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14-0371 (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: 5/15/14 G' Application Number: 14-00000371 Owner: Property Address: 79390 HIGHWAY 111 HENRY, LAWRENCE B APN: 600-390-001- - - PO BOX 3368 Application description: REMODEL - COMMERCIAL PALM DESERT, CA 92261 Property Zoning: REGIONAL COMMERCIAL _ Application valuation: 40000 D b Contractor: Acant:, Architer Engineer: 7�3340GSANINICHOLAS AVENU MAY J a 20911 PALM DESERT, CA 92260 CITY (760) 333-5175 CEQEFrr OF LA DQUINZA Lic. No.: 448326 F�AFE'T LICENSED CONTRACTOR'S DECLARATION 1 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. KDate-� License Class: 13 LicenseNo.: 448326 ��Contractor: OWNER -BUILDER OECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's to License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or cou 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).: 1—) 1, 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.). (_ 1 I am exempt under Sec. , BAP.C- for this reason 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: - LQPERNIIT 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 EXEMPT Policy Number EXEMPT 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. r �/� 1 Date: � �`-'Applicant: ��� WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGEIS UNLA FUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE NDRED 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 court y to enter upon the above-mentioned property fot in ion purposes. Date �� / ignature (Applicant or Agent): �� r Application Number . . . . . 14-00000371 LQPERMIT Structure Information Construction Type . . . . . TYPE V, UNPROTECTED Other struct info . . . . . CODE EDITION 2013 2010 EN FIRE SPRINKLERS' YES MIXED-USE OCCUPANCY A3 /B OCCUPANT LOAD 288.00 ---------------------------------------------------------------------------- 1ST FLOOR SQUARE FOOTAGE 6720.00 Permit ELECTRICAL 2013 Additional desc . . Permit Fee . . . . 214.50 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 11/11/14 Qty Unit Charge Per Extension 1.00 107.2500 LS ELEC NEW COMM, FIRST 2 KSF 107.25 3.00 _ 35.7500 ---------------------------------------------------------------------------- EA ELEC NEW COMM, ADD'L 2 KSF 107.25 Permit . . . MECHANICAL 2013 Additional desc . Permit Fee . . . . 59.59 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 11/11/14 Qty Unit Charge 'Per Extension 2.00 11.9200 EA MECH APPL REP/ALT 23.84 1.00 35.7500 -----------------------------------------------------------7---------------- EA MECH OTHER,EQUIP 35.75 Permit . . . PLUMBING 2013 Additional desc . Permit Fee . . . . 83.44 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 11/11/14 Qty Unit Charge Per Extension 5.00 11.9200 EA PLBG FIXTURE/TRAP - 59.60 1.00 11.9200 EA ' PLBG WATER HEATER/VENT 11.92 1.00 •. 11.9200 ---------------------------------------------------------------------------- EA PLBG WATER INST/ALT/REP 11.92 Permit . . . REMODEL 201.3 Additional desc . Permit Fee . . . . 348.92 Plan Check Fee .00 Issue Date . . . . Valuation 0 LQPERMIT Application Number . . . . . 14-00000371 Permit . . . . . REMODEL 2013 Expiration Date 11/11/14 Qty Unit Charge Per Extension • 1.00 48.6200 LS MISC REMODEL, 1ST 100 SF 48.62 14.00 21.4500 EA MISC REMODEL, ADDL 500 SF 300.30 ---------------------------------------------------------------------------- ' Special Notes and Comments REMODEL OF EXISTING RETAIL BUILDING INTO CHURCH (6720SF -A3 OCCUPANCY)TYPE V -B CONSTR.348 TOTAL OCCUPANT LOAD. 2013 CODES 2010 ENERGY.TUMF EXEMPTION #3. ---------------------------------------------------------------------------- Other Fees . . . . . . . BLDG STDS ADMIN (SB1473) 2.00 PLAN CHECK, REMODEL 373.23 Fee summary Charged Paid ----------------- ----- ----- ---------- Credited ---------- ---------- Due Permit Fee Total 706.45 .00 .00 706.45 Plan•Check Total .00 .00 .00 .00 Other Fee Total 375.23 .00 .00 375.23 Grand Total 1081.68 .00 .00 1081.68 Bin# City of La Quinta Building 8l: 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: 79.390 HWY 111, La Quinta, CA 92253 owner's Name: Shadow Rock Church I Craig Cunnin ham A. P. Number: - 600.390.001 Address: Legal Description: City, sT, zip: Contractor. _ tG Q/� r�A¢���-- Telephone: iii ��'h•'- Svviv'•"'.. ;•a. >^c «s'�3< s ..0.