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10-0258 (RC)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T- &-t 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 10-00000258 Property Address: 79180 CORPORATE CENTRE DR STE 103 APN: 649-820-014- - - Application description: REMODEL - COMMERCIAL Property Zoning: COMMERCIAL PARK Application valuation: 90000 ApplicantL-v3"�ArchitectorEngineer: A /� /GGmJaiI. 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. 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 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.). ( I am exempt under Sec. , B.&P.C. for this reason Date`. —70-/ / :�:' // V Owner: / F RNSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury ere 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: LQPERA11T Owner: PAUL JAMES R Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/12/10 ,. v _17 =nr 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 *Qp the Labo Co I shall f ly wit provisions. Date:plica WARNING: FAILURE TOS UR �RKERS'CO=MPNSA ON COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND IVIL 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�construc ion, -and hereby authorize r sentatives of thi ounty o enter up n the above-mentioned pr, erty f ins icI Da 6� ignature (Applicant or Agent) Application Number . . . . . 10-00000258 ------ Structure Information 2200 SF T.I. SUITE 103 ----- Construction Type . . . . . TYPE V, UNPROTECTED Occupancy Type . . . . . . BUSINESS <50 Other struct info . . . . . CODE EDITION 2007/08 ENERGY FIRE SPRINKLERS YES OCCUPANT LOAD .00 ---------------------------------------------------------------------------- 1ST FLOOR SQUARE FOOTAGE 2200.00 Permit . . . BUILDING PERMIT Additional desc . . MED OFFICE T.I. SUITE 103 Permit Fee . . . . 594.50 Plan Check Fee 386.43 Issue Date . . . . Valuation 90000 Expiration Date'. 10/09/10 Qty Unit Charge Per Extension BASE FEE 414.50 40.00 4.5000 -------------------------------------------------------------------------------- THOU BLDG 50;001-100,000 180.00 Permit . . . ELECT - ADD/ALT/REM Additional desc . . Permit Fee . . . . 55.50 Plan Check Fee 13.88 Issue Date Valuation 0 Expiration Date 10/09/10 Qty Unit Charge Per Extension BASE FEE 15.00 54.00 .7500 ---------------------------------------------------------------------------- PER ELEC DEVICE/FIXTURE 1ST 20 40.50 Permit . . . MECHANICAL Additional desc . . Permit Fee . . . 33.00 Plan Check Fee 8.25 Issue Date . . . . Valuation . . . . 0 Expiration Date 10/09/10 Qty Unit Charge Per Extension BASE FEE 15.00 4.00 4.5000 =--------------------------------------------------------------------------- EA MECH VENT INST/ DUCT ALT 18.00 Permit . . . . . PLUMBING Additional desc . Permit Fee . . . . 85.50 Plan Check Fee 21.38 Issue Date . . . . Valuation . . . . 0 Expiration Date . . ." 10/09/10 LQPERAIIT Yy 1 LQPERAIIT Application Number . . . . . 10-00000258 Permit . . . . . . PLUMBING Qty Unit Charge Per Extension BASE FEE 15.00 10.00 6.0000 EA PLB FIXTURE 60.00 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 2,200 SF MEDICAL OFFICE T.I. TYPE VB CONSTRUCTION. "B" OCCUPANCY, OCCUPANT LOAD = 22. TENANT = DANIEL J. FRUCHETTI D.O. 2007 CODES 2008 ENERGY. ---------------------------------------------------------------------------- Other Fees . . . . . . . . ACCESSIBILITY PLAN REVIEW 38.64 BLDG STDS ADMIN (SB1473) 4.00 ENERGY REVIEW FEE 38.64 Fee summary ------------------ Permit Fee Total Plan Check Total Other Fee Total Grand Total Charged Paid 768.50 .00 429.94 .00 81.28 .00 1279.72 .00 Credited Due .00 768.50 .00 429.94 .00 81.28 .00 1279.72 . P.O. ROX 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 Pelrm.its ,[ll PORTANT! NOTICE TO PROPERTY OWNER 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 _7,9 9 —! �O-� o00 �� ��C� 5�� �3 �� '� ► p3 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 will not issue a buildmg.p.ermit until yowhave 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"O.W- EDGMENT AND VEWFICATION OF INFORMATION DIRECTIONS: Read and `initial each statement below t-bsignify you understand or verify this information. 1. I 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. 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 on. 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 myself from potential financial risk by` hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 5. I 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), inchiding labor and materials, I may be considered an "employer" under state and federal law. 6. I understand if I am considered an "employer" under state and federal law, 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 risk. / 7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures 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. 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.'l 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 (CSILR) at 1- 800-321-CSLB (2752) or www.cstb.