BCOM2017-0007LICENSED 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: C10, B. C-7 License No.: 765650
Date: Y'll' 0 Contractor: stft. OAA/ Jb(Ajw
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).:
( ) 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.).
( ) I; as owner of the property, am exclusively contracting with licensed contractors
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
I ) 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 Name:
Lender's Address:
'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 th w for which this permit is issued.
r I have and will maintain workers' compensation insurance, as required by
Secti(V3700 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: AIG PROPERTY CASUALTY COMPANY Policy Number: 065256957
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 Labor Code, I shall forthwith
comply with those provisions.
Date: y J/' / 7 Applicant`. ' 240 J—t)
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 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 upo he
above-mentioned property for inspection purposes. l
Date: i �1-7 Signature (Applicant or Agent)
Twit Q.�i
� Qu&&
VOICE (760) 777-7125
78-495 CALLE TAMPICO
.D '
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253
DESIGN & DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 4/11/2017
Application Number: BCOM2017-0007
Owner:
Property Address: 79405 HIGHWAY 111 STE 12
RREF LA QUINTA 1 REO LLC
APN: 600340025
280 PARK AVE #WFE[CL:�T�:4�L�j
z
Application Description: SHERWIN WILLIAMS / 3,690SF TI/VB/M-OCC/62-OL/SPRINKLED
NEW YORK, NY 10017
g
Property Zoning:Application
Valuation: $120,000.00
t, o=
w
Applicant:
Contractor:
o
MATT LONG
KALIN ENTERPRISES INCct_10763
WOODSIDE AVE SUITESANTEE,
CA 92071
(619)562-2304
Llc. No.: 765650
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: C10, B. C-7 License No.: 765650
Date: Y'll' 0 Contractor: stft. OAA/ Jb(Ajw
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).:
( ) 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.).
( ) I; as owner of the property, am exclusively contracting with licensed contractors
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
I ) 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 Name:
Lender's Address:
'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 th w for which this permit is issued.
r I have and will maintain workers' compensation insurance, as required by
Secti(V3700 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: AIG PROPERTY CASUALTY COMPANY Policy Number: 065256957
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 Labor Code, I shall forthwith
comply with those provisions.
Date: y J/' / 7 Applicant`. ' 240 J—t)
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 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 upo he
above-mentioned property for inspection purposes. l
Date: i �1-7 Signature (Applicant or Agent)
c
1
Application Number:
BCOM2017-0007
Owner:
Property -Address.
'~79405 HIGHWAY 111 STE 12
RREF LA QUINTA 1 REO LLC
APN:
600340025
280 PARK AVE #W
Application Description:
SHERWIN WILLIAMS / 3,690SFTI/VB/M-OCC/62-OL/SPRINKLED
NEW YORK, NY 10017
Property Zoning:
Application Valuation:
$120,000.00
Date: 4/11/2017
Applicant: Contractor:
MATT LONG KALIN ENTERPRISES INC
10763 WOODSIDE AVE SUITE E
SANTEE, CA 92071
(619)562-2304
Llc. No.: 765650
---------------------------------------------------------------------------------------------
Detail: 3,690SF MERCANTILE TI/VB/M-OCC/62-OL/SPRINKLED [SHERWIN WILLIAMS PAINT STORE] MOE COMPLIANCE DEMONSTRATED FOR REPLACEMENT
OF SWINGING DOORS AT EAST END OF REAR HALLWAY TO ROLL UP DOOR TYPE. THIS PERMIT DOES NOT INCLUDE BUILDING SIGNAGE, REPLACEMENT OF
AIR-CONDITIONING EQUIPMENT OR STORAGE SHELVING. 2016 CALIFORNIA BUILDING CODES.
a
FINANCIAL • .
DESCRIPTION ACCOUNT CITY AMOUNT
ART IN PUBLIC PLACES - COMMERCIAL REMOD
270-0000-43201 0 $100.00
Total Paid for ART IN PUBLIC PLACES -AIPP: $100.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
HOURLY CHARGE - ESGIL PLANS EXAMINER
101-0000-42600
1
$90.00
Total Paid for BLDG CITY STAFF - PER HOUR: $90.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$5.00
Total Paid for BUILDING STANDARDS ADMINISTRATIOM BSA: $5.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
NON-RESIDENTIAL, EA ADDITION 2,000SF
101-0000-42403
0
$38.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
NON-RESIDENTIAL, EA ADDITION 2,000SF, PC.
101-0000-42600
0
$10.13
DESCRIPTION
ACCOUNT
CITY
AMOUNT
NON-RESIDENTIAL, FIRST 2,000SF
101-0000-42403
0
$114.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
NON-RESIDENTIAL, FIRST 2,OOOSF, PC
101-0000-42600
0
$88.16
Total Paid for ELECTRICAL - NEW CONSTRUCTION: $250.29
DESCRIPTION
ACCOUNT
CITY
AMOUNT
APPLIANCE REPAIR/ALTERATION
101-0000-42402
0
$38.01
DESCRIPTION
ACCOUNT
CITY
AMOUNT
APPLIANCE REPAIR/ALTERATION PC
101-0000-42600
0
$15.21
DESCRIPTION
ACCOUNT
CITY
AMOUNT
VENT FAN
101-0000-42402
0
$12.67
DESCRIPTION
ACCOUNT
CITY
AMOUNT
VENT FAN PC
101-0000-42600
0
$5.07
Total Paid for MECHANICAL: $70.96
DESCRIPTION
ACCOUNT
CITY
AMOUNT
FIXTURE/TRAP
101-0000-42401
0
$63.35
DESCRIPTION
ACCOUNT
CITY
AMOUNT
FIXTURE/TRAP PC
101-0000-42600
0
$63.35
DESCRIPTION
ACCOUNT
CITY
AMOUNT
WATER HEATER/VENT
101-0000-42401
0
$12.67
DESCRIPTION
ACCOUNT
CITY
AMOUNT
WATER HEATER/VENT PC
101-0000-42600
0
$7.60
DESCRIPTION
ACCOUNT
CITY
AMOUNT
WATER SYSTEM INST/ALT/REP
101-0000-42401
0
$12.67
DESCRIPTION
ACCOUNT
CITY
AMOUNT
WATER SYSTEM INST/ALT/REP PC
101-0000-42600
0
$12.67
Total Paid for PLUMBING FEES: . $172.31
DESCRIPTION
ACCOUNT
QTY
AMOUNT
REMODEL, EA ADDITIONAL 500 SF
101-0000-42400
0
$182.40
DESCRIPTION
ACCOUNT
QTY
AMOUNT
REMODEL, EA ADDITIONAL 500 SF PC.
101-0000-42600
0
$145.92
DESCRIPTION
ACCOUNT
QTY
AMOUNT
REMODEL, FIRST 100 SF
101-0000-42400
0
$51.68
DESCRIPTION
ACCOUNT
QTY
AMOUNT
REMODEL, FIRST 500 SF PC
101-0000-42600
0
$141.36
Total Paid for REMODEL: $521.36
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SMI - COMMERCIAL
101-0000-20308
0
$33.60
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $33.60
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
h
Bin #
Ste. jIty of La Q uin to
Building 8f Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: Sum/2
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor: �
Telephone: p ell,,4,7-�lyj '
Address: rJGf,S I� y+�l� /�G
Project Description:
City, ST, Zip: CA
Telephone:
State Lic. 7
City Lie. C
Arch., Engr,, Designer:
MAY 1 1 2017
Address: z1p FO
i
City., ST, zip:
COMMUNITY DEVELOPMENT
Telephone: dl _ S
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: � � ,��o�f
Sq. FL: 5V 5 #Stories: # Units:
Telephone #,of Contact Person:
Estimated Value of Project: �G
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Reed
TRACMG
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
21 Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Reylew, ready for corrections/issue
Developer Impact Fee
_
-PiRsWag.Appraval_.
