ST, Zip: t S' 0 1 L Telephone: ; .. .... State Lic. # : City Lic. #; Arch., Engr., Designer: Address: City, ST, Zi Telephone: State Lic. #c >::::<>:>}::•>}:}::•<::;:;,:,<.: !::>.•;; ..,:;:•.:c:;;•rz<}.::..>::�;:::;:>::<•.,•:. ?>> f<s:;:;:;.;;.>},}}};:•}:.}:<z;,`;:?�.<.:;.: Construct ton Type:• Occupancy: 1tagc's P roject a J type (circle one): New Add'nAlter Repair Demo Name of Contact Person: �, \Z S 111�10 Sq. Ft.: y.-8 cl #Stories: 1 Units.: #Units.: Telephone # of Contact Person: �oC7 - �3 � — S %Q Estimated Value of Project: � �� 000 . APPLICANT: DO. NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets 3 Plan Check submitted 4 Item Amount Structural Calcs. Reviewed, ready for corrections 51nWPIan Check Deposit Truss Calcs. Called Contact Person s66Plan Check Balance Title 24 Calcs. Plans picked up q1RID Construction Flood plain plan Plans resubmitted �l / Mechanical Grading:plan 2°" Review, ready f or i e 6 Called Contact Person Electrical Subcontactor List Plumbing Grant Deed Plans picked up. g S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '"' Reyiew,.ready for correctionsfissue Developer Impact Fee Planning Approval Called Contact Person A,I,P,P, Pub. Wks. Appr Date of permit issue School Fees w Total Permit Fees y�30`5k.C`'t d� s n aow • us AFL (arG,,.�i� (7 7i1`foW 4 y r a P.O. Box 1504 BUILDING & SAFETY DEPARTMENT 78-495 CALLE TAMPICO (760) 777-7012 LA QUINTA,-CALIFORNIA 92253 FAX (160) 777-7011 1 To: Greg Butler, Building & Safety Manager To CDD: ✓� D - f D From: Les Johnson, Director -Planning Due Date: Permit #: Status: Building glans Appr va-I (Thi's is an approval to issue a Building Permit) The Planning Department has reviewed the Building Plans for the following project: Description: Address or General Location: 76 - Ba JL Applicant Contact: J^ a .�V ;ThePlan g Department finds that: x ...these Building Plans do not require Planning. Department approval. 0 ...these Building Plans are approved by the Planning Department. 0 ...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 Johnson, Dire )clve . .4 U 2010 J4, of La Qdnfa nning Department ' Date 41 John R. Hawkins Fire Chief Proudly serving the unincorporated areas of Riverside County and the Cities of: Banning Beaumont .; Calimesa 4. Canyon Lake Coachella .; Desert Hot Springs Indian Wells .; Indio 4. Lake Elsinore La Quinta Moreno Valley Palm Desert .; Perris ev Rancho Mirage Rubidoux CSD San Jacinto .; Temecula Board of Supervisors Bob Buster, District I John Tavaglione, District 2 Jeff Stone, District 3 John Benoit, District 4 Marion Ashley, District 5 RIVERSIDE COUNTY FIRE DEPARTMENT In cooperation with the California Department of Forestry and Fire Protection 77-933 Las Montanas Rd STE 201 • Palm Desert, CA 92211 • (760) 863-8886 Fax (760) 863-7072 July 28, 2010 RE: TENANT IMPROVEMENT PLAN CHECK LAQ-IO-TI-023 EMC La Quinta Physical Therapy 78822 Hwy I I I La Quinta, CA You have been issued a release for a tenant improvement on an existing building. THIS IS NOT AN OCCUPANCY PERMIT. It is prohibited to use/process or