07-2929 (RC)i, r
I _<& 4�4Qmk
P.O. BOX 1504 m VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA,"CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
= ---- Date: 1/10/08 .
Application Number: t-07-00002929 �) �� Owner:
Property Address: 46660 WASHINGTON ST STE 10 WASHINGTON 111 , LTD
APN:" 643-020-999-3-309003 C/O JACK TARR
Application description: REMODEL - COMMERCIAL 30240 RANCHO VIEJO Rf D ' B a qq
Property Zoning: REGIONAL COMMERCIAL SAN JUAN CAPISTRANO, i 92675� .1 O y� ►7
Application valuation: '140238
Contractor: CITY OF CQuisTA
F pEPT•
Applicant: Architect or Engineer: A &. M CONSTRUCTION
P.O. BOX 366
LA QUINTA, CA 92247
:. (760) 564-4832
LiC. No.: 746198
. •J
-
----------------------------- ---------------------=- ------ ---- --- ---l--
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
r hereby affirm under penalty of perjury that I am li nsed under provisions of Chapter 9 (commencing with - 1 hereby affirm under penalty.of perjury one of the following declarations: -
Section 7000) of Division 3 of the -Business and Pr f -Zonals Code, and my License is in full force and effect. _ I have and "will maintain a certificate'of consent to self -insure for workers' compensation, as provided -
License -Class: B C1 License Qp.: 746198 . for by Section 3700 of the Labor Code, for the performance'of the work fer�which this permit is
_ V issued.
Date:. tractor. - - Nhave 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
OWNER -BUILDER DECLARATION - insurance carrier -and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the ' Carrier STATE FUND Policy Number 30006388-2008
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to _' I certify that, in the performance f the work for which this permit is issued, I shall not employ. any :
construct; alter, improve,. demolish, or repair any structure, prior to its issuance, also requires the applicant for the : person in any manner so as .become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that,if I.should come subject to the workers' compensation provisions of_Section ,
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business. and Professions Code) or 3700 of the tabor Code, hall forthwitffcom ose provisions. -�-
that he or sheds 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). - ate:l�� plicant:
r (_) 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL _
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
• " and who does the work himself or herself through his or her own employees, provided that the DOLLARS (S100,000). -IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN -
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. - 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.). APPLICANT ACKNOWLEDGEMENT
(_ 1-•1,, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
. - 7044: Business and Professions Code: The Contractors' State License Law does not apply to an owner of. conditions and restrictions set forth on this application. - - -
property who "builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1-. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to -any permit issued as a result of this application,
(_ 1 .I am exempt under. Sec. _ , B.&P.C. for this reason - the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
f L O 'nt it officers antsand m I ees for an act or omission related to the work bein
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
o a w a, i s o ce s, age p oy y g
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 issuan/of-suchrmit, or cessation of work for 180 days will subject
permit to cancellation. '
I certify that I have read this application and state e information is correct. 1 agree to comply with all
city and county ordinances and state laws relatingonstructiorpand hereby authorize representatives
/of tt1 s county to enter upon the above -mentioned nspection purposes
Datnature:(Applicant or Agent
LQPERMIT
Application Number .
. . . . 07-00002929
Permit . . .
BUILDING PERMIT
Additional desc
Permit Fee . . . .
783.00 Plan Check
Fee
508.95
Issue Date . . . .
Valuation
. . .
140238
Expiration Date
7/08/08
Qty Unit Charge
Per
Extension
BASE FEE
639.50 .
41.00 3.50.00
THOU BLDG.100,001-500,000
143.50
Permit
ELECT - ADD/ALT/REM
Additional desc .
Permit Fee
53.16 Plan Check
Fee
13.29
Issue Date . . .
Valuation
. .
0
Expiration Date
7/08/08
Qty Unit Charge
Per
Extension .
BASE FEE '"
15.00
1908.00 .0200
ELEC GARAGE OR NON-RESIDENTIAL
38.16-,.'
Permit . . .
MECHANICAL
Additional desc..
Permit Fee
43.50 Plan Check,Fee
10.88 -
Issue Date
Valuation-
0
Expiration Date
7/08/08
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 9.0000
EA MECH APPL REP/ALT/ADD
9.00
-3-00--------6_5000EA
------------------------------------------------------------
MECH VENT FAN
_
19.50
Permit
PLUMBING
Additional desc .
