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BCOM2015-001378-495 CALLE TAMPICO LA QUI TA, C LIFORNIA 92253 J c&ir 4 4Q" COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BCOM2015-0013 Property Address: 79680 HIGHWAY 111 STE 103 APN: 600030016 Application Description: DUNES BUSINESS PARKT.I. -PAGE INSUR. AGENCY Property Zoning: Application Valuation: $30,000.00 Applicant: MARVEST 42335 WASHINGTON STREET#F424 PALM DESERT, CA 92211 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class: License No.: /I Date: 2 '7`1'JContractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: U I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). ( 11, as owner of the property, am exclusively contracting with licensed contractors to construct the project. (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). (_) I am exempt under Sec. . B.&P.C. for this reason Date: 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 Na Lender's VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of thew or which this mit is issued. I will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier:- Policy Number: _ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the La ode, I hall forthwith comply with those provisions. i Date: Z lJ Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT: Application is hereby made to the Building Official for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application , the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above informs ' orrect. 1 agree to comply with all city and county ordinances and state laws ating to b ilding construction, and hereby authorize representatives of this city to nter u t e bove mentioned property for inspection purposes. Dater G•��JSignature (Applicant orAgent) Date: 4/27/2015 Owner: DUNES BUSINESS PARK -LLC P 0 BOX 1216 ria'I HERMOSA BEACH, CA 92253 Contractor: ==you MARVEST 42335 WASHINGTON STREET #F4 PALM DESERT, CA 92211 CII 7:-� I`•' 'c. LIC. No.: WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of thew or which this mit is issued. I will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier:- Policy Number: _ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the La ode, I hall forthwith comply with those provisions. i Date: Z lJ Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT: Application is hereby made to the Building Official for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application , the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above informs ' orrect. 1 agree to comply with all city and county ordinances and state laws ating to b ilding construction, and hereby authorize representatives of this city to nter u t e bove mentioned property for inspection purposes. Dater G•��JSignature (Applicant orAgent) l .• l• c. FINANCIAL :. DESCRIPTION 'ACCOUNT QTY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $2.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $2.00 $0.00 DESCRIPTION . ACCOUNT QTY AMOUNT PAID PAID DATE DEVICES, ADDITIONAL 101-0000-42403 0 $108.90 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DEVICES, ADDITIONAL PC 101-0000-42600 0 $27.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DEVICES, FIRST 20 101-0000-42403 0 $24.17 $0.00 . PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID, PAID DATE DEVICES, FIRST 20 PC 101-0000-42600 0 $24.17 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for ELECTRICAL: $184.24 $0.00 DESCRIPTION ACCOUNT QTY. AMOUNT PAID PAID DATE OTHER MECHANICAL EQUIPMENT 101-0000-42402 0 $72.52 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE OTHER MECHANICAL EQUIPMENT PC 101-0000-42600 0 $72.52 $0.00 PAID BY METHOD RECEIPT # CHECK # ' CLTD BY Total Paid forMECHANICAL: $145.04 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE REMODEL, EA ADDITIONAL 