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11211 (CSCS)4 P.O. BOX 1504 Building 7€3-�7.1^v Ca�1eSt�dO 78-105 CALLE ESTADO Aririracc LA QUINTA, CALIFORNIA 92253 Owner McCormick, Mac & Patti Mailing Address P. O. Boer 366 City Zip - Tel. La Quinta 92253 Contractor City lZip State Lic.I City & Classif. Lic. # Designer Address Tel. CityI Zip I State I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, alter, Improve, demolish, or repair any structure,prior to its' Issuance also requires the applicant for such permit to rile a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he 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 (5500). - ❑ 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, Buisness and Professions Code: The Contractor's License Lawdoes not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such, improvements are not intended or offered for sale. If, however, the building orimprovement is'sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) '('iy. I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law 'does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - O 1 am exempt under Sec. B. & P.C. for this rea n Dale Owner x WORKERS' COMPENSATION DECLARATION I hereby affirm that I have aecertificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company 0 Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of the work for whic� this permit is issued, I shall not =any person in any manner so as t6 becomes b ect to°the Workers' Compensation Laws of California �-% Date ' Owner �( •+✓/' NOTICE TO APPLICANT: If, "affe&making thislCertificate of Exemption' you should become subject to the Workers' Compensatlon 'previsions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the above-. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip 01 No. 11211 BUILDING: TYPE CONST. OCC: GRP. A.P. Number 769--101--009 Leaal DescriDtion Lot 9 Block it's Desert Club Project Description Pizza Take Out REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: P Sq. Ft. 1500 Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation 96,6969f3.E3ii PERMIT AMOUNT Plan Chk. Dep. 250.00 Plan Chk. Bal. 297.39 Const. 646.50 Mech. 42. Un Electrical 45.00 Plumbing: 85 . so S.M.I. 20.37 Grading Driveway Enc. Infrastructure 688. VU Arts In Publi : 4U$. 49 TOTAL 2559.05 Lib REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: P CONSTRUCTION ESTIMATE NO. ELECTRICAL FEE NO. PLUMBING FEES 1ST FL SO. FT. ® $ UNITS A.C. UNIT COLL. AREA YARD SPKLR SYSTEM 2ND FL SO. FT. ROUGH PLUMB. POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. SO. FT. ® NK7 DRAINAGE PIPING WALL SO. FT. DUCTWORK DRINKING FOUNTAIN. SO. FT. ® URINAL ESTIMATED CONSTRUCTION VALUATION $ METER LOOP WATER PIPING NOTE: Not to be used as property tax valuation OTHER APPJEOUIP. FLOOR DRAIN MECHANICAL FEES GAS (FINAL) WATER SOFTENER VENT SYSTEM.. FAN EVAP.COOL _HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE -UNIT WALL FLOOR SUSPENDED SERVICE LAUNDRYTRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM B.TM. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE,TEMIPERM LAVATORY HEATING SYSTEM- FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER. B.T.U. SO. FT. ® c BATH TUB ROOFING SO. FT. ® c WATER HEATER MAX HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL REMARKS: SO.FT.GAR ® V4c HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE .PLUMBING ' ELECTRICAL HEATING & AIR COND. SOLAR I � SETBACK GROUND PLUMBING ERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMSSEWER.Qa-0EP ja NK7 G OUGH WIRING. DUCTWORK ROCKSTORAGE FOUND.,REINF.z Ay GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE / �! GROUT • WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR.r P / FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING: FIREPLACE SPARK'ARRESTOR GAR. FIREWALL LATHING— VO W MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL , S. INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL *4"f Of/ 4P P.O. BOX 1504 Building (/ �7 (�t-A �L E- ��7&105 CALLE ESTADC Address —lie ^'� /OUINTA, CALIFORNIA 9 Owner �,l�C°a�-�L L, Alla BUILDING: Mailing ' Address -3 A.P. Number QCity Zip Tel. Legal Descri Contractor --- 7 Project Description t t i TTt-w- v v t City �w� IZip Q:;t /Vf • .. State Lic.U City (j & Classif. �– ��7 / Lic. # Arch., Engr., Designer �� vi60E�o Address Tel. City f �Zip State Lic. # CENSED CONTRACTOR'S DECLARATION I hereby affirm that I a licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of th Business aft Professions Code, and my license is in full force and effect. / IF OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he 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 (8500) ('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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such 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 did not build or improve for the purpose of sale.) 1 1 I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License law.) I 1 I am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company r�tCopy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (8100) valuation or less.) I certify that in the performance of thg 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. Date Owner NOTICE TO APPLICANT: If. after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the above- mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip BUILDING DIVISION ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: Sq. Ft. O� Size f� No. Stories No. Dw. I Units ` New Y` Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. c �'— Plan Chk. Bal. , 3 Const. , Mech. Electrical r --- Plumbing s_ S.M.I. Grading Driveway Enc. nfras ructure b 9Q1 TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. @ $ • UNITS SLAB GRADE 2ND FL: '. SO. FT. @ BONDING YARD SPKLR SYSTEM POR. S0. Ff. @ MOBILEHOME SVC. BAR SINK GAR. SO. FT. @ POWER QUTLET ROOF DRAINS FOUND, REINF. GAS (ROUGH) DRAINAGE PIPING CAR P. SQ. FT. 0 OTHER APPJEQUIP. REINF. STEEL WALL SO. FT. TEMP. POLE DRINKING FOUNTAIN SQ. FT. @ GROUT ' URINAL ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation WATER SYSTEM FLOOR DRAIN MECHANICAL FEES _$ WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE,TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. @ c BATH TUB SPARK ARRESTOR SQ. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 11/. c SEWAGE DISPOSAL LATHING SO.FT.GAR @ 1/4c HOUSE SEWER MESH GAS PIPING PERMIT FEE INSULATION/SOUND PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL, AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND, REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT ' WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ _$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL A !MME -i" w C Y of 14EU Quinta This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building Code. certifying that at the time of issuance this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following: III, BUILDING ADDRESS .78-110 CALLE ESTADO I!3 Use Classification TAKE OUT RESTAURANT Mg. Permit No. 11211 i , Group B2 Type Construction V Fre Zone Use Zone CPS MCCORMICK, MAC & PATTI P 0 BOX 366 Owner of Building Address City LA QUINTA, CA 92253 MARK HAROLD By. Dote OCTOBER 22,'1992 Building Official POST IN A CONSTICUOU! PIACt 46ERT SANDS UNIFIED SCH006bISTRICT 82-879 Highway 111 NOTICE: Indio, CA 92201 Document Cannot Be Duplicated (619) 347-8631 Date 7/17/92 No. 111573 Owner Name Mac & Patti McCormick No. 78-090 street Calle Estado Type of Permit La Quinta Permit # Log # City La Quinta zip 92253 Study Area 112 APN # I Tract # Lot # Square Footage 115W Type of Development Commercial No. of units 1� Comments At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes. It has been determined the above-named owner is exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of X 1500 or $ 390.00 have been paid to D.S.0 S.D. for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued. Fees Paid By Richard McCormick Name on the check By James E. Lively Assistant Superintendent, Business Services Telephone Fee collected /exempted by Vickie J. Durrett -� Payment: "Received f Signature r Ch,ck No121 Collector: Attach a copy of county or city plan check application form to district -copy -for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy -accounting r iJN Y C . ERSIDE HEALTH SERVI GENCY IMP°� �'�.AR14 .T OF ENVIRONMENTAL TH o t"+ FOOD FACILITY INSPECTION REPORT Based on an inspection this -day, the items identified below are violations in structural or operational requirements which must be corrected by the next routine inspection or such shorter period of time as may be specified In writing. ��y� ;a�; Failure to comply with any time limits for corrections specified in this notice may result in cessation of your fopd facility operation. The Department of Health appreciates your cooperation. Public health protection is everyone s responsibility. ESTABLISHMENT NAME PHONE DAT TIME IN ec</� C),Cl�1 LOCATION % 110 Cn—�— DISTRICT REINSPECTION DATE OWNER ACTIVITY & SERVICE CODE jrJOR[EMEN 1 OFF C - MAILING ADDRESS PERMIT NO. AA) 1 EXP: 1�' L C.r 1 RECEIVE lyTIME NAME: TITLE: ! �' �%/ ;!i' ;; ; `.:,•: OUT DESCRIPTION OF ITEM VALUE LOST R�MARKS 1. FOOD: Approved source 4; No ' spoilage/contamination 4; Not reused Properly stored 2; Properly protected 0;AM Use of sulfites $; Properly labeled 2. TEMPERATURE CONTROL: Poten- (• r t/ �+.. P r, •! �:, +1' r9A 0 tially hazardous food below 45' F 7� or above 1400 F j; Refer thermometer 1; .. Probe thermometer 2; Food properly thawed 4; Frozen food maintained frozen or not refrozen 11 Ih� 1 ��i� t7 {•{ ( T !>• Q• 3. PERSONNEL; Foodhandler cards 4; Personal hygiene S; Clean clothes 2; <>5 Food handling 2; Hair restraint 2; No smoking 3 Clothing storage 1. "> (,J\^f t5 4. WATER & SEWAGE: Hot and cold potable water under pressure j; Liquid %:'^` waste disposal 3; Plumbing In good repair 2; No cross connections 2. S. EtZIPMENT. Maintained in clean condition 16; Maintained in good repair 10; Properly protected 4; Approved 3. 6. UTENSILS: Proper washing 4, Proper sanitizing 1; Clean 2; No damage.?; Properly stored 2i Testing tpaterlal provided D j• wj.,•c 7. FLOORS: Clean 2; Good repair 2. WALLS & CEILING/WINDOWS & SCREENS: Clean 2; Good repair 2; Light color 1. 8. TOILET/DRESSING ROOM & HAND _INKS: Good repair 3; Clean 3; Self-closing doors 1; Hand cleanser 1; Towels 2; Proper dispensers 2; Toilet tissue 3 Hand wash signs 1; ,Properly vented :Adequate 1, 9. LIGHT 9 VENTILATION: Adequate _3 Exhaust filters 2; Functioning 2; Fixtures protected 1. 10. PEST CONTROL: No insects !; No rodents 1; No animals or birds g; Outer openings protected 2; Self-closing outside doors 1. r 11. REFUSE: Properly stored 2; Containers covered 1; Adequate 2; Clean; <:aa: Surrounding: clean 1. 12. OPERATION: Toxics labeled and separated 1; Living & sleeping quarters separated 1; Signs posted 1; Cleaning ' equipment storage 1, Proper linen storage j; Spoils area maintained 2. POINTS POSSIBLE 200— POINTS LOST-:- 2 = TOTAL SCORE This facility is required by local Ordinance to display a grade card in a conspicuous place selected by the Enforcement Officer. The grade card shall not be concealed and can only be removed by the Enforcement Officer. (TRADES REPRESENT THE FOLLOWING SCORE RANGES: A = 100-90, B = 89-80 and C = 79-0. RIVERSIDE . HEMET PERRIS BANNING PALM SPRINGS INDIO BLYTHE TEMECULA 358-5172 766-2478 857-0738 849-8794 778-2235 342-6287 922-8158 694-5022 D0H•SAN020(REV1AQ Orig.— Office 1st Copy — Owner 2nd Copy —Office Page _of _Pages. -1 1 DIST. # COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY DEPARTMENT OF ENVIRONMENTAL HEALTH PLAN CORRECTION Plan Check # Date DBA _ Address Plans Submitted by. Phone Owner Address Phone The plans are now approved subject to the conditions listed below and the attached compliance sheet. r-A I CONSTRUCTION INSPECTIONS: Contact the Plan Checker for a Preliminary Inspection when construction is approx- imately 80% complete, with plumbing, rough ventilation, and rough equipment installed. Request for inspection should be made at least five (5) working days in advance. A FINAL INSPECTION MUST be made upon completion of ALL work including finished details. APPROVAL to operate shall not be granted, or remodeled areas approved to operate, until the facility has passed the FINAL INSPECTION, and "APPLICATION TO OPERATE" has been completed and PERMIT FEES have been paid. Request for inspection should be made at least five (5) working days in advance. 