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: agree that, as the party legally and financially responsible for this proposed construction activity,.I will abide by all A4apable laws and requirements that govern Owner -Builders as well as employers. hake12. .1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I 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 Permit. Note: A copy of the property owner's driver's.ftense; 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. �1 ^ A 7 Signature of property owner Date: Z_ lle)_ 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 I understand is my personal responsibility, l 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: 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'!o be presented when the permit is issued to verify the property owner's signature.. Property Owner's Signature: Date: 67"n 0/t, L-c�v�Nt( OF LA QUINTA SUB -CONTRACTOR LIST JOB ADDRESSZ!�t)gb PERMIT NUMBER OWNER_o/L BUILDER1:� ` 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. Classification. Trade Trade / . ication. .:...:...Contcaetor .... State;Contractor- Lcense ,. ; : r 1 ura 1111A kecs Com ensation ns . nce. , Gi L, 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 (xx/xx/xx) License Number (xxxx) Exp. Date (xx/xx/xx) EARTHWORK (C-12) CONCRETE (C=8) FRAMING (C-5) STRUCT. STEEL (C=51:} MASONRY (C-29) PLUMBING (C-36) /11 LATH, PLASTER (C-35) DRYWALL (C-9). Y`7 6 S Z) 3 /�✓� a/ HVAC (C-20) _ Z err a SHEET METAL (C-43) FLOORING (C-15! GLAZING IC -17) INSULATION XC 21 SEWAGE DISP. (C-42) PAINTING (C-33) CERAMIC TILE (C-54) . CABINETS (C76) FENCING (C-1:3) LANDSCAPING (.0=27). POOL (C-53) Bine City of is Qulnta Building 8i Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: 7_7—, e OQ, V/14) Owner's Name: —4• UA A. P. Number:(ff 22 Address: / � Contractor: Y;i'>`.iiti':v Fyi:,'.; fli';ij;`:S:•;:b:k;}: ' Telephone: . Address: Project Description: City, ST, Zip:d Telephone:* State Lie. # : City Lie. #; Q r Arch., fir: 1 �!i►'1�1� �l GG (� �. . Address: '7 J -9 Skzti ,z eil� w `o City., ST, Zip: Fdk VK 40G� GliZ-V—, ( I Telephone: P �y " i ZO� z><:4'c' ,� r :. >��.Q..,. �;; " »' Construction Type: Occupancy: State Lie. #:�!;;^y ect tYPa circle one): New Add'n AR Repair Demo Name of Contact Person: 00 �� � Sq. Ft.: 'Z 200 # St ries: # Units: Telephone # of Contact Person: 6 —.406 — IZO Estimated Value of Project: a®f 005) APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Plan Sets Req'd Recd TRACMG Plan Check submitted 'jb PERMIT FEES Item Amount Structural Cafes. Reviewed, ready for corrections -417 Plan Check Deposit Truss Cafes. Called Contact Person Plan Check Balance. Title 24 Cafes. 3 Plans picked up Construction Flood plain plan Plans resubmitted q' i Mechanical Grading plan 2"! Review, ready for correetiossue Electrical Subcontactor List Called Contact Person y Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 3' Review, ready for correctionslissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue �1 School Fees Total Permit Fees 72-1 2. U 1 ko iC- lZ-T. s CERTIFICATE OF COMPLIANCE Part 1 of 4 LTG -1 C Project Name Date DR DANIEL FRUCHETTI InAr 1 3/25/2010 Project Address I Climate Zone Total Cond. Floor Area Unconditioned Floor Area 79180 CORPORATE CENTER DR, STE 15 2,082 0 GENERAL INFORMATION Building Type: m Nonresidential ❑ High -Rise Residential ❑ HoteVMotel Guest Room ❑ School ❑ Relocatable Public m Conditioned Spaces ❑ Unconditioned Spaces School Phase of Construction: ❑ New Construction ❑ Addition m Alteration Method of Compliance: m Complete Building ❑ Area Category ❑ Tailored Documentation Author's Declaration Statement I certify that this Certificate of Compliance documentation is accurate and complete. Signature 44 Name BENTSEN/HUI ENGINEERING Company Da e Bentsen / Hui Engineering 3252010 Address 70-141 SUN VALLEY DRIVE EA # % CEPE # City/State/Zip Phone RANCHO MIRAGE, CA 92270 760 324-7357 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, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with thi uilding rmit plication. Name Signat JACK BENTSEN Y"W��tel� Company Phony BENTSEN/HUI ENGINEERING / (760) 324-7357 Address 70-141 SUN VALLEY DR License # 7 �7 5 City/State2ip RABCHO MIRAGE, CA 92270 Date 2� Q 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 an the use of this and all Energy Efficiency Standards compliance forms; please refer to the Nonresidential Manual published by the California Energy Commission. © LTG -1C Pages 1 through 4 Certificate of Compliance. All Pages required on plans for all submittals. ❑ LTG -2C Lighting Controls Credit Worksheet m 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 I WUIHNING ECEI�TED ETI' DEPT.R APPROVED MAR 2 6 2010FOR CONSTRUCTION L 1E 4galP. laX• Ip Ene Pro 5.0 6 Ene Soft User Num er: . 