13-0527 (RC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
c&JAt 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 13-00000527
Property Address: 79200 CORPORATE CENTRE DR STE 201
APN- 649-820-015- - -
Application description: REMODEL - COMMERCIAL
Property Zoning: COMMERCIAL PARK
Application valuation: 160000
Applicant:
Architect or Engineer:
Owner:
PAUL JAMES R
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/25/13
tolrY OF LA QUI
FINANCE DEPT.
-------------------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: License No.:
Date: Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
construct; alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(_) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
I, as ownerof property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Busif !he
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 reasgg,_ /r7
Date: C/ / c G /rte Owner:
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.).
�r Lender's Name: _
Lender's Address:
.i
LQPERMIT
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 Policy Number
1 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 s Mold, ecome subject to the workers' compensation provisions of Section
3 00 of the Labor ode, I s II fort t 't t cv�'T �o'ip'y�vi h s€p� isions.
Date: Applicant:
WARNING: AILURE TOE ERS' COMPENSATIO 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•bttlldi constru ion, and ereb authorize re sen ives
oI This countyto enter on the above-mentioned property fo inspe io rposes.
Dat e: /� Signature (Applicant or A nt): _
Application Number . . . . . 13-00000527
------ Structure Information EXIST SHELL SPACE
-----
Construction Type .
. . . TYPE V, UNPROTECTED
Occupancy Type . .
. . . BUSINESS <50
Other struct info . .
. . . CODE EDITION 201.0
FIRE SPRINKLERS YES
OCCUPANT LOAD
43.00
------------------------------------------
2ND FLOOR SQUARE FOOTAGE 4310.00
----------------------------------
Permit
BUILDING PERMIT
Additional desc .
Permit Fee . . . .
849.50 Plan Check Fee
552.18
Issue Date . . . .
Valuation . . . .
160000
Expiration Date
10/22/13
Qty Unit Charge
Per
Extension
BASE FEE
639.50
60.00 3.5000
-------------------------------------------------------------
THOU BLDG 100,001-500,000
---------------
210.00
Permit
ELECT - ADD/ALT/REM
Additional desc . .
Permit Fee . . . .
101.20 Plan Check Fee
25.30
Issue Date . . . .
Valuation . . . .
0
Expiration Date . .
10/22/13
Qty Unit Charge
Per
Extension
BASE FEE
15.00
4310.00 .0200
----------------------------------------------------------------------------
ELEC GARAGE OR NON-RESIDENTIAL
86.20
Permit
MECHANICAL
Additional desc . .
Permit Fee . . . .
69.00 Plan Check Fee
17.25
Issue Date . . . .
Valuation . . . .
0
Expiration Date
10/22/13
Qty Unit Charge
Per
Extension
BASE FEE
15.00
12.00 4.5000
----------------------------------------------------------------------------
EA MECH VENT ,T.NST/ DUCT ALT
54.00
Permit
PLUMBING
Additional desc .
Permit Fee . . .
45.00 Plan Check Fee
11.25
Issue Date . . . .
Valuation . . . .
0
Expiration Date . .
10/22/13
LQPERMIT
Application Number . . . . . 13-00000527
Permit . . . . . . PLUMBING
Qty Unit Charge Per
Extension
BASE FEE
15.00
3.00 6.0000 EA PLB FIXTURE
18.00
1.00 3.0000 EA PLB WATER INST/ALT/REP
3.00
3.00 3.0000 EA PLB FIXTURE DRAIN/VENT
REP/ALT
9.00
----------------------7-----------------------------------------------------
Special Notes and Comments
INTERIOR TENANT IMPROVEMENT FOR MEDICAL
OFFICE "ADAVNCED WOMEN'S HEALTHCARE"
SUITE 201. 2010 CODES. ARCHITECT: BOB
RICCIARDI C3808
----------------------------------------------------------------------------
Other Fees . . . . .•. . BLDG STDS ADMIN (SB1473)
7.00
Fee summary Charged Paid Credited
-----------------------------------------------
----------
Due
Permit Fee Total 1064.70 .00
.00
1064.70
Plan Check Total 605.98 .00
.00
605.98
Other Fee Total 7.00 .00
.00
7.00
Grand Total 1677.68 .00
.00
1677.68
LQPERMIT
Bin. # I ,. ...