6 PLANS CHECKED BY - Phone I acknowledge the corrections noted herein and.,as indica ed on he plans and agree to incorporate them during construction: Signature Company Date ��• �-�- DOH-SAN-178(Rev1192) W-OFFICE — Y-APPLICANT — P-BLDG.DEPT. COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY - DEPARTMENT OF4.WJ BLIC HEALTH ENVIRONMENTAL HEALTH SERVICES DIVISION APPLICATION FOR REVIEW OF FOOD ESTABLISHMENT CONSTRUCTION/REMODEL PLANS MOTE: PLANS WILL NOT BE ACCEPTED UNLESS: 1. This Application is complete, and he Plan Check Fee is paid. ESTABLISHMENT NAMEJOB SITE ADDRESS CITY ...4.4 Q uI:✓r, CONTACT PERSON OWNER/OPERATOR NAME ADDRESS C/ `/i C 5920-45. o FOR OFFICIAL USE OOFiClt DATE / 8 / /a% FEE >Pi vd� O l 4P CONTRACTOR ARCHI, ECT NAME f / � / 'r ADDRESS CITY A. GENERAL Type of construction lNew Remodel of Existing Permitted Food Establishment D 11,2 '% Total square footage (including 71 seating areas)Z-1-19� Hours of Operation is x� Seatingg Cappacity for dining: N tuber of workers -per shift (incl. mgmt) Al f PErL PL -AK #vun: n1Knl0i' C6 17A) B. S VICE (Indicate ALL methods of food services to the public): On-site preparation (cutting, cooking, assembly, etc.) Soup or Salad Bar Items individually packaged by manufacturer Customer Self -Service Dispensers Full Service Bar Type of customer utensils (cups, plates, forks, etc.) . Single Seryice (disposable) Multi -Use (re -usable) D. UTILITIES / Water Service: Public Water System (*) NAME OF WATER COMPANY:_ Cl/E/Li P/c� /Fd•✓E C Wiry Private Well (Must be potable) /.30 20 or- eVwo,, ro ay -q Sewage Disposal: Public Sewer System (*) NAME OF SEWER COMPANY: l t) EVnU dy,Pi1,o.Fv LEr0 Septic System (must be Environmenal Health Land Use approved), 49,0 Av" •7 i c� K`; / - 7 q el Septic Tank Capacity: -ALL NEW CONSTRUCTION REQUIRES a letter from' provider stating establishment is or will be connected to utility BEFORE PLANS SHALL BE APPROVED. This utility connection is the responsibility of the applicant/operator and will be verified prior to approval to operate facility. .<0 SA( -Grease Interceptor: NOTE: REQUIRES Interceptor size requirement or waiver letter from sewerage provider. 44LL 9E .TnJ5:7 tCEO, OWNERIREPRESENTATIVE. DECLARATION: I understand that the amount of fee paid is based on my declaration of information on this form, and that incorrect information is grounds for denial of the submitted plans. 1 al;:o understand that plans will be discarded if not picked up within sixty (60) days of approval or denial, and that no inspection of my establishment will be conducted, or approval granted to operate, until all proper information requested has been recaived and plans approved and returned. Signature / Date DOH -SAN -002 (R*v 11(91) RECORDING REQUESTED BY9 AND WHEN RECORDED MAIL THIS DEED AND OAL19S OTHERWISE SHOWN BELOW. MAIL TAX STATEMENT TO: NameMr. & Mrs. Richard McCormick Street Address 1845 Anaheim St., #9B city8Costa Mesa State CA 92627 Name Street Address City 8 State TITLE ORDER N0. 5 3 7 4 8 6 N, MAIL TAX in Go' W -- --' -- -- - � - . . I- --- ESCROW No.2 - 1 3 6 5 4 a Q V::g Wa �o SPACE ABOVE THIS LINE FOR RECORDER'S USE GRANT DEED 769-101-009 THE UNDERSIGNED GRANTOR(S) DECLARE(S) DOCUMENTARY TRANSFER TAX IS $ 77.00 V computed on full value of property conveyed, or El computed on full value less value of liens or encumbrances remaining at time of sale. ❑ unincorporated area 0X city of LA QUINTA ,AND FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, EDDY G. NICHOLSON and LINDA B. NICHOLSON, Husband and Wife hereby GRANT(s) to RICHARD J. McCORMICK and PATTI LYNN McCORMICK, Husband and Wife as Joint Tenants the following described real property in the City of LA QUINTA County Of RIVERSIDE , State of California: LOT 9 IN BLOCK 10, DESERT CLUB TRACT, UNIT #1, AS PER MAP RECORDED IN BOOK 19, PAGE 75 OF MAPS IN THE OFFICE OF THE COUNTY RECORDER OF RIVERSIDE COUNTY, CALIFORNIA. Dated May 1, 1992 STATE OF CALIFOR}R� COUNTY��//-..// OFC(�LIQ� SS. On this � day of in the year 19 before me, the undersil a N ry Public in and for said State, personal) p"Depared personally known to me (or proved to me on the basis of satisfactory evidence) to be the person C, whose name,-, subscribed to the within instrument, and acknowledged to me that A� executed it. WITNESS my hand and official seal. Signature NOTARY ELIC IN AND FOR SAID STATE CO -441 (REV 4/85) by, • • ►, /. ._. • L S •V OFFICIAL NOTARY SEAL -� • ` CAROL J. SCOVILLE 'moi a Notary Public — California RIVERSIDE COUNTY My Cumm. Expires JUL 15,1994 MAIL TAX STATEMENTS AS DIRECTED ABOVE. (This area for official notarial seal) > .y ..., rK.,, ... •.....�r�w.,.�s+.'iprr =.: .: [�•,. +•`« s�".+•. ,oS-;.•.�.T.-'f:�mr.. ti, „ .•nw r. r..•w... .. �.: t • •Is r COUNTY OF, 'RIVE E HEALTH SERVICES AGENCY Assessors Parcel No. DEPARTMENT OF ENVIRONMENTAL HEALTH 741 — lal — 00 9 PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM Applicant: Submit this form with four copies of a SCALED plot plan (1-20 SCALE) drawn to County speculations as indicated on the attached check list. A non-refundable filing fee''(see b'el'ow) is required when the application is submitted. Check must be made payable to the County of Riverside. ,Approval 9f this application shall remain valid for a period not to exceed one year from date of approval. LOG # VERIFY ITEMS IN SECTION A FROM A NON -FEE BUILDING & SAFETY (goldenrod) APPLICATION Agent, Cont Q Contact Person Phone Address City State Zip '`&'*'A M� �5 uci r'o,1 q sGy- y8'aZ ?00-Ao/ 366 1A Qw,,Wr4 64. ad 5r3 OwnerPhone � INCI (64,,I k . Address City State Zip /If Vf- X41A d 1 0 e1 (osr A'5_A C4. 9a Job Property. Address City 78-09 eAttE FS1AN t o 0u// i"y State ' �,a. Zip 9aar> Legal Descriptiorop. (PM, Tract, Lot Lor n 9 /lcac/Z /0 1"Esrar (4 r(/ 7 Lot Size aterAgenc ,)) Use of Permit PIP, CU, etc, Other r/��•r / 50 / X 100 «t`'ca URccEv Foo, �Ac.r c r'rV (�1 S �j Q / r/Z r'CT a11it311irtg THAI tSite:P.r@pTetca Signature of Applicant Date CATEGORY REV CODE FEE CATEGORY REV CODE FEE ❑ SUBSURFACE DISPOSAL (per system) 1238 $153.00 ❑ SITE EVALUATION UPON REQUEST 7349 $120.00 ❑ MULTIPLE PARCELS WITHIN SAME LAND DIVISION (NO PLOT PLAN) , C9' SEWER/SEPTIC VEFjF�C�ATION (�'. t�• GV D. 7348 L$i58!4 a. 1 st 4 Parcels (Each) 1238 $153.00 w 6 �. n , a }✓t _ ' o!L ❑ PRELIMINARY ELECTIVE EVALUATION b. Each Parcel after 4 7344 $ 55.00 (Attach DOH -SAN -53) 7352 $ 69.00 ❑ REREVIEW (2nd review same parcel) 7344'-- $ 55.00 ❑ HOLDING TANK 7351 $119.00 ❑ SITE EVALUATION in Conjuction with Critical Area6 $197.00 ❑ ALTERNATIVE EXPERIMENTAL SYSTEM 7345 $656.00 ❑GRADING PLAN REVIEW DETAILED 1238 $104.00 ❑ SITE EVALUATION Lot Less than 10,0005q:-Ft:a-«•" 7347 $172.00 ❑ GRADING PLAN REVIEW CURSORY 1238 $ 55.00 ❑ SECOND FIELD VISIT (SITE EVALUATION) 7346 $ 85.00 ❑ COPIES (LAND USE) 7786-81 $ .50 INITIAL DATE Holding Tank Agreements Completed ❑ Yes /No/ ! 