Permit Fee
127.50 Plan Check
Fee-.
31.88
Issue Date . . . .
Valuation
0
Expiration Date
7/08/08
Qty Unit Charge
Per
Extension
BASE -FEE
15.00
12.00 6.0000
EA PLB FIXTURE,
72.00
1.00 15.0000
EA PLB BUILDING SEWER
15.00
1.00 7.5000
EA PLB WATER HEATER/VENT
7.50
1.00 3.0000
EA PLB WATER INST/ALT/REP
3.00
1:00 15.0000
EA PLB GAS METER
15.00
LQPERMIT
Application Number . . . . . 07-00002929
-------•----------------------------
Special Notes and -Comments
DENTAL OFFICE 1908 SQ. FT. SUITE ##10 DR.
KELSEY. TENANT IMPROVEMENT B OCC. _
t•. Other Fees '. . . STRONG MOTION (SMI) - COM 29.44
Fee summary ' Charged Paid Credited Due
---------------- --
Permit Fee Total 1007.16 .00 .00 1007.16
Plan Check Total. 565.00 .00 .00 565.00
Other Fee Total 29.44 .00 .00 29.44
Grand Total 1601.60 .00 .00 1601.60
c .
• 1 .T y -
J .
LQPERMIT
B #
City of La Quinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
7
Project Address: _ 110 / G%d /J Srf f-,4 r
Owner's Name: DR, A ARoAo KEt s� y
A. P. Number: 6/443 _ Q z p — p i 7 _ iC �V t'O
Address:
Legal Description:
City, ST, Zip:
Contractor:
�' �'i C oNSTRvGr 0
Telephone:
��
�s `�
Address:
Project Description:. (/ r O e- C ae
City, ST, Zip:
IVI4Jrrp / !i9 t*A-.r /fe-AVIQM 040V Q
Telephone:
State Lic. # :
City Lic: #:
Arch., Engr., Designer: • SoUT-> car
Address: %g, H C.4L64 —53'' Q6
S!%/� .2,z
City, ST, Zip: ZA Q v/N �4 1 64 92 2 r.7
Telephonef 60 s6•S/_ 70 7
nit
Construction Type: v Occupancy:
\
State Lic. #:52 3737
Project type (circle one): New Add'n Alte Repair Demo
Name of Contact Person: -5 tc-1Vc l E % o
Sq. Ft:: 8
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Projec . Z O
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING.
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
3.
Plan Check Balance
Energy Calcs.
Plans picked up
%Z 3
Construction
Flood plain plan
Plans resubmitted
I
Mechanical
Grading plan'
2"d Review, ready for correction issue
Electrical
Subcontactor List
Called Contact Person�]K
(�
g
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''" Review, readyfor corrections/iss a
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
. Total Permit
1�20 X
acsc r r.�u en
ASP'
1"t~Cd' VPQ
t
oceitf�G1�1�IGt/ ,
U 3
P.O. BOX 1504 BUILDING & SAFETY DEPARTMENT
C�OF9�`w 78-495 CALLE TAMPICO (760) 777-7012
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
J
To: Greg Butler, Building & Safety Manager To CDD: December 20, 2007
From: Les Johnson, Director -Planning Due Date: December 28, 2007
r Permit #: 07-2929 Status: 1 st 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: Division of Suites
Address or General Location. 46-660 Washington St. Ste.10
Applicant Contact:: Stephen Nieto-(760)564-4707
The Planning 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..
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 92211-4131 (760) 863-8886 Fax (760) 863-7072
John R. Hawkins
Fire Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
Cities of:
Banning
4.
Beaumont
Calimesa
Canyon Lake
4.
Coachella
4.
Desert Hot Springs
Indian Wells
Indio
Lake Elsinore
La Quinta
Moreno Valley
Palm Desert
4.
Perris
Rancho Mirage
Rubidoux CSD
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
John R. Hawkins
Fire Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
Cities of:
Banning
Beaumont
Calimesa
Canyon Lake
s
Coachella
Desert Hot Springs
Indian Wells
Indio
4.
Lake Elsinore
La Quinta
.; .