CIty Of %d Quin to
Building & Sarety Division
P.O. Box 1504,78-495 Calle Tampico
4.Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:r'24426 &444k'Owner's
Name:. a.V •
A. P. Number. 5t' 2-0_ _ _
Address: 2 -4- J
- -a - 00-3ryo-0%5-
tion:
Contractor. !/ '
City, ST, Zip:
Telephone: (
Address:
Project Description:
City, ST, Zip:
aU elvvk 14M+
Telephone:
.Mg
State Lic. # :
City Lie. #;
Arch., Engr., Designer: l
Address:6e-Vgd C
City., ST, Zip: e_'1 CA cl
Telephone 00016 —,5o.
fKl, t�„
State Lic. #: G �,, .. f� ;
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: 310 # Stories: Z # Units:
Name of Contact Person:
Telephone # of Contact Person: �.
Estimated Value of Project .100/7
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRAC GNG
PERMIT FEES
Plan Sets
3
Plan Check submitted
Item Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calcs.
Called Contact Person
Pian Check Balance
Tide 24 Calci.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical'
Grading plan
V Review, ready for correctio rssne
��
Electrical
Subcontaetor List
Called Contact Person
5�
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
El ROUSE:-
'^' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
M.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees APTI. ON
Tit!t 4 4 Q"
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
To: Greg Butler, Building & Safety Manager
From: Les Johnson, Planning Director -CDD
Permit #:
BUILDING & SAFETY DEPARTMENT
(760) 777-7012
FAX (760) 777-7011
To CDD: 4 ` ( 19
Due Date: '9 —
Status: I S�
Building Plans Approval
(This is an approval to issue a Building Permit)
The Community Development Department has reviewed the Building Plans for
the following project:
Description: n1MC�
Address or General Location:79 (6-J6t*0q0X
Applicant Contact:
X60- ARE,. I2-6!9
The Community Development Department finds that:
❑ ...these Building Plans do not require Community Development
Department approval.
...these BuildingPlans area roved b the Community Development
PP Y tY P
Departmen�r �4�N�k� �; ,; neo.-•
❑ ...these Building Plans require corrections. Please forward a copy of the,
attached corrections to the applicant. When the corrections are made
please return them to the Community Development Department for
review.
Les Johnson, Oanning Director -CDD
V// 8)/' 3
Date
PROUDLY SERVING THE
UNINCORPORATED AREAS
OF RIVERSIDE COUNTY
AND THE CITIES OF.
BANNING
BEAUMONT
CALIMESA
CANYON LAKE
COACHELLA
DESERT HOT SPRINGS
EASTVALE
INDIAN WELLS
INDIO
JURUPA VALLEY
LAKE ELSINORE
LA QUINTA
MENIFEE
MORENO VALLEY
NORCO
PALM DESERT
PERRIS
RANCHO MIRAGE
RUBIDOUX CSD
SAN JACINTO
TEMECULA
WILDOMAR
BOARD OF
SUPERVISORS:
KEVIN JEFFRIES
DISTRICT 1
JOHN TAVAGLIONE
DISTRICT 2
JEFF STONE
[DISTRICT 3
JOHN BENOIT
DISTRICT 4
MARION ASHLEY
DISTRICT 5
RI`IERSIDE CouNTY FIRE DEPARTMENT
IN COOPERATION WITH
THE CALIFORNIA DEPARTMENT OF FORESTRY AND FIRE PROTECTION
77-933 Las Montanas Rd., Ste. #201, Palm Desert, CA 92211-4131 • Phone (760) 863-8886
• Fax (760) 863-7072
www.rvcfiire.org
April 22, 2013
RE: TENANT IMPROVEMENT PLAN CHECK -Non Structural
LAQ-I3-TI-014 Advanced Women's Healthcare
79-200 Corporate Centre #201 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 2010 CBC.
THE FOLLOWING CONDITIONS MUST BE MET PRIOR TO INSPECTION:
Install door hardware and exit signs as per Chapter 10 of the 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.
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.