16 2 - 9c ' Certification of Existing S.D. System Required ❑ Yes (2 WOCB Clearance Required ❑Yes No (Attach Form DOH SAN 007, Santa Ana Region Only) Z66 Soils Percolation Report Required ❑ Yes Special Feasibility Boring Report Required ❑ Yes Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes 210 Grading Handout Provided ❑ Yes Staff Specialist Lot Inspection Required ❑ YesN Maintenance Booklet Provided ❑ Yes VNo Lot Inspection Date Initials C/42 [Soils Percolaticn-8o'nng-RepeFt by "�"�Eic/ roject # Date �--� Soils Map Page Soil Type Ap roved By - `'��-, Date 9 N . of Systems Type of System(s) ❑ Hol'din nk ❑Replacement ❑ New Addition No - _. Ing s 9drootttsr�Fixture�Units Edr 6: Nodi (1j,Septic Tank oil Rate Greasafaamf. GreaselntcPlltfSl`ii�p> . ❑ Existing e•+/� �•� u _ �u foal. % SD Gal. f nrlirf: /rR ri,e,x . ,,Sq :, -'Et- {,,, Total. Linear Sidewall Allowance Leach Bed sq. ft. ttom Area Ai t r . FrocW _ t sq. ft. per running ft. Inlet Tested Depth ❑ NA Install Lines) ft. long ft. wide with min. chemo s rock below drainlines or Of Bottom Area Proposed Bottom Testad Depth Le hlines/bed s ecial deli n for slope: aE p 9 Applicable Q ( Pit Diameter ❑ 5 6 o. Pits ~ Pit Below Inlet t+ (BI) - eepage Pit Total Depth (TD) Ot1, Max. All owabl De th e4^°�.� N / A e Factor Well Review Approved: Signature A11A Date Well Drilling Permit # Grading Plan Approved: Signature /✓ A Date REMARKS: / �'. .tea G?�l/� 7TH cel' �cr �6 l' X� idi�- d4/1 Id se�/Wiz. � This application is Af PROVED/; . k1ZE)=for the category checked in SECTION B above, regarding the design of a awl sid, acm'R_ sposal-system as indicated oR,the accompanie plot plan, using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the above -designed system. Na-mras1Fmcfina is pec. *** can-arsa- -•(4)•--SepNe-teak-mast-be•da�inimumfrorp.awy..waUs , (2)---•°L-each-fines-nwst-be-4GG4- riwir"m4fom aay wet a.area •(3)-t;—Seepage-pits-mtist-beJ50...miaimum. fwm:an.y w.elLe,4, tcluding expansiort.acea y SEu�.r_R GINE �Gr�r.n/.- vva A'OfTt�f Sc;rl /�/� A.fJy 6{/EC[.f N. /"v--cIY' irk" ri r'CC,C„f y ei.7 hrX rrn: i. / it.•., Et/-t.r`:� ��rv. S-- ��1Gn Signature of Health Official { (ivr�ri 7k�-/i��a�v� ,,+` r� �i� Date��?/Na AQFTF�Av �7 4cr tA.1 A■ 'A r2 ti. ""at- rA ❑ CASH rCHECK NO.f RECEIPT NO. a �-! r� Issued By 44y Date 7 - DISTRICT DISTRICT ❑ Riverside .Indio ❑,• Hemet ❑ Perris ❑ Rancho Calif. ❑ Blythe DOH-SAN-122(Rev1/92) DISTRIBUTION: WHITE—Office file ' YELLOW—Applicant PINK—Bldg. Dept. GOLDENROD—Plans/Records 4J >, X I M I M >, C (D 0 - C U C a) fu 4 14 im 4 (1) 0) 4J It E 3 U CL THE KNOX COMPANY'. 846 PRODUCTION PLACE - NEWPORT BEACH, CA 92663 - (714) 650-2885 V-4 E L W CL.0 c 0 w4J W 14 (13 4J I'd L .9-9499 INVOICE NO. L 111 W L a 11.11 M ML001111 h ii L L- C 0 L L CL -A 4- '113 X —7, —U— L 0 MODEL COLOR 320 0 DKD R 0 N Z E. 14 7. 000 147. 0 0 4J M -w u • in q I 1. 39 0 0. 111 Cn K C 0) 1,, .13 "'.5 r? `5 LA Invoice Date %. FEDERAL I.D. #95.3617858 1w ler No. I (" L 4J SOLD TO: ONTCHOVYIS F-11ZA.R.F.r) (.)I'f' -. VII MCCORNICK 78-1-10 CI 1: 'S T () 1) 0 LO QUINTA, Cr -1 92253 SHIP TO: i a Q� PINTCH01I PIZZERI'n- V1 C C0 R III I C K PTTN 111 (4 C 1845 ANAHE-IM 9--f-I (10(31'() rIE-sr-1, cf) 1 -11.1.-••531."OUt - - S - 0.1. .-- 4:1.4 RIVERSIDE: COU -!TY FIRE DEPT CODESDEPT RIVE -+ . . Date hipp d Salesman Termsbd-Zone TSWh h ii L L- C 0 L L F.O.B. NEWPORT 14EAC't-1 Quantity Description ... Unit Price Amount L C M W MODEL COLOR 320 0 DKD R 0 N Z E. 14 7. 000 147. 0 0 4J M U E� 01" L.. w 147. 00 • T X I 1. 39 0 0. 111 Cn 1 115 8 11 3 9 1,, .13 "'.5 r? `5 EJ 0 CUSTOMER F-103 REV. 1/86 CC 0 M ( C "o in C r - (0 .,q L C M W 0 111 -H U 4J M H 0 0. 111 Cn 1,, .13 (b. C 0 M ( C R90 CUSTOM DESIGNED OVEN FOR PIZZA, BAKED GOODS, AND PREPARED DISHES. OVENS Vertical Sliding Door(s), for loading and unloading Easy Access Rotating Shelves Built -In Ventilation Easy Installation Air Curtain Across Door(s) High Volume Back-up System Lighted. Interior Even Baking NSF C CAPACITY CHART SIZE A 8 C D E F 36" 52" 52" 76" 87" 26" 24" 48" 641/4" 641/4" 76" 8i" 26" 27" 56" 731/4" 731/4" 76" 87" 26" 27" SHELF SIZE NO. OF Shelves 8 10' PIE PANS 12" 14' 16" 18" WIDTH BTWN Shelves 36 3 24 28 15 12 9 — 81/2 36 4 32 24 20 16 12 — 71/7 48 3 78 48 27 21 15 12 81/2 48 4 104 64 36 28 20 16 71/2 56 3 114 66 48 30 21 18 81/2 56 4 152 88 64 40 1 28 24 71/, 135 E. CevaUos, San Antonio, Texas 78204 512/222-2278 Oven Specifications Gas Fired Maximum 250,000 BTU/HR, Natural or LP Electrical 120 Volts 60 Hertz Single Phase 20 Amps `�`%%noq,I o ! c{,s 4, ? Exhaust Vent 12';16" or 20" Depending on number of doorsCI ,'sj =4440 'fl��fRT:T1�OSo Exhaust Fan 1500 cfm per door Make Up Air 1500 cfm per door MN,148 M N156 MMB56 135 E. CevaUos, San Antonio, Texas 78204 512/222-2278 rFtOTATINC�OVEN • LEAST EXPENSIVE 135 E. Cevallos, San Antonio, Texas 78204 5121222-2278 �. ". sox 154 76105 CALLE ESTADO LA OUINTA. CALIFORNIA $2253 Contractor i9':f-/fes% Owner `i/r�� G ✓%'ter `C� off! Address Job Address `%k^/i O L La Quinta City License No.: Expires: Bldg. permit No.: This form shall be posted on the job with the Building Inspection Card and it shall be the duty of the General Contractor or if Owner -Builder Permit, the owner to see that all sub -contractors sign this card, giving his City of La Quints Business License Number, Contractors License Number and a current certificate of Workman's Compensation Insurance Certificate when he starts the job. Failure to comply may cause Building Inspectors to stop work, or complaints to be filed against such contractors or owners. CITY CONT. SUB -CONTRACTORS NAME LIC. NO. EXPIRES LIC. NO. EXPIRE: 1. Grade 6 Excavate C% 2. Pipelines GVW -3. Cement -Foundations c e 4. Cement Walks i Drives /11 5- Asphalt Paving '-�` 6. Framing AA A4 -1.P; 7•. Steel Structural --�— S. Masonry 9. ll. L2. 13. 14. L5. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 26. Plumbing Lathing Drywall Plastering HVAC Electrical - C-Le,G ( Roofing An~ v Sheet Metal% Floors -All Types Glass - Glazing Insulation/weatherstrip Sewage Disposal Painting/Decorating 0 "' Tile &f Ak Cabinets -Installations Ornamental Metal Fences/Blockwalls, -$,— Landscaping ,(uoff Others MA DO NOT RI M VE THIS CARD Before Final Building Inspection will Be Made I`.�w...�•j�yA enA @:I'A t,7i ♦►, T:�l.- �C_ Contractor_ Address Ed Of P.O. sox 1504 491�18 76105 CALLE ESTADO 1 LA OUINTA. CALIFORNIA 92253 - -- Owner %%�� G Job Address La Quinta City License No.: Expires: Bldg. Permit No.: This form shall be posted on the job with the Building Inspection Card and it shall be the duty of the General Contractor or if Ovner-Builder permit, the owner to see that all sub -contractors sign this card, giving his City of La Quinta Business License Number, Contractors License Number and a current certificate of Workman's Compensation Insurance Certificate when he starts the job. ,Failure to comply may cause Building Inspectors to stop work, or complaints to be filed against such contractors or owners. CITY CONT. SUB -CONTRACTORS NAME LIC. NO. EXPIRES LIC. NO. EXPIRES (r� ' 1 • Grade i Excavate 2. Pipelines V 64 3. Cement -Foundations _ 4. Cement Walks i Drives 5. Asphalt Paving If 6. Framing 7. Steel Structural _ S. Masonry l:? 