500 SF 101-0000-42400 0 $65.25 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE REMODEL, EA ADDITIONAL 500 SF PC 101-0000-42600 0 $52.20 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE REMODEL, FIRST 100 SF 101-0000-42400 0 $49.31 $0.00 PAID BY METHOD RECEIPT # - ,CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE' REMODEL, FIRST 500 SF PC 101-0000-42600 0 $134.88 $0.00 PAID BY METHOD RECEIPT # CHECK # . CLTD BY Total Paid for REMODEL: $301.64 $0.00 DESCRIPTION _ ACCOUNTQTY 'AMOUNT PAID PAID DATE SMI - COMMERCIAL 101-0000-20308 0 $8.40 $0.00 PAID BY METHOD RECEIPT #' CHECK # CLTD BY Total Paid forSTRONG MOTION INSTRUMENTATION SMI: $8.40 $0.00 TOTALS:•0 Description: DUNES BUSINESS PARK T.I. -PAGE INSUR. AGENCY Type: BUILDING, COMMERCIAL Subtype: REMODEL Status: APPROVED Applied: 3/23/2015 KHE Approved: 4/27/2015 BHA Parcel No: 600030016 Site Address: 79680 HIGHWAY 111 STE 103 LA QUINTA,CA 92253 Subdivision: PM 31143 Block: Lot: 4 Issued: Lot Scl Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $30,000.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 3/23/2015 Details: 1,570 SF OFFICE. T.I. FOR "PAGE INSURANCE AGENCY" SUITE 103. "B" OCCUPANCY 39 OCCUPANT LOAD. 2013 CODES. Applied to Approved Printed: Monday, April 27, 2015 2:39:09 PM 1 of 4 V?WsYSTEMS ADDITIONAL CHRONOLOGY CHRONOLOGY TYPE STAFF NAME. ACTION DATE COMPLETION DATE NOTES NOTE KAY HENSEL 3/23/2015 3/23/2015 APPLICATION SUBMITTED AT FRONT COUNTER ON 3/20/15. PROCESSED & SENT TO PLANNING BUCKET ON 3/23/15 PLAN CHECK PICKED UP JIM JOHNSON 4/3/2015 4/3/2015 MARTY MARTINOVICH PICKED UP P/C CORRECTIONS RESUBMITTAL PHILIP JUAREZ 4/9/2015 4/9/2015 PLANS RESUBMITTED MARTY MARTINOVICH 760-774-6495 PLANS SENT PLANNING BUCKETFOR CORRECTIONS TELEPHONE CALL BURT HANADA 4/27/2015 4/27/2015 INFORMED MARTY M. THAT PERMIT IS READY TO ISSUE, CONDITIONS NAME TYPE NAME ADDRESSI CONTACTS CITY STATE ZIP PHONE FAX EMAIL APPLICANT MARVEST — 42335 WASHINGTON STREET #F424 PALM DESERT CA 92211 Printed: Monday, April 27, 2015 2:39:09 PM 1 of 4 V?WsYSTEMS FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY AMOUNT PAID CONTACTS BY. BSAS SB1473 FEE 101-0000-20306 0 $2.00 $0.00 Total Paid forBUILDING STANDARDS ADMINISTRATION $2,00 $0.00 NAME TYPE NAME ADDRESSI CITY STATE ZIP PHONE FAX EMAIL CONTRACTOR MARVEST 42335 WASHINGTON STREET #F424 PALM DESERT CA 92211 $27.00 $0.00 OWNER DUNES BUSINESS PARK LLC P 0 BOX 1216 HERMOSA BEACH CA .92253 FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD BY. BSAS SB1473 FEE 101-0000-20306 0 $2.00 $0.00 Total Paid forBUILDING STANDARDS ADMINISTRATION $2,00 $0.00 BSA: DEVICES, ADDITIONAL 101-0000-42403 0 $108.90 $0.00 DEVICES, ADDITIONAL 101-0000-42600 0 $27.00 $0.00 PC DEVICES, FIRST 20 101-0000-42403 0. $24.17 $0.00 DEVICES, FIRST 20 PC 101-0000-42600 0 $24.17 $0.00 Total Paid for ELECTRICAL: $184.24 $0.00 OTHER MECHANICAL 101-0000-42402 0 $72.52 $0.00 EQUIPMENT OTHER MECHANICAL 101-0000-42600 0 $72.52 $0.00 EQUIPMENT PC Total Paid forMECHANICAL: $145.04 $0.00 REMODEL, EA 101-0000-42400 0 $65.25 $0.00 ADDITIONAL 500 SF REMODEL, EA 101-0000-42600 0 $52.20 $0.00 ADDITIONAL 500 SF PC REMODEL, FIRST 100 SF 101-0000-42400 0 $49.31 $0.00 Printed: Monday, April 27, 2015 2:39:09 PM 2 of 4 SYSTEMS DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD RETURNED STATUS REMARKS REVIEW TYPE REVIEWER BY REMODEL, FIRST 500 SF 101-0000-42600 0 $134.88 $0.00 DATE PC BURT 3/23/2015 4/3/2015 4/2/2015 REVISIONS REQUIRED NON-STRUCTURAL Total Paid for REMODEL: $301.64 $0.00 SMI -COMMERCIAL 101-0000-20308 0 $8.40 $0.00 HANADA Total Paid forSTRONG MOTION INSTRUMENTATION SMt $8.40 $0.00 TOTALS:.4i 00 ATTACHMENTS PARENT PROJECTS 79-680 HIGHWAY 111 DOC 4/2/2015 BURT HANADA STE 103 T.I.. 1st 79-680 HIGHWAY 111 1 STE 103 T.I..docx REVIEWS submittaldocx