An approved audible interior notification alarm device shall be provided in approved
location. A C-10 licensed contractor must submit plans, designed in accordance with
NFPA 72 to the Fire Department for review and approval prior to installation
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.
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. Key(s) shall be provided at
time of final inspection.
As it maybe necessary to maintain proper fire sprinkler protection due to constructions
changes, fire sprinkler system plans for the tenant improvement area may be required to be
submitted, to the Fire Department for review.
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.
Si cerely,
By:
Jaso Stubble
Fire Safety Specialist
I
P.O. BOX 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPERTY OWNER'S PACKAGE
(760) 777-7012
FAX (760) 777-7011
Disclosures & Forms for Owner -Builders Applying for Construction Peru its
IMPQ.(tLAIM NOTICE TO MOPERTY OWNER
Dear Property Owner:
Ari. application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at _
We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you awara.of your
responsibilities and possible risk you may incur by having this permit issued in your game as the
Owner -Builder. We will not issue a building -permit until you have read, initialed your understanding of each'provision,
signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice
unless you, the property owner, obtain the prior approval of the permitting authority.
OZ'S ACKNNOW EDGMI T AND RI CATION 6FP-IINFORM IWA N
AE
71understand
'9 : Read and initial ecich. statement below to signify you understand or verify this information.
a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as
an Owner -Builder, may be held liable and subject to serious. financial risk for any injuries sustained by an unlicensed person
and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those
injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers
%oP my party
2. I understand building permits are not required to be signed by property owners unless they are responsible for the
traction and are not hiring a licensed Contractor to assume this responsibility.
/ I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect
my4lf from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
o
I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
pe is and contracts.
.5 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
of y construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer"
der state and federal law.
6. I understand if I am considered an "employee' under state and federal taw, I must register with the state and federal
government, withhold payroll taxes, provide workers' compensation disability insurance; and contribute to unemployment
compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial
•ASkK_
I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential
arcs cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed
under contract with a licensed general building Contractor.
- c 1 • i
8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be he'd liable tet. 1
financial or personal. igjuries sustainedby any subsequent owner(s) that result from any latent construction defects in thl�
or[cmaaship or materials.
9. 1 understand I may obtain more information regarding my obligations as an "employer" from the internal Revenue
Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at l-
00-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.
• IQ. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
party legally and financially responsible for proposed construction activity at the following address:
11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
-applicable laws and requirements that govern Owner -Builders as well as employers.
11� I agree to notify the issuer of this form immediately of any additions, deletions, or charges to any of the information I
have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with
someone who does not have a license, the. Contractors' State License Beard may be unable to assist you with any financial loss
you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court It is also
important for you to: understand that if an ud liceosod Contractor or employee of that individual or firm is injured while working
on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors,
You will be responsible for verifying whether or not those Contractors are propefky licensed and the status of their workers'
coition insurance coverage.
Before a building permit can be issued, taus form must be completed and signed by the property owner and returned to
the agency responsible for issuing tlhe permit. Note: A copy of the property owner's driver's Reensei form notarAadvn; or
other verification acceptable to the agency is required to be presented when the permit is issued to verify the propel ty
owner's signature.
Signature of property o _s Date:
Note: The following Authorization Form is required to be completed by the property owner only when designating
an agent of the property owner to apply for a construction permit for the Owner -Builder -
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHAL
Excluding the Notice to Property Owner, the execution of which I understandis my personal responsibility, I hereby authorize
the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder
Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of authorized Agent:
Tel No 76 a -,2) P -V - 1343
Address of Authorized Agent: 'S '� S g (� o n ' / �`T Q g gg. C+
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above
information and certify its accuracy. Note: A copy of the owner's drive ' ticense, form notarization, or other verification
acceptable to the agency is required to be pres!�,ptgd when th nit is issued to verify the property owner's signature.