�.vi: i�•Q Address: 72-3iO,gioi/U.cl-6t4s Project Description: 6720 sf Tenant Improvement in a City, ST, zip: wz'/Y 4 �-tw--r—CA 'jab O commercial building (old Patios Plus). Work includes:. Telephone: .Yi':J'} , ';+its j' . `iii' h:v {{h iq<•�,� A. INTERIOR WALL CONSTRUCTION State Lic. # : '�"r'J�e�� City Lic. #; Arch., Engr., Designer: Duane Valencia B. ADJUST LIGHTING AND HVAC V. Vr6Rr1W1E;RE9fRWM9 D. PROVIDE ONE ADDITIONAL MEANS OF EGRESS Address: 79185 Diane Drive City, ST, zip: La Quinta CA 92253 . E. UPGRADE FIRE ALARM SYSTEM Telephone: '.. State Lic. #::>>- C2356 g Name of Contact Person: Duane Valencia Construction Type: V-A (existing)Occupancy: A-3 M-13 Project type (circle one): New Add,,n Alter Repair Demo Sq. Ft.: 6720 # stories: 1 # units: 1 Telephone #,of Contact Person: 760.275.2512 Estimated Value of Project: $40,000. APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Reed TRACKING PERMIT FEES Plan Sets Pian Check submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanlcal Grading plan god Review, ready for correctio s/issue Electrical Subeontactor List Called Contact Person `1A ! Plumbing Grant Deed Plans picked up S.M.1. H.O.A. Approval Plans resubmitted Grading IN HOUSE. Review, ready for correctlonsAssue Developer Impact Fee Planning Approval Called Contact Person A.1.P.P. Pub. Wks. Appr Date of permIt issue School Fees j Total Permit Fees q 1 • tl�ft�Cv COMMUNITY DEVELOPMENT DEPARTMENT 78-495 CALLS TAMPICO LA QUINTA, CALIFORNIA 92253 (760) 777-7125 FAX (760) 777-7011 To: Greg Butler, Building Official From: Les Johnson, CDD Director Permit #: 12-373 To PD: 05/13/2014 Due Date: ASAP PER LES Status: 2ND Building Plans- Approval (This is an approval to issue a Building Permit) Planning has reviewed the Building Plans for the following project: Description: T.I. SHADOW ROCK CHURCH Address or General Location: 79-390 HIGHWAY 111 Applicant Contact: DUANE VALENCIA 760-275-2512 Planning finds that: ❑ ...these Building Plans do not require Planning approval. ...these Building Plans are approved by Planning. ❑ ..: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 Planning for review. Les Johnson, Community Development Department Director Date TO FROM: T,af 4 XP. Qghgr& MEMORANDUM Building Division Wally Nesbit, Principal Planner( DATE: 4/28/2014 T.I. for Shadow Rock Church RE: 79390 Highway 111 Please be advised that a Conditional Use Permit (CUP) has been approved on 4/22/14 for this project. The following corrections/COA are applicable: 1. Per COA #9 of CUP 2014-157, the applicant shall have a signed property lease to permit the tenant construction and proper functioning of the proposed development, prior to issuance of any permit(s). ��c ,-��, - y�� c���r �►c c ce-s£ 2. Per COA #12 of CUP 2014-157, applicant shall provide a minimum of five (5) R6✓� bicycle parking slots. Bike rack(.) shall be placed in shaded locations, out of the way of approved pedestrian ways and shall be provided with a mechanism which permits locking a bicycle onto the rack. Show location of required bicycle parking on site and floor plans, and provide a detail on Shee1_C-D7" Gtj f If you have any questions, please contact me at X7069. P:\FILES\CUP\14\157 Shadow Rock Church\Correspondence\BLDG CK 4-28- 14.doc t� 1 J./ .amort . /./ti, Bin # City of La Quinta -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 # I 3� 1 Project Address: -71 �37v " 76,,- 9641wnersame: A. P. Number: ' Address: 71 276) 17�Vl Legal Description: City, ST, Zip: Z,q " C�' Contractor:;::::: Telephone: :::.;.:•:; ; ::;:::isv%^ ....................::....::......::...:: Address: Project Description: City, ST, Zip: h ewww im 1rub /51, Tele hone: 3fv,:,,;:.;:.::::;:.:;:;;: :: State Lic. # : City Lie. #•: : k!8 Apr Nb% Arch., Engr., Designer: DUO) o 44 Address: City, ST, Zip:. - zk4RA Telephone: _7GU 51 7i�� Z <:<<:; :.:.