_
Called. Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
Schodl Fees
Total Permit Fees
BIA
Qty.' of La Qurnta
Bulkfty 8c Safety Division
P.O. Box 1504,78-495 Calle Tampico
[ a.Qufita, CA 92253 - (760) 777-7012
r Building Permit Application and Tracking Sheet
Pemdt #
- r lot
Project Address:" 79405 Highway111• Sude:T2
Owner's Name:. Sherwin Williams
y
A. P. Number.
Address: 2100 Lakeside Blvd #500
Legal Description:
Contractor. TBD
City, ST, Zip: Richardson, TX 75082
Telephone:
Address:
PmjectDescription: Tenant Improvements for new retail paint
City, ST, Zip:
store in existing lease space -Interior Partitioning, Ceilings;
Telephone: Q
Lighting, Finishes, Plumbing & Electrical, .HVAC Ductwork.
State Lia # :Lic. #;
City
Modify existing Storefront for New Auto Sliding Doors, Install
Arch., Engr., Designer. Baker Architecture - Ronnie Rollman
Overhead Doors in Existing Stud Wall & Replace Existing. Pair
Address: 4080 Center Street #203
of Service Corridor Doors
City, ST, Zip: San Diego, CA 92103
Telephone: - 619.358.9220
State Lia #:
Name of Contact person: Matt Long
Construction Type: V -B Occupancy: M.
Project type (circle one): New Add'nAlter Repair Demo
Sq, Ft.: 3,690 # Stories: 1 # Units: f
Tdcphone # of Contact Person: 770-639-9032
Estimated Value of Project: $120,000 .
" APPLICANT: DO NOT WRITE BELOW THIS UNE
M
Submittal
Req'd Rev'd TRACIC>TiG PERMff FEES -
man Sefi
Plan Check submlued
Yeem Amould
Strodaral Cales
Reviewed, ready for axreeda�
Check Deposit. .
TrUU Calls-
Called CadaetPom
Pian Check Balance.
Ilde 24 Cake,
Ptaus piekal up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Gmdftqpho
2" Review, ready for correctioustissue
Electrical
Submataetor Last
Calla) Contact Person
Plumbing
Grant Deed
Plans picked up *
ML
H-OAL Approval
Plans resabmitted
Grading
IN HOUSE:-
'`' Review, ready for awrecdonwissm
Developer fmpaet Fee
Planolug Approval.
Called Contact Person
AJ.P.P.
Pub. Wim. Appr -
Date of permit issue
Scbool Fees
�
Total Permit Fees
' .4
.
PROUDLY SERVING THE
UNINCORPORATED AREAS
.OF RIVERSIDE COUNTY
AND THE CITIES OF:
BANNING
`BEAUMONT
.CALI M ESA
CANYON LAKE
COAC H ELLA
DESERT HOT SPRINGS
EASTVALE
INDIAN WELLS
INDIO
JURUPA VALLEY
LAKE ELSINORE
LA QUINTA
'MENIFEE
MORENO VALLEY
NORCO
PALM DESERT
'PERRIS
RANCHO MIRAGE
RUBIDOUx CSD
BAN JACINTO
TEM EC U LA
YJILDOMAR
'BOARD OF `
SUPERVISORS:
<EVIN JEFFRIES
DISTRICT 1
JOHN TAVAGLIONE
DISTRICT 2
JEFF STONE
DISTRICT 3
y
JOHN BENOIT
I DISTRICT 4
MARION ASHLEY .
DISTRICT 5
CAL FIRE - RIVERSIDE UNIT..
RIVERSIDE COUNTY FIRE DEPARTMENT
OFFICE OF THE FIRE MARSHAL
77-933 Las Montanas Rd., Ste. #201, Palm Desert, CA 92211-4131 • Phone (760) 863-8886
Fax (760) 863-7072
www.rvcfiir6.org
April 5th, 2017 r
Matt Long
4721 Crest Knoll Drive
Mableton, GA 30126 ,
RE: Tenant Improvement Plan Check-Sherwin.Williams
LAQ-17-TI-008/BCOM2017-0007 79405 Highway 111 Suite 12 LA Quinta, CA
Fire Department personnel have reviewed and have approved the plans you submitted
for the�above referenced project. Please be advised the following conditions apply as a
part of the conditions for the issuance of a building permit.
The following conditions must be met prior to occupancy:
Deferred Submittals Required: '
1) . Fire Sprinkler— Tenant Improvement plans must be submitted and reference the
installing contractor performing the work. Permit fees in the amount.of $614.00 will
be required. Final inspection: A sprinkler 5 -Year certification is current (every 5
years).
2) Fire Alarm —Tenant Improvement -plans must be submitted and reference the
installing contractor performing the work. Permit fees in the amount of $627.00 will
be required.
3) High Pile. Storage/Rack- Tenant Improvement plans must be submitted and
reference the installing contractor performing the work. Permit fees in the amount
of $348.00 will be required.'.
4) FPE Report- Tenant Improvement plans must be submitted and reference the
installing contractor performing the work. Permit fees in the amount of $584.00 will
be required.
Buildings/facilities
- 1)--.Install-Knox Key -Lock box,—mounted-per-recommended=standard-of-the-Knox -- --
Company. If, the building/facility is protected with a fire alarm system or burglar
alarm system, the lock boxes will require "tamper" monitoring. Special forms are
available from this office for the ordering of the Key Switch: This form must be
authorized and signed by this office for the correctly coded. system to be purchased..
2) Provide keys to the tenant space for inclusion in the main building Knox Box.
Key(s) shall have durable and legible tags affixed for identification of the correlating
tenant space.
3) Approved building address shall be placed in such a position as to be plainly visible.
and legible from the street and rear access if applicable. Building address numbers
shall be a minimum of 12". -Minimum 6" tall suite addressing shall be provided to
both the front and rear entrances. All addressing must be legible and of a
contrasting color with the background and adequately illuminated to.be visible from
the street at all. hours. -
Other requirements:
1) Install portable fire extinguishers per Title 19, *but not less than 2A1 OBC in rating. All
new and existing portable fire extinguishers shall have current annual servicing
performed and tagged.
`2) All fire -rated drop door assemblies are required to have a current annual
certification at time of final inspection..
3)- Applicable -room door(s) shall be*posted "ELECTRICAL "FACP", "FIRE RISER".
and "ROOF ACCESS" on the outside of the door so it is visible and .in a contrasting
color.
4) A durable sign stating "This door to remain unlocked during business hours" shall
be placed on or adjacent to the front exit doors. The sign shall be in letters not less
than one inch high on a. contrasting background.
5) Illuminated Exit Signage and Egress -illumination placement and functional test will
be witnessed by, OFM Fire Inspector at time of final inspection.
The Fire Department approved plans and conditions letter must be at the job site.
Applicant/installer shall be responsible to contact the Fire Department to schedule
inspections. Requests for inspections are to be made at least 72 hours in advance and
may be arranged by calling (760)863-8886:
SUBJECT TO FIELD INSPECTION - Nothing in our review shall be construed as
encompassing structural integrity. Review of this plan does not authorize or approve any
omission or deviation from all applicablb'regulations. Final approval is subject to field .
inspection.
All questions regarding the meaning of these conditions should -be referred to the Office
of the Fire Marshal staff at -(760)863-8886.