Property Owner's Signature: Date: /-2�
r
0
Im
BUILDING ENERGY ANALYSIS REPORT
PROJECT:
Advanced Women's Healthcare Tenant Improvement
79200 Corporate Center Drive, Suite 201
La Quinta, CA 92253
Project Designer:
Robert H. Ricciardi Architects
75-400 Gerald Ford Drive, Suite 115 -c
Palm Desert, Ca 92211 0rf►c�6
760 408 1208
( ) -
Report Prepared by:
Tim Scott
Scott Design and Title 24, Inc,
77-085 Michigan Drive
Palm Desert, Ca 92211
(760) 200-4780
CITY OF LA QUINT
BUILDING & SAFETY DEP
APPROVED
FOR CONSTRUC ON
DA l
111,-7- 1�f-1
Job Number:
RECEIVED
Date:
APR 11 202
4/9/2013 CITY OF LA QUINTA
COMMUNITY DEVELOPMENT
The EnergyPro computer program has been used to perform the calculations summarized in this compliance report. This program has approval and is
authorized by the California Energy Commission for use with both the Residential and Nonresidential 2008 Building Energy Efficiency Standards.
This program developed by EnergySoft, LLC—www.energysoft.com.
EnerovPro 5.1 by EneravSoft User Number: 6712 Run Code: 2013-04-09717:44:05 ID:
•
0
K
I TABLE OF CONTENTS I
Cover Page 1
Table of Contents 2
Form LTG -1-C Certificate of Compliance 3
Form LTG -2-C Lighting ,Controls Credit Worksheet 7
Form LTG -3-C Indoor Lighting Power Allowance 8
Form LTG -MM Lighting' Mandatory Measures 9
Form MECH-3-C Mechanical Ventilation 10
EnergyPro 5.7 by EnergySoft Job Number: ID: User Number: 6712
L
•
0
CERTIFICATE OF COMPLIANCE (Part 1 of 4) LTG -1 C
Project Name
Date
Advanced Women's Healthcare Tenant Improvement
4/9/2013
`Project Address
Climate Zone
Total Cond. Floor Area
Unconditioned Floor Area
79200 Corporate Center Drive, Suite 201 La
15
4,310
0
GENERAL INFORMATION
Building Type: m Nonresidential ❑ High -Rise Residential ❑ Hotel/Motel Guest Room
❑ School ❑ Relocatable Public m Conditioned Spaces ❑ Unconditioned Spaces
School
Phase of Construction: ❑ New Construction ❑ Addition ❑ Alteration
Method of Compliance: ❑ Complete Building m Area Category ❑ Tailored
Documentation Author's Declaration Statement
I certify that this Certificate of Compliance documentation is accurate and complete.
Signature
Name'
Tim Scott
Company
Date
Scott Design and Title 24, Inc,
4/9/2013
Address
CEA #
77-085 Michigan Drive
CEPE # 5-7D b
City/State/Zip
Phone
Palm Desert, Ca 92211
(760) 2004780
The Principal Lighting Designer's Declaration Statement
• 1 am eligible under Division 3 of the California Business and Professional Code to accept responsibility for the
lighting design.
• This Certificate of Compliance identifies the lighting features and performance specifications required for
compliance with Title 24, Pages 1 and 6 of the California Code of Regulations.
• The design features represented on this Certificate of Compliance are consistent with the information provided
to document this design on the other applicable compliance forms, workshee s, calculations, plans and
specifications submitted to the enforcement agency for approval with th u i permit application.
� � �
Name �
Si a�u
RobeH. Ricciardi
rt
Company
Phone
Robert H. Ricciardi Architects
(760) 408-1208
Address
License #
75-400 Gerald Ford Drive, Suite 115
C,
City/State/Zip
Date
Palm Desert, Ca 92211
Lighting Mandatory Measures
Indicate location on building plans of Mandatory Measures Note Block:
LIGHTING COMPLIANCE FORMS & WORKSHEETS check box if worksheets is included
For detailed instructions on the use of this and all Energy Efficiency Standards compliance forms; please refer to the Nonresidential Manual published
by the California Energy Commission.
m LTG -IC Pages 1 through 4 Certificate of Compliance. All Pages required on plans for all submittals.
m LTG -2C Lighting Controls Credit Worksheet
Q LTG -3C Indoor Lighting Power Allowance
❑ LTG -4C Pages 1 through 4 Tailored Method Worksheet
❑ LTG -5C Pages 1 and 2 Line Voltage Track Lighting Worksheet
EnergyPro 5.1 by Ener Soft User Number: 6712 RunCode: 2013-04-09717:44:05 ID: Page 3 of 10
•
•
CERTIFICATE OF COMPLIANCE (Part 2 of 4) LTG -1 C
Project Name
Advanced Women's Healthcare Tenant Improvement
Date
1 4/9/2013
INDOOR LIGHTING SCHEDULE and FIELD INSPECTION ENERGY CHECKLIST
Installation Certificate, LTG -1- INST Retain a copy and verity form is completed and signed.)