Moreno Valley
Palm Desert
Perris
Rancho Mirage
s
Rubidoux CSD
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., Suite 201 • Palm Desert, California 92211 (760) 863-8886. • Fax (760) 863-7072
December 17, 2007
A & M Construction
P.O. Box 366
La Quinta, CA
RE:.. TENANT IMPROPease
PLAN CHECK
LAQ-07-TI-13 shington St., Suite 10, La Quinta, CA
You have been issued a 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 2000 UBC.
THE FOLLOWING CONDITIONS MUST BE MET PRIOR TO INSPECTION:
Install door hardware and exit signs as per Chapter 10 of the 2001 CBC.
Fire sprinkler system plans for the tenant improvement area must be submitted to the Fire
Department for review, along with a plan/inspection fee. 'A licensed C-16 contractor will have
to submit plans for review and.approval and modify the fire sprinkler system in accordance
with. NFPA 13, 1999 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.
Provide keys 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.
Shelving, counters; etc., must be in place, however, no merchandise may be placed in the
building prior.to inspection
A minimum 2A10BC 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.
ELECTRICAL PANEL BOX:
All breakers must be labeled and a clearance of 36,inches must be maintained around the
panel at all times.
a
OTHER REQUIREMENTS:
Approved building address shall.be placed insucha position as,to be plainly visible and
legible from.the street and rear access if applicable. Building address numbers shall be a
minimum of 12" for building(s) up to. 25' in height,. and 247 in height for buildings) exceeding
25' in height. In. multi -tenant buildings, businesses shall post the business name and suite
number on back doors. as well as the front. Suite numbers or letters must be a minimum of 6°
in height. - All addressing must be legible and of a contrasting .color with the background and.
adequately illuminated to be visible from the street at all hours.
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.
Applicantrinstaller 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 maybe arranged
by calling (760) 863-8886.-•
All questions regarding the meaning of these conditions should be referred to the Fire
Department Planning & Engineering, Staff at (760) 863-8886.
Sincerely,
Norman Davidson
Fire Safety Specialist
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t(3
(21.5 trot
P 7017: 76' Reach Parked
44-52' (113.3 cm)
1
39' P 7016:66" Reach Parked
36r5B'
(99cm) 34-St8'(87.9cm)
(93.04cin)
P 7015: SG" Reach Parked
with '2*
24-SM' (62.5 cm)
(30 cm) cone
40-Sa-
(103.31 cm)
with 8'
(20 cm) cone I
Min imnmCeiling 8equirement:86.5" ('219.7cm)
progeny
More I han Imaging. Excellence.
Progeny Dental
1407 Barclay Boulevard • Buffalo Grove, IL 60089 USA
PHONE (888) 924-3800 • (847) 850-3800 v FAX (847) 459-5175
www.progenydentaI.com
Copyrkp 2005 Rage y Im NI rfyas reserved
to
PREVA DC
SPECIFICATIONS
Line Voltage
100-230VAC +l- 10% 50-60 Hz
Line Load
Maximum current 5 amps
Tube Potential
60, 65 or 70 kVp
Tube Current .
4, 5, 6, or 7 mA
Exposure Time
10 ms to 2 seconds
Cone Length
20 cm (8 inches)
Minimum Inherent
Filtration
2 mm Al equivalent C0 70 kVp
focal Spot
0.4 mm (IEC 336)
Duty Factor
1:15
Shipping Weight
90 lbs.
.Applicable Documents
Federal Regulations
21 CFR, UL, CE 0120
Warranty
2 Years, Limited
Options
Exposure hand switch
12" Cone
8" Rectangular cone
Choice of 56", 66" or 76" (total reach)
Two stud mounting plate
Metal stud mounting plate _
Specifications subject to change without notice
For more information, contact your Progeny representative today.
TITLE 24 REPORT
Title 24 Report for:
Dr. Aaron Kelsey, DOS, Tenant Improvement
46-660 Washington, Suite 10
La Quinta Ca 92
'CITYOF LA QUINTA.
BUILDING & SAFETY DEFT.
