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09-1245 (RC)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 09-00001245 Property Address: 79180 CORPORATE CENTRE DR STE 104 APN: 649-820-014- - - Application description: REMODEL - COMMERCIAL Property Zoning: COMMERCIAL PARK Application valuation: 40000 Applicant: Architect or Engineer: 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).: 1 _ 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 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. , B.&P.C. for this reason Date:/Owner: TRUCTION LENDING AGENCY I hereby affirm under penalty of perju tha ere is a construction lending agency for the performance of the work for which this permit is issued ISec. 3097, Civ. C.I. Lender's Name: Lender's Address: LQPERMIT Owner: PAUL JAMES R 55525 CHERRY HILLS LA QUINTA, CA 92253 Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 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 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 W �qf-Ihe Labor Code, 1 s 11 forthwith com`ppll with th provi7i ns. Date/pplicant:/ F/WARNE TO SECURE WORKERS' 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 build* nstruction, and hereby authorize representatives of this co my t ente/%fir upon the above-mentioned prop ty for'ins e n purp Da e O Signature (Applicant or Agent): C /09 Application Number . . . . . 09-00001245 ------ Structure Information 1,687SF TI/VB/B-OCC/17-OL/SPRINKLED ----- Other struct info . . . . . CODE EDITION 2007CBC FIRE SPRINKLERS FULLY MIXED-USE OCCUPANCY B ---------------------------------------------------------------------------- OCCUPANT LOAD 17.00 Permit . . . BUILDING PERMIT Additional desc . . Permit Fee . . . . 349.50 Plan Check Fee 227.18 Issue Date . . . . Valuation . . . . 40000 Expiration Date 6/19/10 .Qty Unit Charge Per Extension BASE FEE 252.00 15.00 6.5000 ---------------------------------------------------------------------------- THOU BLDG 25,001-50,000 97.50 Permit ...ELECT - ADD/ALT/REM Additional desc . Permit Fee 48.74 Plan Check Fee 12.19 Issue Date . . . . Valuation . . . . 0 Expiration Date 6/19/10 Qty Unit Charge Per Extension BASE FEE 15.00 1687.00 .0200 ---------------------------------------------------------------------------- ELEC GARAGE OR NON-RESIDENTIAL 33.74 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 26.00 Plan Check Fee 6.50 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 6/19/10 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 4.5000 EA MECH VENT INST/ DUCT ALT 4.50 1.00 6.5000 -----------------------------------------=-----------------=---------------- EA MECH VENT FAN 6.50 Permit . . . PLUMBING Additional desc . . Permit Fee . . . . 51.00 Issue Date . . . Expiration Date . . 6/19/10 Qty Unit Charge Per LQPERAIIT Plan Check Fee . . 12.75 Valuation . . . . 0 Extension Application Number . . . . . 09-00001245 Permit . . . . . . PLUMBING Qty Unit Charge Per Extension BASE FEE 15.00 3.00 6.0000 EA PLB FIXTURE 18.00 2':00 7.5000 EA PLB WATER HEATER/VENT 15.00 1.00 .1 3.0000 EA PLB WATER INST/ALT/REP 3.00 ----------------------------------- ---------------------------------------- Special Notes and Comments 1,687SF TI/VB/B-OCC/17-OL/SPRINKLED [LABCORP OFFICE] THIS PERMIT DOES NOT INCLUDE BUILDING SIGNAGE OR ALTERATIONS TO THE EXTERIOR FACADE. 2007 CALIFORNIA BUILDING CODES. December 21, 2009 8:57:41 AM AORTEGA -----------------------------7---------------------------------------------- Other Fees . . . . . . . . . ACCESSIBILITY PLAN REVIEW 22.72 BLDG STDS ADMIN (SB1473) 2.00 ENERGY REVIEW FEE 22.72 Fee summary Charged Permit Fee Total 475.24 Plan Check Total 258.62 Other Fee Total 47.44 Grand Total 781.30 LQPERAIXT Paid Credited Due .00 .00 475.24 .00 .00 258.62 .00 .00 47.44 .00 .00 781.30 Bin # I� GZ City of La Quinta , ,- Building 8r Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # / Lj � Project Address: Owner's Name: L�8ygc g . 