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05-2636 (CSCS)44 P.O. BOX 1504' 78-495 CALLE TAMPICO . ki. ' LA QUINTA,:CALIFORNIA 92253 BUILDING & SAFETY D] BUILDING PEF • ti Application Number. J- 05-00.002636 Property Address: 79315 HIGHWAY 111 APN. 649-030-034- - - Application description:- NEW COMML - STORES & CUSTOMER SERVICE Property Zoning: REGIONAL COMMERCIAL 1 Application valuation: 5936234 Applicant: Architect or Engineer: Lll.. LVV.- -------- - - - - -- ---------------------------------------------- LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class: B—�= --! /► License N 711039 r1 Dater_ r _; contractor=.f� l�C✓1�yv �- OWNER -BUILDER DECLARATION • I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to construct,.alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the ' improvements are not intended or offered for sale. If, however, the building or improvement is sold within (`,d•'^"� - one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). - - (_ 1 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 t, • 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 f 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: LQPERMIT • - M .. VOICE 760 777-7012 FAX (760) 777-7011 TMENT INSPECTIONS (760) 777-7153 Date: 5/17/06 Owner: Walmart-Stores Inc 2001 SE 10th .Street _ BENTONVILLE, AR 72.716` y Contractor: CSI CONSTRUCTION CO 9272 JERONIMO' ROAD, ,STE #116 I�I� /1V.JJ1.- CITY O LAF faUINT A FI;VANCE DEPT WORKER'S COMPENSATION DECLARATION ' I hereby affirm under penalty of perjury one of the following declarations: 1 _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: _ Carrier HRH INS Policy Number 1098385252 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. C - •f' ° Dated `P 1,can, S•�+- C.Oh ��j i� c �'4 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 - ' - F • ' _ IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. x , 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 buil"constion,and her by a horize r esentativesof this county to ent upon the above-mentioned propertn purposes L--ate: s r Date: Signature (Applicant or Agent) ` Application Number . . . . . 05-00002636 Permit. . . BUILDING PERMIT Additional desc . Permit Fee . . 13413.50 Plan Check Fee .8718.78 Issue Date Valuation 5936234 Expiration Date 11/13/06 Qty Unit Charge Per Extension BASE FEE 3539.50 4937.00 2.0000 THOU BLDG 1,000,001 -.-.UP 9874.00 Permit ELEC-NEW COMMERCIAL Additional desc " Permit Fee - 2707.16 Plan Check Fee 676.79 Issue Date Valuation 0 Expiration Date 11/13/06 Qty Unit Charge --Per Extension BASE FEE 15.00 134608.00 0200 -------------------=------------------------------------------------- ELEC GARAGE•OR NON-RESIDENTIAL 2692.16 ------ Permit. . . GRADING PERMIT Additional desc . Permit Fee . . . . 15.00 Plan Check Fee.. .00 'Issue Date Valuation 0 Expiration Date 11/13/06 . 0ty Unit Charge Per. Extension ---------------------------------------------------------------------------- BASE FEE 15.00 Permit MECHANICAL Additional desc . Permit Fee . . . . 593.00 Plan Check Fee 148.25 Issue Date . . Valuation 0 Expiration Date 11/13/06 Qty Unit.Charge Per{ Extension BASE FEE 15.00 5.00 9.0000.EA MECH FURNACE <=100K 45.00 5.00 9.0000 EA MECH B/C <=3HP/100K BTU 45.00 8.