•.::.::.- ;::::..;t g:::<:; •.•... Construction Type: Occupancy Project type (circle one): New Add'n Alter Repair Demo State Lic. #: Name of Contact Person: ahs?k_4 � G Sq. FL: # Stories: # Units: Telephone #,of Contact Person: 21 f - 2)'51 �� - Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES, Plan Sets 3 Plan Check submitted cS z'q Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss C21cs. Called Contact Person Plan Check Balance. Title 24 Cates. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for correction issue p Electrical Subcontactor List Called Contact Person Plumbing Grant Decd Plans picked up S.M.I. Ii.O.A. Approval Plans resubmitted Grading IN ROUSE:- Review, ready for corrcctionsrtssue Developer Impact Fee Planning Approval Galled Contact Person A.I.P.P. Pub. Wks. Aper Date of permit issue School Fees Total Permit Fees 0 1: _ Juane Valencia architect 79185 Diane Drive La Ount% CA 92253 T 764275-2512 visuArontiersaverrzonnet i www.viwalfrontiersnet i . CA Registered Architect C23'569 i . LEED AP Certified I . 3d .Computer Modeling . Computer Animations • Complete Construction Documents . BIM Specialist . Archi; ADTm Training To: City of La Quinto Building Department Re: ShadowRodk TI 79390 Hwy 111 We are looking to make the following revisions during construction as shown on these replacements_ sheets bub- bled in red.... 1. Panic Hardware previously shown added to main entry door has been removed per CBC 1008.1.9.3; (See floor plan and door schedule) 2. Emergency lighting to be added already exists in the form of emergency ballasts in existing fixtures. We are keeping the existing and not adding additional emergency lights. See Reflected Ceiling Plan and electrical plans.' Duane Valencia, architect j J Q P.O. Box 1504 78-495 CALLE TAMPIC0 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT (760)777-7012 FAX (760) 777-7011 Finance Department; Please Collect the Following Fees for the Services Rendered HTE PERMIT #14-371 PROJECT: SHADOWROCK CHURCH T.I. (UNDER CONSTRUCTION) ADDRESS: 79-390 HIGHWAY 111 CUSTOMER: DUANE VALENCIA SERVICES. RENDERED: ADDITIONAL PLAN REVIEW — REVISION TO PLANS: CLARIFICATION TO EXISTING ILLUMINATED EXIT SIGNS; PANIC HARDWARE EXEMPTION TO MAIN DOOR OF LOBBY; AND NEW FLOOR MOUNTED RECEPTACLE AT RAISED PLATFORM PER APPROVED PLANS DATED 05/30/2014.2010 ENERGY 2013 CODES. SUPPLEMENT TO PERMIT 14-371 Fees: NON STRUCTURAL REVIEW & ADMIN. (I hr x $143/HR).......................................$ 143.00 TOTAL FEES NOW DUE: .............................................. $ 143.00 Date: _May 30, 2014 Initials:__,5;, � 3c%n _ CITY OF.LA QUINTA SUB-CONTRACTOR. LIST `"� I// 4_4 I �\ I��► 6202� (�G! A JOB ADDRESS �""r-qPERMIT NUMBER OWNER _ _ _ -BUILDER This form shall b.e posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authoriz to work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance. of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response. Trade ! Cl�ssiftcat�On Contractor .:........................:::.::::::::::::::::.:::::::::. tor::s.: icense.:.......:......:..:. State Conttac L ::::::::.::::.:.::;:.;:.;;::.;:.;:.;;.;:;:::::>:::;:>::>:.>:.Cit ::.::.:::::::....... sueanCe............... Workers..Cbm ensat�on.In.:.............................. ............. ... p.. `> Y . . ess.L is Company Classification e9A B C-8) License Nu ber 1xxxxxX) Date Exp. .Da xX/XX XX).