store any materials in this occupancy that would classify it as an "H" occupancy per Sec. 307 of the 20007 CBC. THE FOLLOWING CONDITIONS MUST BE MET PRIOR TO INSPECTION: Install door hardware and exit signs as per Chapter 10 of the 2007 CBC. A minimum 2A1 OBC 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. A durable sign stating "This door to remain unlocked during business hours" shall be placed on or adjacent to the front exit door. The sign shall be in letters not less than one inch high on a contrasting background. Provide key(s) 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. Key(s) shall be provided at time of final inspection. As may be necessary to maintain proper fire sprinkler protection due to constructions changes, fire sprinkler system plans for the tenant improvement area are required to be submitted to the Fire Department for review. Location of Exit signs shall be added, deleted and/or adjusted during a scheduled site inspection. 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. Y All questions regarding the meaning of these conditions should be referred to the Fire Department Planning & Engineering Staff at (760) 863-8886. Sincerely, By: Jason Stubble Fire Safety Specialist i CERTIFICATE OF COMPLIANCE and FIELD INSPECTION ENERGY CHECKLIST (Page 1 of. 5) MECH-1C PROJECT NAME EMC - LA QUINTA PHYSICAL THERAPY & OCCUPATIONAL THERAPY DATE: 106-10-2010 CLIMATE ZONE: 10 PROJECT ADDRESS: 39000 BOB HOPE DRIVE - RANCHO MIRAGE - CALIFORNIA CONDITIONED FLOOR AREA: 8600 -SQ. FT. GENERAL INFORMATION BUILDING TYPE ❑X NONRESIDENTIAL HIGH RISE RESIDENTIAL ❑ HOTEL/MOTEL GUEST ROOM ❑ SCHOOLS (PUBLIC SCHOOL) ❑ RELOCATABLE PUBLIC SCHOOL BLDG. Q CONDITIONED SPACES ❑ UNCONDITIONED SPACES PHASE OF CONSTRUCTION ❑ NEW CONSTRUCTION ❑ ADDITION ❑X ALTERATION APPROACH OF COMPLIANCE: ❑ COMPONENT Q OVERALL ENVELOPE TDV ENERGY ❑ UNCONDITIONED (FILE AFFIDAVIT) FRONT ORIENTATION: N, E, S. W OR IN DEGREES N HVAC SYSTEM DETAILS FIELD INSPECTION ENERGY CHECKLIST MEETS CRITERIA OF REQUIREMENTS EQUIPMENT 2 INSPECTION CRITERIA SPECIAL FEATURE 1 PASS FAIL —DESCRIBE REASON 3 ITEM OR SYSTEM TAGS (I.E. AC-1, RTU-1, HP-1) E AC-1, AC-4 ❑ ❑ ❑ EQUIPMENT TYPE:4 AIR COOLED ❑ ❑ ❑ NO. OF SYSTEMS j ❑ ❑ ❑ MAX. ALLOWED HEATING CAPACITY N/A ❑ ❑ ❑ MINIMUM HEATING EFFICIENCY N/A ❑ ❑ ❑ MAX. ALLOWED COOLING CAPACITY 120,000 BTU/HR ' ❑ ❑ ❑ COOLING EFFICIENCY — ❑ ❑ ❑ DUCT LOCATION/ R—VALUE PLENUM/ 4.2 ❑ ❑ ❑ DUCTLEAKAGE MUST ABE SUBMITTED NO ❑ ❑ ❑ ECONOMIZER NO ❑ ❑ ❑ THERMOSTAT YES ❑ ❑ ❑ FAN CONTROL NO ❑ ❑ I El EQUIPMENT 2 INSPECTION CRITERIA FIELD INSPECTION ENERGY CHECKLIST SPECIAL FEATURE 1 PASS FAIL -DESCRIBE REASON 3 ITEM OR SYSTEM TAGS (I.E. AC-1, RTU-1, HP-1) (E) AC-2, AC-3 ❑ ❑ ❑ EQUIPMENT TYPE:4 AIR COOLED ❑ ❑ ❑ NO. OF SYSTEMS 1 ❑ ❑ ❑ MAX. ALLOWED HEATING CAPACITY N/A ❑ ❑ ❑ MINIMUM HEATING EFFICIENCY N/A ❑ ❑ ❑ MAX. ALLOWED COOLING CAPACITY 150,000 BTU/HR ❑ ❑ ❑ C60UNG EFFICIENCY — ❑ ❑ ❑ DUCT LOCATION/ R—VALUE PLENUM/ 4.2 ❑ ❑ ❑ DUCT MECH LEAKAGE GMUSTS ABE SUBMITTED NO 1 ❑ ❑ ❑ ECONOMIZER NO ❑ ❑ ❑ THERMOSTAT YES ❑ ❑ El CONTROL NO El ❑ 1. I 2. DTHE ACTUAL (INSTAL EDEEQUIPMENTT PERFORMANCE EFFICIENCY ANDDETAILS ON PAGE 2 OF THE INSPECTIONCHECKLIST CAPACITY IS LESS THAN THE P F COMPLIANCE SUBMITTAL OR FROM THE BUILDING PLANS) THE RESPONSIBLE PARTY SHALL RESUBMIT EIIEF THE NEW CHANGES. 