Field Inspector ❑
Certificate of Acceptance, LTG -2A and LTG -3A (Retain a copy and verify form is completed and signed.)
Field Inspector ❑
A separate Lighting Schedule Must Be Filled Out for Conditioned and Unconditioned Spaces Installed Lighting Power listed on
this 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 wafts per square foot of portable lighting shall not be required to be included in the
® calculation of actual indoor lighting power density in accordance with the Exception to §146(a). All portable lighting in excess of
0.2 watts per square foot is totaled below.
Luminaire (Type, Lamps, Ballasts
Installed Watts
A
B
C
D
E
F
G
H
None
or
Item
Ta
Complete Luminaire Description
(Le, 3 lamp fluorescent troffer,
F32T8, one dimmable electronic ballasts
d
a ,a
w r-
:.E
3:J
How wattage
Was determined
o d
a •`
Z
LL
X
=
= N
c �
Field
Ins ector2
a�
6
or"
CEC rM
Default o w�
From a
NA8
w
N
(L ti
A1/A2
(3) 4 ft Fluorescent T8
91.0
❑
44
4,004
❑ ❑
B
(3) 4 ft Fluorescent T8
91.0
® ❑
1
91
❑ ❑
C
(2) 2 ft Fluorescent T8 Elec
33.0
® ❑
1
33
❑ ❑
Dos
(2) 4 It Fluorescent T8
64.0
❑ ❑
2
128
❑ ❑
F
(2) 4 ft Fluorescent T8
64.0
® ❑
10
6401
❑ 1 ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
❑ 1 ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
Installed Watts Page Total:
4,896
Building total number of pages:
Installed Watts Building Total
Sum of all pages)
4.896
Enter into LTG -1 C Pa e 4 of 4
1. Wattage shall be determined according to Section 130 (d and e). Wattage shall be rating of light fixture, not rating of bulb.
2. If Fail then describe on Page 2 of the Inspection Checklist Form and take appropriate action to correct. Verify building plans if necessary.
Ener Pro 5.1 by Ener Soft User Number: 6712 RunCode: 2013-04-09717:44:05 ID: Page 4 of 10
0
0
CERTIFICATE OF COMPLIANCE Part 3 of 4
LTG -1 C
Project Name
Advanced Women's Healthcare Tenant Improvement
Date
1 4/9/2013
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, f) tailored lighting controls —
general lighting controlled separately from display, ornamental and display case lighting and g) demand responsive automatic
controls for retail stores > 50,000 ft2, in accordance with Section 131.
MANDATORY LIGHTING CONTROLS — FIELD INSPECTION ENERGY CHECKLIST
Field
Inspector
Number Special
Type/ Description of Units Location in Building Features
Pass
Fail
jh^ LL @,W L s D-✓ a- 04 -rt Ay ❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
0
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
0
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
SPECIAL FEATURES INSPECTION CHECKLIST See Page 2 of 4 of LTG -1C
The local enforcement agency should pay special attention to the items specified in this checklist. These items require special written
justification and documentation, and special verification. The local enforcement agency determines the adequacy of the justification,
and may reject a building or design that otherwise complies based on the adequacy of the special justification and documentation
submitted.