7, �, L,,, L A. P. Number: u L� Address: �J� ,�(f A Legal Description: City, ST, Zip: 41—/ Contractor: Tcicphoie: < ":ci: #::•}i::3y c:':v...�;?}?'y' `<?:E:: Address: Project Description: City, ST, Zip: Telephone: :�;.<:::;:.>.;.F:::<.;J::z::>::: • •�<•»»>r , State Lie. # : City Lie. #.: Arch., Engr., Designer: /�o Address: City, ST, Zip: �+•..>:{{pJ:{{{{h!:i{ivnl{:iCJ:{.%' }`i:','r\.!:3:>i Telephone: :; ::<?>;f' ?J<:«{.:;:.. ry y•v::v..: P Jilii;:LL{:?C;F{1.S:4k�i??;;i:.iC:iil:{:iSy:�•��': %-�- J:%:::'>i`•Js'•::r%:G?dv<...... Ju-. State Lic. #: ...: •: ...cz,•; :v; :;;..,..:...... . Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: (� /lm � Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: " 60 — Estimated Value of Projec . APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person OWPlan Check Balance Title 24 Cities. nW Plans picked up ( r'1 Construction Flood plain pian Pians resubmitted 101 log Mechanical Grading plan 2". Review, ready for correctio s ssu y Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person lopLP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees F C 0 ox -I I 1?��L1 X09- 2S,%A9w6o aL -w 15w� wraW ' 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 Permits WPOR A.NT! NOTICE TO PROPF.R.TV OVYP 8 Dear Property Owner. An. 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 aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We mill 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. OWNER'S AC . i I XDGMENT AND VERM, CATION OF IN_ RO A`�N MREMONS: Read and initial each statement below to signify you understand or verify this information. 1. 1 understand 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. 1, 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 Din my property. 2. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. �3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect rttyself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. _5.1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer'' Under state and federal law. 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the .state and federal g vteo cement, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment C,otnpensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial k 7.1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential Sockures cannot .legally build them with the intent to offer them for sale, unless all work is performed by licensed subcOntraetors and the number of structures does not exceed four within any calendar year, or all of the work is performer under- contract with a licensed general building Contractor. 8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal_ injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. 9. I understand i may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Srdall Business Administration, the California Department of Benefit Paymetits, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- 800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 10. 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. 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes 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 Board 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 unlicensed 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 properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing; the.perniit. Note: A copy of the property owner's driver's.ticense, form notarization, or other verification acceptable to the agency is required to be presented when the- permit is issued to verify the property owner's signature. Signature of property own 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 BEHALF Excluding the Notice to Property Owner, the execution of which l understand. is my