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU 132.00 10.00 22..5000•EA MC B/C >15 <=30HP/500K-1M BTU 225.00 1.00 33.5000 EA MECH B/C >30<50HP/1M-1.75M BTU 33.50 1.00 6.5000 EA MECH AH <=10K CFM 6.50 2.00 6.5000 EA MECH EVAP COOLER, 13.00 LQPERMIT Application,Number 05-00002636 : Permit . . . . MECHANICAL Qty Unit Charge Per Extension 10.00 6.5000 EA MECH-VENT FAN 65.00- 2.00 6.5000 EA MECH EXHAUST HOOD ---------------------------------------------------------------------------- 13.00 Permit PLUMBING Additional desc ". Permit Fee 824.25 Plan Check Fee 206.06 Issue Date Valuation' 0 Expiration Date 11/13/06 Qty Unit Charge Per Extension BASE FEE 15.00 96.00 6.0000 EA PLB FIXTURE 576.00 2.00 15.0000 EA PLB BUILDING SEWER 30.00 10.006:0000 EA PLB ROOF DRAIN 60.00 6.00 7.5000 EA PLB WATER HEATER%VENT 45.00 3.00 12.0000 EA PLB INTERCEPTOR 36.00 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 3.00 7.5000 EA PLB OTHER BACKFLOW <=2 INCH 22.50 1.00 15.0000 EA PLB OTHER BACKFLOW >2 INCH 15.00 29.00 .7500 EA. PLB GAS PIPE >=5 21-75 -------_--------------------------------------------------------------------- Special Notes.and Comments . Sam's Club Retail Store, 134,608 sqft, M/S-3 Occupancy, Type VN Sprinkled, Occupant -Load 31927. " ---------------------------------------------------------------------------- Other Fees. . . . . . . . . . ACCESSIBILITY PLAN REVIEW 871.88 ART IN PUBLIC PLACES -COM 29661.17 DIF CIVIC CENTER - COMM 9255.28 ENERGY REVIEW FEE 871.88 DIF FIRE PROTECTION -COMM 3117.56 STRONG MOTION (SMI) - COM 1246..60 DIF STREET MAINT FAC -COMM 2240.75 DIF TRANSPORTATION - COMM 167958.97 - Fee summary Charged Paid Credited Due --- ------ -- Permit Fee Total 17552.91 .00 .00 ------ 17552.91 Plan Check Total 9749.88 8000.00 ".00 1749.88 Other Fee Total 215224.09 .00 .00 215224.09 . Grand Total .242526.88 8000.00 00 234526.88 Applicant: 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.: Date: Contractor: 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 am exempt under Sec. B.&P.C. for this reason i 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 N Lender's Contractor: CSI CONSTRUCTION CO 9272 JERONIMO ROAD, STE #116 , 92618 (949)380-39 Llc. 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 the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier: _ Policy Number: _ _ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that; if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: 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 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 upon the above-mentioned property for inspection purposes. Date: Signature (Applicant or Agent): 78-495 CALLE TAMPICO D 44" ' VOICE (760) 777-7125 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 DESIGN &DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 3/16/2018 Permit Type/Subtype: BUILDING, COMMERCIAL/STORES/CUSTOMER SERVICE Owner: Application Number: CSCS-05-2636 Walmart Stores Inc Property Address: 79315 HIGHWAY 111 2001 SE 10th Street APN: 649030034 72716 Application Description: Property Zoning: Application Valuation: $0.00 Applicant: 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.: Date: Contractor: 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 am exempt under Sec. B.&P.C. for this reason i 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 N Lender's Contractor: CSI CONSTRUCTION CO 9272 JERONIMO ROAD, STE #116 , 92618 (949)380-39 Llc. 