9. Plumbing nCCL� -� 10.' Lathing Drywall '252 %% -P' 12. PlasteringPooL� ��}} ' t 3 • HVAC Electrical PpU� 15. Roofing ,}7G�/�S o, ��rl S3 O pf 6 s -� 16. Sheet Metal ! cry f'S �iJyo 8 17. Floors -All Types 3 16. Glass - Glazing •d' M 19• Insulation/weatherstrips RD 413 20. Sewage Disposal 21. Paintin corating 01.11& 22. Tile P(i!D� r -� 23. Cabinets-Ipstallations QL4)A e c-d%idM 24 . 19 et a J t�� - 3 D 25. Fences/Blockwalls 26. 27. Landscapin Others ST[[(� GIA/• 2s. -- % F(,V IW C�-1e&,TV _ p�oe r I NOT RFMOVB THIS CARD efore Final Building Inspection Will Be Made This Form Must Be Completed and Filed With Title 24 Calcs and Plans VT?- TAKE OUT PIZZA Vja-je- + Ve-Nf Scke...ije_ Is se,o elf - ol 0, 10 TA -K -.E - ----- OUT P.T.ZZ A T k4' (TAtl 1 1� 47 C:Y,' VI IA VA J- c 4 40 Gas Service- Vs TITLE 24 REPORT FOR: TAKE-OUT PIZZA CALLE ESTADO LA OUINTA• CALIFORNIA PRO•_=S-T DESIGNER': �. _11:x, -_:, REPORT PREPARED BY. HN H 11AC310ER CIVIL ENGINEER 4501 E SUNNY L U= S=0LiSUITE `-ii � 1 1 PALM SPRINGS CALIF ' 2264 (619),327-4565 9 Job Number: Date: 6i23!1992 The COMPLY .._tet CoiiiGt_lter program hc1_ been used to perform the calculations _.ttffitTarized in this Compliance report. This program has interim approval and is authorized by the California Energy Commission for use with the Second Generation Nonresidential Building Energy Efficiency Standards for Nonresidential Occupancies. Second Generation Residential Occupancies shown to comply with this program conform to the results produced by the Public omain Point System, developed by thE.California Energy Commission. This program developed by Saba! Dodd Associates (:__.. 429-0803. Table Of Contents for Title 24 Report --------------------------------- ---- Cover Page.......................................................... i Tableof Contents ................................................... Farm CF -1B Certificate .:f Compliances Nonresidential ................ S Form MF -1 Mandatary Measures Checklist .............................. E Farm WS -1A Energy Budgets Worksheet ......... . ........ e .... a ........ S Form CF -5A Allowed Lighting Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Farm SCM Performance Run .......................................... 11 Form CF -4 HVAC Summary .............................................. 14 Farm WS -4 HVAC System Summary Sheets................4................ 15 Farm CF Allc-wedlfLighting Summary .................................. 16 HVAC Zone & Space Leads Summary ..................................... 17 TA CE BI IEI�FTE_QF_CO!'1FLIANCE :part i cf G:�---CF_1B page G of 10 Project: TAKE-OUT PIZZA 1 COMPLY 24 v 3.10 ------------------ Designer: Building Permit No ------------------ Location: India Date: 6/3/1992------------------ � Check:ed By Documentation: JOHN H HACKER CIVIL ENGINEER Date (User # 2655) --------------------------------------------------------------------------- PRINCIPAL DESIGNER. The proposed building will be in substantial compliance with the California Building Energy Efficiency Standards provided it is built according to the plans and specifications and provided future improvements are completed according to the requirements indicated on this Certificate of Compliance. The plans and specifications have been prepared to include all significant energy conservation features required for compliance with the Standards. Building areas that are unconditioned and/or not subject to the standards are indicated on the plans. Plans Dated:- --------------------- Specs Dated: Signature: Daze: (O ^�1�Z Cal. License No: -1 c,I------- OWNER. The energy conservation features and performance specifications indicated on this 1document and on the plans and specifica,tiops shall apply Ilt�_;re alteYatl•��ndemonstratedt�� - f_ ' unless compliance is demonstrated anew and a new Certificate of Compliance is submitted. A copy of this Certificate will be retained and transmitted to future tenants, subsequent owners or others with responsibility for making improvements or modifications to the building. If this certificate is last, a new Certificate may be required before a per it is issued for alterations. Unconditioned areas are indicated on thie plans and, if these areas are conditioned in the future, they must be made to comply with the applicable energy standards then in effect. r Sianat�;re: ��ate: ENFORCEMENT AGENCY. The proposed building, and future alterations -will comply with the California Building Energy Efficiency Standards, provided future alterations meet the requirements indicated on this Certificate and all applicable mandatary measures, as long as the building occupancy type remains unchanged. Signature: Date: -------------------------------------------------------- Name: Agency" d n r,� �YeSS: ------------------------------------------------------------------- CERTIFICATE OF COMPLIANCE (part 2 of 3)CF-IB age 4 of 18 ------ Project: TAKE-OUT PIZZA 1 COMPLY 24 v 3.10 _ ------------- Designer: Building Permit No ------------------ Location: Indio Date: 6/23/1992 1C�PecF=:ed By Documentation: JOHN! H HACKER CIVIL ENGINEER � Date fuser # X655) --------------------------------------------------------------------------- ENERGY ANALYST. The energy performance analysis summarized below was performed using an approved CEC calculation method, with CEC approved fixed and restricted engineering inputs for the applicable climate zone and occupancy type, and using a reasonable representation of building zoning and physical configuration. All significant energy conservation features are list becaw, or on an attached supplement. S i a na. t ++. r • ---- - -- --------------------------- JOHN JOHNI H HACKER CIVIL ENGINEER Job 4501 E SUNNY DUNES RD SUITE D PALM SPRINGS CALIF 92264 (619) 327-: 565 GENERAL REFERENCE CF -4 8.50 1 Unconditioned or Multi. -tenant Shell? CF -4 0.79 CF -4 58460 CEC Occupancy Type h.!, Restaurant 3 UBC Occupancy Group/Division ---- _ 4 Climate Zane IdJS-1A 15 O Conditioned Floor Area WS -1A 1500 soft 6 Unconditic ped Floor Area .0 sqft 7 Budget Table '(from Standards) 1988 ed. Sec 2-53 8 Allowed Energy Budget WS -1A 280.0 9 Calculation Method CEC Code/Date CPO=til 6/23/1988 10 Multiplier CEC 1.027 11 Calculated Energy Use WS -1A 169.6 k:Btu/sgft-yr ENVELOPE REQUIREMENT`= 12 Average Roof/Ceiling Rt CF -2 20.44 h-F-sqft/Btu 13 Average Exterior Floor Rt CF -2 0.00 h-F-sgft/Bt+_( 14 Average Opaque }Wall Rt CF-? 