RETURNED STATUS REMARKS REVIEW TYPE REVIEWER SENT DATE DUE DATE NOTES DATE BURT 3/23/2015 4/3/2015 4/2/2015 REVISIONS REQUIRED NON-STRUCTURAL HANADA PLANNING JAY WUU 3/23/2015 4/3/2015 3/25/2015 REVISIONS REQUIRED CANNOT APPROVE WITHOUT KNOWING USE FIRE JACQUELINE 3/26/2015 4/9/2015 3/30/2015 APPROVED - GARCIA CONDITIONS BURT 4/9/2015 4/23/2015 4/27/2015 APPROVED NON-STRUCTURAL HANADA PLANNING JAY WUU 4/9/2015 I 4/23/2015 I 4/21/2015 READY FOR APPROVAL ATTACHMENTS Attachment Type CREATED OWNER DESCRIPTION PATHNAME SUBDIR ETRAKIT ENABLED 79-680 HIGHWAY 111 DOC 4/2/2015 BURT HANADA STE 103 T.I.. 1st 79-680 HIGHWAY 111 1 STE 103 T.I..docx submittaldocx Printed: Monday, April 27, 2015 2:39:09 PM 3 of 4 N? SYSTEh1S Printed: Monday, April 27, 2015 2:39:09 PM 4 of 4 SYSTEMS i B►n. # i� 0ty Of La Quin to • Bullding 8r Safety Dit+idort P.O. Box 1504,78-495 Calle Tatnplco 4.Quinta, U 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet PeriWt # Project Address: _ v ��✓ 3 owner's Name: . n1 t4 A. P. Number. Address: Legal Description: City, ST, Contractor. �¢ �G�/fSf Telephone: 3! 0 — — f0a Address: Z — 3 3 s' N,t j�vd S% Z Project Description: City, ST, Zip: Afl/t!a a--S rAl, LAY fs2 ? / — — � (.t._ Telephone:d6 . 6 � State Lic. #: CityLic N; Arch, Engr•. Designer.— Address: _6 O �/t�i✓6�a�aQ L.1.J G City, ST, Zip: ..0. G� .? Z' Telephone: State Lia Ce .oZ D peS Construction Type:. Oxu Project type (circle one): New Add'a Alter Repair Sq. FL: j" d # Stories: # Unitx Demo Name of Contact Person: 1 A & AlOxlel` Telephone # of Contact Person: .6 0 -- '� y � Estirnaw Value of Project 3 iS 4000 APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd ReNd TRACIMG PERMIT FEES Plan Sets Pian Check submitted �j. Item Amount Structural (ales. Reviewed, ready corrections t{ Plan Check Deposit. . Trus Cale$. Called Contact P Plan Check Balance Titre 24 Cates. Pians picked up Construction Flood plain plan Plans resubmitted.'. Mecharilcal Girndiag plan Z'! Review, ready for correctionslissue Electrical Subeontaetor List Called CoutactPerson Plumbing Grant Deed Plans #!eked up S.M L H.O.A. Approval Plans resabmtthd Gradlog IN HOUSE-, ''' Review; ready for eorrectionsfiasue Developer Impact Fee Planning APproval called contact Person A.LP.P. A • Pub. Wks. Appr School Fees Date of permit issue Total Permit Fees I- BUILDING ENERGY ANALYSIS REPORT I EC MAR ` ® 2015 ®�yM fti �QU"VrA P'�yix, PROJECT: CPMC REALTY 79-680 HWY 111 LA QUINTA, CA Project Designer: M BV ARCHITECT 71-670 SPRINGFIELD LANE # 7A PALM DESERT, CA 92211 760.200.5099 Report Prepared by: PAUL ALLEN SMITH Paul Allen Smith Title 24 Energy Consultant 1183 PALMAS RIDGE PALM SPRINGS, CA 92262 760.831.9879 Job Number: 316 Date: 3/17/2015 ,i CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTION DATE. 41 L ey mow► 2D I S -Od13 The EnergyPro computer program has been used to perform the calculations summarized in this compliance report. This program has approval and is authorized by the California Energy Commission for use with both the Residential and Nonresidential 2013 Building Energy Efficiency Standards. This program developed by EnergySoft, LLC — www.energysoft.com. EnergyPro 6.5 by EnergySoff User Number.- 8132 ID: 316 TABLE OF CONTENTS Cover Page Table of Contents Form LTI-01-E Indoor Lighting Form LTI-02-E Lighting Controls Form LTI-03-E Indoor Lighting Power Allowance V EnergyPro 6.5 by EnergySoft Job Number: ID: 316 User Number: 8132 1 2 3 8 11 STATE OF CALIFORNIA INDOOR LIGHTING CEC-NRCC-LTI-01-E (Revised 06/1 CERTIFICATE OF COMPLIANCE — USER INSTRUCTIONS NRCC-LTI-01-E Indoor Lighting (Page 1 of 5) Project Name: CPMC REALTY Date Prepared: 3/17/2015 Climate Zone: 15 Conditioned Floor Area: 1,570 YES NO FORM TITLE YES NRCC-LIT-01-E Certificate of Compliance. All Pages required