Lisa Nottingham - Fire Safety Specialist
Y
Hazardous Materials Inventory Statement
La Quinta #3487
Hazardous Materials Inventory Statement (HazMat)
'
Anticipated Inventory
'
-
Current
Phys.
Amount
NFPA 704 Ratings
SARA
NFPA 30
Common Name
State
on Hand
Units
Health
Fire
React
Class
Class
CAS
Main Chemical (by weight)
Acrylic Paint
L
.20.0
Gallons
2 -
3
0
F,I,D
IB
471-34-1
Calcium Carbonate
Base component for 2 -package Polyurethane
L
: 12.0
. Gallons
2
3
0
F,I,D
r IB
13463-67-7
Titanium Dioxide a
Base component for Epoxy Zinc -Rich Coating
L
8.0
Gallons
2
3
0
F,I
IB
25036-25-3
Epoxy Polymer
Cellulose Nitrate Lacquer
L ,..
:79.0
Gallons
2
3
- 0
F,I,D '
IB
67-64-1
Acetone
Coreactant for 27package Epoxy Coating
L
16.0
Gallons
3
3
0
F,I,D
IB
-14808-60-7
Crystalline Silica, respirable powder
Epoxy Ester Coating
L
_ 2.0
Gallons
2
3
0
F,I,D
IB
108-88-3
Toluene
Lacquer
L
5.0
Gallons
3
=' 3
0
F,I
IB
67-64-1
Acetone
Paint Remover -
r . L
-6.0
'Gallons
• 3
3
0
F,I,D
IB • .
108-88-3
Toluene
Plasticized Cellulose Nitrate Lacquer
•L _
-25.0
Gallons.
2-,
3
0
F,I,D ':
IB
67-64-1
Acetone '
Pre -Catalyzed Lacquer
L . "
' ' 7.0
Gallons
:34 '
3
0
F,I,D
- IB
.98-56-6.
,p-Chlorobenzotrifluoride
Reducer ` -
L
8.0
Gallons
2
3
`0.
F,I
IB
67-56-1
Methanol* .
Reducer `.
'L -
20.0
Gallons
2
3
0
F,I,D
IB
108-88-3
Toluene ;
Reducer �..
L
- 39.0
Gallons *:
1
3
0
;F,I
IB
67-64-1
Acetone 4:
Reducer
L ,
3.0
Gallons
2'
-3
.0 . -
F,I - IB
98-56-6
p-Chlorobenzotrifluoride,
Class IB Total
250:0 • Gallons'
ti
Alkyd Coating
L,•
85.0
Gallons-
2
3
0
F,I,D
IC' '
471-34-1
Calcium Carbonate
Shellac
L.
5.0
Gallons
3
3
'0
_F,I,D
IC
1317-65-3
Calcium Carbonate.
Class IC Total
90A
Gallons
Alkyd Coating ` -
- JL
'F 14.0 'Gallons
2
2
0
F,I,D
IF"
64742-88-7
Med. Aliphatic Hydrocarbon Solvent
Alkyd Coating
L .'
5. 0. Gallons
3
'2
0
'F,I,D
II
37244-96-5
Nepheline Syenite
Alkyd'Stain
L
:60.0
Gallons ,
2
2
0
F,1
II
64742-88-7
Med. Aliphatic Hydrocarbon Solvent
Base component for 2 -package Polyurethane '
L
16.0
Gallons
2
2
0'
F.1
II
37244-96-5
Nepheline Syenite '
Base component for Epoxy Zinc -Rich Coating
L'
8.0
Gallons
3
2
0
F,I,D
II
98-56-6
p-Chlorobenzotrifluoride
Component for 2 -package Epoxy•Coating
L ,
23.0
Gallons =
3
2
' 0
F,I,D
_ II '
37244-96-5
Nepheline Syenite
Conditioner
` L
4.0
Gallons
2
2
0
F,I
II
64742-88-7
Med. Aliphatic Hydrocarbon Solvent
Coreactant for 2 -package Waterborne Polyurethane
* L*
'8.0
Gallons
3
2
Or
,F,I,D
II °
28182-81-2
Hexamethylene Diisocyanate Polymer
Oil Stain
L
48.0
Gallons
2
2
0
F,I,D
II
64742-65-0
Heavy Paraffinic Oil
Oil Stain
L
32.0
Gallons
2
2
0
F,I,D
II
8001-26-1
Linseed Oil
Stain (solvent based)
L
32.0
Gallons
2
2
0
F,I,D
II
64742-88-7
Med. Aliphatic Hydrocarbon Solvent
Class 11 Total
. 250.0
Gallons
Cleaning Solution
L
10.0
Gallons
2
2
0
F,I,D
IIIA
64742-47-8
Light Aliphatic Hydrocarbon
Class IIIA Total10.0
I =
Gallons
MAR 10 2017.
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT
Run Date: 2/28/2017 9:09 AM onfidential Business Information of The Sherwin-Williams Company WA► Page: 1 of 2
CAAAAAA=mL.G HENT
Hazardous Materials Inventory Statement
Class IB Total
250.01
Gallons
Class IC Total
90.0
Gallons.
Class II Total +
250.01
Gallons
Class IIIA Total
10.01
Gallons
La Quinta #3487`
Hazardous Materials Inventory Statement
(HazMat)
�1 �,
Anticipated Inventory
Current
�. J
'
Phys.,
Amount , NFPA 704 Ratings
SARA
NFPA 30.
't
Common Name -
- State
on Hand Units Health Fire React Class
Class
CAS Main Chemical (by weight)
Aerosol Cleaner
L
6.0 Pounds-, 3. 2 •0
F,P,I
1 -
111-76-2 2-Butoxyethanol -
Aerosol Coating _
L'' -
12.0 Pounds 3 2 1 u
`F,P,I
1 - ; 7440-66-6 Zinc '
Aerosol Coating E,
L
18.0 Pounds,'. 3 ' " • 2 '0
F;P,I
'; 1
115-10-6 Dimethyl Ether
Aerosol Coating
*:L•
- 12.0 Pounds 2 4 • 2 '0
F,P,I,D
�', 1 ,
67-64-1 „ Acetone
Aerosol Paint Remover `. - .
L
2.0 Pounds 3 •2 •.0
F,P,I D
1
75-09-2 Methylene Chloride
Level 1 •Total
50 " Pounds - -
- _
-. _ _� �
' � ` � � {
Aerosol Coating ' :'
4
•'t •..
L'T:
• a' • � •' y ,� F .fit
_ 60.0 `Pounds 2' 3. y 0
r .
F,P,I D
P
2 ';
•� -
`67-64-1' Acetone
..
Aerosol Coating . •��;
,
L. y
x,;20.0 Pounds ; 2', Y3- ;0
F,P,I D
- 2
1317-65-3 Calcium Carbonate
Aerosol Coating ;- !
- ��,} L
4:01.Pounds 2 -.3u� k 0
FPI I
2 r```
108-88-3, . Toluene - �"
•' rti ,
Aerosol Coating
µ� a L;:
;
r 2.0 Pounds b,, 2� ,, r3• �'0
F;P,I D
2 " ,
'14807-96 6 Talc',
`,,;a
Aerosol Coating •T r :;'• ti-
T L
- ,�
t �;
r 2.0.`Pounds A �• `2 3 _0
.F,P,I,D
.'6.F
- �" 2 �;
67-64-1 ,,Acetone
Aerosol Coating `" } ` , _`
L'
2 0 Pounds 2 ` c* 3 Y ' 0
P I D
2 +` ' "
64-17-5 Ethanol w;
Aerosol Coating`; -
t: ; ` '"LF'
2.0 'Pounds 2 .< - 3 0 .:
f,P,l D
;:-� 2
' "471-34-1 ,..Calcium Carbonate s ti
t
Aerosol Coating �'
L ' .