3. FOR ADDITIONAL DETAILED DISCREPANCY USE PAGE 2 OF THE INSPECTION CHECKLIST FORM. 4. INDICATE EQUIPMENT TYPE: GAS(PKG OR, SPLIT), VAV, HP (PKG OR SPLIT), HYDRONIC, PTAC, OR OTH OPOPTRX ENERGY " QUINTA dl�N®IETY DEPT. R APPROVED 2008 NONRESIDENTIAL COMPLIANCE FORMS AUGU T 2009 I DATE - 7191*D BY,I CERTIFICATE OF COMPLIANCE and FIELD INSPECTION ENERGY CHECKLIST (Page 2 of 5) MECH-1C PROJECT NAME EMC — LA QUINTA PHYSICAL THERAPY & OCCUPATIONAL THERAPY DATE: 106-10-2010 SPECIAL FEATURES INSPECTION CHECKLIST 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. Discrepancies: 2008 NONRESIDENTIAL COMPLIANCE FORMS AUGUST 2009 CERTIFICATE OF COMPLIANCE and FIELD INSPECTION ENERGY CHECKLIST (Page 3 of 5) 1MECH-1C PROJECT NAME DATE: EMC — LA QUINTA PHYSICAL THERAPY & OCCUPATIONAL THERAPY 06-10-2010 Required Acceptance Tests Designer: This form is to be used by the designer and attached to the plans. Listed below are all the acceptance tests for mechanical systems. The designer is required to check the applicable boxes by all acceptance tests that apply and list all equipment that requires an acceptance test. If all equipment of a certain type requires a test, list the equipment description and the number of systems. The NA number designates the Section in the Appendix of the Nonresidential Reference Appendices Manual that 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. Enforcement Agency: Systems Acceptance. Before occupancy permit is granted for a newly constructed building or space, or a new space —conditioning system serving a building or space is operated for normal use, all control devices serving the building or space shall be certified as meeting the Acceptance Requirements for Code Compliance. Systems Acceptance. Before occupancy permit is granted. All newly installed HVAC equipment must be tested using the Acceptance Requirements. , The MECH-1C form is not considered a completed form and is not to be accepted by the building department unless the correct boxes are checked. The equipment requiring testing, person performing the test (Example: HVAC installer, TAB contractor, controls contractor, PE in charge of project) and what Acceptance test must be conducted. The following checked —off forms are required for ALL newly installed equipment. In addition a Certificate of Acceptance forms shall be submitted to the building department that certifies plans, specifications, installation certificates, and operating and maintenance information meet the requirements of §10-103(b) and Title 24 Part 6. The building inspector must receive the properly filled out and signed forms before the building can receive final occupancy. Test Description MECH-2A MECH-3A MECH-4A MECH-5A MECH-6A MECH-7A MECH-8A MECH-9A MECH-10A MECH-11A Equipment Requiring of Outdoor