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 the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier: _ Policy Number: _ _ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that; if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: 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 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 upon the above-mentioned property for inspection purposes. Date: Signature (Applicant or Agent): o .. Date: 3/16/2018 Application Number: CSCS-05-2636 Owner: PropertyAddress: 79315 HIGHWAY 111 Walmart Stores Inc APN: 649030034 2001 SE 10th Street Application Description: 72716 Property Zoning: Application Valuation: $0.00 Applicant: Contractor: CSI CONSTRUCTION CO 9272 JERONIMO ROAD, STE #116 92618 (949)380-39 --------------------------------------------------------------------------------------------- LIC. No.: Detail: FINANCIAL DESCRIPTION ACCOUNT QTY AMOUNT ART IN PUBLIC PLACES -COM 27000003650500 $29,661.17 Total Paid for ART IN PUBLIC PLACES -COM: $29,661.17 DESCRIPTION ACCOUNT QTY AMOUNT DIF CIVIC CENTER - COMM 25200003650000 $9,255.28 Total Paid for DIF CIVIC CENTER - COMM: $9,255.28 DESCRIPTION ACCOUNT QTY AMOUNT DIF FIRE PROTECTION -COMM 25700003650000 $3,117.56 Total Paid for DIF FIRE PROTECTION -COMM: $3,117.56 DESCRIPTION ACCOUNT QTY AMOUNT DIF STREET MAINT FAC -COMM 25500003650000 $2,240.75 Total Paid for DIF STREET MAINT FAC -COMM: $2,240.75 DESCRIPTION ACCOUNT QTY AMOUNT DIF TRANSPORTATION - COMM 25000003650000 $167,958.97 Total Paid for DIF TRANSPORTATION - COMM: $167,958.97 DESCRIPTION ACCOUNT QTY AMOUNT ENERGY REVIEW FEE 10160003220600 $871.88 Total Paid for ENERGY REVIEW FEE: $871.88 DESCRIPTION ACCOUNT QTY AMOUNT HOURLY PLAN CHECK 10160003428200 $331.45 DESCRIPTION ACCOUNT QTY AMOUNT HOURLY PLAN CHECK 10160003428200 $70.00 DESCRIPTION ACCOUNT' QTY AMOUNT HOURLY PLAN CHECK 10160003428200 $418.60 DESCRIPTION ACCOUNT QTY AMOUNT HOURLY PLAN CHECK 10160003428200 $140.00 DESCRIPTION ACCOUNT QTY AMOUNT HOURLY PLAN CHECK 10160003428200 $183.75 Total Paid for HOURLY PLAN CHECK: $1,143.80 DESCRIPTION ACCOUNT QTY AMOUNT PERMIT FEES 0 $13,413.50 DESCRIPTION ACCOUNT QTY AMOUNT PERMIT FEES 0 $2,707.16 DESCRIPTION ACCOUNT QTY AMOUNT PERMIT FEES 0 $15.00 DESCRIPTION ACCOUNT QTY AMOUNT PERMIT FEES 0 $593.00 DESCRIPTION ACCOUNT QTY AMOUNT PERMIT FEES 0 $824.25 Total Paid for PERMIT FEES: $17,552.91 DESCRIPTION ACCOUNT QTY AMOUNT PLAN CHECK FEES 0 $8,000.00 DESCRIPTION ACCOUNT QTY AMOUNT PLAN CHECK FEES 0 $718.78 DESCRIPTION ACCOUNT QTY AMOUNT PLAN CHECK FEES, 0 $676.79 DESCRIPTION ACCOUNT QTY AMOUNT PLAN CHECK FEES 0 $148.25 DESCRIPTION ACCOUNT. QTY AMOUNT PLAN CHECK FEES 0 $206.06 Total Paid for PLAN CHECK FEES: $9,749.88 DESCRIPTION ACCOUNT QTY AMOUNT PLAN REVIEW, ACCESSIBILTY 10160003220600 $871.88 ` Total Paid for PLAN REVIEW, ACCESSIBILTY: $871.88 DESCRIPTION ACCOUNT QTY AMOUNT STRONG MOTION (SMI) - COM 10100002030800 $1,246.60 Total Paid for STRONG MOTION (SMI) - COM: . $1,246.60 S P.O. BOX 1504 BuildingA— ., 1 . -�� J�s 78-495 CALLE TAMPICO Address - LA QUINTA, CALIFORNIA 92253 os APPLICATION ONLY uwner v a i r ^/; r+ U s h BUILDING: TYPE CONST. �5 N OCC. GRP. Mailing ��, O�O�� Address 7—W1=r �� S eet- A.P. Number C'tAy I�� lzi� Tel. Legal Description N" -r, Irlhtl.1 1-190 �l Z�' 4 � Sam�C hAb Contractor Project Description 01A nf, W LA Address City Zip Tel. Sq. Ft. Size i aog No. No. Dw. Stories Units State Lic. & Classif.7 City Lic. # 600D�"c Ignerrgr' r - �er�OW1"1L i- u �YC�1 C New Add ❑ 1s7 Alter ❑ Repair ❑ Demolition ❑ Address Vel. I 1 i Weis -;f Ocean 10vct 4ficcr Cc�v\�"l r c0'rdtlYlGl�lc� CitY L�� C11 Zip State J,0 £SOZ Lic. # (!