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06-1413 (RC)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description Property Zoning: Application valuation: Applicant: CI 06-00001413 79440 HIGHWAY 111 STE 649-820-004- - REMODEL - COMMERCIAL REGIONAL COMMERCIAL 20000 T-iht 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT* Owner: 104 KLEINE NEIL WAYNE 41910 BOARDWALK A-10 PALM DESERT PALM DESERT, CA 92211 Architect or Engineer: -------------------------------------------------- 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 id Professionals Code, and my License is in full force and effect. Licqpse Class: B Eense No.: 851948 Date ontractor: OWNER -BUILDER DECLARATION hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cade) 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 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through. his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). (_ 1 1, 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. , B.&P.C. for this reason { r:o 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: LQPE%NIIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/25/06 Contractor: D ° PELLETIER & LEATHEAD GENL CONT 41-589 ALLIGATOR POND ROAD JUN 08 2006 INDIO, CA 92203 (760)772-1313 Lic. No.: 851948 CITY OF LAQUINYi ------------------ 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 STATE FUND Policy Number 229005495 _ 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 / ^ �37 0 of the Labor Code, shall forthwi comply with thos - rovisions. .'Date: Q� C�p icant: . WARNING: FAILURE TO SECURE WOR RS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. , 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building co ction, and hereby authorize representatives - of thiscoy�ty Ot� enter upon t ove-mentioned property f inspec 'on purposes Date: y / ignature (Applicant or Agent): Application Number . . . . . 06-00001413 ------ Structure Information EXISTING SHELL ----- Other struct info . . . . . CODE EDITION 01B04E05EN FIRE SPRINKLERS YES MIXED-USE OCCUPANCY B OCCUPANT LOAD 10.00 ---------------------------------------------------------------------------- 1ST FLOOR SQUARE FOOTAGE 975.00 Permit . . . BUILDING PERMIT Additional desc . Permit Fee . . . . 207.00 Plan Check Fee 134.55 Issue Date . . . . Valuation . . . . 20000 Expiration Date 11/21/06 co, Qty Unit Charge Per Extension BASE FEE 45.00 18.00 9.0000 ---------------------------------------------------------------------------- THOU BLDG 2,001-25,000 162.00 ` Permit . . . ELECT - ADD/ALT/REM Additional desc . Permit Fee . . . . 53.00. - Plan Check Fee 13.25 Issue Date Valuation . . . . 0 Expiration Date 11/21/06 Qty Unit Charge Per Extension BASE FEE 15.00 . 20.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 15.00 1.00 18.5000 EA ELEC SVC <=600V/<=200A 18.50 10.00 .4500 -------------------------------------------='-------------------------------- EA ELEC DEVICE/FIXTURE >20 4.50 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 44.00 Plan Check Fee 11.00 Issue Date . . . Valuation . . . . 0 Expiration Date 11/21/06 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 4.5000 EA MECH VENT INST/ DUCT ALT 4.50 r 1.00 9.0000 EA MECH B/C <=3HP/100K BTU 9.00 1.00 6.5000 ----------------=-----------------------------------------------------------• EA MECH VENT FAN 6.50 w� LQPERA1IT Permit . . . . PLUMBING Application Number . . . . . 06-00001413 Permit . . . PLUMBING Additional desc . Permit Fee . . . . 67.50 Plan Check Fee 16.88 Issue Date . . . . Valuation . . . . 