2.0 -Pounds"' ' - 3 z •- 3- '1
F 1
,2 . ^:115-10-6;
Dimethyl Ether..' S
Aerosol Coating 4 �;,- t' . •
*. L^2.:'l 2.0 Pounds .3' r - _ 3 t,0?.
!''"
-.F;P,I D
2
14808-60-7, ,Crystalline Silica, respirable powder
Aerosol Coating �
" L
2.0 -Pounds" '�3 `;-'3' -.0.
• F,P,I D4`.
? 2r k'
74-98-6 .;Propane
a
AerosolUndercoatingx •._ '; x.
_:__- _.,•L'�
'. 2.0• Pounds-` ti 2'� 3 ' '0
F,PJD�
2
67-64-1 'Acetone
Level 2:Total ' :: F.. . ,' , ..
- .. - . -" `.100.0° Pounds.,
;.
i.4: A .S '.. •
r
r
aT :' ♦}ice .. F Y
`
,{i ..
.. - 9 F .•��•
- 4.r.-.
Aerosol Coating r' ., ;' ', ¢
` �L'
. - x;2:0 •Pounds, r 3 4. 1"
> F;P;I D,,,-
-'..3
74-98-6 Propane
f "r
Aerosol Coating }' v ,
L
-� r:. 2.0- Pounds' 3 4 s�. Okt
,
uF,R l
h3 -
a
108-88-3 4' Toluene.
•
Aerosol Coating `°
" L
..,
17.0' 'Pounds, 3 4 ,.:0.
F,P,I D
3
67-64-1' ; , Acetone '
T,
Aerosol Pesticide d - "
,
�L�
_ -.. r 4.0 Pounds . ` • '2 ` �4 ^ 0
? F,P,I
u 3' ^ , `64742-47=8 Aliphatic Solvent
Level 3 Total
l'
25.0` .Pounds -
'
e
'. _ • .
.
_
HMISSUMMARY'
r
Storage Class
Units - 4 Aerosol Level
Units
,
Class IB Total
250.01
Gallons
Class IC Total
90.0
Gallons.
Class II Total +
250.01
Gallons
Class IIIA Total
10.01
Gallons
Level 1 Total
54.01
Pounds
Level 2 Total
- _ 100.0
Pounds
Level 3 Total
25.0
Pounds
• 1. r F
Storage Class IB, IC, II, IIIA Total 600.0 Gallons ' Aerosol Level 2 & 3 Total • 125.0 Pounds *y
Run Date: 2/28/2017 9:09 AM ti
Confidential Business Information of The Sherwin-Williams Company , Page: 2'of 2 '-- �•�
Hazardous Materials Inventory Statement
La Quinta #3487
'
Hazardous Materials Inventory Statement•(HazMat)
Anticipated Inventory
Current
_
,
Phys.
Amount
NFPA 704 Ratings
SARA
NFPA 30
Common Name
State
on Hand
Units
Health
Fire
React
Class
Class
CAS
Main Chemical (by weight)
Acrylic Paint
L
20.0
Gallons,
2
3
0
F,I,D
IB
471-34-1
Calcium Carbonate
Base component for 2 -package Polyurethane
L
12.0
Gallons
2
3
0
F,I,D
IB
13463-67-7
Titanium Dioxide
Base component for Epoxy Zinc -Rich Coating
L , ;
8.0
Gallons
2
3
0,
F,I
IB
25036-25-3
,Epoxy Polymer
Cellulose Nitrate Lacquer `_ -
L
79.0
Gallons
2
'3
0
F,I,D
IB -
67-64-1
Acetone
Coreactant for 2 -package Epoxy Coating
L
16.0
Gallons • .
.3
3
0 -
F,I,D
IB
14808-60-7
Crystalline Silica, respirable powder
Epoxy Ester Coating
L
2.0
Gallons
2
3
0,
F,I,D
IB
108-88-3
Toluene
Lacquer
- L :'
5.0
Gallons
3
3 _
0
F,I '
IB
67-64-1
Acetone
Paint Remover `
L`
6.0
'Gallons •
3
3,..
'0
F,I;D
IB
108-88-3
Toluene
Plasticized Cellulose Nitrate Lacquer., * '
L
'25.0
Gallons
2
3.
0
F,I,D
IB
67-64-1
Acetone
Pre -Catalyzed Lacquer
f, ,° L' •
-7.0
Gallons
3
3 "'
' 0
F,I,D
IB t ..
98-56-6
p-Chlorobenzotrifluoride
Reducer ".
L
' • 8.0
Gallons .'
2
3 ":
0:
F,I
IB .,
67-56-1
Methanol -
Reducer
L
_
20.0
Gallons
2
3
0
F,I;D
•• IB
• 108-88-3 :
Toluene
Reducer *
L
39.0
Gallons
1
•3
0
F,I
..IB
67-64-1
Acetone '
Reducer
L
3.0
Gallons ,
'2 .
3
0
F j
IB
98-56-6 '
p-Chlorobenzotrifluoride
Class IB Total
250.0
Gallons
-
Alkyd Coating ,•
L
85.0
Gallons .
2
3 .w
0,
F,I,D
IC
471-34-l'
Calcium Carbonate
Shellac
L :•
-' 5.0
Gallons
3
., 3
0
F,I,D
IC
1317-65-3
Calcium Carbonate
Class IC Total
90.0
Gallons
Alkyd Coating
L -
'14.0
Gallons
2
2 -
0
F,I,D'�
- II
64742-88-7
Med. Aliphatic Hydrocarbon Solvent
Alkyd Coating - _
L
5.0
Gallons
3 ..
2
0
F,I,D
II
37244-96-5
Nepheline Syenite
Alkyd Stain
L
60.0
Gallons
-T2
2•
+ 0
F.I
lir
64742-88-7
Med. Aliphatic Hydrocarbon Solvent
Base component for 2 -package Polyurethane
t L .•,:
' 16.0
Gallons
2
2
0
F, 1.
Al
37244-96-5
. Nepheline Syenite •
Base component for Epoxy Zinc -Rich Coating
L
8.0
Gallons
3 "
2
.0�
F,I,D
II
98-56-6 '
p-Chlorobenzotrifluoride
Component for 2 -package Epoxy Coating_
L.
23.0
Gallons `
- -3
2
0
F,I,D,.
:II
37244-96-5
Nepheline Syenite
Conditioner
,,L.
4.0
Gallons
2 -
2
0
F,I
II -
64742-88-7
Med. Aliphatic Hydrocarbon Solvent
Coreactant for 2 -package Waterborne Polyurethane
L
8.0
Gallons
3
2
0
'F,I,D
II ' .
28182-81-2
'Hexamethylene Diisocyanate Polymer
Oil Stain
L
48.0
Gallons
2
2
0
F,I,D
II
64742-65-0
Heavy Paraffinic Oil
Oil Stain
L.
32.0
Gallons
2
2
0
F,I,D
II
8001-26-1
Linseed Oil
Stain (solvent based)
L
32.0
Gallons
2
2
0
F,I,D
II
64742-88-7
Med. Aliphatic Hydrocarbon Solvent
Class 11 Total
250.0
Gallons
Cleaning Solution
L
10.0
Gallons
2
2
0
F,I,D
IIIA
64742-47-8
Light Aliphatic Hydrocarbon
Class IIIA Total
10.0
Gallons
■ r®v�d.m ..ate
r
MAR 10 2011
7
Run Date: 2/28/2017 9:COM OF LA QUINTA Confidential Business Information of The Sherwin-Williams Company Page: 1 of 2 ' -
C.O%°UiJfrY DEVELOPMENT t -Cf YOHZA�A
T
Hazardous Materials Inventory Statement'
Class IB Total
250.01
Gallons
Class IC Total
90.0
Gallons
Class II Total
- 250.01
Gallons
Class IIIA Total
10.01
Gallons
La Quinta #3487
Hazardous Materials Inventory Statement (HazMat),
_
"•
''. '
"'
{
;�'� `
�-'
""
Anticipated Inventory
_
r
..