9.83 h-F-sgft/Btu 15 Glazing Area in !Mall CF -2 104 sqft 16 Average SC (Glazing in Wall) CF -2 0.77 17 Glazing Area in Roof CF -2 0 sqft 18 Average SC (Glazing in Roof) CF -2 C}•C)C) LIGHTING REQUIREMENTS 19 Whole Building Allowed Adjusted LPD 22 Package Lighting Reduction 23Lighting Controls Required? MECHANICAL REQUIREMENTS 24 System Type 25 Fare Wattage Indy' 26 Rated Cooling Efficiency 27 Rated Cooling Capacity 28 Rated Heating Efficiency 9 Rated Heating Capacity Cooling?30 Enonomizor 1 CF -?X f d _ _ c .. . _ _ - CF -5 2.000 WS -1A 0.000 CF -5 No ---------------- CF 0.630 CF -4 8.50 CF -4 )C l 60000 CF -4 0.79 CF -4 58460 CF -4 h.!, watts/sqft watts/sqft watts/sqft (EER) Btu/hr (SSE/COP) Btu/hr CERTIFICATE OF COMPLIANCE (part G of G)CF-1B page 5 of 18 Project. TAKE-OUT PIZZA � MPLY 24 v 3.10 ____ _________- DesignYr: Building_ Permit No --------- Lccaticn� Irfdi Date. 6/' 3/:'49 Chfeck:ed By ------------- Documentation: JOHN H HACk::ER CIVIL ENGINEER Date (User # 2b55) --------------------------------------------------------------------------- Nate. More than one Part 3 may be submitted, but all must reference the same Parts 1 & 2. The person responsible for preparing the compliance documerftaticz,n for each major building system 8ci::nowledges the foiiowinq compliance stater?ent by signing the appropriate space belch'. Compliance Statement. The proposed bi_iildinq irfiprovements substantially comply with the requirements indicated cin the Certificate of Compl i a n c e for thfis building,dated---_____. The pians. and specifications _ - �ec�ficati��n� include the significant energy conservation features. and the compliance d-Dcumentati in is consistent with thfe plans and specific_.i ions ENVELOPE 1 Average Rc- ,f/ Ceiling Rt Average Exterior Floor C Average Opa,;f_?e Wall Rt 4 Glaring Area in gall 5 Averace SC (Wall) E Gla z i rfc Area , in Roof 7 Average SC (no4f:? Other Requi r emeniits•: M de1e: smprcivcf-,t -------------------------- C?.44 Plans Dc` -ed--____-- Specs Dated Rt;, f - ?i? 9. SC Si QnRt—u e Date ----------------- 104 Name 0.77 Company Company . .------------------------------- C) Addre,= . i?. City/St.ate/Zip----------- -------------- Telephone ---- License ----------------- Enforcement Agency_ -------------------- LIGH-TNG Modeled 8 Basis. of Alllc.wed LPD Performance 9 Pack: A _,r WS -5C LPD 2.00(--) 10 Pack -age Lightinq Red. 0. 11 Allowed Adjusted LPD(CF-5) 22. (-)t?t? 1' Lighftinq Control Credits':' N • Other Requirements - Improvement -------------------------- Plans Dated-------- Specs Dated Sicnature Date Name Company ------------------------------- Address -----7-------------------------- C i ty /Mate / Z i G.'------------------------ TeleDhone Livens= --------------------- Er,forcement Agency MECHANICAL ModeIed Improvements -------------------------- 13' Fan Wattage Inde•: 0. FSC? Plans Dated-------- Specs Dated ------ 14 Rated Cc Zing, Efficiency 8. 5(? 15 -ted Cooling Capacity 1. S1gni'.(f.11-i a D,, ------- 1 6 16 Rated Heat-1ng - Efficiency 7':-j ---------------------------------- 17 Rate, Heating, Output - 5?=4*-() L:cMQC--..ny------------------------------- 18 Economizer- Co .'_ino-: Nr, Addr es: 19 Sim_;_ ,ane of_,_-. Heat /C,,-_,i No Ci t y/State/Zip------------------------- e, T�'�_,n Lice ---------------_-------- ,MANDA.TORY MEASURES CHECKLIST (part 1 of 2) MF -1 page E of 15 2 -------------------------------------------------------------------------- Project; TAKE-OUT PIZZA ; COMPLY 2? v 3.10 , ----------------- Designer: Building Permit No , Location: Indic, Datee 6/23/199 ; C�,ecL::ed Ey ------------------ D,_,cumentati� ono JOHN H HACKER CIVIL ENGINEER Date (User # 2655 ) ---------------------------------------------------------------------------- ENVELOPE MEASURES Reference o Certified insulation Materials Ger Sec. V -5311(a) --------- +_+ insulation installed to meet Flame Spread and Smoke Density Requirements of Sec. 2-5311(b) _+ Urea Formaldehyde Foam insulation Installed per Sec. �-5311(c)--------- o RetrofitInsulation -specifiEd per Sec. 2-5313 o Air infiltration is minimized by specification of tested manufactured door_ and windows and proper sealing_ and weatherstripping per Sec. 2-5317 --------- LIGHTING SYSTEM MEASURES o Certified Luminaires/Ballasts per Sec. 2-5314(b) --------- o Independent CAI-) r+_+l within enclosed Areas per Sec. 5119(a) --------- o Manual Sw1tCi,1nC( Readily Accessible per Sec. 2"5319(b) o Reduction of Lighting Load to at least 50% per Sec. 2-5319(c) (Occupancy Sensors or Programmable 'rimers meeting CEC Criteria may Substitute) o Separate Switching of Daylit Areas per Sec. -5319(d) ___------ ,_, Separate Switching of Display and Valance Lighting in Retail/Wholesale Occupancies per Sec 2-5319(h) o Automatic Control of Display Lighting in Retail/Wholesale Occupancies per Sec. -5319(h) o Tandem Wiring _f i and - Lamp Luminaires per Sec. 2-5319(h) ) DAYLTGHTiJG AND LUMEN MAINTENANCE OO;TR_LS (when appReferencei cable) o Uniform Illumination reduction to 500 per Sec. 2-501S(e).1 ------ o Flicker Free Operation and no Premature Lamp Failure per Sec. 2-5319(e). o Time Delays to 'Pre veMt Undesirable Cycling per Sec. 5319(().3 --'------. 'MANDATORY MEASURES CHECKLIST (part 2 of 2) MF -1 page 7 of 18 --------------------------------------------------------------------------- Project: TAKE-OUT PIZZA :"COMPLY 24 v 3.10 ------------------ Designer: Building Permit No : Location: Indict Date: E/23/1992 i GI!ecl::ed E+ Documentation; JOHN H HACKER CIVIL ENGINEER Date (User 55) --------------------------------------------------------------------------- o Step Switching Devices with Separation between On/Off Settings perSec. 2-5319(e).4 o Photocell Sensors with a Diffusing Cover and no Oucique .Co ver per Sec. 2-5319(e).5 o Manufacturer's instructions provided for installation and Calibration per Sec. 2-5319(e).E, o Proper Installation -of Controls including Sensor Location, Certification of Initial Calibration and Control of Luminaires only within Daylit Areas per Sec. 2 -5319(e).6 --------- o Visible or Audible Malfunction Alarm provided per Sec. 2-5319(g) OCCUPANCY SENSING DEVICES (when applicable) is o 1 i c : � 53 Visible _r Audible Malfunction Alarms per Sec. .