0 Expiration Date 11/21/06 Qty Unit Charge Per Extension BASE FEE 15.00 7.00 6.0000 EA PLB FIXTURE 42.00 1.00 7.5000 EA PLB WATER HEATER/VENT 7.50 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 ---------------------------------------------------------------------------- Special Notes and Comments MASSAGE ESTABLISHMENT TENANT IMPROVEMENT -SUITE 104(US ASIAN PAIN CARE) -975 SF. "B" OCCUPANCY,.TYPE VN CONSTRUCTION, 10=OCCUPANT LOAD. 2001 CBC,CMC,CPC, 2004 CEC, 2005 ENERGY CODES.PERMIT DOES NOT INCLUDE SIGNS. Prior to Occupancy, approval by the La Quinta Code Compliance Division is required. Contact the department directly to schedule an inspection at Ph: (760) 777=7050. ---------------------------------------------------------------------------- Other Fees . . . . . . . ACCESSIBILITY PLAN REVIEW 13.46 ENERGY REVIEW FEE 13.46 Fee summary Charged Paid Credited Due Permit Fee Total 371.50 .00 .00 371.50 Plan Check Total 175.68 .00 .00 175.68 Other Fee Total 26.92 .00 .00 26.92 Grand Total 574.10 .00 -.00 574.10 C. LQYE%NIIT r Bin # PerMlt ' Project Address:' 7 NA P. Number: S 0 t t .gal Description: ' �ntractor: ) City of La Quinta/ /,,f 40 6 Building U Safety Division P.O. Box 1504, 78-495 Calle Tampico F/1/a ` La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Ll Owner's Name: /—(!Pvp Address: l q u y w City, ST, Zip: U( q Z 2S' 3 TI h 't Total Permit Fees I . u Address: e ep one. Project Description: City, ST, Zip: GN/�ti.'-1� ���Qp�6lGf•�e��' Telephone: State Lie. # : City, Lic. #: Arch., Engr., Designer: . Address: City, ST, Zip: �, V t �Y Telephone: State Lic. #: Name of Contact Person:j�.\ r AWT Constructio . ype: Occupancy: . Project (circle one): New Add'n Alter Repair Demo S . t.: #Stories: #Units: Telephone # of Contact Person: stimated Value_t f Project: /O APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES ; `Sets I ; Plan Check submitted 9C7 Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person . it Plan Check Balance Energy Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading,plan* V Review, ready for correction issue Z Electrical Subcontactor List Called Contact Person lumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading , IN HOUSE:- 7rd Review, ready for correctionsrssue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. �+Pub. Wks. Appr Date of permit issue % 0� ; School Fees 't Total Permit Fees I Craig E. Anthony Fire Chief Proudly serving the unincorporated areas of Riverside County and the Cities of. Bmung 4. Beaumont Calimesa 4. Canyon Lake Coachella Desert Hot Springs .;. Indian Wells r. Indio g. Lake Elsinore La Quinta 4. Moreno Valley e Palm Desert r. . Pends Rancho Mirage San Jacinto Temecula Board of Supervisors Bob Buster, District 1 John Tavaglione, District 2 Jeff Stone, District 3 Roy Wilson, District 4 Marion Ashley, District 5 RIVERSIDE COUNTY FIRE DEPARTMENT 82-675 Higtrway lo, ax January 18, 2006 Lench Design Studio, Inc. P.O. Box 450 La Quinta, CA 92253 Re: Non -Structural Building Plan Review LAQ4)6-BP-004 179-440 Hwy 111 Ste. 101, 102,103,104, 105,106 Fire Department personnel have reviewed and approved the plans you submitted for the above referenced project Please be advised the following conditions apply as a part of the conditions for the issuance of a building permit. 1) Fire Department approval is based upon the 2001 CBC requirements for Group B or M occupancies. It is prohibited to use, process or store any materials in the occupancy that would classify it as a Group H occupancy per Sec. 307 of the 2001 CBC. 2) The Fire Department is required to set a minimum fire flow for the remodel or construction of all commercial buildings using the procedure established in the 2001 CFC. A fire flow of 1500 gpm for a 2 -hour duration at 20 psi residual operating pressure must be available before any combustible material is placed on the job site. 3) The required fire flow shall be available from a Super