on plans for all submittals. Unconditioned Floor Area : 0 Lighting Controls, Certificate of Compliance, and PAF Calculation. All Pages required on plans for all submittals. General Information Indoor Lighting Power Allowance NO NRCC-LIT-04-E Tailored Method Worksheets NO NRCC-LIT-05-E Line Voltage Track Lighting Worksheets Building Type: ❑ Schools ® Nonresidential ❑ Relocatable Public Schools ❑ 0 High -Rise Residential Conditioned Spaces ❑ ❑ Hotel/Motel Unconditioned Spaces Phase of Construction: ❑ New Construction ❑ Addition ® Alteration Method of Compliance: ❑ Complete Building 123 Area Category ❑ Tailored LIGHTING COMPLIANCE DOCUMENTS (select yes for each document included) For detailed instructions on the use of this and all Energy Efficiency Standards compliance documents, refer to the Nonresidential Manual published by the California Energy Commission. YES NO FORM TITLE YES NRCC-LIT-01-E Certificate of Compliance. All Pages required on plans for all submittals. YES NRCC-LIT-02-E Lighting Controls, Certificate of Compliance, and PAF Calculation. All Pages required on plans for all submittals. YES NRCC-LIT-03-E Indoor Lighting Power Allowance NO NRCC-LIT-04-E Tailored Method Worksheets NO NRCC-LIT-05-E Line Voltage Track Lighting Worksheets Summary of Allowed Lighting Power Conditioned and Unconditioned space Lighting must not be combined for compliance Indoor Lighting Power for Conditioned Spaces Indoor Lighting Power for Unconditioned Spaces Watts Watts Installed LightingInstalled Lighting 1,180 0 1. N RCC-LTI-01-E, page 4 + N RCC-LTI-01-E, page 4 + 2' PORTABLE ONLY FOR OFFICES + NRCC-LTI-01-E, page 3 3 Minus Lighting Control Credits 270 Minus Lighting Control Credits 0 NRCC-LTI-02-E, page 2 NRCC-LTI-02-E, page 2 4 Adjusted Installed Lighting Power _ 910 Adjusted Installed Lighting Power = 0 (row 1 plus row 2 minus row 3) (row 1 minus row 3) CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 STATE OF CALIFORNIA INDOOR LIGHTING CERTIFICATE OF COMPLIANCE — USER INSTRUCTIONS NRCC-LTI-01-E Indoor Lighting (Page 2 of S) Project Name: CPMC REALTY Date Prepared: 3/17/2015 S. . Complies ONLY if Installed <_ Allowed Complies ONLY if Installed <_ Allowed Form/Title 6. Allowed Lighting Power Conditioned NRCC-LTI-03-E, page 1 1,256 Allowed Lighting Power Unconditioned NRCC-LTI-03-E, page 1 0 Declaration of Required Installation Certificates — Declare by selecting yes for all Installation Certificates that will be submitted. (Retain copies and verify forms are completed and signed.) YES NO Form/Title NRCI-LTI-01-E - Must be submitted for all buildings ❑ Field Inspector NRCI-LTI-02-E - Must be submitted for a lighting control system, or for an Energy Management Control System (EMCS), to be recognized for compliance. ❑ Field Inspector NRCI-LTI-03-E - Must be submitted for a line -voltage track lighting integral current limiter, or for a supplementary overcurrent protection panel used to energize only line -voltage track lighting, to be recognized for compliance. ❑ Field Inspector NRCI-LTI-04-E - Must be submitted for two interlocked systems serving an auditorium, a convention center, a conference room, a multipurpose room, or a theater to be recognized for compliance. ❑ Field Inspector NRCI-LTI-05-E - Must be submitted for a Power Adjustment Factor (PAF) to be recognized for compliance. ❑ Field Inspector NRCI-LTI. 06-E - Must be submitted for additional wattage installed in a video conferencing studio to be recognized for compliance. ❑ Field Inspector Declaration of Required Certificates of Acceptance — Declare by checking all of the Certificates of Acceptance that will be submitted. (Retain copies and verify forms are . completed and signed.) YES NO Form/Title NRCA-LTI-02-A - Must be submitted for occupancy sensors and