Current
Phys. Amount `
NFPA'704 Ratings
' SARA
NFPA 30
Common Name
" j P t
State * on Hand,
Units
Health Fire
React
Class
Class
CAS
Main Chemical (by weight) '
Aerosol Cleaner k ,
�- s
•-L
6.0
Pounds
3 -2
.0
.F,P,1
1
111-76-2
2-Butoxyethanol
'
r,•
Aerosol Coating -'F
x
L: `
12.0
Pounds
3 2
1
F,P I
1 - .
.7440-66-6
Zinc
Aerosol Coating
L .
,18.0
Pounds
3. t'" .`2°='
A'._-
F. P, 1
-` "1 .
115-10-6
Dimethyl Ether
Aerosol,.Coating
.� r'
Lw-�
12.0 •'Pounds
,2 2 .
0
.F,P,I D
:_'1 #. - - 67-64-1" ,'Acetone
,.
- .
Aerosol Paint Remover „,
i _
L"r� .
','x:2.0
Pounds
- 3 •"2.
0''.
F;P,I,D
,` 1
' {75-09-2 r
' Methylene Chloride .
Leve1.1=Total
50'
Pounds ,r.'
r
Aerosol Coating" " " , '-
4 t,
�. -L' ' ,
= 60.0
Pounds
'" '
. 0 `;
F,P-1 D
.2
'67-64-1 ',
Acetone,
Aerosol Coating "r
''
r _
'
3� " . �+;=.,� •° L t
y • 20.0
"Pounds
,2,- .3`
2x "3 , .,0 `+ '.F;PI D'
. 2
1317-65-3.''Calcium .Carbonate.
Aerosol Coating ° "r
<�
,�^ ~ `�'#
'L ti,
,, 4.0 •Pounds
•
; �, 2x: 3,
0 ,
r,..F,P 1
�rF 2
108-88-3 '-Toluenez
Aerosol Coating
,a
L'
2.0
Pounds .r
2 3 --
*`0 D�
2
X14807-96-6': Talc'
Aerosol Coating
,,
a
L.
'. 2.0'
Pounds
2 3... . x 0;
�F,P,I
�F;P,I,D
2
67-64-1
Acetone �.
Aerosol Coating
.,
'Y
L"r =
. 2.0
Pounds
2, 3 .
+�0°"
D
.' 2
64-17-5
Ethanol,
t
Aerosol Coating R
,
° ' �- "g ::
` L-
r 2.0 *Pounds ;
. 2 ` 3 ,
sF;P,I
0` ' .F,P,I,D
2:-
= . 47,1-34-1
Calcium Carbonate
-
Aerosol Coating t; ' •:
'�
`` +='' '
L' ,
2:0
Pounds
3... 3 1"
' F,P I
�' 2
• ,•115-10-6 •
Dimethyl Ether
t
Ae�osoLCoating ;_'
. 3'
-. L '-'.
2.0,
Pounds:!x
F3' R' _� 3 '' 0 _�' F,P,I D
,. 2
14808-60-7
;Crystalline Silica, respirable
powde F ..'
Aerosol Coating . _-
- °'• ' ^L
2.0 n Pounds.'3,,,7":
3 .
0f`_ ,
F,PI,D .''
2
•74-98-6
'Propane
Aerosol Undercoating. = ...,"
' *
L
'2.0
'Pounds
2 37--
01. 4. 'F,P;I,D 2
x.'67-64-1
Acetone,
Level
100.0
Aerosol Coating •
Fes- `, , �� t•'. '"
;. 2.O ,Pounds
:3' 4
1
, F,P,I D
+' 3 .
74-98-6
Propane
Aerosol Coating
+
L
2.0 , Pourids ,
3' 4',i
0. •
F,P,t
+3
108-88-3 .
Toluene
Aerosol Coating
._
r
3
'67-64-1
Acetone ,'• ,'
Aerosol Pesticide'` _
F
; '` •.
L
`4.0
'Pounds
:�2 =4 '=.`
•0
F,P,I
1. • 3
64742 47-8
Aliphatic Solvent
Level 3 Total
-
rid•
25:0
=Pounds'
't' , a.
s
?
%,.
-HMIS`SUMMARY=
'
a ,r ` �.�
..R ..
' -.. .� ,
rm l • -
$torage Class
a' -.Units
Aerosol Level
...
•t
Units
Class IB Total
250.01
Gallons
Class IC Total
90.0
Gallons
Class II Total
- 250.01
Gallons
Class IIIA Total
10.01
Gallons
Level 1 Total
54.01
Pounds
Level 2 Total
100.0
Pounds
Level 3 Total
25.01
Pounds
Storage Class IB, IC, II, IIIA Total --,,,600.0 Gallons R Aerosol Level 2 & 3 Total 125.0 _ Pounds
- r Run Date: 2/28/2017.9:09 AM
J
Confidential Business Information of The Sherwin-Williams Company Page: 2 of 2
CERTIFICATE OF COMPLIANCE NRCC-LTI-01-E
Indoor Lighting (Page 1 of 6)
Project Name: Date Prepared:
La Quinta, CA 12/23/2017
A. General Information
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
Climate Zone:
Title
Conditioned Floor Area:
3,698
NRCC-LTI-01-E
Unconditioned Floor Area:
x
Building Type:
Schools
ED Nonresidential
E]Relocatable Public Schools .
❑ High -Rise Residential
❑X Conditioned Spaces
❑ Hotel/Motel .
❑ Unconditioned Spaces
Phase of Construction:
❑ New Construction
❑ Addition
Ex Alteration
Method of Compliance:
❑x Complete Building
Area Category
Tailored
Project Address:
La Quinta Center Highway 111 #12, La Quinta, CA
Line Voltage Track Lighting Worksheets
B. 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
Comp. Doc.
Title
x
FOR CONSTRUCTION
NRCC-LTI-01-E
Certificate of Compliance. All pages required on plans for all submittals.
x
NRCC-LTI-02-E
Lighting Controls, Certificate of Compliance, and PAF Calculation. All pages required on plans
for all submittals.
x
CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance April 2016
NRCC-LTI-03-E
Indoor Lighting Power Allowance.
x
NRCC-LTI-04-E
Tailored Method Worksheets ,
x
NRCC-LTI-05-E
Line Voltage Track Lighting Worksheets
x
NRCC-LTI-06-E
Indoor Lighting Existing Conditions
CITY a OUINTA
& SAFETY DEPT.
.BUILDING
APPROVED
RECEIVED
FOR CONSTRUCTION
11
)A1 1 6Y
MAR 10 2011 WTk
- � T
CITY OF LA OUIIdTA .