(e.g..9State Carri r Name Fund, CalComP) er Policy Number mb Format Varies) Exp.. Date xxlxx xx) m ber License Number E x . Da to (xx/xx/xxxxxx) ) E1ti T".:.',O'RK': C'.12 R... HW......::�:.:::::::. �\( CONCRETE 11i4�//4 `F:R:AML..:..�::(. �::::::. , 1 `CL'1 I� 'v' AG f /4�?Y � O � o�. C7 b � � Lc H L D AIC) G STRU:CTS:7!EL'(C...S..:..1:::.... .� �-J / v <PLUM.BINE:.:(C:36):>;»::<::>:::;<:»>::>. ,/ v�LL� � �Gf/L1��l2J�'^ L 3 V 73 b O r �} �S &6 S oz 70 3r 1 a >L' `TH"?:PLASTER'>(C=3:5!):'"? AR.' ::::........::.::: bRYWALL (C 9) �/ 0 JA c t h— � � G ��0 ��� / o� iVAc`c=zo"> <<><<< >> 1 ) ,�pG�9 �9 G`�b %? �.bl a C5 '�C��L9iQciNs_Go, 5235_-: 6 ELECTRICAL(;Cx;0 rr No^T �LLCI��G l� 3� �asrd avU M��o �� / »:: S15T ` "ETAt :C 43 ` << :H EM...:.:.:...:.(::.:::;�:........... ...... LOGRIN GI)........::::::: .... .. :;GLA.... 'N' INSULATION> q.. 3'> >> »> > ::SEWAGrtDISP.»{C P4TNT.I.NG{C:;.:.:: � ............:::::.: .C,ERAM.IC.. TILE_ (5 LANpS. ARING>{:C;=27:1:» » t PROUDLY SERVING THE UNINCORPORATED AREAS OF RIVERSIDE COUNTY AND THE CITIES OF. BANNING BEAUMONT CAL (MESA CANYON LAKE COACHELLA DESERT HOT SPRINGS EASTVALE INDIAN WELLS INDIO LAKE ELSINORE LA QUINTA MENIFEE MORENO VALLEY PALM DESERT PERRIS RANCHO MIRAGE RUSIDOUx CSD SAN JACINTO TEMECULA WILDOMAR BOARD OF SUPERVISORS: BOB BUSTER DISTRICT 1 JOHN TAVAGLJONE DISTRICT 2 JEFF STONE DISTRICT 3 JOHN BENOrr DISTRICT 4 MARION ASHLEY DISTRICT 5 R SI09 COUNTY FIRE DEPARTIMEW IN COOPERATION WITH THE CALIFORNIA DEPARTMENT OF FORESTRY AND FIRE PROTECTION 77-933 Las Montarias Rd., Ste. #201, Palm Desert, CA 92211-4131 . Phone (760) 863-8886 • Fax(760)863-7072 www.rvcfire.org May 14, 2014 RE: TENANT IMPROVEMENT PLAN CHECK -Non Structural LAQ- I 4 -TI -0 10 Shadow Rock Church 79390 Hwy 111 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 2013 CBC. THE FOLLOWING CONDITIONS MUST BE MET PRIOR TO INSPECTION: Install door hardware and exit signs as per Chapter 10 of the 2013 CBC. 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. Approved suite addresses shall be placed in such a position to be plainly visible and legible from the street. Said numbers shall contrast with their background. EXISTING FIRE ALARM - The existing fire alarm system shall be modified to provide proper coverage as required by the California Building Code, California Fire Code and adopted standards. A C-10 licensed contractor must submit plans, designed in accordance with NFPA 72 for review and approval prior to installation. (Prior to building final inspection) FIRE SPRINKLERS - The fire sprinkler system within the building or tenant space was approved for the original layout and commodities of the original or a past occupancy. The sprinkler system will need to be modified and designed in accordance with adopted standards. A licensed C-16 contractor shall do all sprinkler work and/or certification. Plans shall be submitted for review and approval prior to installation. (Prior to building final inspection) 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. Keys) shall be provided at time of final inspection. Riverside County Fire Department Fire Protection Planning Section 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 Montañas Rd., # 201Palm Desert, CA 92211-4131Ph. (760) 863-8886 (760) 863-7072 Form C – Revised 6/20/2014 Fire Department Clearance/Release Date: June 20th, 2014 To: City of La Quinta – Building & Safety Permit/Lot #: LAQ-14-TI-010 (Shadow Rock Church) Job Site Address: 79390 Hwy 111,La Quinta, CA _____________ Final For Recordation _____________ Release For Building Permit(s) _____________ Shell Final Only (No Tenant) _______X______ Final For Occupancy(with minor corrections) _____________ 