automatic time switch controls. ❑ Field Inspector NRCA-LTI-03-A - Must be submitted for automatic daylight controls. ❑ Field Inspector NRCA-LTI-04-A - Must be submitted for demand responsive lighting controls. ❑ Field Inspector CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 STATE OF CALIFORNIA INDOOR LIGHTING CEC-NRCC-LTI-01-E (Revised 06/ CERTIFICATE OF COMPLIANCE — USER INSTRUCTIONS NRCC-LTI-01-E Indoor Lighting (Page 3 of 5) Project Name: CPMC REALTY Date Prepared: 3/17/2015 A separate Lighting Schedule Must Be Filled Out for Conditioned and Unconditioned Spaces. Installed Lighting Power listed on this Lighting Schedule is only for: ® CONDITIONED SPACE ❑ UNCONDITIONED SPACE I A. INDOOR LIGHTING SCHEDULE and FIELD INSPECTION ENERGY CHECKLIST I ❑ The actual indoor lighting power listed on this page and on the next page includes all installed permanent and planned portable lighting systems. ❑ When Complete Building Method is used for compliance, list each different type of luminaire on separate lines. ❑ When Area Category Method or Tailored Method is used for compliance, list each different type of luminaire by each different function area on separate lines ❑ Also include track lighting in schedule, and submit the track lighting compliance form (NRCC-LTI-05-E) when line -voltage track lighting is installed. B. Installed Portable Luminaires in Offices — Exception to Section 140.6(a) ❑ This section shall be filled out ONLY for portable luminaires in offices (As defined in §100.1). All other planned portable luminaires shall be documented on next page of this compliance form. ❑ This section is used to determine if greater than 0.3 watts of portable lighting is planned for any office ❑ Fill out a separate line for each different office. Small offices that are typical (having the same general and portable lighting) may be grouped together. This allowance shall not be traded between offices having different lighting systems. Office Portable Luminaire Office Installed Portable Luminaire Watts Per Square • ' Office Location Field Schedule Foot Inspector A B C D E F G H I J Installed Z portable 0 Watts If F <_ 0.3, Identify Office area in which j, C luminaire - '^ Msquare per enter zero; E x G these portable luminaires are m Complete Luminaire Description T. rE watts in this o ; ii; installed _ (i.e., LED, under cabinet, furniture mounted Watts per `�° - office ; r° foot if F > 0.3, direct/indirect) Luminaire (B x C) (D / E) (F-0.3) ❑ 0. ❑ ❑ Enter sum total of all pages into NRCC- Total installed portable luminaire watts that are greater than 0.3 watts per square foot per office: LTI-01-E; Page 1 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 STATE OF CALIFORNIA INDOOR LIGHTING CEC-NRCC-LTI-01-E (Revised 06/ CALIFORNIA CERTIFICATE OF COMPLIANCE — USER INSTRUCTIONS NRCC-LTI-01-E Indoor Lighting (Page 4 of 5) Project Name: CPMC REALTY Date Prepared: 3/17/2015 A separate Lighting Schedule Must Be Filled Out for Conditioned and Unconditioned Spaces. Installed Lighting Power listed on this Lighting Schedule is only for: ❑ CONDITIONED SPACE ❑ UNCONDITIONED SPACE C. INDOOR LIGHTING SCHEDULE and FIELD INSPECTION ENERGY CHECKLIST Luminaire Schedule Installed Watts Location Field Inspector 1 A B C D E F G H How wattage was determined a o N Complete Luminaire Description r 3 n > 0 w rn o. c 3 z O1 N E (Le, 3 lamp fluorescent troffer, T. v 3 Za o o'o °1• 3 n x a " Primary Function area in which 2 F32T8, one dimmable electronic ballast) `�° m = R rD `� - °a' a these luminaires are installed Pass Fail TYPE A 12 Lamp 4 ft T8 Energy Saving Elec 54.0 ® ❑ 20 1,080 Comp Bldg Office [31 ❑ TYPE X EXIT/EMERGENCY 20.0 ® ❑ 5 100 Comp Bldg Office ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ a ❑ INSTALLED WATTS PAGE TOTAL: 1,180 Enter