Ventilation Constont Volume & Single—Zon Air Distribution Economizer Demand Supply Vole LeakageLeak aWater Supply Hronic System Variable Automatic Demand Testing or Verification its for VAV & CAV Unitary Duct Control DCV Ventilationtion Fan Testt Temp.Flow Reset Shed Control Control (E) AC-1 1 o ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ (E) AC-2 1 ❑X ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ (E) AC-3 1 ❑X ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ D (E) AC-4 1 ❑X ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ D ❑ ❑ ❑ ❑ -❑ ❑ D ❑ D ❑ D ❑ D ❑ ❑ ❑ ❑ ❑ ❑' ❑ El El El El 11 1:1 El El El El El El El El 1:1 El El El El F1 2008 NONRESIDENTIAL COMPLIANCE FORMS AUGUST 2009 CERTIFICATE OF COMPLIANCE and FIELD INSPECTION ENERGY CHECKLIST (Page 4 of 5) MECH-1C PROJECT NAME EMC — LA QUINTA PHYSICAL THERAPY & OCCUPATIONAL THERAPY DATE: 06-10-2010 Test Description MECH-12A MECH-13A MECH-14A MECH-15A Equipment Requiring Testing # of unit s Fault Detection & Diagnostics for DX Units Automatic Fault Detection & Diagnostics for Air & Zones Distributed Energy Storage DX AC System Thermal Energy Storage (TES) System Test Performed By. (E) AC-1 1 ❑ ❑ ❑ ❑ WESTERN ALLIED CORPORATION (E) AC-2 1 ❑ ❑ ❑ ❑ WESTERN ALLIED CORPORATION (E) AC-3 1 ❑ ❑ ❑ ❑ WESTERN ALLIED CORPORATION (E) AC-4 1 ❑ ❑ ❑ ❑ WESTERN ALLIED CORPORATION D D ❑ ❑ D ❑ ❑ ❑ ❑ D ❑ ❑ D ❑ D ❑ ❑ ❑ D D ❑ ❑ D D D D D ❑ D D D D D D ❑ D D D a D ❑ ❑ D D ❑ ❑ ❑ D D ❑ ❑ D D D ❑ D ❑ D D D D ❑ D D ❑ ❑ D El El El El D El El❑ D D ❑ D D D D ❑ ❑ ❑ ❑ D ❑ D D ❑ ❑ D D ❑ D D ❑ D ❑ D ❑ D D ❑ D ❑ ❑ 2008 NONRESIDENTIAL COMPLIANCE FORMS AUGUST 2009 CERTIFICATE OF COMPLIANCE and FIELD INSPECTION ENERGY CHECKLIST (Page 5 of 5) MECH-1C PROJECT NAME DATE: EMC — LA QUINTA PHYSICAL THERAPY & OCCUPATIONAL THERAPY 06-10-2010 Documentation Author's Declaration Statement • 1 certify that this Certificate of Compliance documentation is accurate and complete. NAME: SIGNATOF2 T. NGUYEN COMPANY NAME: % -71to WESTERN ALLIED CORPORATION ADDRESS: IF APPLICABLE 12046 EAST FLORENCE AVE. CEA# CEPE# CITY/STATE/ZIP PH ONE: SANTA FE SPRINGS, CA 90670 (562) 944-6341 Principal Mechanical Designer's Declaration Statement • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the mechanical design. • This Certificate of Compliance identifies the mechanical features and performance specifications required for compliance with Title 24, Parts 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. r NAME: T. NGUYEN SIGNA COMPANY NAME: p WESTERN ALLIED CORPORATION ADDRESS: LICENCE No. 12046 EAST FLORENCE AVE. 198821 CITY/STATE/ZIP PHONE: SANTA FE SPRINGS, CA 90670 (562) 944-6341 MANDATORY MEASURES Indicate location on plans of Note Block for Mandatory Measures M-0.1 MECHANICAL COMPLIANCE. FORMS 8 WORKSHEETS (check box if worksheet is included) For detailed instructions on the use of this and all Energy Efficiency Standards compliance forms, refer to the 2008 Nonresidential Manual Note: The Enforcement Agency may require all forms to be incorporated onto the building plans. MECH-1C ® MECH-1C Certificate of Compliance. Required on plans for all submittals. ❑ MECH-2C Mechanical Equipment Summary is required for all submittals. ❑ MECH-3C Mechanical Ventilation, and Reheat is required for all submittals with mechanical ventilation. ❑ MECH-4C Fan Power Consumption is required when for all prescriptive submittals. 