COMMUNITY DEVELOPMENT.
i
CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance April 2016
CERTIFICATE OF COMPLIANCE NRCC-LTI-01-E
Indoor Lighting (Page 2 of 6)
Project Name: Date Prepared:
La Quinta, CA 2/23/2017
C. 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
ti Watts
01
Installed Lighting + 3,485
1
Installed Lighting +
NRCC-LTI-01-E, Table H, page 5
NRCC-LTI-01-E, Table H, page 4
02
Portable Only for Offices + 0
2
NRCC-LTI-01-E, Table G, page 4
03
Minus Lighting Control Credits 0
3
Minus Lighting Control Credits
NRCC-LTI-02-E, page 2
NRCC-LTI-02-E, page 2
04
Adjusted Installed Lighting Power = 3,485
4
Adjusted Installed Lighting Power =
(row 1 plus row 2 minus row 3)
(row 1 minus row 3)
Complies ONLY if Installed s Allowed (Box 04 < Box 05)
Allowed Lighting Power
6
Allowed Lighting Power '
05
Conditioned _ 3,698
Unconditioned =
NRCC-LTI-03-E, page 1
NRCC-LTI-03-E, page 1
Alterations with replacement luminaires that have at least
Alterations with replacement luminaires that have at least
50/35% lower power compared to the original ebsting luminaires,
50/35% lower power compared to the original ebsting luminaires,
may instead use the allowed wattage from NRCC-LTI-06, page 1..
may instead use the allowed wattage from NRCC-LTI-06, page 1.
D. Declaration of Required Certificates of Installation
Declare by selecting yes for all of the Certificates that will be submitted. (Retain copies and.verify forms are completed and signed.)
Yes
No
Form
Title
x
NRCI-LTI-01-E
Must be submitted for all buildings.
Field Inspector
x
NRCI-LTI-02-E
Must be submitted for a lighting control system, or for an Energy
Field Inspector
Management Control System (EMCS), to be recognized for compliance.
x
NRCI-LTI-03 E
Must be submitted for a line -voltage track lighting integral current limiter,
Field Inspector
or for a supplementary overcurrent protection panel used to energize only
line -voltage track lighting, to be recognized for compliance.
x
NRCI-LTI-04-E
Must be submitted for two interlocked systems serving an auditorium, a
Field Inspector
convention center, a conference room, a multipurpose room, or a theater
to be recognized for compliance.
x
NRCI-LTI-05-E
Must be submitted for a Power Adjustment Factor (PAF) to be recognized'
Field Inspector
for compliance.
x
NRCI-LTI-06-E
Must be submitted for additional wattage installed in a video conferencing
Field Inspector
studio to be recognized for compliance.
CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance April 2016
CERTIFICATE OF COMPLIANCE NRCC-LTI-02-E
Indoor Lighting - Lighting Controls (Page1 of 3)"
Project Name: Date Prepared:
La Quinta, CA 12/23/2017
A. Mandatory Lighting Control Declaration Statements
Indicate if the measure applies by checking yes or no below:
Yes
No
Control Requirements
x
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 §110.9.
x
Lighting shall be controlled by a lighting control system or energy management control system in accordance
with §110.9. An Installation Certificate shall be submitted in accordance with §1
x
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 §130.4(b).
x
A Track Lighting Supplementary Overcurrent Protection Panel shall be installed in accordance with §110.9
and §130.0. Additionally, an Installation Certificate shall be submitted in accordance with §130.4(b).
x
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 §130.1.
x
All luminaires shall be functionally controlled with manually switched ON and OFF lighting controls in accordance
with §130.1(a).
x
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 §130.1(a)4.
x
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 §130.1(b).
x
All installed indoor lighting shall be equipped with controls that meet the applicable shut -OFF control requirements
in §130.1(c).
x
Lighting in all Daylit Zones shall be controlled in accordance with the requirements in §130.1(d) and daylit zones
are shown on the plans.
x
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 §130.1(e).
x
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 §130.4(a). The controls required.
to meet the Acceptance Requirements include automatic daylight controls, automatic shut -OFF controls,
and demand responsive controls.
CERTIFICATE OF COMPLIANCE NRCC-LTI-02-E
Indoor Lighting - Lighting Controls (Page 2 of 3)
Project Name: Date Prepared:
La Quinta, CA 2/23/2017
A separate document must be filled out for Conditioned and Unconditioned Spaces. This page is only used for the following:
�X Conditioned Spaces Unconditioned Spaces
B. Mandatory and Prescriptive Indoor Lighting Control Schedule, PAF Calculation, and Field Inspection Checklist
Standards Complying With'
(check all that apply or
PAF Credit
Field
Lighting Control Schedule
leave blank if exempted)
Calculation'
Inspector
01
02
03
04
051061
07
08
09
10
11
12
13
14
15
•
LL
<
m
m
o_
LL
,•
- ..
O
xc
obi
cT
tOi
�
t0f '
W!
�
tOi
J
�
�
,
S
o"
�
d
H
of Lighting
o
ELType/Description
r Control (i.e. occupancy sensor,
3
U
Q,
- automatic time switch, dimmer,
w
Location in Building
automatic daylight, etc.) .
r
U
SALES AREA
TIME SWITCHED/AUTO DAYUGHTING/DI MMING
3
X
X
X
I.X
I
X
1,584
RR/OFFICE
OCCUPANCY SENSOR
3
X
.X
X
317
TINTING/WHOLESALE
TIME SWITCH/DIMMING
2
X
X
X
X
X
1,469
El
❑
❑
❑
E
El
EI
El
Control Credit PAGE Total (Sum of Column 13)
IF MULTIPLE PAGES ARE USED, ENTER SUM TOTAL OF Control Credit for all pages HERE (Sum of all Column 13)
Enter Control Credit total into NRCC-LTI-01-E, page 1
(1) §130.1(a)=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(a)2=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. PRFs 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 - 2016 Nonresidential Compliance January 2016
R
J, e
CERTIFICATE OF COMPLIANCE NRCC-LTI-02-E
Indoor Lighting Controls (Page 3 of 3)
Project Name: Date Prepared:
La Quinta, CA 12/23/2017
Documentation Author's Declaration Statement
I certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Laura Longoria
Company:
Signature Date:
Henderson Engineers, Inc.
02/23/17
Address:
CEAMERS Certification Identification (if applicable):
15851 Dallas Parkway, Suite 240
City/State/Zip: '
Phone:
Addison, TX 75001
(214) 647-3068 '
Responsible Person's Declaration Statement ,.
R
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 building, 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 included with the documentation the builder provides to the building owner at
occupancy.
op—
Responsible Designer Name: Responsible Designer Signature:
David D..Haake
Company:
_
Signature Date:
Henderson Engineers, Inc.
Address:
License: Feb
8345 Lenexa Drive, Suite 300. `
161.37
City/State/Zip:
Phone:
Lenexa, KS 66214
(913) 742-5000
CERTIFICATE OF COMPLIANCE NRCC-LTI-01-E
Indoor Lighting (Page 3 of s)
Project Name: Date Prepared:
La Quinta, CA - 12/23/2017
E. Declaration of Required Certificates of Acceptance ,
Declare by selecting yes for each Certificate of Acceptance that will be submitted. (Retain copies and verify forms are
completed and signed.)
Yes
No
Form
Title `
X.
NRCA-LTI-02-E
Must be submitted for occupancy, sensors and automatic time_switch
Field Inspector
controls. '
�v
x
NRCA-LTI-03-E
Must be submitted for automatic daylight controls
Field Inspector
x
NRCA-LTI-04-E
Must be submitted for demand responsive lighting controls:.
Field Inspector
A separate lighting schedule must be filled out for conditioned and unconditioned spaces. Installed lighting power listed on this
lighting schedules is only for:
EX Conditioned Space i El Unconditioned Space
F. Indoor Lighting Schedule and Field Inspection Energy Checklist
F] 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.
0 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 submifthe track lighting compliance form (NRCC-LTI-05-E) when line -voltage
track lighting is installed.