Field Inspector's Notes or Discrepancies:
Ener Pro 5.1 by Ener Soft User Number: 6712 RunCode: 2013-04-09T17:44:05 ID:
Pa e 5 of 10
•
LJ
•
CERTIFICATE OF COMPLIANCE Part 4 of 4 LTG -1C
Project Name
Date
Advanced Women's Healthcare Tenant Improvement 1
4/9/2013
CONDITIONED AND UNCONDITIONED SPACE LIGHTING MUST
NOT BE COMBINED FOR COMPLIANCE
Indoor Lighting Power for Conditioned S aces
Indoor Lighting Power for Unconditioned Spaces
Watts
Watts
Installed Lighting 4,896
Installed Lighting
0
from Conditioned LTG -1C, Page 2
from Unconditioned LTG -1C, Page 2
Lighting Control Credit - 851
Lighting Control Credit _
0
Conditioned Spaces from LTG -2C
Unconditioned Spaces from LTG -2C
Adjusted Installed 4,045
Adjusted Installed =
0
Lighting Power
Liqhting Power
Complies if Installed:5 Allowed
Complies if Installed 5 Allowed
Allowed Lighting Power
5'172
Allowed Lighting Power
Conditioned Spaces from LTG -3C or PERF -1
Unconditioned Spaces from LTG -3C)0
Required Acceptance Tests
Designer:
This form is to be used by the designer and attached to the plans. Listed below is the acceptance test for the Lighting system,
LTG -2A and LTG -3A. The designer is required to check the acceptance tests and list all control devices serving the building or space
shall be certified as meeting the Acceptance Requirements for Code Compliance. If all the lighting system or control of a certain type
requires a test, list the different lighting and the number of systems. The NA7 Section in the Appendix of the Nonresidential
Reference Appendices Manual describes the test. Since this form will be part of the plans, completion of this section will allow the
responsible party to budget for the scope of work appropriately. Forms can be grouped by type of Luminaire controlled.
Enforcement Agency:
Systems Acceptance. Before Occupancy Permit is granted for a newly constructed building or space or when ever new lighting
system with controls is installed in the building or space shall be certified as meeting the Acceptance Requirements.
The LTG -2A and LTG -3A forms are not considered complete forms and are not to be accepted by the enforcement agency unless
the boxes are checked and/or filled and signed. In addition, a Certificate of Acceptance forms shall be submitted to the enforcement
agency that certifies plans, specifications, installation certificates, and operating and maintenance information meet the requirements
of §10-103(b) of Title 24 Part 6. The field inspector must receive the properly filled out and signed forms before the building can
receive final occupancy. A copy of the LTG -2A and LTG -3A for each different lighting luminaire control(s) must be provided to the
owner of the building for their records.
LTG -2A and
Luminaires Controlled
LTG -3A
Controls and
Sensors and
Number of
Automatic
Luminaires
Daylighting Controls
Equipment Re uirin Testing
Description
controlled
Location
Acceptance
Occ Sensor- Multi -Level
(3) 4 ft Fluorescent T8
44
Tenant Improvement
m
Occ Sensor - Multi -Level
(3) 4 ft Fluorescent T8
1
Tenant Improvement
m
Occ Sensor - Multi -Level
(2) 2 it Fluorescent T8 Elec
1
Tenant Improvement
El
Occ Sensor- Multi -Level
(2) 4 ft Fluorescent T8
2
Tenant Improvement
El
13
❑
11
El
11
EnergyPro 5.1 by Ener Soft User Number: 6712 RunCode: 2013-04-09717:44:05 ID: Page 6 of 10
•
•
LIGHTING CONTROLS CREDIT WORKSHEET Part 1 of 2
LTG -2C
Project Name
Advanced Women's Healthcare Tenant Improvement
Date
1 4/9/2013
POWER ADJUSTMENT FACTORS PAF FOR NON -DAYLIGHT CONTROLS
A Separate PAF Worksheet Must Be Filled Out for Conditioned and Unconditioned Spaces. Control Credits listed on this
schedule are only for:
m CONDITIONED SPACES 0 UNCONDITIONED SPACES
A B C D E F
G
Watts of Power
Room # Zone ID Plan Room Area Control Adjustments
Areas Lightin.q Control Description' Reference ftZ Lighting Factor'
Control
Credit Watts
E x F
Tenant Improvemel Occ Sensor- Multi -Level Al/A2 4,310 4,004 0.20 801
Tenant Improvemej Occ Sensor- Multi -Level B 4,310 91 0.20 18
Tenant Improvernei Occ Sensor- Multi -Level C 4,310 33 0.20 7
Tenant Improvernei Occ Sensor- Multi -Level D os 4,310 128 0.20 26
PAGE TOTAL 851
Note:
Conditioned and
Unconditioned
Building total of non -daylight control credit watts for all pages of LTG -2C Pae 1 of 2
Enter building total of all da ti ht controls credit watts from LTG -2C Page 2 of 2 0
Space shall be
separately
totaled
BUILDING TOTAL OF ALL CONTROL CREDIT WATTS
(FOR BOTH NON -DAYLIGHT AND DAYLIGHT CONTROL CREDITS) 851
Enter in LTG -1C; Page 4: Lighting Control Credit as appropriate for CONDITIONED
or UNCONDITIONED Spaces
1. Description shall be consistent with Type of Control defined in Table 146-C
2. Power Adjustment Factor taken from Table 146-C
EnergryPro5lbyEnergySoft User Number. 6712 RunCode: 2013-04-09Tf7.44:05 to.