personal responsibility, l hereby authorize the following person(s) to act asmy 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: Address of Authorized Agent: Tel No 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 driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: i� John R. Hawkins Fire Chief Proudly serving the unincorporated areas of Riverside County and the Cities of: Banning Beaumont 4. Calimesa Canyon Lake 4. Coachella 4. Desert Hot Springs Indian Wells Indio ., Lake Elsinore 4. La Quinta 4. Moreno Valley .; Palm Desert 4. Perris 4. Rancho Mirage Rubidoux CSD 4. San Jacinto Temecula Board of Supervisors Bob Buster, District I John Tavaglione, District 2 Jeff Stone, District 3 Roy Wilson, District 4 Marion Ashley, District 5 RIVERSIDE COUNTY FIRE DEPARTMENT In cooperation with the California Department of Forestry and Fire Protection 77-933 Las Montanas Rd STE'201 • Palm Desert, CA 92211 • (760) 863-8886 • Fax (760) 863-7072 December 14, 2009 RE: TENANT IMPROVEMENT PLAN CHECK LAQ-09-TI-042 Labor Corp 79-180 Corporate Center #104 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 asan "H" occupancy per Sec. 307 of the 20007 UBC. THE FOLLOWING CONDITIONS MUST BE MET PRIOR TO INSPECTION: Install door hardware and exit signs as .per Chapter 10 of the 2007 UBC. 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. Provide key(s) to the tenant space for inclusion in the main building Knox Box. Key(s) shall have durable and legible tags affixed for identification of the correlating tenant space. Key(s) shall be provided at time of final inspection. An approved audible interior notification alarm device shall be provided in approved locations. A C-10 licensed contractor must submit plans, designed in accordance with NFPA 72, 2002 Edition, to the Fire Department for review and approval prior to installation. As may be 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, along with a plan/inspection fee. The sprinkler system will have to be modified and designed in accordance with NFPA 13, 2002 Edition. A licensed C-16 contractor shall do all sprinkler work and certification. The approved plans, with Fire Department Job card must be at the job site for all inspections. Approved suite address shall be placed in such a position to be plainly visible and legible from the street. Said numbers shall contrast with their background. 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. Sincerel , 1 By: n Stub e F' . Safety Specialist CITY OF LA QUINTA' SUB -CONTRACTOR LIST ' JOB ADDRESS- -:VG - PERMIT NUMBER OWNER-S��o��l BUILDER _�s o_u. 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. :. ct..: Trade Classification Contra or''o.Contract / ..:......... . .::.:::.::..,....... :. :.. s Vcense oI" . sat�on: nsurante:°'::::': • ;»:...:.::::.:. 9t rrip. n i •' . G n . License:;:;.:: it . Busi e s Y Company Name Classification (e.g. A, B, C-8) License Number (xxxxxx) Exp. Date (xx/xx/xx) Carrier Name (e.g. State Fund, CalComp) Policy Number (Format Varies) Exp. Date (xxlxx/xx) License Number (xxxx) Exp. Date (xx/xx/xx) CONCRETE (C-8) V. FRAMING C -51) STRUCT.*:STE L ( MASONRY (C-29) � PLUMBING (C-361 ' ' - ; . rra zrdustnes �• +P6A � •� 3 �� l Coa�sa v o •e -y 10/ 3-31-lO 7777- CATH; PLASTER (,6.:35) i DRYWALL (C-9) ,.:. �� — i' s-31- {� -/-/o %6 i 9y 5`31:10 ELECTRICAL. (C=10) ..': S s►�'i eC'{C,. C-1(7 of d3(�1� 3 -31-I �j U�Der �"I V�'UO�l 1-1-10 3 a5 l0-31 Fi5 -a 5- -11 O °f �wQ�rw P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 To: Greg Butler, Building & Safety Manager From: Les Johnson, Director -PDD Permit #: 09-1245 BUILDING & SAFETY DEPARTMENT (76 0) 777-7012 FAX (760) 777-7011 To PD: 12-07-2009 Due Date: 12-14-2009 Status: 1St review Building Plans Approval (This is an approval to issue a Building Permit) The Planning Department has reviewed