sum total of all pages into NRCC-LTI-01-E; Page 2 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 STATE OF CALIFORNIA INDOOR LIGHTING CEC-NRCC-LTI-01-E Revised 06/14 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE — USER INSTRUCTIONS NRCC-LTI-01-E Indoor Lighting (Page 5 of 5) Project Name: CPMC REALTY Date Prepared: 3/17/2015 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: PAUL ALLEN SMITH Documentation Author Signature: Company: Paul Allen Smith Title 24 Energy Consultant Signature Date: 3/17/2015 Address: 1183 PALMAS RIDGE CEA/ HERS Certification Identification (if applicable): City/State/Zip: PALM SPRINGS, CA 92262 Phone: 760.831.9879 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Compliance is true and correct. 2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer). 3. The energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations. 4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. 5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the ing, and made available to the enforcement agency for all applicable inspections. I understand that a completed signed copy of this Certificate of Compliance is required to be incl d with the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: MARK B. VALENTINO Responsible Designer Sign lire: Company: MBV ARCHITECT Date Signed: Address: 71-670 SPRINGFIELD LANE # 7A licenser city/state/Zip: PALM DESERT, CA 92211 Phone: 760.200.5099 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 STATE OF CALIFORNIA INDOOR LIGHTING — LIGHTING CONTROLS CEC-NRCC-LTI-02-E (Revised 06/14) CERTIFICATE OF COMPLIANCE NRCC-LTI-02-E` Indoor Lighting - Lighting Controls (Page 1 of 3) Project Name: CPMC REALTY Date Prepared: 3/17/2015 The NRCC-LTI-02-E shall be used to document all mandatory and prescriptive lighting controls that are applicable to the project. Mandatory Lighting Control Declaration Statements (Indicate if the measure applies by checking yes or no below.) YES NO Control Requirements Lighting shall be controlled by self-contained lighting control devices which are certified to the Energy Commission according to the Title 20 Appliance Efficiency Regulations in accordance with Section 110.9. Lighting shall be controlled by a lighting control a system or energy management control system in accordance with §110.9. An Installation Certificate shall be submitted in accordance with Section 130.4(b). One or more Track Lighting Integral Current Limiters shall be installed which have been certified to the Energy Commission in accordance with §110.9 and §130.0. Additionally, an Installation Certificate shall be submitted in accordance with Section 130.4(b). A Track Lighting Supplementary Overcurrent Protection Panel shall be installed in accordance with Section 110.9 and Section 130.0. Additionally, an Installation Certificate shall be installed in accordance with Section 130.4(b). All lighting controls and equipment shall comply with the applicable requirements in §110.9 and shall be installed in accordance with the manufacturer's instructions in accordance with Section 130.1. All luminaires shall be functionally controlled with manually switched ON and OFF lighting controls in accordance with Section 130.1(a). General lighting shall be separately controlled from all other lighting systems in an area. Floor and wall display, window display, case display, ornamental, and special effects lighting shall each be separately controlled on circuits that are 20 amps or less. When track lighting is used, general, display, ornamental, and special effects lighting shall each be separately controlled; in accordance with Section 130.1(a)4. The general lighting of any enclosed area 100 square feet or larger, with a connected lighting load that exceeds 0.5 watts per square