Page 7 o 10
•
•
INDOOR LIGHTING POWER ALLOWANCE LTG -3C
Project Name
Advanced Women's Healthcare Tenant Improvement
Date
4/9/2013
ALLOWED LIGHTING POWER Chose One Method
A Separate LTG -3C must be filled out for Conditioned and Unconditioned Spaces. Indoor Lighting Power Allowances listed on this
page are only for:
m CONDITIONED SPACES ❑ UNCONDITIONED SPACES
COMPLETE BUILDING METHOD
WATTS
BUILDING CATEGORY From §146 Table 146-E PER(ft')
X
COMPLETE
BLDG. AREA
=
ALLOWED
WATTS
TOTALS
AREA
WATTS
AREA CATEGORY METHOD
WATTS
BUILDING CATEGORY From 146 Table 146-F PER(ft)
X
Area ft2
=
ALLOWED
WATTS
Medical and Clinical Care 1.20
4,310
5,172
TOTALS
4,310
5,172
AREA
WATTS
TAILORED METHOD
Total Allowed Watts using the Tailored Method taken from LTG -4C Pae 1 of 4 Row 3
0
The indoor lighting power allowance using the Tailored Method of compliance shall be determined using the LTG -4C set of forms. A separate set of LTG -
4C forms shall be filled out for CONDITIONED and UNCONDITIONED spaces
EnergyPro 5.1 by EnerqySoft User Number. 6712 RunCode: 2013-04-09717:44:05 ID: Page 8 of 10
•
LJ
•
LIGHTING MANDATORY MEASURES: NONRESIDENTIAL LTG -MM
Project Name
Date
Advanced Women's Healthcare Tenant Improvement
4/9/2013
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 li htin .
2
Override for Building Lighting Shut-off: The automatic building shut-off'system is provided with a manual, accessible
override switch in sight of the lights. The area of override is not to exceed 5,000 square feet.
§119(h):
Automatic Control Devices Certified: All automatic control devices specified are certified, all alternate equipment shall
be certified and installed as directed by the manufacturer.
§111:
Fluorescent Ballast and Luminaires Certified: All fluorescent fixtures specified for the project are certified and listed in the
Directory. All installed fixtures shall be certified.
§131(a):
Individual Room/Area Controls: Each room and area in this building is equipped with a separate switch or occupancy
sensor device for each area with floor -to -ceiling walls.
Uniform Reduction for Individual Rooms: All rooms and areas greater than 100 square feet and more than 0.8 watts
§131(b):
per square foot of lighting load shall be controlled with bi-level switching for uniform reduction of lighting within the
room.
Daylight Area Control: All rooms with windows and skylights that are greater than 250 square feet and that allow for
131 c
§ ()'
the effective use of daylight in the area shall have 50% of the lamps in each daylit area controlled by a separate switch;
or the effective use of daylight cannot be accomplished because the windows are continuously shaded by a building on
the adjacent lot. Diagram of shading during different times of the year is included on plans.
§131(c):
Display Lighting. Display lighting shall be separately switched on circuits that are 20 amps or less.6.