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. ________________________________ Authorizing Signature For Release Lisa Nottingham,F.S.S. Print Name 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. Sincerely, Fire. Safety Specialist t t- 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. Sincerely, Fire. Safety Specialist ',CERTIFICATE OF COMPLIANCE AND FIELD INSPECTION CHECKLIST y( _ i,, CEC-LTG(Revised 08109) A _>F a N CALIFORNIA ENERGY COMMISSION C RE< .CE . RTIFICATE OF COMP L AftW OF LA QUINTA (Page 1 of 4) LTG -1C Project Name: BUIDate: Shadow Rock Church APPROVED I •3 Project Address: ate one: Building CFA: 79.390 HWY 111, La Quinta, CA 922 3 pA 14 By Unconditioned Floor Area: General Information Building Type: Nonresidential ❑ High -Rise Residential ❑ Hotel/Motel ❑ Schools ❑ Relocatable Public ❑ Conditioned Spaces ❑ Unconditioned Spaces Schools Phase of Construction: ❑ New Construction • ❑ Addition Alteration Method of Compliance: r Complete Building ❑ Area Category ❑ Tailored Documentation Authors Declaration Statement ' • 1 certify that this Certificate of Compliance documentation is accurate and complete. An Name: Duane Valencia Signature: Company: V15UAL FRONTIERS vi5ualfrontier5@verizon.net Da 5/1/2014 Address: If applicable: 141185 Diane Drive, La Quinta, CA CEA # CEPE # City/State/ZiPhone: eA QUINTA, CA 82253 160.215.2512 Principal Lighting Designers Declaration Statement • I am eligible under Division 3 of the California Business and Professions 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: Duane Valencia Signature: Comp any: V15UAL FRONTIER5 vi5ualfrontiemverizonnet one: 160.215.2512 Address. 1 q 185 Diane Drive, La Quinta, CA License # C2356 q City/State/Zip: EA QUINTA, CA 82253 Date: 5/1/2014 Lighting Mandatory Measures Indicate location on building plans of Mandatory Measures Note Block: CD 10 LIGHTING COMPLIANCE FORMS & WORKSHEETS (check box if worksheet 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. LTG -1C Pages 1 through 4 Certificate of Compliance. All Pages required on plans for all submittals. n To'?p Lighting Controls Credit Worksheet . M2ZIndoor Lighting Power Allowance ❑ LTG -4C Pages 1 through 4 Tailored Method Worksheet T Pages 1 afrd 2 Line Voltage Track Lighting Worksheet F lA QUINTA C Q CEaELOPW% 2008 Nonresidential Compliance Form August 2009 CERTIFICATE OF COMPLIANCE AND FIELD INSPECTION CHECKLIST CEC-LTG-1C (Revised 08109) CALIFORNIA ENERGY COMMISSION -10 CERTIFICATE OF COMPLIANCE (Page 2 of 4) LTG -1C INDOOR LIGHTING SCHEDULE and FIELD INSPECTION ENERGY CHECKLIST Project Name: Shadow Rock Church Date: 5/1/2014 Installation Certificate, LTG-1-INST (Retain a copy and verify form is completed and ❑Field Inspector signed.) Certificates of Acceptance, LTG -2A and LTG -3A (Retain a copy and verify form is ❑ Field Inspector completed and signed.) A separate Lighting Schedule Must Be Filled Out for Conditioned and Unconditioned Spaces Installed Lighting Power listed on this Lighting 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 Schedule (Type, Lamps, Installed Watts Ballasts A B C D E F G H Field How wattage was Inspector 2 determined CEC Accordin Default to C E" Complete Luminaire Description ` W `- a c N ° .� ar x z (i.e, 3 lamp fluorescent troffer, v, E g from §130 .0 E F32T8 one dimmable electronic ballast) -J NA8 d ore Z —J c °- u - (E) 2x2 TRAY LIGHT w/ q GRID PARABOLIC, - 2 TUBE 64 ❑ ❑ qb 6144 ❑ ❑ RECE55ED C,OMPAr.T FLOUREM ENT (NORA NHP -18M) (E)8(N) 18 ❑ ❑ 1 126 ❑ ❑ LED STAGE LI6HT5 - par slim q 1 ❑ ❑ 8 116 ❑ ❑ LED STAGE LIGHTS - DJ 50 ❑ ❑ 4 200 ❑ ❑ ❑ ❑ 1:10 —1:1 ❑ ❑. ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 1 ❑ ❑ ❑ INSTALLED WATTS PAGE TOTAL: 1246 Installed Watts Building Total Building total number of pages 1 146 (Sum of all pages) Enter into LTG -1 C 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, 2008 Nonresidential Compliance Form August 2009 CERTIFICATE OF COMPLIANCE AND FIELD INSPECTION CHECKLIST CEC-LTG-1C (Revised 08109) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE (Page 3 of 4 LTG -1 C Project Name: Date: Shadow Rock Church 5/1/2014 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 ft2, automatic daylighting controls for daylit areas > 2,500 ft2, d) shut-off controls, e) display lighting controls, 0 tailored lighting controls - general lighting controlled separately from display, ornamental and display case lighting and demand responsive automatic controls for retail stores > 50, 000 ft2 in accordance with Section 131. MANDATORY LIGHTING CONTROLS - FIELD INSPECTION ENERGY CHECKLIST Field,, l.nspector,: Type / Description Number of Units Location in Building Pas s fail MULTI-LEVEL OCCUPANCY 5WITGH 1 ALL ROOMS EXCEPT NEW TOILET RM5 ❑ ❑ OCCUPANCY 511ITGH 2 NEW TOILET ROOMS 0 DMX LIGHTING CONTROLLER BRAIN (SPECIALTY) 1 FOR LED 5TAGE LIGHTS ❑ ❑ . o .,01. ❑ 0. a a ❑, ❑ ❑ o ❑ ❑ a. o Field Inspector's Notes or Discrepancies: 2008 Nonresidential Compliance Form August 2009 CERTIFICATE OF COMPLIANCE AND FIELD INSPECTION CHECKLIST CEC-LTG-1C (Revised 08/09) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE (Page 4 of 4) LTG -1C Project Name: Date: Shadow Rock Church 5/1/2014 Conditioned and Unconditioned space Lighting must not be combined for compliance Indoor Lighting Power for Conditioned Spaces Indoor Lighting Power for Unconditioned Spaces Watts Watts Installed Lighting,1246 Installed Lighting from Conditioned LTG -1 C Page 2 from Unconditioned LTG -1 C Page 2 Lighting Control Credit 1424 Lighting Control Credit - Conditioned Spaces from LTG -2C Unconditioned Spaces from LTG -2C Adjusted Installed 5822 Adjusted Installed Lighting Power -LightingPower Complies if Installed <_ Allowed = - Complies if Installed /Howed Allowed Lighting Power 10152 Allowed Lighting Power Conditioned Spaces from LTG -3C Unconditioned Spaces from LTG -3C Required Acceptance Tests a 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 and LTG -3A. The designer is required to check the acceptance tests and list all control devices serving the building or space Shag 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 and LTG -3A forms are not considered a complete form and are not to be accepted by the enforcement agency unless the boxes are checked and/or fifled 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 and LTG -3A for each different lighting luminaire control(s) must be provided to the owner of the building for their records. Luminaires Controlled LTG -2A and 3A Controls and 's Sensors and N Automatic Equipment Requiring E c Daylighting Controls Testing Description z ° 1 Location Acceptance ❑ ❑ 2008 Nonresidential Compliance Form August 2009 CERTIFICATE OF COMPLIANCE AND FIELD INSPECTION CHECKLIST CEC-LTG-2C (Revised 07/10) CALIFORNIA ENERGY COMMISSION LIGHTING CONTROLS CREDIT WORKSHEET (Page 1 of 2) LTG -2C Project Name: Shadow Rock Church Date: 1 5/1/2014 POWER ADJUSTMENT FACTORS (PAF) FOR NON -DAYLIGHT CONTROLS Separate PAF Worksheet Must Be Filled Out for Conditioned and Unconditioned Spaces. Control Credits listed on this schedule are only for: CONDITIONED SPACES ❑ UNCONDITIONED SPACES A B C D E F G Control Credit Watts E x F Room # Zone ID Areas Lighting Control Description Plan Reference(ft) Room Area Watts of Control Lighting Power Adjustments Factor? Sanctuary multi level occ 001 2994 4048 0.2 809.6 2x2 3072 SlimPar 776 DJ 200 Childrens Church multi level occ 002 593 576 0.2 115.2 Nursery multi level occ 003 359 256 0.2 51.2 Preschool multi level occ 004 286 256 0.2 51.2 Storage multi level occ 005 141 192 0.2 38.4 Office 1 multi level occ 006 122 128 0.2 25.6 Office 2 multi level occ 007 119 