APPROVED
FOR QDNSTRUCTION
dA L L
South Wesf oncepts
78-120 Calle Estado, Suite 206
La Quinta, Ca 92253
(760) 564=4707
Report Prepared By:
Tim Scott
Scott Design. & Title 24
77085 Michigan Dr.
Palm Desert; CA 92211
(760) 200-47.80
Job Number: j
Date:
12/14/2007 A ti {
he EnergyPro computer program has been used to perform the calculations summarized in this compliance report. This program has approval and is
uthorized 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.
'?%j EnergyPro 4.3 by EnergySoft Job Number: User Number: 6712
xK
TABLE OF CONTENTS
Cover Page
1
Table of Contents -
2
Form LTG-1-C Certificate of Compliance
3
Form LTG-2-C Indoor Lighting Schedule
7
Form LTG-3-C Portable,,Lighting, Worksheet
8
Form LTG-4-C Lighting Controls Credit Worksheet .
9
Form LTG-5-C Indoor Lighting'Power Allowance
10
Form LTG-6-C Tailored Method Worksheet
11
Form LTG-7-C Room Cavity Ratio Worksheet
12
Form LTG-MM Lighting Mandatory Measures , ;
13
CERTIFICATE OF COMPLIANCE (Part 1 of 4) LTG-1-C
PROJECT NAME
DATE
Dr. Aaron Kelsey, DDS, Tenant Improvement
12/14/2007
OJECT ADDRESS
46-660 Washington, Suite 10 La Quinta
Permit #
PRINCIPAL DESIGNER - LIGHTING
TELEPHONE
Building
South West Concepts
(760) 564-4707
DOCUMENTATION AUTHOR
TELEPHONE
Checked by/Date
Scott Design & Title 24
(760) 200-4780
Enforcement Agency Use
GENERAL INFORMATION
DATE OF PLANS
BUILDING CONDITIONED FLOOR AREA
CLIMATE ZONE
1,876 Sq.Ft.
15
BUILDING TYPE O NONRESIDENTIAL ❑ HIGH RISE RESIDENTIAL ❑ HOTEL/MOTEL GUEST ROOM
❑X CONDITIONED SPACES ❑ UNCONDITIONED SPACES ❑ INDOOR & OUTDOOR SIGNS
PHASE OF CONSTRUCTION ❑X NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION
METHOD OF LIGHTING ❑ COMPLETE BUILDING ❑ AREA CATEGORY O 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 ccurate and complete.
DOCUMENTATION AUTHOR
SIG N TU
DATE
Tim Scott 711
it / d4j-7
The Principal Lighting Designer hereby certifies that the proposed building design represented in this set of construction documents
is consistent with the other compliance forms and worksheets, with the specifications, and with any other calculations submitted with
this permit application. The proposed building has been designed to meet the lighting requirements contained in Sections 110, 119,
130 - 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 California as a civil engineer or electrical engineer, or I am a licensed architect.
❑ I affirm that I am eligible under the provisions of Division 3 of the Business and Professions Code by Section 5537.2 or 6737.3 to sign this document
as the person responsible for its preparation; and that I am a licensed contractor performing this work.
❑ I affirm that I am eligible under the exemption to Division 3 of the Business and Professions Code to sign this document because it pertains to a
structure or type of work described as exempt pursuant to Business and Professions Code Sections 5537, 5538 and 6737.1.
PRINCIPAL LIGHTING DESIGNER - NAME
SIGNATURE
DATE
LIC. #
South West Concepts
LIGHTING MANDATORY MEASURES
Indicate location on plans of Note Block for Mandatory Measures
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
1KLTG-1-C, Part 4 of 4: Certificate of Compliance. Part 4 of 4 submittal is required when lighting controls are installed
®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
TG-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: 6712 Job Number: Page:3 of 14
CERTIFICATE OF COMPLIANCE (Part 2 of 4) LTG-1-C
PROJECT NAME DATE
Dr. Aaron Kelse , DDS,'Tenant Im rovement 12/14/2007
INSTALLED INDOOR LIGHTING POWER FOR CONDITIONED AND UNCONDITIONED SPACES
INSTALLED
.. _ WATTS
INSTALLED LIGHTING, CONDITIONED SPACES (From LTG-2-C) 2,598
PORTABLE LIGHTING (From LTG-3-C) 0
LIGHTING CONTROL CREDIT, CONDITIONED SPACES (From LTG-4-C) 255
CONDITIONED SPACE ADJUSTED INSTALLED LIGHTING POWER 2,343
INSTALLED LIGHTING, UNCONDITIONED SPACES (From LTG-2-C) 0
LIGHTING CONTROL CREDIT, UNCONDITIONED SPACES. (From LTG-4-C) . 0.