Outdoor Lighting Measures:
§130(c)1:
Mandatory lighting power determination for medium base sockets without permanently installed ballasts
§132(a):
All permanently installed luminaires with lamps rated over 100 Watts either have a lamp efficacy of at least 60 lumens
per Watt or are controlled by a motion sensor.
§132(b):
All Luminaires with lamps rated greater than 175 Watts in hardscape area, including parking lots, building entrances,
canopies, and all outdoor sales areas meet the Cutoff Requirements.
§132(c)1:
All permanently installed outdoor lighting meets the control requirements listed.
§132(c):
Building facades, parking lots, garages, canopies, and outdoor sales areas meet the Multi -Level Lighting Requirements
listed.
Ener Pro 5.1 by
EnergySoft User Number: 6712 RunCode: 2013.04.09717:44:05 /D: Page 9 of 10
s
0
MECHANICAL VENTILATION AND REHEAT MECH-3C
Project Name
Advanced Women's Healthcare Tenant Improvement
Date
4/9/2013
MECHANICAL VENTILATION §121 b 2 REHEAT LIMITATION (§144(d))
AREA BASIS
OCCUPANCY BASIS
VAV MINIMUM
A
B
C
D
E
F
G
H
I J
K
L
M N
Zone/System
Condition
Area
ftz
CFM
per
t
Min CFM
By Area
B X C
Number
Of
People
CFM
per
Person
Min CFM
by
Occupant
E X F
REQ'D
V.A.
Max of
D or G
Design 50% of
Ventilation Design Zone
Air Supply
CFM CFM
B X 0.4
CFM / fe
Max. of
Columns
H, J, K,
300 CFM
Design
Minimum
Air Transfer
Setpoint Air
Tenant Improvement
4,310
0.15
647
647
647
AC 1-4
Total
647
647
Totals Column I Total Design Ventilation Air
C Minimum ventilation rate per Section 121, Table 121-A.
E Based on fixed seat or the greater of the expected number of occupants and 50% of the CBC occupant load foregress purposes fors aces without fixed seating.
H Required Ventilation Air REQ'D V.A. is the larger of the ventilation rates calculated on an AREA BASIS or OCCUPANCY BASIS Column D or G).
I Must be greater than orequal to H, or use Transfer Air column N to make up the difference.
J Design fan supply CFM Fan CFM x 50%; or the design zone outdoor airflow rateer 121.
K Condition area (ft2) x 0.4 CFM / ft; or
L Maximum of Columns H, J, K, or 300 CFM
M This must be less than orequal to Column L and greater than orequal to the sum of Columns H plus N.
N Transfer Air must be provided where the Required Ventilation Air (Column H) is greater than the Design Minimum Air (Column M). Where required, transfer air must be greater than or
equal to the difference between the Required Ventilation Air Column H and the Design Minimum Air Column M , Column H minus M.
Ene Pro 5.1 by EnerqySoft User Number: 6712 Run Code: 2 013-04-0 9 71 7:44:05 ID: Pae 10 of 10
p��'� CITY OF LA QUINTA SUB -CONTRACTOR LI T
JOB ADDRESS Z91; ' CONI 07A A44—PERMIT NUMBER OWNER BUILDER
This form shall be 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 authorized 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.
i ion:,
Trade. /. Class�f cat
:.. Contrac r S pikers Com' ensaUon Insurance ;.:: .
_............. to..::.:....... tate ::Contractor s.:Lrcense:.:..,.::.:
Cit. Bus�ness;.L�eense
`
Company Name Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date Carrier Name Policy Number
(xx/xx/xx) (e.g. State Fund, CalComp) (Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
—
UT,-c-�o S _/
7 � x� T ,.. =
ROOFING. (C-39).
-
r
SHEET METAL (C-43:)
'
FLOURING (C-1-5)
LAZING (C-17)
Vl Y 1 L C 12
INSULATION (C_2)
SEWAGE DISP. (C'-42).
PAINTING (C-33)�,�%
CERAMIC TILE (C-54)
...
{
ABINETS (:C 6)
��/NF—? 6P,7 -e
Cid fid'
/
FENCING (:C-1'3)
;
NDSCAPING`:(C-27.): .::
POOL (C-53)
I