�-L��1'J(g) . I_ o Limits � �n Emi•I ions per exceptions t� � Sec. 2-5319(e), HVAC AND PLUMBING SYSTEM MEASURES o Piping Insulated as per Sec. 2-531' o Certified HVAC Equipment per Sec. -5314(a) o Certified Plumbing Equipment per Sec. 2-5314(a) o Heating and Cooling Equipment efficiency per Sec. 2-5314(b) is Pilotless ignition n of Gas Appliances per Sec. 2-5314(c) cAutomatic Controls for Off -Hours per Sec. 2-5315(a) o Thermostat Set Point Requirements per Sec. 2-5315(b).1 --------- 2-5315(b).2 •i O Sequential Control of Heating and Cooling per Sec. o Automatic Exhaust Fan Dampers per Sec. 2-5316(b) o Thermostat Controls for Each Zane per Sec. 2-5315(b) o Ventilation Pr=ovided per Secs. 5316 & 2-5343 o Ventilation and Recirculation Air Quality Infc, per 1403t:b?.3--------- o s,_.1tFY Heaters 'Y:_:r ilofr!est1C Hot Water ct:;:._ Pools per Sec. 2-53 --------. ENERGY BUDGETS WORKSHEET (part 1 of 2) WS -1A page 8 of 18 --------------------------------------------------------------------------- Project: TAKE-OUT PIZZA COMPLY 24 v 3.10 ------------------ Designer: i Building Permit No Location: India Date: 6/23/1992 Checked -By -7 ------------------ Documentation: JOHN H HACKER CIUI L 'ENGINEER f Date (User # 2655) --------------------------------------------------------------------------- BUILDING ENERGY COMPLIANCE BUDGET BY FLOOR/OCCUPANCY Cond. Budget Adj. A 1 1 owd Perimeter (KBtu Allowd Pack A Energy Floor Energy Flr Occupancy (ft) Ratio /sgft) .LPD LPD Budget Area (MBtu) ---------------- ---- ----- ------ ------ ------ ------ ----- ------ i Restaurant 155 9.69 261 +(3.000 - 1.50)x 36= 280.0 x 1500 = 420 TOTALS 1500 420 BUILDING COMPLIANCE BUDGET 420 MBtu .! 1500 sgft = 280.0 KBtu/sgft 1 1' ENERGY BUDGETS WORKSHEET (part 2 of ) WS -1A page 9 of 18 --------------------------------------------------------------------------- Project: TAKE-OUT PIZZA :'COMPLY 24 v 3.10 ------------------- Designer: Building Permit No , ' ------------------ L,_,cation: Indic, Date: 6/23/1992 1 Checked By Dc,cumentation: JOHN H HACKER CIVIL ENGINEER f Date (User ## .2655) --------------------------------------------------------------------------- BUILDING ENERGY CONSUMPTION BY SPACE L__ Total SCM Energy Energy Floor Floor Estimate Use Space Name Area Mul.t Area CKBtu/sgft) (MBtu) ----------------------- ----- ---- ----- ----------- ------ RESTAURANT 1500 x 1 = 1500 .. 169.6 254.4 TOTALS 1500 254.4 BUILDING ENERGY CONSUMPTION 254.4 MBtu 1 1500 sgft = 169.6 KBtu/sgft L__ ALLOWED LIGHTING SUMMARY CF -5A page iD of 18 --------------------------------------------------------------------------- Pro.ject: TAKE-OUT PIZZA COMPLY 2? v 3.10 ------------------- Designer: ----------------=Designer: Building Permit No ------------------ Location: Indic, Date: 6/23/1992 Checked By Documentation: JOHN H HACKER CIVIL ENGINEER : Date (User # 2655) --------------------------------------------------------------------------- ALLOWED ADJUSTED LPD 1. Total Allowed Lighting Watts (from below) 3000 watts 2. Control Credit Watt=_. (WS -5A.) 0 watts 3. Adjusted Watts (line 1 - line 2) 3000 watts 4. Conditioned Floor Area. (from CF -1? 1500 sgft 5. Allowed Adjusted Lighting Power Density (line 3 / line 4) 2.()00 w/sgft ALLOWED LIGHTING POWER BY SPACE Total Allowed Floor Vert Horiz Floor Lighting Total Space Name Area ----- Mult Mult ---- ----- Area ----- (watts/sgft) Watts ---------------------- RESTAURANT 1500 x 1 x 1 = 1500 ------------ x 2.000 _ --------- 3000 TOTALS 1500 3000 .SCM INPUT DATA SUMMARY (part 1 of 2) SCM -1 page 11 of 18 --------------------------------------------------------------------------- Project: TAKE-OUT PIZZA COMPLY 24 v 3.10 ------------------ Designer: Building Permit No ------------------ Location: Indic, Date: 6/23/1992 Checked By Documentation: JOHN. H HACKER CIVIL ENGINEER Date (User # 2655) --------------------------------------------------------------------------- Space Name: RESTAURANT AREAS Exterior Wall 1456.0 sqft South Glazing 100.0 sqft North Glazing 4.0 sqft Door 20.0 sqft Roof 1500.0 0 sqf t Slab 1500.0 sqft Raised Floor 0.0 sqft Total Conditioned Floor 1500.0 sqft WINTER R -VALUES (including air" film resistances) ----------------- 7 ------- 7---------------------- Wal1 10.22 Window 1.54 Door 2.58 Roof 20.44 Skylight f " 0.00 Floor If1 6. 00 HVAC SYSTEM Number of Systems Heating Equipment Name Heating Equipment Type Rated Heating Efficiency Cooling Equipment Name Cooling Equipment Type Rated Coaling Efficiency Economizer Water Heating Equipment Type Rated Water Heating Efficiency Fan Power Rate Air Circulation c. GENERAL Heat Capacity of Exterior Wall Lighting Power Climate Zane I Day&Night 58OBV060074 Gas Fired 0.790 Day&Night 50OBV060074 Air Conditioner 0. 500 No Gas Fired 0.780 944 watts 160 CFM .86 .000 watts/sqft 15 SOM INPUT DATA SUMMARY (part 2 of ) SCM -1 page 12 of 18 --------------------------------------------------------------------------- Project: TAKE-OUT PIZZA ; COMPLY 24 v 3.10 ------------------ Designer: Building Permit No ------------------ Location: Indio Date: G/23!1992 Checked By ------------------ Documentation: JOHN H HACKER CIVIL ENGINEER Date (User # 655) --------------------------------------------------------------------------- OTHER PHYSICAL PARAMETERS ------------------------- W811 Absorptivity Door Absorptivity Roof Absorptivity Ceiling height SHADING COEFFICIENTS -------------------- South North OVERHANGS €< S I DEF I NS -------------------- South � North r r� Glass CEC SC WFMF o. SS o. 88 0.88 0.88 Exterior Shade SC Wi nt Summ 7 - Window Height Width G.0 G.0 5.0 6. 0 0.70 ) 0.70 0.70 i0.0 f t Overall SC Wi nt Summ 0.77 0.77 0.77 0.77 Overhang Height Depth 1.0 10.0 0.1 2.0 Side -Fin Distance Depth SCM -ANALYSIS PERFORMANCE RESULTS SCM-: page 13 of 18 ---------------------------------------------------------------------------- Proiect: TAKE-OUT PIZZA :.COMPLY 24 v 0.10 ------------------ Designer: Building Permit No ------------------ Loc_.tion: India Date: 6/23/1992 f Checked By ------------ Documentation: JOHN H HACKER CIVIL ENGINEER- Date CUser # 2655) ------------------------------------------------------------------------=----- Space Name: RESTAURANT BALANCE POINT TEMPERATURES AND DEGREE DAYS ------------------------------------------- -------------------------------------------- Daytime Niqhttime B T1 - 42.87 (Winter) BPT! - 3.43 Cooling BPT'._ = 47.96 (Summer) BPT2 = 70.05 BPT3 = 47.96 (Economizer) DPTS = 70.05 Lighting HDD = 0 (Heating) HDD = 2324 16.8 CUD = 10148 ( Cooling) CDD = 14' BUILDING --------------------------------- HEAT TRANSFER (Btu/hr-F) Building Envelope Heat Transfer Rate: Winter = 284.5 Summer - 283.3 Overall Heat Transfer Fatter ("K") : Winter- = 523.9 Summer = 503.8 ANNUAL LOADS (MBtus) Heating = 1.7 Cooling = 53.5 ANNUAL SITE ENERGY REO i I REMENTS (MBt us ) --------------------------------------- --------------------------------------- Site Heating = 2.3 Site Cooling = 26.1 Site Far, = 14.7 Site Lighting = 33.5 Site Receptacle = 8.4 Site Hct Water = 0.':_i ANNUAL SOURCE ENERGY USE ESTIMATE (KBtu/sgft) Source Heating = 1.6 Source Cooling = 52.1 Source ce Fan - 22.4 Total Space Conditioning Energy 83.0 r 1.027 = 85.3 Scarce Lighting = E7.0 Source Rer_eptacle = 16.8 Source Hot hater = 0.6 TOTAL ANNUAL SOURCE ENERGY USE ESTIMATE 169.6 KBtu/_elft HVAC 'EC! !I PMENT SUMMARY FORM CF --4 page 14 of 18 ---------------------------------------------------------------------------- Pro.jecte TAKE-OUT PIZZA COMPLY 24 v 3.10 i ------------------ Designer: _______________Designer° Building Permit No Location: Indic, Date: 6/3/1992 ; E011 04; By Documentation: JOHN H HACKER CIVIL ENGINEER 1 Date �:U=•er # �b55.� --------------------------------------------------------------------------- HVAC EQUIPMENT SUMMARY BY ZONE NoHeating Cooling. No HVAC Zane HVAC System (WS -4) Sys KBtu Eff KBtu Eff ----------------------------------------------- --- ---- ---- ---- ---- 1 RESTAURANT Day&Night. 59OBV060074 1 58 0.79 60 8050 Total_ 58 KBtu 60 KBtu FAN ENERGY N . Motor Drive Conv No. Fan 'HVAC System Sys BHP Eff. Eff. Fact Fans Watts ----------------------- --- ---- - ----- ----- ---- ---- ----- Day&Night 5BOBV060074 (Fan!) 1 x 1.00 / CO. 7S .. 1.003 746 x 1 = 944 Total 944 FAN WATTAGE INDEX 944 watts / 1500 sgft = 0.630 watts/sgft HVAC •SYSTEM SUMMARY SHEET WS -4 page 15 of 18 --------------------------------------------------------------------------- Pro ject: TAKE-OUT PIZZA 1 COMPLY 24 v 3.10 ------------------- Designer: ---- - 'Designer: Building Permit No ------------------ Locati� Win: India Date: 6/3/1992 Checked By Documentation: JOHN H HACKER CIVIL ENGINEER ; Date (User # X6557 --------------------------------------------------------------------------- HEATING Heating System Name: System Type: Output Capacity: Rated SSE or COP: Supply Air Temperature-. Day&Night 5B aBVt )60 X74 Gas Fired 58460 Btu/hr 0. 7911 105 F COOLING Cooling System Name: Day &Ni gh t 5BOBV060074 System Type: Aar Conditioner Total Output Capacity: 60000 Btu/hr Sensible Output Capacity: 44400 Btu/ hr Latent Output Capacity: 15600 Btu/hr Rated EER: 5.500 Coil Bypass Factor: 0.100 Economizer: 1 No Supply Air Telperat:_sre: 55 F FANS Supply Air CFM: Fan Type: Fan Multiplier: Brake Horsepower: Motor Efficiency: Drive Efficiency: DUCTS Supply Duct Heat Cain: Return Duct Heat Gain: Supply Duct Air Leakage: Return Duct Air Leakage: 160 cfm Blow -Through 1 . 1. 00 79.0 100.0 5.0 1.0 2.0 Y 2.0 7 ALLOWED LIGHTING SUMMARY CF -5A page 1E of 18 =-------------------------------------------------------------------------- Pro ecta TAKE --OUT PIZZA 1 COMPLY 24 v 5.10 , ------------------ Designer° Building Permit No ------------------ Location: Indic Date: 6/23/1?52 Checked By ------------------ Documentation; JOHN H HACKER CIVIL ENGINEER Date :User #k 2655? ------------------------------------------------------------------------- =- ALLOWED ADJUSTED LPD 1. Total Allowed Lighting Watts :from below: 3000 watts 2. Control Credit Watt= (WS -50 it watts S. Adjusted Watts cline 1 - line 2) 3000 watts 4. Conditioned Floor Area (from CF -1:) 1500 sgft 5. Allowed Adjusted Lighting Power Density :line C / line 4? '2.000 w/soft ALLOWED LIGHTING POWER BY SPACE Total Allowed Floor Vert Horiz Floor Lighting Total Space Name Area Mult tMult Area `watts/sgft) Watts ----------------------- ----- RESTAURANT 1500 ---- ----- x 1 x 1 = ----- 1500 x ------------ 2.000 )00 = --------- 3000 TOTALS 1500* 3000 .HVAC ZONE HEATING & COOLING LOAD SUMMARY page 17'of 18 --------------------------------------------------------------------------- Pro jecto TAKE-OUT PIZZA !'COMPLY '4 v 3.10 --- Designera Building Permit No ------------------ Location: Indio Date: 6/23/1992 i Checked By Documentation: JOHN H HACKER CIVIL ENGINEER Date t:User #�ES�.? --------------------------------------------------------------------------- HVAC ZONE DESCRIPTION! HVAC Zane Name: RESTAURANT Heating System Name; D:.y&N ght 5aOBV060074 Cooling System Name: Day&Night 58oBV0600 4 System Multiplier: I Heating Schedule: Retail Heating Cooling Schedule: Retail Cooling Fan Schedule. Retail Occupancy Peak: Load Method: COINCIDENT Relative HuITSidlty. 50 %v COOLING SPACES IN! THIS ZONE PEAR; ----------------------- ---- HEATING PEAK SENSIBLE LATENT ---- RESTAURANT ( Jan 1 1 am) ------- 1860' -------- ------ (Jul 4pm) 35126 9750 TTOTAL SPACE LOAD 18602 35138 9750 ' $tpa__ � „� a,.� �s A_r- �_ csm. 1 �.._,� csm. 7G� -i'�i Supply Duct .Condudlibn 930 1756 Supply Duct Leakage 372 703 195 Supply Fan Heat Gain _0 i? EFFECTIVE SPACE LOAD ------- 21257 -------- ------ 33290 9754 Ventilation t: 270 cfm) 13.77 18q cfm7 5338 -1731 Return Air Lighting Gain i? Return Duct Conduction 213 333 Return Duct Leakage 435 766 195 Return Far; Heat Gain -3223 3223 TOTAL SYSTEM LOAD 308413 48989 8228 4. 1 .tons 0.7 tons SYSTEM PERFORMANCE 53460 43563 11730 AT DESIGN CONDITIONS 3.6 tans .1.0 tens SPS\E HEATING & COOLING LOAD SUMMARY . page 18'of 18 :-------------------------------------------------------- ------------------ Pro)ect: TAKE-OUT PIZZA 1. :'COMPLY 24 v 2.10 Designer: E010051 -------- ------------------ Documentation: Indio . Date: 6/23/1992 : checked By Documentation: JOHN H HACKER CIVIL ENGINEER : Date (User k 2655) -------------------------------------------------------------------------- SUMMARY OF PEAK HOUR LOADS FOR SPACE Space Name: DESIGN CONDITIONS HEATING -------------------- ------- Peak Hoer: Jan 11am Indoor Conditions: 70 E OB Outdoor Conditions:- 29 F DB LOAD COMPONENT Btu/hr Wall Conduction 5839 Window Conduction 2772 boor Conduction 819 Roof Conduction 5009 Skylight Conduction 0 Floor Conduction 0 Slab Conductign, 6665 Interior gond(c#ioh 0 Infiltration 0 Solar Gain Lighting Equipment Occupants SPACE LOADS 18602 Btu/hr RESTAURANT COOLING SENSIBLE LATENT Jul 4pm 7S E DB 50 % RH 100 F DB 72 F WE Btu/hr 3291 1538 423 3632 0 . 0 0 0 2471 0005 5120 7650 85128 etd/hr 2.9 tons Btu/hr 0 0750 9750 Btu/hr 0.8 tons SUPPLY AIR QUANTITIES --------------------- Heating: 18602 Btu/hr / [1,10 * (105 F Supply - 70 F TStat)] = 483 cfm Cooling: 55128 Btu/hr Z [1.08 + ( 78 £ TStat - 55 R Supply)3 = 1414 £fm