UNCONDITIONED SPACE ADJUSTED INSTALLED LIGHTING POWER 0
{
ALLOWED INDOOR LIGHTING POWER FOR CONDITIONED SPACES .
❑ COMPLETE BUILDING METHOD (From LTG-5-C) - ALLOWED
❑X AREA CATEGORY METHOD (From LTG-5-C) - w - a WATTS
❑X TAILORED METHOD (From LTG-5-C) ALLOWED LIGHTING POWER 2 439
LTERNATE COMPLIANCE
PERFORMANCE METHOD
❑ COMMMON LIGHTING SYSTEM (From LTG-8-C)
ALLOWED INDOOR LIGHTING POWER FOR UNCONDITIONED SPACES From LTG-5-C 0
AiAAIPI AT/lmV IAIr1l1llIn AKim r%AN/ 1 it-uvI\I t- AII-r^RMATlf% f%e%LlTm/11 t- -
CONTROL LOCATION
(Room #)
&WSEr
CONTROL TYPE
(Auto Time Switch, Dimming, etc.)
_.L A .. -Y
Check if
SPACE CONTROLLED Daylighting
NOTE TO
FIELD
CONTROL.
IDENTIFICATION
-fi n�tr- A.eNI.�
DC
CERTIFICATE OF COMPLIANCE (Part 3 of 4) LTG -
NAME
Dr. Aaron Kelsev, DDS, Tenant Im
CONTROL
IDENTIFICATION
DATE
nt 12/14/2007
CONTROL TYPE
(Occupant, Daylight, Dimming, etc.)
Occ Sensor - — 250 sgft
Occ Sensor - — 250 sgft
LUMINA!ES
CONTROLLE
TYPE
# OF
LUMINAI
A
20
B
2
NOTE :TO
FIELD
r
L_
L
CERTIFICATE OF COMPLIANCE (Part 4 of 4) LTG-1-C
PROJECT NAME
Dr. Aaron Kelsey, DDS, Tenant. Improvement
DATE
12/14/2007
esigner:
This form is to be used by the designer and attached to the plans. Listed below are all the acceptance
Jests 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 7b M
y E Vg �, do-jk .
OGc,
❑ LTG-3-A: Automatic Daylighting Controls Acceptance Document
Equipment requiring acceptance testing
EnergyPro 4.3 by EnergySoft User Number: 6712 1 Job Number: Page:6 of 14 1
INDOOR LIGHTING SCHEDULE (Part 1 of 2) LTG-2-C
ECT NAME
Dr. Aaron Kels
DDS, Tenant I
nt
DATE
12/14/2007
IINSTALLED LIGHTING POWER FOR CONDITIONED SPACES I
Luminaire
Lamps/Ballasts
Installed Watts
C
D
E
F
G
H
I
J
Name
Type Description
Div
-03
N�
333
yQ
N CD
fD `� °
oriv�
3c�m
V N
3�3
g^Q
'6
`D M o
3��
��
N N
m
�c3
wm
C n
•J
Yesl No
r
c
3 c
5—B
N ��
lD a
N
xo ni
`N �.