hydrant(s) (6"x 4"x 21/2"x 21/2") located not less than 25' or more than 165' from any portion of the building(s) as measured along approved vehicular travel ways. 4) Install a complete fire sprinkler system per NFPA 13. The post indicator valve -and fire department connection shall be located to the front within 25' to 50' of a hydrant, and a minimum of 25' from the building. System plans must be submitted to the Fire Department for review, along with a plantiinspection fee. The approved plans, with Fire Department Job card must be at the job site for all inspections. (Fide sprinkler riser location should be placed within the building in relation to the approved location of the FDC/P1V.) 5) Whenever sprinkler overhead mains of 4" size or larger are provided, the Riverside County Fire Department requires documentation from a structural engineer that the roof structural members will be capable of supporting the weight of the water filled mains and attached lines. Provide appropriate detailed documentation, with a wet stamp and signature, by the project structural engineer. 6) Install an alarm monitoring system for fire sprinkler system(s) with 100 or more heads (20 or more in Group I, Division 1.1 and 1.2 occupancies). Valve monitoring, water -flow alarm and trouble signals shall be automatically transmitted to an approved central station, remote station or proprietary monitoring station in accordance with 2001 CBC, Sec. 904.3.1. An approved audible sprinkler flow alarm shall be provided on the exterior in an approved location and also in the interior in a normally occupied location. A C-10 licensed. contractor must submit plans, designed in accordance with NFPA 72, 1999 Edition, to the Fire Department for review and approval prior to installation. EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE 82-675 Highway 111, 2"a FI., Indio, CA 92201 • (760) 863-8886 • Fax (760) 863-7072 7) Install Knox Key Lock box, Model 3200, mounted per recommended standard of the Knox Company. If the building/facility is protected with a fire alarm system or burglar alarm system, the lock boxes will require c "tamper" monitoring. Special forms are available from this office for the ordering of the Key Switch. This form must be authorized and signed by this office for the correctly coded system to be purchased. 8) All egress doors shall comply with CBC Sec.. 1003.3.1.8 for proper door hardware. 9) Install portable fire extinguishers per Tide 19, but not less than 2A10BC in rating. Contact a certified extinguisher company for proper placement and spacing of equipment 10) Approved building address shall be placed in such a position as to be plainly visible and legible from the street and rear access if applicable. Building address numbers shall be a minimum of 12° for building(s) up to 25' in height, and 24' in height for building(s) exceeding 25' in height. In multi -tenant buildings, businesses shall post thebusiness name and suite number on back doors as well as the front Suite numbers or letters must be a minimum of 6' in height. All addressing must be legible and of a contrasting color with the background. Please contact the Fire Department Planning & Engineering staff for final inspection prior to occupancy. 