A separate lighting schedule must be filled out for Conditioned and Unconditioned Spaces. This page is only used for the following: e
Conditioned Space ElUnconditioned Space
A. Summary Totals of Lighting Power Allowances
aIf 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)
01 Complete Building Method Allowed Watts, documented in section B of NRCC-LTI-03-E 3,698 N/A
(below on this page).
02 Area Category Method Allowed Watts, documented in section C-1 of NRCC-LTI=03-E N/A
(below on this page).
03 Tailored Method Allowed Watts, documented in section A of NRCC-LTI-04-E. N/A
Total Allowed Building Watts 3,698
Enter number into correct cell on NRCC-LTI-01-E, Page 2,,Row 1
I F
Check here if building contains both conditioned and unconditioned areas.
B. Complete Building Method Lighting Power Allowance
01 02 03
Watts per Complete
Type of building (from §140.6 Table 140.6-B) ft2 X Bldg. Area =
General Commercial Building 1.0 3,698
Total Area 3,698
Total Wafts. Enter num berinto section (a), row 1 (above on this page)
04
Allowed
Watts
3,698
N/A
3,698
C-1. Area Category Method Lighting Power Allowances
Watts
Total from section C-2
t. Total from section C-3
Total watts. Enter number into section (a), row 2 (above on this page)
For Alterations Only - Reduced lighting power option (Total Allowed Watts x 0.85). Enter this value into section (a), row 2 if using this option.
CERTIFICATE OF COMPLIANCE NRCC-Ln-03-E
Indoor Lighting Power Allowance (Page 4 of 4)
Project Name: Date Prepared:
La Quinta, CA, 2/23/2017
Documentation Author's Declaration Statement
I certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name: ".
Documentation Author Signature:
Laura Longoria
Company:
Signature Date:
Henderson Engineers, Inc.
02/23/17
Address:
CEA/HERS,Certification Identification (if applicable):
15851 Dallas Parkway, Suite 240 '
City/State/Zip:
Phone:
Addison, TX 75001
(214) 647-3068
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 t 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 building, 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 included with the documentation the builder provides to the building owner at
occupancy.
Responsible Designer Name: w
Responsible Designer Signature: ,
David D. Haake
-
Company: `
Signature Date:
Henderson Engineers, Inc.
Address:
License: Feb 23 20t7
8345 Lenexa Drive, Suite 300
16137
City/State/Zip:
Phone:
Lenexa, KS 66214
(913) 742-5000
CERTIFICATE OF COMPLIANCE NRCC-LTI-01-E
Indoor Lighting (Page 5 of 6)
Project Name: Date Prepared:
La Quinta, CA 12/23/2017
A separate lighting schedule must be filled out for Conditioned and Unconditioned Spaces. Installed lighting power listed on this
lighting schedule is only for:
�X Conditioned Space ❑ Unconditioned Space
H. Indoor Lighting Schedule and Field Inspection Energy Checklist
Luminaire Schedule
Installed Watts
Location
Field
Inspector
1
2
3
4
5
6
7
8
Name
or. -
Item Tag •
Complete luminaire description
(i.e. 3 -lamp fluorescent troffer, F32T8,
one dimmable electronic ballast)
CL
How wattage was
determined
a
c
�.
o
.0
Z
o
m x
3
a i
m
Marea
m
0
~
Primary function
in which these
luminaires are
installed
m
a
LL
CEC According
Default to
from §130.0(c)
NA8
A
2X4 LED TROFFER
45
❑ ❑
2
90
OFFICE
❑
❑
B
4' LED STRIP, DIMMABLE DRIVER
44
❑X ❑
4
176
RESTROOM
❑
❑
C
6" LED DOWNLIGHT
19
❑X ❑
4
76
RESTROOM/ALCOVE
❑
❑
D
8' LED STRIP, DIMMABLE DRIVER
88
❑X ❑
35
3,080
SALES/WHOLESALE
❑
❑
U
LED STRIP UNDERCABINET
10.5
❑X ❑
6
63
OFFICE
❑
❑
❑ ❑
❑
❑
❑ ❑
❑❑
❑ ❑
El
El
❑ ❑
El
El
❑ ❑
❑❑
INSTALLED WATTS PAGE TOTAL
3,485
Enter sum total of all pages
into NRCC-LTI-01-E, Page 2
CERTIFICATE OF COMPLIANCE NRCC-Ln-01-e
Indoor Lighting. (Page 6 or 6)
Project Name: Date Prepared:
La Quinta, CA 2/23/2017
Documentation Author's Declaration Statement
I certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Laura Longoria
Company:
Signature Date: ,
Henderson Engineers, Inc.
02/23/17
Address:
CEAMERS Certification Identification (if applicable):
15851 Dallas Parkway, Suite 240
City/State/Zip: _
Phone: -'
Addison, TX 75001
(214) 647-3068
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) l 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 building, 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 included with the documentation the, builder provides to the building owner at
-
occupancy.00
Responsible Designer Name: Responsible Designer Signature: ,
David D. Haake
Company:
Signature Date:
Henderson Engineers, Inc.
Address:
License: Feb
8345 Lenexa Drive, Suite 300
16137
City/State/Zip: + `
Phone:
Lenexa, KS 66214
(913) 742-5000
April 2016
CERTIFICATE OF COMPLIANCE
NOTES:
NRCC-LTS-01-E
Sign Lighting
2) The Mandatory Measures (sign lighting controls) are required for compliance with the sign lighting Standards. If the person
responsible for installing the sign lighting power is not also responsible for the sign lighting controls, then the owner of the sign,
(Page 1 of 5)
A. General Information
Compliance and an Installation Certificate applicable to the portion of construction for which they are responsible; alternatively,
the person with chief responsibility for construction shall prepare and sign the Certificate of Compliance Declaration Statement for
the entire construction. (e.g. a C-10 contractor may complete parts 1a and 1b on one compliance document and a C-45 contractor
Project Name:
documents together for the same complete installation).
have responsibility for installing the sign lighting controls:
Date Prepared:
12/2312017
La Quinta, CA
1a. Check Yes or No for all of the following
There are existing sign lighting controls that comply with the applicable provisions of §110.9 and §130.3.
Project Address:
Fx Yes ❑ No
There are no existing sign lighting controls and I will be installing sign lighting controls that comply with the applicable provisions
La Quinta Center Hwy 111 #12,
La Quinta, CA
Yes No
Location of Sign:
Ex Outdoor Signs ,.
❑ Indoor Signs
installing sign lighting controls that comply with the applicable provisions of §110.9 and §130.3.
Phase of Sign Construction:
❑x New Signs
E]Sign Alterations
Type of Lighting Control:
❑ New Lighting Controls
Replaced Lighting Controls
❑ Not Installing Lighting Controls
This Certificate of Compliance includes the following components (check all that apply)
Fx Mandatory Measures
.Maximum Allowed
Specific Lighting
(Lighting Controls)
Lighting Power
Sources
1. Mandatory Sign Lighting Controls
NOTES:
1) The same responsible person may install both the sign lighting power and the sign lighting controls, or a different responsible
person may install the sign lighting controls than the responsible person installing the sign lighting power.
2) The Mandatory Measures (sign lighting controls) are required for compliance with the sign lighting Standards. If the person
responsible for installing the sign lighting power is not also responsible for the sign lighting controls, then the owner of the sign,
general contractor, or architect shall be responsible to have the sign lighting controls installed.