A
V) 4 ft Fluorescent T8 Energy Savings
ec
F32T8
2
30
1.0
58.0
X
1 20
1.160
B
V) 4 ft Fluorescent T8 Energy Savings
2
30
1.0
58.0
X
2
116
C
V) 13w Compact Fluorescent Triple 4 Pin
lec
CFM 13W/GX24 -1
2
13
2.0
25.0
X
19
475
D
(1) 18w Compact Fluorescent Triple 4 Pin
Elec
CFM 18W/GX24 -2
1
181
1.0
21.0
X
7
147
F
Linear Rope lightingAmbient
LX
1
700
1.0
700.0
X
I
1 1
700
PAGE TOTAL 2 598
BUILDING TOTAL (sum of all pages) 2, 598
PORTABLE LIGHTING (From LTG-3-C)
CONTROL CREDIT (From LTG-4-C) 255
ADJUSTED ACTUAL WATTS 2 343
EnergyPro 4.3 by EnergySoft User Number: 6712 Job Number: Page:7 of 14 1
PORTABLE LIGHTING WORKSHEET LTG-3-C
ROJECT NAME
Dr. Aaron Kelsey, DDS, Tenant Improvement
DATE
12/14/2007
TABLE 1 - PORTABLE LIGHTING
NOT SHOWN ON PLANS FOR OFFICE AREAS >250 SQUARE FEET
A
B
C
D
ROOM #
OR ZONE ID
DEFAULT
W/s ft
AREA
SF
TOTAL WATTS
B X C
TOTAL
0
0
TABLE 2 - PORTABLE LIGHTING
SHOWN ON PLANS FOR OFFICE AREAS >250 SQUARE
FEET
A
B
C
D
E
F
G
ROOM #
OR ZONE ID
PORTABLE LIGHTING
Description
# OF
FIXT.
LUMIN.
WATTS PER
FIXTURE
TASK
AREA
(SF)
# OF
TASK
AREAS
TOTAL
AREA (SF)
(D x E)
TOTAL
WATTS
(C x E)
Suite 10
1,876
1
1,876
TOTAL
1876
1 0
TABLE 3 - PLANS SHOW PORTABLE LIGHTING IS NOT REQUIRED FOR OFFICE AREAS > 250 SQUARE FEET
ROOM # TOTAL AREA
OR ZONE ID (SF)
TOTALL 0
BUILDING SUMMARY - PORTABLE LIGHTING
Designer needs to provide detailed documentation that the lighting
level provided by the overhead lighting meets the needs of the
space. The details include luminaire types and mounting locations
relative to work areas.
BUILDING SUMMARY
TOTAL AREA (SF)
(FROM TABLES 1+2+3)
TOTAL WATTS
BUILDING TOTAL
1,876
0
EnergyPro 4.3 by EnergySoft User Number: 6712 Job Number: Page:8 of 14
LIGHTING CONTROLS CREDIT WORKSHEET (Part 1 of 2) LTG-4-C
CONTROL CREDITS FOR CONDITIONED SPACES
OJECT NAME DATE
Dr. Aaron Kelsey, DDS Tenant Improvement 12/14/20.07
A
B
C
D
E F G
H
I
J
ROOM #
ZONE ID
CONDITIONED
AREAS
LIGHTING
CONTROL
DESCRIPTION
PLAN
REF.
ROOM
AREA
(SF)
DAYLIGHTING
WATTS OF
CONTROL
LIGHTING
LIGHTING
ADJUST.
FACTOR'
CONTROL
CREDIT
WATTS
(H X 1)
WINDOW
WALL
RATIO
GLAZING
VLT
SKYLIGHT
EFFECTIVE
APERTURE'
Suite 10
occ sensgtt �- 250
A
1,876
1,160
0.20
232
suite 10
Occ Sensqft �— 25o
B
1,876
116
0.20
23
1) From Equation 146-A
2) From Table 146-A
PAGE TOTAL
BUILDING TOTAL
Enter in LTG-2-C: Lighting Control Credit
EnergyPro 4.3 by EnergySoft User Number: 6712 Job Number: Page:9 of 14 1
INDOOR LIGHTING POWER ALLOWANCE LTG-5-C
4
L
4
OJECT NAME
Dr. Aaron Kelsey,DDS Tenant Improvement '
kILLOWED
DATE
12/14/2007
LIGHTING POWER Choose One Method
COMPLETE BUILDING METHOD - CONDITIONED SPACES
WATTS
PER SF
COMPLETE
BLDG. AREA
ALLOWED
WATTS
BUILDING CATEGORY (From Section 146 Table 146-13)
AREA CATEGORY METHOD - CONDITIONED SPACES
AREA
(SF)
ALLOWED
WATTS
AREA CATEGORY (From Section 146 Table 146-C)
WATTS
PER SF
PAGE TOTAL
BUILDING TOTAL
1
AREA
WATTS
TAILORED METHOD - CONDITIONED SPACES
TOTAL ALLOWED WATTS 2,439
(From LTG-6-C or from computer run.)