� W'y) J1 V WP IMC LICENSED CONTRACTOR'S DECLARATION I her affirm that I am licensed under provisions of Chapter 9 (commencing with Section '00 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. / 111 In (% q �{p SIGNATURE DATE OWNER -BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5, Business and Professions Code: Any city or county which requires a PERMIT AMOUNT permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). Plan Chk. Dep. 1 �p Plan Chk. Bal. ❑ 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 Profes- sions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or im- provement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law) ❑ 1 am exempt under Sec. B. & P.C. for this reason Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Date owner Infrastructure WORKER'S COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE TOTAL REMARKS INTA A Na (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become ZONE: Minimum Setback Distances: BY: subject to the Workers' Compensation Provisions or the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Front Setback from Center Line I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Rear Setback from Rear Prop.Line Lender's Name Side Street Setback from Center Line Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. Side Setback from Property Line 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 FINAL DATE INSPECTOR construction, and hereby authorize representatives of this city to enter the above-mentioned property for inspection purposes. Issued by: Date Permit Signature of applicant Date Mailing Address Validated by: Validation: City, State, Zip WHITE = BUILDING DEPARTMENT YELLOW = APPLICANT PINK = FINANCE Date 5/12/06 No. 28469 Owner Wal-Mart Stores Address City Zip Tract # Type Commercial Lot # No. Street Unit 1 79315 Highway 111 Unit 2 Unit 3 Unit 4 Unit 5 Comments Sam's Club CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road La Quinta,, CA 92253 (760) 771-8515 APN # Jurisdiction Permit # Study Area No. of Units S.F. Lot # No. 134608 Unit 6 Unit 7 Unit 8 Unit 9 Unit 10 �AIVIEDSC� BERMUDA DUNES r rr RANCHO MIRAGE t7 INDIAN WELLS d PALM DESERT LA QUIINDITA ��' 649-030-034 La Quinta 1 Street S.F. CC#1071998 in the amount of $48,458.88 plus #1159136 in the amount of $8,876.48 to equal total due At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, residential additions under 5 00 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile ho mes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $0.42 X 134,608 S.F. or $56,535.36 have been paid for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued. Fees Paid By CC/Arvest Bank - Lucas Kellner Name on the check By Dr. Doris Wilson Superintendent Fee collected /exem Signature Check No. 1071998 Telephone 626.917.6800 Funding Commercial. NOTICE: Pursuant to Government Code Section 6 0(d)(1), is will serve to notify you that the 90 -day approval period in which you may protest the fees o r other payment identified above will begin to run fron144tdo on which the building or installation permit for this project is issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE: This Document NOT VALID if Duplicated Embossed Original -Building Department/Applicant Copy -Applicant/Receipt Copy -Accounting Payment Recd ' $0.00 7 $56,535.36 h'twedurier""' f� lJy NOTICE: Pursuant to Government Code Section 6 0(d)(1), is will serve to notify you that the 90 -day approval period in which you may protest the fees o r