2008 NONRESIDENTIAL COMPLIANCE FORMS AUGUST 2009 CERTIFICATE OF COMPLIANCE and FIELD INSPECTION ENERGY CHECKLIST (Page 1 of 5) MECH-1C PROJECT NAME EMC - LA QUINTA PHYSICAL THERAPY & OCCUPATIONAL THERAPY DATE: 06-10-2010 CLIMATE ZONE: 10 PROJECT ADDRESS: 39000 BOB HOPE DRIVE - RANCHO MIRAGE - CALIFORNIA CONDITIONED FLOOR AREA: 8600 SQ. FT. GENERAL INFORMATION BUILDING TYPE ❑X NONRESIDENTIAL ❑ HIGH RISE RESIDENTIAL ❑ HOTEL/MOTEL GUEST ROOM ❑ SCHOOLS (PUBLIC SCHOOL) ❑ RELOCATABLE PUBLIC SCHOOL BLDG. © CONDITIONED SPACES ❑ UNCONDITIONED SPACES PHASE OF CONSTRUCTION ❑ NEW CONSTRUCTION ❑ ADDITION © ALTERATION APPROACH OF COMPLIANCE: ❑ COMPONENT Q OVERALL ENVELOPE TDV ENERGY ❑ UNCONDITIONED (FILE AFFIDAVIT) FRONT ORIENTATION: N, E, S. W OR IN DEGREES N HVAC SYSTEM DETAILS FIELD INSPECTION ENERGY 'CHECKLIST MEETS CRITERIA OF REQUIREMENTS EQUIPMENT 2 INSPECTION CRITERIA SPECIAL FEATURE 1 PASS FAIL -DESCRIBE REASON 3 ITEM OR SYSTEM TAGS (I.E. AC-1, RTU-1, HP-1) E AC-1, AC-4 ❑ ❑ ❑ EQUIPMENT TYPE:4 AIR COOLED ❑ ❑ ❑ NO. OF SYSTEMS 1 ❑ ❑ ❑ MAX. ALLOWED HEATING CAPACITY N/A ❑ ❑ ❑ MINIMUM HEATING EFFICIENCY N/A ❑ ❑ ❑ MAX. ALLOWED COOLING CAPACITY 120,000 BTU/HR ❑ ❑ ❑ COOLING EFFICIENCY - ❑ ❑ ❑ DUCT LOCATION/ R-VALUE PLENUM/ 4.2 ❑ ❑ ❑ DUCT LEAKAGE TESTING - IF YES, A MECH-4A MUST BE SUBMITTED NO ❑ ❑ ❑ ECONOMIZER NO ❑ ❑ ❑ THERMOSTAT YES ❑ ❑ El - FAN CONTROL NO ❑ ❑ ❑ EQUIPMENT 2 INSPECTION CRITERIA FIELD INSPECTION ENERGY CHECKLIST SPECIAL FEATURE' PASS FAIL -DESCRIBE REASON 3 ITEM OR SYSTEM TAGS (I.E. AC-1, RTU-1, HP-1) (E) AC-2, AC-3 ❑ ❑ ❑ EQUIPMENT TYPE:4 AIR COOLED ❑ ❑ ❑ NO. OF SYSTEMS 1 ❑ ❑ ❑ MAX. ALLOWED HEATING CAPACITY N/A ❑ ❑ ❑ MINIMUM HEATING EFFICIENCY N/A ❑ ❑ ❑ MAX. ALLOWED COOLING CAPACITY 150,000 BTU/HR ❑ ❑ ❑ COOLING EFFICIENCY - ❑ ❑ ❑ DUCT LOCATION/ R-VALUE PLENUM/ 4.2 ❑ ❑ ❑ AUCT MECH 4AG USTSBE SUBMITTED NO ❑ ❑ ❑ ECONOMIZER NO ❑ ❑ ❑ THERMOSTAT YES ❑ 1❑ FAN CONTROL NO ❑ 1. INDICATE SPECIAL FEATURE DETAILS ON PAGE 2-OF THE INSPECTION CHECKLIST FORM. 2 F THE ACTUAL CO PLIANCE SUBMITTAL EOREFROM THE BUILDING QUIPMENT APLANS) THE NCE NRESPONSBLECY AND AP CITY RTY SHALL IS LESS THAN RESUBMITENETHEORGYE THE NEW CHANGES. 3. FOR ADDITIONAL DETAILED DISCREPANCY USE PAGE 2 OF THE INSPECTION CHECKLIST FORM. 4. INDICATE EQUIPMENT TYPE: GAS(PKG OR, SPLIT), VAV, HP (PKG OR SPUT), HYDRONIC, PTAC, OR OTHER e CITY OF LA QUIn' TA M7g7 =DE" SAFETY DEPT. APPROVED 2008 NONRESIDENTIAL COMPLIANCE FORMS T 2009 11=11113— CERTIFICATE OF COMPLIANCE and FIELD INSPECTION ENERGY CHECKLIST (Page 2 of 5) 1MECH-1C PROJECT NAME EMC — LA QUINTA PHYSICAL THERAPY & OCCUPATIONAL THERAPY DATE: 106-10-2010 . SPECIAL FEATURES INSPECTION CHECKLIST 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. Discrepancies: f 2008 NONRESIDENTIAL