UNCONDITIONED SPACES
Complete Building and Area Catagory Methods
Category (From Section 146 Table 146-B&d)
WATTS
PER SF
AREA
(SF)
ALLOWED
WATTS
PAGE TOTAL
BUILDING TOTAL
AREA
WATTS
TAILORED METHOD - UNCONDITIONED SPACES
TOTAL UNCONDITIONED SPACES ALLOWED WATTS
(From LTG-5-C and LTG-6-C)
0
EnergyPro 4.3 by EnergySoft User Number: 6712 Job Number: Page:10 of 14
�TAILORED METHOD WORKSHEET (Part 1 of 3) LTG-6-C
PROJECT NAME DATE
Dr. Aaron Kelsey, DDS, Tenant Improvement 12/14/2007
TAILORED LPD SUMMARY Separate Tailored Method Worksheets must be filled out for conditioned and unconditioned spaces.
1. Watts for Illuminance Categories (from Tailored LPD Total below) 2,43g watts
2. Watts for Display Lighting
Q+ Q+ Q+ IQ= 0 watts''
Wall Display Floor Display Ornamental/Special Very Valuable Display
Effects Display
I4. Total Allowed Watts (lines 1+2) > 2,439 watts
TAILORED LPD - Illuminance Categories From Table 146-D
A
B
C
D
E
F
G
ROOM
NAME
TASK/ACTIVITY
or
NON -TASK AREA
ILLUMINANCE
CATEGORY
ROOM
CAVITY
RATIO
RCR From
LTG-7
Y N
FLOOR
AREA
ALLOWED
LPD
ALLOWED
WATTS
(E x F)
Suite 10
Health Care Dental - Instrument
-Tray
E
0.00
❑
1 876
1.30
2,439
El El
a❑
00
❑❑
El El
❑a
El El
El
El El
El -El
El
El El
❑❑
;
❑o
❑❑
El El
PAGE TOTAL 1 876 2 439
BUILDING TOTAL 1,8761 1 2 439
FT 2 WATTS
EnergyPro 4.3 by EnergySoft User Number: 6712 Job Number: Page:11 of 14
A
B
C
D
E
F
Room
Name
Task/Activity
Description
Room
Area (A)
M
Room
Perimeter (P)
(ft)
Room Cavity
Height (H)
(ft)
Room Cay. Ratio
2.5 x H x P
/A
EnergyPro 4.3 by EnergySoft User Number: 6712 Job Number: Page:12 of 14 1
LIGHTING MANDATORY MEASURES LTG-MM
4
r
L
r
L
PROJECT NAME
DATE
Dr. Aaron Kelsey, DDS, Tenant Improvement
12/14/2007
DESCRIPTION
Enforcement
—Designer
X §131(d)1 For every floor, all interior lighting systems shall be equipped with a separate automatic
control to shut off the lighting. This automatic control shall meet the requirements of
Section 119 and may be an occupancy sensor, automatic time switch, or other device
capable of automatically shutting off the lighting.
X] §131(d)20verride for Building Lighting Shut-off: The automatic building shut-off system is
provided with a manual, accessible override switch in sight of the lights. The area
of override is not to exceed 5,000 square feet.
a§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.
X❑ 6132 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.
a §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: 6712 . Job Number: ` Page:13 of 14
LIGHTING INSPECTION CHECKLIST LTG -II
ECT NAME
Dr. Aaron Kelsev, DDS, Tenant Im
ment
INS
12/14/2007
FIXTURE
CODE
TYPE
DESCRIPTION
LAMP
TYPE
LAMP
QUANT.
NUMBER OF
FIXTURES
WATTS PER
FIXTURE
FIELD NOTES
A
2 4 ft Fluorescent T8 Energy Savings Elec
F32T8
2
20
58.0
B
2 4 ft Fluorescent T8 Energy Savings Elec
F32T8
2
2
58.0
C
2 13w Compact Fluorescent Triple 4 Pin Elec
CFM
2
19
25.0
D
1 18w Compact Fluorescent Triple 4 Pin Elec
CFM
1
7
21.0
F ._
Linear Rope lighting
Ambient LX.
1
1
700.0
.
I EnergyPro 4.3 by EnergySoft User Number: 6712 Job Number: Page:14 of 14 1