the Building Plans for the following project: Description: TENANT IMPROVEMENT / LABCORP ° , ° Address or General Location: 79-180 CORPORATE CENTER DR. #104 Applicant Contact: JAMES PAUL The Planning Development Department finds that: ❑ ...these Building Plans do not require Planning Department approval. ...these Building Plans are approved by the Planning Department. ❑ ...these. Building Plans require corrections. Please forward a copy of the attached corrections to the applicant. When the corrections are made please return them to the Planning Department for review. Les Johns' Director -PD Fecalved DEC 7 2009 Clfy of La Qu. Planning Deeo!tmertt Date I TITLE 24 REPORT Title 24 Report for: LABCORP 79180 CORPORATE CENTER WAY, STE 104 LA Q U I NTA, CA 92248 Project Designer: ROBERT RICCIARDI 75-860 SARAZEN WAY PALM DESERT, CA 92211 (760) 408-1208 Report Prepared By: JACK BENTSEN Bentsen/ Hui Engineering 70-141 Sun Valley Drive Rancho Mirage, CA 92270 (760) 324-7357 "CITY OF LA QUINTA BUILDING & SAFETY DEPT. Job Number: APPROVED 0921 FOR CONSTRUC N DATE B Date: 12/17/2009 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 4.3 by EnergySoft Job Number. 0921 User Number: 6457 CERTIFICATE OF COMPLIANCE (Part 1 of 4) LTG -1-C PROJECT NAME DATE LABCORP 12/17/2009 PROJECT ADDRESS 79180 CORPORATE CENTER WAY, STE 104 LA QUINTA Building Permit # PRINCIPAL DESIGNER - LIGHTING TELEPHONE BENTSEN/HUI ENGINEERING (760) 324-7357 DOCUMENTATION AUTHOR TELEPHONE Checked by/Date Bentsen/ Hui Engineering 760 324-7357 Enforcement Agency Use GENERAL INFORMATION DATE OF PLANS BUILDING CONDITIONED FLOOR AREA CLIMATE ZONE 7/02/09 1,527 Sq.Ft 15 BUILDING TYPE ❑X NONRESIDENTIAL ❑ HIGH RISE RESIDENTIAL ❑ HOTELIMOTEL GUEST ROOM ❑X CONDITIONED SPACES ❑ UNCONDITIONED SPACES ❑ INDOOR & OUTDOOR SIGNS PHASE OF CONSTRUCTION ❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION METHOD OF LIGHTING ❑ COMPLETE BUILDING AREA CATEGORY ❑ TAILORED ❑ PERFORMANCE COMPLIANCE ❑ 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 a ate ai mple DOCUMENTATION AUTHOR SIGNATURE DATE JACK BENTSEN _ The Principal Lighting Designer hereby certifies that the proposed bui g design represented in this set of construction documents is consistent with the other compliance forms and worksheets, with tKLd 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 - 132, 146, 148 & 149 of Title 24, Part 6. ❑ The plans & specifications meet the requirements of Part 6 (Sections 10-103a). ❑ The installation certificates meet the requirements of Part 6 (10-103a 3). ❑ The operation & maintenance information meet the requirements of Part 6 (10-103c). 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 Califomia 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 Pode to sign this document because it pertains to a structure or type of work described as exempt pursuant to Business and P o ession ode ections 5537, 5538 and 6737.1. PRINCIPAL LIGHTING DESIGNER -NAME SIGNATORDATE LIC. # BENTSEN/HUI ENGINEERING l U YG LIGHTING MANDATORY MEASURES Indicate location on plans of Note Block for Mandatory M ures 71 LIGHTING COMPLIANCE FORMS & WORKSHEETS Check box if worksheet is included ®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 DO LTG -2-C: Indoor Lighting Schedule ❑LTG -3-C: Portable Lighting Worksheet ❑LTG -4-C: Lighting Controls Credit Worksheet ®LTG -5-C: Indoor Lighting Power Allowance ❑LTG -6-C: Tailored Method Worksheet ❑ LTG -7-C: Room Cavity Ratio Worksheet ❑LTG -8-C: Common Lighting Systems Method Worksheet ❑LTG -9-C: Line Voltage Track Lighting Worksheet EnergyPro 4.3 by EnergySoft User Number. 6457 Job Number. 