3) If more than one person has responsibility for compliance, each responsible person shall prepare and sign a Certificate of
Compliance and an Installation Certificate applicable to the portion of construction for which they are responsible; alternatively,
the person with chief responsibility for construction shall prepare and sign the Certificate of Compliance Declaration Statement for
the entire construction. (e.g. a C-10 contractor may complete parts 1a and 1b on one compliance document and a C-45 contractor
may complete parts 2a and 2b on a separate compliance document - the Responsible Designer shall submit the two compliance
documents together for the same complete installation).
have responsibility for installing the sign lighting controls:
Ex Yes, I have responsibility for the sign lighting controls, E]No, I do not have responsibility for installing the sign lighting
and will complete parts 1a and 1b of this document. controls. Some else will complete parts 1a and 1b.
1a. Check Yes or No for all of the following
There are existing sign lighting controls that comply with the applicable provisions of §110.9 and §130.3.
1
Fx Yes ❑ No
There are no existing sign lighting controls and I will be installing sign lighting controls that comply with the applicable provisions
2
of §110.9 and §130.3.
Yes No
There are existing sign lighting controls that do not comply with the applicable provision of §110.9 and §130.3 and I will be
3
installing sign lighting controls that comply with the applicable provisions of §110.9 and §130.3.
❑ Yes 1:1 No
CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance ' April 2016
CERTIFICATE OF. COMPLIANCE NRCC-LTS-01-E
Sign Lighting (Page 2 of s)
Project Name: Date Prepared:
La Quinta, CA 12/23/2017
1 b. Mandatory Sign Lighting Controls: If the person signing the Certificate of Compliance Declaration Statement on this
NRCC-LTS-01-E is responsible for complying with the sign lighting control requirements, that person shall answer all of the
following questions.
If there are construction documents, indicate where on the building plans the mandatory
This Sheet
measures (sign lighting control) note block can be located:
§130.3(a)l. All indoor sign lighting is controlled with an automatic time -switch control or astronomical
Y
N
N/A
1
time -switch control.
❑
❑
Ex
§130.3(a)2A. All outdoor sign lighting is controlled with photocontrol in addition to an automatic time -switch
Y
N
N/A
2
control, or an astronomical time -switch control
Ex
El
❑
EXCEPTION to §130.3(a)2A. Outdoor signs in tunnels, and signs in large permanently covered outdoor areas
Y
N/A
that are intended to be continuously lit, 24 hours per day and 365 days per year. a
❑X
§130.3(a)2B. All outdoor sign lighting that is ON both day and night is controlled with a dimmer that provides the
Y
N
N/A
3
ability to automatically reduce sign lighting power by a minimum of 65 percent during nighttime hours. Signs that
are illuminated at night and for more than 1 hr during daylight hours shall be considered ON both day and night. '
EXCEPTION to §130.3(a)2B. Outdoor signs in tunnels and large covered areas that are intended to be
Y
N/A
illuminated both day and night.
❑
Ex
§130.3(a)3. Demand Responsive Electronic Message Center Control. An Electronic Message Center (EMC)
Y
N
N/A
4
having a new connected lighting power load greater than 15 kW has a control installed that is capable of
�x
reducing the lighting power by a minimum of 30 percent when receiving a demand, response signal: '
EXCEPTION to §130.3(a)3. Lighting for EMCs that is not permitted by a health or life safety statute, ordinance, or
Y
N/A
regulation to be reduced by 30 percent.
�x
Field Inspector Notes:
Sign Lighting Mandatory Measures
A. The mandatory features and devices are required for all sign lighting projects as applicable. The mandatory measures require that
lighting controls are certified by the manufacturers to the Energy Commission, and that sign lighting systems have controls for
efficient operation. Mandatory features also set requirements for how lighting systems are classified according to technology, and
how to calculate installed wattage.
B. Mandatory measures for signs are specified in §110.9, §130.0, and §130.3. These mandatory measures for signs are similar to
the mandatory measures for the other indoor and outdoor lighting Standards.
CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E
Sign Lighting (Page 3 of s
Project Name: Date Prepared:
La Quinta, CA 12/23/2017
2. Mandatory Sign Lighting Measures
I have responsibility for installing the sign lighting
x❑ Yes, I have respnsibility for the sign lighting and will ❑ No, I do not have responsibility for installing
the sign
complete parts 2a and 2b of this compliance document lighting. Someone else will complete parts 2a and 2b
of this compliance document.
2a. Maximum Allowed Lighting Power Method of Compliance
Certificate of Compliance and Field Inspection Energy Checklist
Complete this part if there are signs using the maximum allowed lighting power method of compliance. (Complete part 2b of this
Certificate of Compliance if there are signs using the Specific Lighting Source method of compliance)
A
B
C
D I E F G
H
I
J
rn m 3
Design
Complies
Allotted Watts
Watts
Y/N
UJ
C
O W
2
2c E 3 N N m `"
h
°. S
Field Inspector
Symbol
>
o' = Q �� w o
o
o•
v
Check that Sign
or Code
Description of the Sign
in E a
3
Complies
REF 1-E2
EXTERIOR STORE SIGNAGE
❑
42 1 12.0 504
10
Y
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
A
Symbol or code used on the plans (when plans are required) and other documents.
B
A description of the sign, or location of sign on the building; and the location of sign on construction documents.
C
OPTIONAL - Check this box only if this sign has a permanent, pre-printed, factory -installed, ENERGY VERIFIED label, confirming
that the sign complies with §140.8 of the California 2013 Title 24, Part 6 Standards, using the Maximum Allowed Power Allowance
method of compliance..The only labels that will be recognized for this purpose are ENERGY VERIFIED Certification Marks authorized by
Underwriters Laboratories (UL) or other Product Certification Body accredited to ISO/IEC Guide 65 by the American National
Standards Institute in accordance with ISO/IEC 17011. Surveillance by the Accredited Certification Body shall be an ongoing annual
inspection program carried out by a Type A Inspection body in accordance with ISO/IEC 17020. For signs with such an ENERGY
VERIFIED label, columns'D through'I' are not required to be filled out. Note: Using an ENERGY VERIFIED label is an optional
method to validate compliance. An ENERGY VERIFIED label is not needed for compliance.
D
The sign area in square feet.
E
List "I" if the sign is internally illuminated. List "E" if the sign is externally illuminated. .
F
Allowed watts per square foot. Enter 12 if the sign is listed as "I" in column E. Enter 2.3 if sign is listed as "E" in column E.
G
Multiply the square footage in column D times the allowed Lighting Power Density (LPD = watts) in column F.
H
Show the total installed watts in the sign, as determined according to the applicable provisions of §130(c). .
I
Enter Y if the number in column H is less than or equal to the number in column G. Otherwise; the sign does not comply.
J
This page doubles as a field inspection checklist.
Field Inspector Notes:
CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance April 2016
•
CERTIFICATE OF COMPLIANCE NRCC-LTS-01-E
Sign Lighting (Page 5 of 5
Project Name: Date Prepared:
La Quinta, CA ' ' 2/23/2017
Documentation Author's Declaration Statement
I certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:.
Laura Longoria
Company:
Signature Date:
Henderson Engineers, Inc:. -
02/23/17
Address:
CEA/HERS Certification Identification (if applicable):
15851 Dallas Parkway, Suite 240
City/State/Zip:
Phone:
Addison TX, 75001
(214) 647-3067
Responsible Person's Declaration Statement
I certify the following under penalty of perjury, under the laws of the State of California: r
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 building, 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 included with the documentation the builder provides to the building owner at
occupancy.
Responsible Designer Name: Responsible Designer Signature:
David D. Haake
Company: Signature Date:
Henderson Engineers, Inc.
Address:
License: ,Feb
8345 Lenexa Drive, Suite 300
16137
City/State/Zip:
Phone:
Lenexa, KS 66214
(913) 742-5000