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, Tracy Hobday Chief Fre Department Planner B . Y Walter Brandes Fre Safety Specialist Cc: City of La Quinta - Building Dept. HVEMP DaftUA Guila%PROJECTS%BuUng KXACRe-W-004.dot c r -- Certificate of Occupancy �OFTBuilding & Safety Department This Certificate is issued pursuant to the requirements of Section 109 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. P BUILDING ADDRESS: 79-440 Highway 111 Suite 104 s i f Use classification: Commercial "US Asian Pain Care" TI Building Permit No.: 06-1413 4 Occupancy Group: B Type of Construction: VN Sprinkled Land Use Zone: CR f - i Owner of Building: Neil Kleine Address: 41910 Boardwalk A-10 City, ST, ZIP: Palm Desert, CA 92211 �• By: Daniel P. Crawford Jr. Date: 8/15/06 ' Building Official COPY i POST IN A CONSPICUOUS PLACE 0001 X TemporaryCertificate'of Occupancy O ot� �� IncasoinTsn Building & Safety Department OF This Certificate is issued pursuant to the requirements of Section 109 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: 79-440 Highway 111 Suite 104 Use classification: Commercial "US Asian _Pain Care" Message Establishment TI Building Permit No.: 06-1413 Occupancy Group: B Type of Construction: VN Sprinkled Land Use Zone: CR * 30 day Temporary Certificate of Occupancy, see attached correction list. Owner of Building: Neil Kleine Address: 41910 Boardwalk A-10 City, ST, ZIP: Palm Desert, CA 92211 --� d By: Daniel P. Crawford Jr. Date: Expires 9/14/06 Building Official POST IN A CONSPICUOUS PLACE 4 • TITLE 24 REPORT e i } Title 24 Report for: US Asian Pain Care 79-440 Hi� av 111, Suite 104 La Quanta, CA Project Designer: Report Prepared By: Insu-form, Inc. 41-921 Beacon Hill, Suite A Palm Desert, CA 9221'I,�I� OF LAQUINTA (760) 779-0657 BUILDING & SAFETY DEPT. APPROVED FOR C NSTRUCTION DAT ~J Z� BYt' Job Number: 1 Date: APR 0.5- 2006 4/5/2006 BY The EnergyPro.computer program has been used to perform the calculations summarized in this compliance report. This program has approval and is authorized by the California Energy Commission for use with both the Residential and Nonresidential 2005 Building Energy Efficiency Standards. This program developed by EnergySoft, LLC - www.energysoft.com. EnergyPro 4.0 by EnergySoft Job Number: User Number: 2655 ., sit TABLE OF CONTENTS Cover Page 1 Table of Contents 2 Form LTG -1-C Certificate of Compliance 3 Form LTG -2-C Interior Lighting Schedule 7 Form LTG -3-C Portable Lighting Worksheet 9 Form LTG -5-C Interior Lighting Power Allowance 10 Form OL•TG-1-C Certificate of Compliance 11 Form LTG -MM Lighting Mandatory Measures 13 Lighting Inspection Checklist 14 CERTIFICATE OF COMPLIANCE (Part 1 of 4) LTG -1 -C PROJECT NAME DATE US Asian Pain Care 4/5/2006 PROJECT ADDRESS 79-440 Highway 111, Suite 104 La Quinta PRINCIPAL DESIGNER - LIGHTINGTELEPHONE Biiltlng permit`# DOCUMENTATION AUTHOR TELEPHONE Insu-form, Inc. (760) 779-0657 Ctiecfiedtiy%Dafe Enforcement GENERAL INFORMATION Agency.: DATE OF PLANS BUILDING CONDITIONED FLOOR AREA E ZONE CLIMAT 975 sy.Fc. 15 BUILDING TYPE O NONRESIDENTIAL HIGH RISE RESIDENTIAL HOTELJMOTEC GUEST ROOM CONDITIONED SPACES UNCONDITIONED SPACES INDOOR & OUTDOOR SIGNS PHASE OF CONSTRUCTION NEW CONSTRUCTION ADDITION ALTERATION METHOD OF LIGHTING COMPLIANCE COMPLETE BUILDING AREA CATEGORY E] TAILOREDPERFORMANCE COMMON LIGHTING STATEMENT OF COMPLIANCE This Certificate of Compliance lists the building features and performance specifications needed to comply with Title 24, Parts 1 and 6 of the California Code of Regulations. This certificate applies only to building lighting requirements. The documentation preparer hereby certifies that the documentation is accurate and complete. DOCUMENTATION AUTHOR �,...�...