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
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Policy Number mb
Format Varies)
Exp.. Date
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m ber
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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