foot shall meet the multi-level lighting control requirements in accordance with Section 130.1(b). All installed indoor lighting shall be equipped with controls that meet the applicable Shut -OFF control requirements in Section 130.1(c). Lighting in all Daylit Zones shall be controlled in accordance with the requirements in Section 130.1(d) and daylit zones are shown on the plans. Lighting power in buildings larger than 10,000 square feet shall be capable of being automatically reduced in response to a Demand Responsive Signal in accordance with Section 130.1(e). Before an occupancy permit is granted for a newly constructed building or area, or a new lighting system serving a building, area, or site is operated for normal use, indoor lighting controls serving the building, area, or site shall be certified as meeting the Acceptance Requirements for Code Compliance in accordance with Section 130.4.(a). The controls required to meet the Acceptance Requirements include automatic daylight controls, automatic shut -OFF controls, and demand responsive controls. CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 STATE OF CALIFORNIA INDOOR LIGHTING — LIGHTING CONTROLS CERTIFICATE OF COMPLIANCE NRCC-LTI-02-E Indoor Lighting - Lighting Controls (Page 2 of 3) Project Name: CPMC REALTY Date Prepared' 3/17/2015 A separate document must be filled out for Conditioned and Unconditioned Spaces. This page is used only for the following: 0 CONDITIONED SPACES ❑ UNCONDITIONED SPACES MANDATORY AND PRESCRIPTIVE INDOOR LIGHTING CONTROL SCHEDULE, PAF CALCULATION, and FIELD INSPECTION CHECKLIST PAF Credit Calculation Z (D fD n n d Standards Complying With 1 O r '=3' N n n o X m ' X n M y ,, � v � Lighting Control Schedule (✓ all that apply, or enter'E' if Exempted) o ' C o -n = a o a o A B C D E F G H t I J K L M N O Type/ Description of Lighting Control (i.e.: occupancy sensor, # w w w w w A Location in Building automatic time switch, of O o O O O P o C dimmer, automatic daylight, Units v 1--� a F+ fD °� in a to — V v etc...) Room 1 Dimming w/Occ Sensor ✓ 1,080 0.25 270 ✓ ❑ Q a ❑ ❑ ❑ ❑ ❑ ❑ a Control Credit PAGE TOTAL (Sum of Column M): 270 IF MULTIPLE PAGES ARE USED, ENTER SUM TOTAL OF Control Credit for all pages HERE (Sum of all Column M): 270 Enter Control Credit total into NRCC-LTI-01-E; Page 1. 1. §130.1(0) = Manual area controls, §130.0(b) = Multi Level; §130.1(c) = Auto Shut -Off; §130.1(d) = Mandatory Daylight; §130.1(e) = Demand Responsive; §140.6(d) _ Additional lighting controls installed to earn a PAF; §140.6(d) = Prescriptive Secondary Sidelit Daylight Controls. 2. Check Table 140.6-A for correct Factor. PAFs shall not be traded between conditioned and unconditioned spaces. As a condition to earn a PAF, an Installation Certificate is also required to be filled out signed, and submitted. CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 STATE OF CALIFORNIA INDOOR LIGHTING - LIGHTING CONTROLS CERTIFICATE OF COMPLIANCE NRCC-LTI-02-E Indoor Lighting - Lighting Controls (Page 3 of 3) Project Name: CPMC REALTY - DatePrepared: 3/17/2015 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. 44 Documentation Author Name: PAUL ALLEN SMITH Documentation Author Signature: Company: Paul Allen Smith Title 24 Energy Consultant signature Date: 3/17/2015 Address: 1183 PALMAS RIDGE CEA/ HERS Certification Identification (if applicable): city/State/Zip: PALM SPRINGS, CA 92262 Phone: 760.831.9879 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Compliance is true and correct. 2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer). 3. The energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations. 4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. 