� L -"" DATE 0- 5 The Principal Lighting Designer hereby certifies that the pr os d building design represented in this set of construction documents is consistent with the other compliance forms and worksheets, with the specifications, and with any other calculations submitted with this permit application. The proposed building has been designed to meet the lighting requirements contained in Sections 110, 119, 130 through 132, and 146, 148 and 149 of Title 24, Part 6. Please Check One: (These sections of the Business and Professions Code are printed in full in the Nonresidential Manual.) I hereby affirm that I am eligible under the provisions of Division 3 of the Business and Professions Code to sign this document as the person responsible for its preparation; and that I am licensed in the State of California as a civil engineer or electrical engineer, or I am a licensed architect. I affirm that I am eligible under the provisions of Division 3 of the Business and Professions Code by Section 5537.2 or 6737.3 to sign this document as the person responsible for its preparation; and that I am a licensed contractor performing this work. I affirm that I am eligible under the exemption to Division 3 gf the Business and Professions Code to sign this document because it pertains to a structure or type of work descril � as exempt pursuant t ss and Professions Code Sections 5537, 5538 and 6737.1. �� LIC. G Indicate location on plans of Note Block for Mandji ry Measures ©LTG -1-C, Parts 1 of 4 and 2 of 4:Certificate of Compliance. Part 1 of 4 and 2 of 4 are required for all submittals ®LTG -1-C, Part 3 of 4: Certificate of Compliance. Part 3 of 4 submittal is required only if Control Credits are claimed ®LTG -1-C, Part 4 of 4: Certificate of Compliance. Part 4 of 4 submittal is required when lighting controls are installed ®LTG -2-C: Interior Lighting Schedule ®LTG -3-C: Portable Lighting Worksheet OLTG-4-C: Lighting Controls Credit Worksheet XILTG-5-C: Interior Lighting Power Allowance 7LTG-6-C: Tailored Method Worksheet DLTG-7-C: Room Cavity Ratio Worksheet DLTG-8-C: Common Lighting Systems Method Worksheet DLTG-9-C: Line Voltage Track Lighting Worksheet EnergyPro 4.0 'by EnergySoft User Number: 2655 Job Number: Page:3 of 14 CERTIFICATE OF COMPLIANCE (Part 2 of 4) LTG- -c PROJECT NAME US Asian Pain Care DATE 4/5/2006 INSTALLED INTERIOR LIGHTING POWER FOR CONDITIONED AND UNCONDITIONED SPACES INSTALLED WATTS INSTALLED LIGHTING, CONDITIONED SPACES (From LTG -2-C) 861 PORTABLE LIGHTING (From LTG -3-C) 0 LIGHTING CONTROL CREDIT, CONDITIONED SPACES (From LTG -4-C) 0 CONDITIONED SPACE ADJUSTED INSTALLED LIGHTING POWER 861 INSTALLED LIGHTING, UNCONDITIONED SPACES (From LTG -2-C) 0 LIGHTING CONTROL CREDIT, UNCONDITIONED SPACES (From LTG -4-C) 0 UNCONDITIONED SPACE ADJUSTED INSTALLED LIGHTING POWER p ALLOWED INTERIOR LIGHTING POWER FOR CONDITIONED SPACES ❑ COMPLETE BUILDING METHOD (From LTG -5-C) ALLOWED ❑X AREA CATEGORY METHOD (From LTG -5-C) WATTS ❑ TAILORED METHOD (From LTG -5-C) ALLOWED LIGHTING POWER 1.170 ALTERNATE COMPLIANCE ❑ PERFORMANCE METHOD ❑ COMMMON LIGHTING SYSTEM (From LTG -8-C) ALLOWED INTERIOR LIGHTING POWER FOR UNCONDITIONED SPACES From LTG -5-C) 0 MANDATORY INTERIOR AND DAYLIGHTING AUTOMATIC CONTROLS CERTIFICATE OF COMPLIANCE (Part 3 of 4) LTG -1 -C' PROJECT NAME DATE US Asian Pain Care 4/5/2006 CONTROLS FOR CREDIT IN CONDITIONED AND UNCONDITIONED SPACES CONTROL LOCATION CONTROL (Room # or Dwg. #) IDENTIFICATION CONTROLTYPE ................... .................... .................... .................... LUMINAIRES CONTROLLED NOTETO: TYPE # OF LUMINAIRES FIELD:;:;:;; CERTIFICATE OF COMPLIANCE (Part 4 of 4) LTG -1 -C] PROJECT NAMEDATE US Asian Pain Care 4/5/2006 Designer. This form is to be used by the designer and attached to the plans. Listed below are all the acceptance tests for lighting systems. The designer is required to check the boxes by all acceptance tests that apply and list all equipment that require an acceptance test. If all equipment of a certain type requires a test, list the equipment description and the number of systems to be tested in parentheses. The NJ number designates the Section in the Appendix of the Nonresidential ACM Manual that describes the test. Also indicate the person responsible for performing the tests (i.e. the installing contractor, design professional or an agent selected by the owner). 