010-03-25T09:47:5 1 :1 Ige 1 of 6 -*10-zo, it ff Ic f CERTIFICATE OF COMPLIANCE (Part 2 of 4) LTG -1C Project Name DR DANIEL FRUCHETTI Date 1 3/25/2010 INDOOR LIGHTING SCHEDULE and FIELD INSPECTION ENERGY CHECKLIST Installation Certificate, LTG -1- INST Retain a copy and verify form is completed and signed. Field Inspector ❑ Certificate of Acceptance, LTG -2A (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 watts per square foot of portable lighting shall not be required to be included in the ® calculation of actual indoor lighting power density in accordance with the Exception to §146(a). All portable lighting in excess of 0.2 watts per square foot is totaled below. Luminaire e, 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, dimmable electronic ballasts m LL _5 C da •m z E 3 J How wattage Was determined E E z J one lL X 0 0 c 3 Field Ins ectorz � O D CEC E- 0 Default c0i w, From Q H NA8 a LL TYPE A (4) 4 ft Fluorescent T8 Rapid Start ElecRO ❑ 98 ® ❑ 4 392 ❑ ❑ TYPE B (2) 4 R Fluorescent T8 Rapid Start ElecRO ❑ 51 ® ❑ 30 1,530 ❑ ❑ TYPE C (2) 4 IT Fluorescent T8 Rapid Start ElecRO ❑ 51 ® ❑ 2 102 ❑ ❑ TYPED (1) 26w Compact Fluorescent Quad 2 Pin ❑ 37 0 ❑ 2 74 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 1 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Installed Watts Page Total: 2,098 Building total number of pages: Installed Watts Building Total Sum of all pages 2'098 Enter into LTG -1G Page 4 of 4 1. Wattage shall be determined according to Section 130 (d and e). Wattage shall be rating of light fixture, not rating of bulb. 2 . If Fail then describe on Page 2 of the Inspection Checklist Form and take appropriate action to correct. Verify building plans if necessary. EnergyPro 5.0 by EnergySoft User Number- 6457 RunCode: 2010-03-25709:47:51 ID: 1007 Pae 2 of 6 CERTIFICATE OF COMPLIANCE Part 3 of 4 LTG -1C Project Name DR DANIEL FRUCHETTI Date 1 3/25/2010 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 ftz, automatic daylighting controls for daylit areas > 2,500 fe, 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 W, 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 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ SPECIAL FEATURES INSPECTION CHECKLIST See Page 2 of 4 of LTG -1 C 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: EnergyPro 5.0 by Energ Soft User Number: 6457 RunCode: 2010-03-25T09:47:5 ID: 1007 PaTe 3 of 6 INDOOR LIGHTING POWER ALLOWANCE LTG -3C Project Name DR DANIEL FRUCHETTI Date 3/25/2010 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 Comp Bldg Medical and Clinic 1.10 2,082 2,290 TOTALS AREA WATTS AREA CATEGORY METHOD WATTS BUILDING CATEGORY From §146 Table 146-F PER(ft) X Area ftz = ALLOWED WATTS TOTALS AREA WATTS TAILORED METHOD Total Allowed Watts using the Tailored Method taken from LTG -4C (Page 1 of 4 Row 3 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 s aces EnergyPro5.0byEnergySoft User Number: 6457 RunCode: 2010-03-25T09:47:5 /D: 1007 Page 5 of 6 CERTIFICATE OF COMPLIANCE Pall 4 of 4 LTG -1C Project Name Date DR DANIEL FRUCHEM 1 3/25/2010 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 Z098 Installed Lighting 0 from Conditioned LTG -1 C, Page 2 from Unconditioned LTG -1 C, Page 2 Lighting Control Credit _ 0 Lighting Control Credit _ 0 Conditioned Spaces from LTG -2C Unconditioned Spaces from LTG -2C Adjusted Installed — Z098 Adjusted Installed = 0 Lighting Power Ughting LightingPower Complies if Installed:5 Allowed Complies if Installed:5 Allowed Allowed Lighting Power Allowed Lighting Power Conditioned Spaces from LTG -3C or PERF -1 2,290 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. 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. Fors 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 form is not considered a complete form and is 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 for each different lighting luminaire control(s) must be provided to the owner of the building for their records. Controls for Credits LTG -2A Controls and Sensors and Automatic Number of Daylighting Luminaire Controls E ui ment Requiring Testing Description controls Location Acceptance 13 13 EnerayPro 5.0 by Ene Soft User Number. 6457 RunCode: 2010-03-25T09:47:5 0:1007 Pa - e 4 of 6 LIGHTING MANDATORY MEASURES: NONRESIDENTIAL LTG -MM Project Name Date DR DANIEL FRUCHEM 3/25/2010 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 automafically 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. 19 h §1 ()' Automatic Control Devices Certified: All automatic control devices specified are certified, all alternate equipment shall be certified and installed as directed by the manufacturer. §111: Fluorescent Ballast and Luminaires Certified: All fluorescent fixtures specified for the project are certified and listed in the Directory. All installed fixtures shall be certified. Tandem Wiring for One and Three Lamp Fluorescent Fixtures: All one and three lamp fluorescent fixtures are tandem §132: wired with two lamp ballasts where required by Standards Section 132; or all one and three lamp fluorescent fixtures 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. 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 loadshall 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 500% 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. 32 b §1 ()" 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. Energ Pro 5.0 by Energ Soft User Number. 6457 RunCode: 2010-03-25T09:47:56 ID: 1007 Page 6 of 6