5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the buildi d made available to the enforcement agency for all applicable inspections. I understand that a completed signed copy of this Certificate of Compliance is required to be in uded 'th the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: MARK B. VALENTINO Responsible DesignerSignatu Company: MBV ARCHITECT Date Signed: Address: 71-670 SPRINGFIELD LANE # 7A License: City/State/Zip: PALM DESERT, CA 92211 Phone: 760.200.5099 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 STATE OF CALIFORNIA INDOOR LIGHTING POWER ALLOWANCE MRS1 CEC-NRCC-LTI-03-E (Revised 06/14) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTI-03-E Certificate of Compliance - Indoor Lighting Power Allowance (Page 1 of 4) Project Name: CPMC REALTY Date Prepared: 3/17/2015 ALLOWED LIGHTING POWER A separate page must be filled out for Conditioned and Unconditioned Spaces. This page is only for: ❑ CONDITIONED spaces ❑ UNCONDITIONED spaces A. SUMMARY TOTALS OF LIGHTING POWER ALLOWANCES 0 If using Complete Building Method for compliance, use only the total in column (a) as total allowed building watts. ❑ If using Area Category Method, Tailored Method, or a combination of Area Category and Tailored Method for compliance, use only the total in column (b) as the total allowed building watts (a) (b) 1. Complete Building Method Allowed Watts. Documented in section B of NRCC-LTI-03-E (below on this page) 2. Area Category Method Allowed Watts. Documented in section C-1 of NRCC-LTI-03-E (below on this page) 1,256 3. Tailored Method Allowed Watts. Documented in section A of NRCC-LTI-04-E 0 TOTAL ALLOWED BUILDING WATTS. Enter number into correct cell on NRCC-LTI-01, Page 2, Row 1 1,256 ❑ Check here if building contains both conditioned and unconditioned areas. B. COMPLETE BUILDING METHOD LIGHTING POWER ALLOWANCE A B 1,256 C 0 D TYPE OF BUILDING (From §140.6 Table 140.6-B) WATTS PER (ft) X COMPLETE BLDG. AREA = ALLOWED WATTS Total Area: Total Watts. Enter Total Watts into section A, row 1 (Above on this page) C -1 AREA CATEGORY METHOD TOTAL LIGHTING POWER ALLOWANCES (C-2 plus C-3) Watts Total from section C-2 1,256 Total from section C-3 0 Total Watts. Enter Total Watts into section A, row 2 (Above on this page) 1,256 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014 STATE OF CALIFORNIA INDOOR LIGHTING POWER ALLOWANCE CEC-NRCC-LTI-03-E (Revised 06/14) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTI-03-E Certificate of Compliance - Indoor Lighting Power Allowance (Page 4 of 4) ProlectName: CPMC REALTY Date Prepared: 3/17/2015 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: PAUL ALLEN SMITH Documentation Author signature: Company: Paul Allen Smith Title 24 Energy Consultant signature Date.- 3/17/2015 Address: 1183 PALMAS RIDGE CEA/ HERS Certification Identification (if applicable): City/State/Zip: PALM SPRINGS, CA 92262 Phone. 760.831.9879 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Compliance is true and correct. 2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer). 3. The energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations. 4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance , documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. 5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the b and made available to the enforcement agency for all applicable inspections. I understand that a completed signed copy of this Certificate of Compliance is required to; a includ with the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: MARK B. VALENTINO Responsible Designer Sign dire: Company: MBVARCHITECTDate . signed: 3-L -I �- Address: 71-670 SPRINGFIELD LANE # 7A License: C —`* i �„^ City/State/Zip: PALM DESERT, CA 92211 Phone:776(00..20w0.5099 CA Building Energy Efficiency Standards - 2013 Nonresidential Compliance June 2014