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. Building Departments: ' Before an occupancy permit is granted for a newly constructed building or space, or a new lighting system 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. In addition a Certificate of Acceptance, LTG -1-A, Forms shall be submitted to the building department that: A. Certifies plans, specifications, installation certificates, and operating and maintenance information meet the requirements of §10-103(b) and Title 24 Part 6. Test Description Test Performed By: ❑ LTG -2-A: Lighting Control Acceptance Document - Occupancy Sensor Acceptance - Manual Daylight Controls Acceptance - Automatic Time Switch Control Acceptance Equipment requiring acceptance testing ❑ ' LTG -3-A: Automatic Daylighting Controls Acceptance Document Equipment requiring acceptance testing 4.0 by EnergySoft User Number: 2655 Job Number: Page:6 of 14 • INTERIOR LIGHTING SCHEDULE (Part 1 of 2) LTG -2-C] PROJECT NAME DATE US Asian Pain Care I I 4/5/2006 INSTALLED LIGHTING POWER FOR CONDITIONED SPACES Luminaire Lamps/Ballasts 'Installed Watts C D E F G H I J Name 1 Type Description CD -0 c c CT w•� co nriv� m m -0 c d Z 3•N3 �.�� 3m* ��N mn C n r- =33 3'0� M. �-.Q G7�� U) CD (( Elec ft Fluorescent T8 Energy Savings F32T8 30 1.0 29.0 X1 1 29 �) ft Fluorescent_ T8 Energy Savings 30 1.0 104.0 X 8 832 • N PAGE TOTAL 861 BUILDING TOTAL (sum of all pages) 861 PORTABLE LIGHTING (From LTG -3-C) CONTROL CREDIT (From LTG -4-C) C j ADJUSTED ACTUAL WATTS 861 4.0 by EnergySoft User Number: 2655 Job Number: Page:7 of 14 INTERIOR LIGHTING SCHEDULE (Part 2 of 2) LTG -2-C PROJECT NAME DATE US Asian Pain Care 4/5/2006 INSTALLED LIGHTING POWER FOR UNCONDITIONED SPACES Luminaire -- Lamps/Ballasts Installed Watts C D E F G H I J Name 4. Tye Description pori (D 'p r -Z cmc 333 L " -�D`or�3 cria� 'andN rWZ cwc 3m3 T.D r c 3v� 0 (D C) dc Cm r c Z �. c 3 N in L�r2in Nam (D a ( PAGE TOTAL BUILDING TOTAL (sum of all pages) CONTROL CREDIT (From LTG -4-C) D y 1 ADJUSTED ACTUAL WATTS Q EnergyPro 4.0 by EnergySoft User Number: 2655 Job Number: Page$ of 14] PORTABLE LIGHTING WORKSHEET LTG -3-C PROJECT NAME US Asian Pain Care DATE 4/5/2006 TABLE 1 - PORTABLE LIGHTING NOT SHOWN ON PLANS FOR OFFICE AREAS >250 SQUARE FEET A B C D ROOM # OR ZONE ID DEFAULT /s ft AREA SF TOTAL WATTS B X C E F G ROOM # OR ZONE ID PORTABLE LIGHTING # OF LUMIN. WATTS PER TASK AREA # OF TASK TOTAL AREA (SF) TOTAL WATTS Description FIXT. FIXTURE (SF) AREAS (D x E) (C x E) TOTAL 0 0 I IAtSLL Z - VUKIABLE LIGHTING SHOWN ON PLANS FOR OFFICE AREAS >250 SQUARE FEET A B C D E F G ROOM # OR ZONE ID PORTABLE LIGHTING # OF LUMIN. WATTS PER TASK AREA # OF TASK TOTAL AREA (SF) TOTAL WATTS Description FIXT. FIXTURE (SF) AREAS (D x E) (C x E) TOTAQ 0 1 0 TABLE 3 PLANS SHOW PORTABLE LIGHTING IS NOT RFOIIIRFn rno nrrlrrc ADCAO ---_ INTERIOR LIGHTING POWER ALLOWANCE LTG - PROJECT NAME US Asian Pain Care DATE 4/5/2006 ALLOWED LIGHTING POWER Choose One Method COMPLETE BUILDING METHOD - CONDITIONED SPACES WATTS PER SF COMPLETE BLDG. AREA ALLOWED WATTS BUILDING CATEGORY (From Section 146 Table 146-B) AREA CATEGORY METHOD - CONDITIONED SPACES AREA (SF) ALLOWED WATTS AREA CATEGORY (From Section 146 Table 146-0) WATTS PER SF Medical and Clinical Care 1.20 975 -1,170 PAGE TOTAL BUILDING TOTAL 975 975 AREA 1 170 1,170 WATTS TAILORED METHOD - CONDITIONED SPACES TOTAL ALLOWED WATTS (From LTG-" or from computer run.) UNCONDITIONED SPACES Complete Building and Area Catagory Methods, Category (From Section 146 Table 146 -B&C) WATTS PER SF AREA (SF) ALLOWED WATTS ` PAGE TOTAL. BUILDING TOTAL