0921 Page:2 of 7 CERTIFICATE OF COMPLIANCE (Part 2 of 4) LTG -1-C PROJECT NAME DATE LABCORP 1 12/17/2009 INSTALLED INDOOR LIGHTING POWER FOR CONDITIONED AND UNCONDITIONED SPACES INSTALLED LIGHTING, UNCONDITIONED SPACES (From LTG -2-C) 0 LIGHTING CONTROL CREDIT, UNCONDITIONED SPACES (From LTG4-C) 0 UNCONDITIONED SPACE ADJUSTED INSTALLED LIGHTING POWER 0 ALLOWED INDOOR LIGHTING POWER FOR CONDITIONED SPACES ❑ COMPLETE BUILDING METHOD (From LTG -5-C) ❑X AREA CATEGORY METHOD (From LTG -5-C) ❑ TAILORED METHOD (From LTG -5-C) ALLOWED LIGHTING POWER INSTALLED ALTERNATE COMPLIANCE WATTS ❑ PERFORMANCE METHOD ❑ COMMMON LIGHTING SYSTEM (From LTG -8-C) INSTALLED LIGHTING, CONDITIONED SPACES (From LTG -2-C) 1,653 PORTABLE LIGHTING (From LTG -3-C) 0 LIGHTING CONTROL CREDIT, CONDITIONED SPACES (From LTG -4-C) 0 CONDITIONED SPACE ADJUSTED INSTALLED LIGHTING POWER 1 1,653 INSTALLED LIGHTING, UNCONDITIONED SPACES (From LTG -2-C) 0 LIGHTING CONTROL CREDIT, UNCONDITIONED SPACES (From LTG4-C) 0 UNCONDITIONED SPACE ADJUSTED INSTALLED LIGHTING POWER 0 ALLOWED INDOOR LIGHTING POWER FOR CONDITIONED SPACES ❑ COMPLETE BUILDING METHOD (From LTG -5-C) ❑X AREA CATEGORY METHOD (From LTG -5-C) ❑ TAILORED METHOD (From LTG -5-C) ALLOWED LIGHTING POWER ALLOWED WATTS 1,832 ALTERNATE COMPLIANCE ❑ PERFORMANCE METHOD ❑ COMMMON LIGHTING SYSTEM (From LTG -8-C) ALLOWED INDOOR LIGHTING POWER FOR UNCONDITIONED SPACES From LTG -5-C) o MANDATORY INDOOR AND DAYLIGHTING AUTOMATIC CONTROLS CONTROL LOCATION (Room #) CONTROL IDENTIFICATION CONTROLTYPE (Auto Time Switch, Dimming, etc.) SPACE CONTROLLED Check if NOTE TO FIELD NOTES TO FIELD - For Buildina Department Use Only EnergyPro 4.3 by EnergySoft User Number: 6457 Job Number. 0921. Page:3 of 7 CERTIFICATE OF COMPLIANCE (Part 4 of 4) LTG-1-C PROJECT NAME- LABCORP DATE 12/17/2009 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 I EnergyPro 4.3 by EnergySoft User Number. 6457 Job Number: 0921 Page:4 of 7 1 INDOOR LIGHTING SCHEDULE (Part 1 of 2) LTG -2-C PROJECT NAME DATE LABCORP I 12/17/2009 INSTALLED LIGHTING POWER FOR CONDITIONED SPACES Luminaire Lamps/Ballasts Installed Watts C D E F G H I J Name Type Description M cvc 333 NN(' nriv� '3N y cmc 3.in3 .•.c c 3v`� 2 y O M0 C Vm J r C Z 3• c O y a�Z, U) CD a es B (2) 4 ft Fluorescent T8 Rapid Start Elec F32T8 2 32 1.01 58.0 X 27 1,566 C 4' surface Wrap 32TS 2 32 1.0 58.0 X 1 58 G ((2) Compact Fluorescent Triple 4 Pin P) 26w FTR26W/GX24 -3 1 26 1.0 29.0 X 1 29 PAGE TOTAL 1,653 BUILDING TOTAL (sum of all pages) 1 ,653 PORTABLE LIGHTING (From LTG -3-C) O CONTROL CREDIT (From LTG -4-C) O ADJUSTED ACTUAL WATTS 1 653 I EnerpvPro 4.3 by EnerovSoft User Number: 6457 Job Number: 0921 Page:5 of 7 1 INDOOR LIGHTING POWER ALLOWANCE LTG -5 - PROJECT NAME LABCORP DATE 12/17/2009 ALLO_WED(Choose COMPLETE BUILDING METHOD - CONDITIONED SPACES ALLOWED WATTS WA 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 1,527. 1,832 PAGE TOTAL BUILDING TOTAL Q AREA �O Q WATTS TAILORED METHOD - UNCONDITIONED SPACES TOTAL UNCONDITIONED SPACES ALLOWED WATTS (From LTG -5-C and LTG -6-C) 0 D EnergyPro 4.3 by EnergySoft User Number. 6457 Job Number: 0921 Page:6 of 7 PAGE TOTAL BUILDING TOTAL 1 ,527 1 ,527 AREA 1 ,832 1 ,832 WATTS TAILORED METHOD - CONDITIONED SPACES TOTAL ALLOWED WATTS O (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 Q AREA �O Q WATTS TAILORED METHOD - UNCONDITIONED SPACES TOTAL UNCONDITIONED SPACES ALLOWED WATTS (From LTG -5-C and LTG -6-C) 0 D EnergyPro 4.3 by EnergySoft User Number. 6457 Job Number: 0921 Page:6 of 7 LIGHTING MANDATORY MEASURES LTG -MM PROJECT NAME DATE LABCORP 1 12/17/2009 DESCRIPTION Designer Enforcement r §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. r §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. X] §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. X] §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. X❑ §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. §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. EnergyPro 4.3 by EnergySoft User Number. 6457 Job Number: 0921 Page:7 of 7