other payment identified above will begin to run fron144tdo on which the building or installation permit for this project is issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE: This Document NOT VALID if Duplicated Embossed Original -Building Department/Applicant Copy -Applicant/Receipt Copy -Accounting ,STMARTME-Riverside When: Recorded Return. To: W. al -Mart �R-ealty. Co: ' -c/o J.'Matthew'Wil' 'Coxj Es"q. Gresham Savage:N61,-b & Tilde -ft .5 50 E. Hospitality' Lane, suite m.0 San Bernardino,.I bA, .02,408,42052 MAIL TAX. S-T-ATXM9-'NT$ TO: Wal-Mart Realty Co: Property Dept 0%13,,, Mail Stop. 0550 T. a 061 S -E 1�h (W,$fore. 14100 4941 -.0M Bentonville, AR 727110 DOCUMENTARY TRANSFER TAXI COPY of Doc 'e Ument R corded 0, L .has, not been compared with ori ginal. County Rec(,�Oer V., - I )VIN'TY, CALIFORNIA NOT OF -PUBLIC R=ORD,:TVIR$UANT-TO:REVENUE: AND TAXATION CODE.SECTLON 1:1932 GRANT M�: FOR VALUABLE C0NSMkRATJ0.N',.r.ecdjp* dfw.jub ereby y ' hi& . acknowledged; -A WAL-MARTREAL ESTATE : . BUSINESS - -TRLJST,,ADdlawW.'$ fy does- hereby GRANT tb- WAL-MARTREALTYCO., ah Arkangas: corporation, W a_ that � certain' fcW. the -State o property. -1h. ie bty of t -f 11 f0afonfia, n a,,' 'County :Riverside, described ;as -that. portion.- tb4 U A whi6h 'is overlaid`. Lot B of �a. 10 -44 pproved;by;ft-_:Qt-y, .,L. t recoiffigured pursuant I& tiiWAd---.fixx t City .1 Quinfa The lotsh -a -,are desclibed"Mi Exhibits �W' and �V' attached'`hereto and.made parthereof *This Grant Deed perfectsthe jhfent. of Lot Line Adjustaidbt-2005-w a&d b ' the Qt approve by �. y of La Quints. I DATED: March. I &j 2006: drimi-DoW (W&Mzm to W&"ian Reeky. for U.A) 1Y76+LAj0P1NTA_(.SwM$) — 14111TY WAL-MART RE TE BUSINESS TkUST, e aw4rgsWt#ory tust. J an STATE OF ARKANSAS COUNTY OF BENTON before me, CC2;u a:a a Notary Public; in and for said County.and State; personally appeared La-Fi-� e. Wo ; ki: n.s. personally known to me•:or-proved to me on the basis of satisfactory evidence to be the person whose name; -is subscribed to the within instrument and acknowledged to .me that sh,e eacecated t>ze same in ho/ author ed opacity, and that by .ham signature on ttie-instrument the person, or entityupon tiehalf'Of.. h ,h the.person�acted.,executed the. -,.instrument. WITNESS ,my hand and`;officialseal:, p Qu Ga eay, :,Notary Pi lic �..N®TAR SEAL. P,au1a A Spy Notary Putilic Benton County, State.o Arkansas. ' J My Ccmm�sion Exxp�rss G/.1/2012 -2- bra,„ uaa (W tq w�Ma,r,acoty (�r Li -i ) • • , 'T ///'' ., •` I4 rte' •, ... • N` •'. u. 1yxi ,,•. • • 4 uli �F , HIBI`I LO•T L INE'ADJ:USTMENT`Q5 LEGAL DESCRIPTION • EXISTING'LOT `A. 'FARCE-1 OF PARCEL MAP<NO: 30420; AS SHOWN BY'2vJAP ON FI EIN,BOOK 202 PAGE(S:) 40 THROUGH- 44 NE; OF PARCEL IVIAPs,`RECORDS OF` R RSMF.COUNTY, CALIFQRi�]IA:. EM9TING LOT-f-W. , PARCEL 2 A ND 3: OF'PARCEL MAP N.O. 30420 AS SHOWN BY -M.AP ON FILE `IN BOOK 202 PAGES) 40THROUGH 44, INCLUSIVE;, OP PARCE:L.M.APS , RECORDS OF•RIVERSIIIDE;COUNTY* .CALIFORNIA, TOGETMR; TTHARCEL • ` 3 OF PARCEL 1VIAP NO 33588 AS• SHQWN BY MAP ON FII..E IN'BOOK 214 PAGES) 24'THROUGH27; INCLUSIVE, QF PAR'CEL.' F RECQRDS OF RNERSWE COUNTY,; CALIFORNIA: hp's - - , 1• Uq • - �° ems_ LF�o: . , - _ - llNtT�Y p�.VE1:OPME�T p�PT` y VED;`t C M, Prepared by: DK'Nasland.PLS 5562 304 01;8 1` _• r My License renews9-30 2007 1/19/2006, 1107,AM t, 1 • TO: FROM DATE: RE: M E M O R A N D U M Plans Examiners for Sam's Club, La Quinta Greg Butler, Building & Safety