D D AREA D" D WATTS TAILORED METHOD - UNCONDITIONED SPACES TOTAL UNCONDITIONED SPACES ALLOWED WATTS (From LTG -5-C and LTG -6-C) 01 n Pro 4.0 User Number: 2655 Job Number: Paae:10 of 14 CERTIFICATE OF COMPLIANCE (Part 1 of 2) OLTG-I-C 11 of 14 PROJECT NAME DATE US Asian Pain Care 4/5/2006 PROJECT ADDRESS 79-440 Highway 111, Suite 104 La Quinta PRINCIPAL DESIGNER - LIGHTING TELEPHONE ?Building Peern'it>#i€` DOCUMENTATION AUTHOR TELEPHONE _ »>CtieckedtiyXDafe >; Insu form, Inc. (760) 779-0657EnforcementA GEgene,Use,__ NERAL INFORMATION DATE OF PLANS OUTDOOR LIGHTING ZONE ❑ LZ1 ❑ LZ2 ❑ LZ3 © LZ4 FUNCTION TYPE © OUTDOOR LIGHTING OUTDOOR SIGNS ❑ ❑INDOOR SIGNS PHASE OF CONSTRUCTION ❑ NEW CONSTRUCTION ❑ ADDITION ® ALTERATION STATEMENT OF COMPLIANCE This Certificate of Compliance lists the outdoor lighting system specifications need to comply with Title 24, Parts 1 and 6 of the California Code of Regulations. This certificate applies only to building lighting requirements. The documentation preparer hereby certifies that the documentation is accurate and complete. DOCUMENTATION AUTHOR SIGNATURE DATE The Principal Lighting Designer hereby certifies that the proposed outdoor lighting and signs design represented in this set of construction documents is consistent with the other compliance forms and worksheets, with the specifications, and with any othe calculations submitted with this permit application. The proposed building has been designed to meet the lighting requirements contained in Sections 110, 119, 130 through 132, and 146, and 149 of Title 24, Part 6. Please Check One: (These sections of the Business and Professions Code are printed in full in the Nonresidential Manual.) ❑ I hereby affirm that I am eligible under the provisions of Division 3 of the Business and Professions Code to sign this document as the person responsible for its that I preparation; and am licensed in the State of California as a civil engineer or electrical engineer, or I am a licensed architect. ❑ I affirm that I am eligible under the provisions of Division 3 of the Business and Professions Code by Section 5537.2 or 6737.3 to sign this document as the person responsible for its preparation; and that I am a licensed contractor performing this work. ❑ I affirm that I am eligible under the exemption to Division 3 of the Business and Professions Code to sign this document because it pertains to a structure or type of work described as exempt pursuant to Business and Professions Code Sections 5537, 5538 and 6737.1. PRINCIPAL LIGHTING DESIGNER - NAME SIGNATURE DATE LIC. # LIGHTING COMPLIANCE FORMS & WORKSHEETS Check box if worksheet is included MOLTG-1-C: Certificate of Compliance. Required on plans for all submittals for outdoor lighting. Part 2 of 2 may be incorporated in schedules on the plans Either LTG -1 -C or OLTG-I-C may be used for signs as follows: 1. Use LTG -1 -C if the project consists solely of indoor signs. 2. Use LTG -1 -C if the project consists of indoor lighting, outdoor or indoor signs, but no other outdoor lighting. 3. Use OLTG-I-C if the project consists solely of outdoor signs. 4. Use OLTG-I-C if the project consists of outdoor lighting, outdoor or indoor signs, but no other indoor lighting. NIOLTG-2-C: LIGHTING COMPLIANCE SUMMARY. Applicable parts required for ALL outdoor lighting allowances (Except Signs). OOLTG-3-C: AREA CALCULATIONS WORKSHEET. Applicable parts required for all outdoor area calculations. OOLTG-4-C: SIGN LIGHTING COMPLIANCE. Required for all internally and extemally illuminated signs. signs, for both indoor and outdoor EnergyPro 4.0 by EnergySoft User Numher• pass 11 of 14 CERTIFICATE OF COMPLIANCE' (Part 2 of 2) OLTG-1-C PROJECT NAME I DATE US Asian Pain Care 4/5/2006 Lighting