COMPLIANCE FORMS AUGUST 2009 CERTIFICATE OF COMPLIANCE and FIELD INSPECTION ENERGY CHECKLIST (Page 3 of 5) MECH-1C PROJECT NAME DATE: EMC — LA QUINTA PHYSICAL THERAPY & OCCUPATIONAL THERAPY 06-10-2010 Required Acceptance Tests Designer: This form is to be used by the designer and attached to the plans. Listed below are all the acceptance tests for mechanical systems. The designer is required to check the applicable boxes by all acceptance tests that apply and list all equipment that requires on acceptance test. If all equipment of a certain type requires a test, list the equipment description and the number of systems. The NA number designates the Section in the Appendix of the Nonresidential Reference Appendices Manual that 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. Enforcement Agency: Systems Acceptance. Before occupancy permit is. granted for a newly constructed building or space, or a new space —conditioning system serving a building or space is operated for normal use, all control devices serving the building or space shall be certified as meeting the Acceptance Requirements for Code Compliance. Systems Acceptance. Before occupancy permit is granted. All newly installed HVAC equipment must be tested using the Acceptance Requirements. The MECH-1C form is not considered a completed form and is not to be accepted by the building department unless the correct boxes are checked. The equipment requiring testing, person performing the test (Example: HVAC installer, TAB contractor, controls contractor, PE in charge of project) and what Acceptance test must be conducted. The following checked —off forms are required for ALL newly installed equipment. In addition a Certificate of Acceptance forms shall be submitted to the building department that certifies plans, specifications, installation certificates, and operating and maintenance information meet the requirements of §10-103(b) and Title 24 Part 6. The building inspector must receive the properly filled out and signed forms before the building can receive final occupancy. Test Description MECH-2A MECH-3A MECH-4A MECH-5A MECH-6A MECH-7A MECH-8A MECH-9A MECH-1OA MECH-11A of nits Outdoor Ventilation for VAV & Constant Volume & Single —Zone Air EcControlef Demand Control ply ValveWater Leakage Supply H ronic � System Variable Automatic Demand Testing Verification g CAV Unitary Ventlation DCV FanpVAV Temp. Reset Control Control (E) AC-1 1 ❑X ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ (E) AC-2 1 ❑X ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ (E) AC-3 1 ❑X ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ (E) AC-4 1 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ El EJ El 11 11 El El 0 El El 2008 NONRESIDENTIAL COMPLIANCE FORMS AUGUST 2009 CERTIFICATE OF COMPLIANCE and FIELD INSPECTION ENERGY CHECKLIST (Page 4 of 5) MECH-1C PROJECT NAME EMC — LA QUINTA PHYSICAL THERAPY & OCCUPATIONAL THERAPY DATE: 06-10-2010 Test Description MECH-12A MECH-13A MECH-14A MECH-15A Equipment Requiring Testing units Fault Detection & Diagnostics for DX Units Automatic Fault Detection & Diagnostics for Air & Zones Distributed Energy Storage DX AC System Thermal Energy Storage (TES) System Test Performed By. (E) AC-1 1 ❑ ❑ ❑ ❑ WESTERN ALLIED CORPORATION (E) AC-2 1 ❑ ❑ ❑ ❑ WESTERN ALLIED CORPORATION (E) AC-3 1 ❑ ❑ ❑ ❑ WESTERN ALLIED CORPORATION (E) AC-4 1 ❑ ❑ ❑ ❑ WESTERN ALLIED CORPORATION ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ .❑ ❑ ❑ ❑ o ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ a ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑. ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 1 ❑ ❑ ❑ 2008 NONRESIDENTIAL COMPLIANCE FORMS AUGUST 2009 CERTIFICATE OF COMPLIANCE and FIELD INSPECTION ENERGY CHECKLIST (Page 5 of 5) MECH-1C PROJECT NAME DATE: EMC — LA QUINTA PHYSICAL THERAPY & OCCUPATIONAL THERAPY 06-10-2010 Documentation Author's Declaration Statement • 1 certify that this Certificate of Compliance documentation is accurate and complete. NAME: RE T. NGUYEN COMPANY NAME: pgTE WESTERN ALLIED CORPORATION %/7 / d ADDRESS: IF APPLICABLE 12046 EAST FLORENCE AVE. CEA# CEPE# CITY/STATE/ZIP PHONE: SANTA FE SPRINGS, CA 90670 (562) 944-6341 Principal Mechanical Designer's Declaration Statement • 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the mechanical design. This Certificate of Compliance identifies the mechanical features and performance specifications required for compliance with Title 24, Parts 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: T. NGUYEN SIG COMPANY NAME: pqT�, WESTERN ALLIED CORPORATION /17/0? ADDRESS: LICENCE NO. 12046 EAST FLORENCE AVE. 198821 CITY/STATE/ZIP PHONE: SANTA FE SPRINGS, CA 90670 (562) 944-6341 MANDATORY MEASURES Indicate location on plans of Note Block for Mandatory Measures M-0.1 MECHANICAL COMPLIANCE FORMS & WORKSHEETS (check box if worksheet is included) For detailed instructions on the use of this and all Energy Efficiency Standards compliance forms, refer to the 2008 Nonresidential Manual Note: The Enforcement Agency may require all forms to be incorporated onto the building plans. MECH-1C © MECH-1C Certificate ,of Compliance. Required on plans for all submittals. ❑ MECH-2C Mechanical Equipment Summary is required for all submittals. ❑ MECH-3C Mechanical Ventilation, and Reheat is required for all submittals with mechanical ventilation. ❑ MECH-4C I Fan Power Consumption is required when for all prescriptive submittals. r 2008 NONRESIDENTIAL COMPLIANCE FORMS AUGUST 2009 Certificate of Occupancy T-Vf 4 4 a" Building & Safety Department This Certificate is issued pursuant to the requirements of Appendix Chapter 1 Section 110 of the 2007 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: 78-822 HIGHWAY 111 Use classification: EISENHOWER MEDICAL PHYSICAL THERAPY Occupancy Group: B Sprinklers Installed: YES Building Official Type of Construction: VB Sprinklers Required: YES Building Permit No.: 10-381 Land Use Zone: CR Occupant Load: 112 Owner of Building: JANET CURCI WALSH Address: 17300 17th ST #J City, ST, ZIP: TUSTIN, CA 92780 By: STEVE TRAXEL Date: OCTOBER 6, 2010