128 0.2 25.6 Conference multi level occ 008 139 256 0.2 51.2 Womens occ 009A 141 72 0 0 Mens occ 009B 115 54 0 0 Lobby multi level occ 010 657 640 0.2 128 Hall multi level occ 011 268 384 0.2 76.8 Break Room multi level occ 011A 84 128 0.2 25.6 Hall 2 multi level occ 1 012 92 1128 0.2 25.6 PAGE TOTAL 1424 Note: Conditioned and Unconditioned Spaces Shall Be Separately Totaled Number of Pages of LTG -2C Page 1 of 2 Building total of non -daylight control credit watts for all pages of LTG -2C Page 1 of 2 Enter building total of all daylight controls credit watts from LTG -2C Page 2 of 2 BUILDING TOTAL OF ALL CONTROL CREDIT WATTS (FOR BOTH NON -DAYLIGHT AND DAYLIGHT CONTROL CREDITS) Enter in LTG -1C Page 4: Lighting Control Credit as appropriate for CONDITIONED or UNCONDITIONED Spaces 1424 1. Description shall be consistent with Type of Control defined in Table 146-C 2. Power Adjustment Factor taken from Table 146-C 2008 Nonresidential Compliance Forms July 2010 INDOOR LIGHTING POWER ALLOWANCE CEG -LTG -3C (Revised 08/09) CALIFORNIA ENERGY COMMISSION INDOOR LIGHTING POWER ALLOWANCE LTG -3C Project Name: Shadow Rock Church B Date: 5/7/2014 ALLOWED LIGHTING POWER Chose One Method E A Separate LTG -3C must be filled out for Conditioned and Unconditioned Spaces. Allowances listed on this page are only for: N CONDITIONED spaces Indoor Lighting Power ❑ UNCONDITIONED s aces PLETE BUILDING METHOD BUILDING CATEGORY (F WATTS COMPLETE ALLOWED 46 Table 146-E PER ft2 X BLDG. AREA= WATTS 1.6 6120 10,152 TOTALS 1 10,152 AREA WATTS AREA CATEGORY METHOD — Part B Addition a e Allowance from Table 146-F Footnotes A B C D E F G Additiona ALLOWED Primary Function S Ft I Watts Per f? Allowed Wattage Allowa B o antity of Special Description\eacQh Luminaire ZT erimary FunctionArea Total Design Wafts WATTS Smaller of D or F TOTALS — Enter into Area Category Method Part A (table above) Additional watts available y when allowed according to the footnotes on bottom Table 146-F for chandelier or sconce; art, craft, asse y or manufacturing specialized task work; precision comme 'al/ industrial work; or lab specialized task work. 2. Special luminaires a light fixtures described in the Table 146-F Footnotes that are subje an additional watta a allowance TAILORED ETHOD Total Allowed Watts using the Tailored Method taken from LTG -4C (Page 1 of 4) Row 3 The door lighting power allowance using the Tailored Method of compliance shall be determined using the L -4C set of forms. A separate set of LTG -4C forms shall be filled out for CONDITIONED and UNCONDITIONED 2008 Nonresidential Compliance Forms August 2009 LIGHTING MANDATORY MEASURES: NONRESIDENTIAL LTG -MM Project Name Shadow Rock Church Date 5/1/2014 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. Tandem Wiring for One and Three Lamp Fluorescent Fixtures: All one and three lamp fluorescent fixtures are tandem §132: wired with two lamp ballasts where required by Standards Section 132; or all one and three lamp fluorescent fixtures arespecified with electronic high -frequency ballasts and are exempt from tandem wiring requirements. §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. J f POST IN A CONSPICUOUS PLACE Certificate of Occupancy Community Development Department This Certificate is issued pursuant to the requirements of Chapter 1 Section 111 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: 79-390 HIGHWAY 111 Use classification: ASSEMBLY – SHADOW ROCK CHURCH Building Permit No.: 14-0371 Occupancy Group: A-3/B Type of Construction: VB Land Use Zone: CR Code Edition: 2013 Sprinkler Installed: YES Occupant Load: 288 Owner of Building: HENRY, LAWRENCE B Address: PO BOX 3368 City, ST, ZIP: PALM DESERT, CA 92261 ____________ TOM HARTUNG_________________ By: KIRK KIRKLAND Building Official (Interim) Date: JUNE 20, 2014