Schedules on Plans Show that Outdoor Lighting Meets Allowed Lighting Power ❑ FX Lighting power allowance. forgeneral site illumination on OLTG-2-C Part 1 of 4 Not Applicable RLighting ❑X power allowance for local ordinances or for security multipliers on OLTG-2-C Part 2 of 4 Not Applicable ❑ FX Lighting power allowances for specific applications, other than vehicle service stations with canopies on OLTG-2-C Part 3 of 4 Not Applicable ❑X Lighting power allowances for vehicle service station canopies on OLTG-2-C part 4 of 4 Not Applicable ❑ Sign lighting compliance on OLTG-4-C Not Applicable Mandatory Measures on Plans Show that Outdoor Licihtinci Meets Outdoor Liqhtinci Controls And E ui ment ❑ FX Installed lighting power has been determined in accordance with Section 130(c)1 Not Applicable ❑ XD All permanently installed luminaires with lamps rated 100 Wafts either have a lamp efficacy of at least 60 lumins per Watt or are controlled by a motion sensor per Section 132(a) Not Applicable RAll X❑ Luminaires with lamps rated greater than 175 Wafts in hardscape area, including parking lots, building entrances, canopies, and all outdoor sales areas meet the Cutoff Requirements of Section 132(b) Not Applicable R All permanently installed outdoor lighting meets the control requirements of Section 132(c)1 Not Applicable RBuilding F facades, parking lots, garages, canopies, and outdoor sales areas meet the Multi -Level Lighting Requirements of Section 132(c) Not Applicable MANDATORY INTERIOR AND DAYLIGHTING AUTOMATIC CONTROLS NQTET0 FIELD' CONTROL LOCATION (Room #) CONTROL IDENTIFICATION CONTROL TYPE (Auto Time Switch, Dimming, etc.) SPACE CONTROLLED Check if Daylighting EnergyPro 4.0 by EnergySoft User Number: 2655 . Job Number: Page:12 of 14 t _IGHTING MANDATORY MEASURES LTG -MM NAME US Asian Pain Care DATE 4/5/2006 DESCRIPTION Designer Enforcement X § 131(d)1 For every floor, all interior lighting systems shall be equipped with a separate automatic control to shut off the lighting. 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. X❑ § 131(d)20verride 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. R§ 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. X❑ § 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. § 132 Tandem Wiring for One and Three Lamp Fluorescent Fixtures: All one and three lamp fluorescent fixtures are tandem wired with two lamp ballasts where required by Standards Section 132; or all one and three lamp fluorescent fixtures are specified 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. ® § 131(b) Uniform Reduction for Individual Rooms: All rooms and areas greater than 100 square feet and more than 0.8 watts per square foot of lighting load shall be controlled with bi-level switching for uniform reduction of lighting within the room. rXi § 131(c) Daylight Area Control: All rooms with windows and skylights that are greater than 250 square feet and that allow for 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(e) Display Lighting. Display lighting shall be separately switched on circuits that are 20 amps or less. r r EnergyPro 4.0 by EnergySoft User Number: 2655 Job Number: Page: 13 of 14 • ILIGHTING INSPECTION CHECKLIST LTG -I PROJECT NAME INSPECTION DATE US Asian Pain Care 4/5/2006 4.0 by EnergySoft User Number: 2655 Job Number: Page: 14 of 14 FIXTURE CODE TYPE DESCRIPTION LAMP TYPE LAMP QUANT. NUMBER OF FIXTURES WATTS PER FIXTURE FIELD NOTES 1 4 ft Fluorescent T8 Energy Savings Elec F32T8 1 1 29.0 4 4 It Fluorescent T8 Energy Savings Elec F32T8 4 8 104.0 Type DESCRIPTION MH METAL HALIDE INC INCANDESCENT INC/LV INCANDESCENT LOW VOLTAGE CFL COMPACT FLUORESCENT ,. FL FLUORESCENT O OTHER 4.0 by EnergySoft User Number: 2655 Job Number: Page: 14 of 14