Manager June 29, 2005 Sam's Club Allowable Area, Increases In the course of.your plan review, please make sure that you require a hard copy of recorded easement documents that will substantiate a "no -build easement" between the proposed Sam's Club and the property to the west. It appears that this will be necessary in order to consider allowing unlimited area for this building. Also, in briefly looking at a proposed site plan (I haven't actually looked at the one in the submitted set of plans), it appears that there may be a fenced area (garden center?) at the northwest corner of the building which might encroach across a real property line. Please bear in mind that, while we may allow an easement to maintain a 60 -foot yard, we would not allow construction over any. property line. As ays, thank ou for your help, -z., RMO-DEPT.M.HEALTH Fax:760-320-1470 Area.#IV - Plan Chec� - nR �Sam's � 'sClub� Oct 17 2005 10:57 P.02 COUNTY. OF RIVERSIDE COMMUNITY HEALTH DEPARTMENT OF ENVIRONMENTAL.H 4 LTH T T --� /4 /��6s PLAN CORRECTION . , c _D w -I I-, La QuintaAddress 8917 6800 JayWnuk Inc. Address 2001 &E-A Phone 62 - .Phone ,Uwrli- VV con�i jfie u . ilans are now �ed subject to listed below and the attached: to the final - InspPC 'or-waterapproval.:Priol :-J:. This plan does'not include sewage For moree approval.: r local water agency- :4'terceptor sizing foTM from you. idt-.(76()'j863-7000-oth and easily cle 2.. All fibor,:wall an I ceiling finishes in food. seryice areas must be smo of-tinhs suchas d fis:)eiisers.th :Provide a grease, rersio:16 Land Use bevater and self service waitress.. �fthe -floor basin style. Behind all sinKS in ule SPRtil I 1-Y, I 10.0 3 1;�,nop sink must be .:., 1 111, :: f �atthO�Jnte� FRP/tile � i to a- height.of 81 ed 'roof W 0 current at A be firl's 1 must meet curren standal,ao, faces wit� an �a' rash enclosure m roved tw.0 pa�ft. 4. '-rbe-.t surface with a 1111 3 .�Oxy- iable. 'Seal these interior sul b )oth'.and easil ('clear s6al"' d ag airist entry. y lor and walls are sm singExterior doorj must alsq be e eill clo d'1fg'rpatertharj21G d ie:;troorrydo lfclosing an "ind must likewise be se 5. All exterior windows such a� drive through w . ows u -:a1f.. 9t: city of 1600 Service su br� .,a velocity o in. Sery wi door. air curtain must 0 verm curtains. The delivery d dicated air cu h 'havq,, e addressed. y' ...siquare-inc es, e 6 t6le flooe. id A - nj.-ata' hei Jht-bf-T above c ireset On-. All'issues ed with this plan o ��ai;n!g7jde has beert..issu A construction lin to th juidelines sbt-forth th&ei - - -------- 4-' - d to apeak' 6W be 'r'es61Ved gdbor'�c!! s in correction%!r or greater than the -number of W&Ker!�� assigned provided shall be equal,, locker 'From the: The number of arbo atdir. shift 16 anti -backflow device- rri�unted upstream of e. n style must have a 8:_ The soda lin h as PVC.. ted (.i must be non reactive suc jTwiVhin the in or "Il'l 1 )p fully enclose onward- all' .1 t Preparation areas rriList t.. R and Meat Department na'dk.-B&,` Bakery, 0elilRorisseele a 'warehouse settl'' �ffified air 5alancierepos 11 be 'required for the snack:bar and rofisger16,002. eAta6 st hoodss prior to -Q final'.'a'!'Iloroval- i--------- �,;pfw. �it appr6xindately jnipeetic�n wheft cbn4trtiption i E for a Preliminar3 j5g: Coniafot the Pian.Checke should be made at least five (5.) WNSTRUCTI N INSPECTIONS: n and rough equipment installed. Request�for'iiivetfi�n�-_ addresse:the'' 80% complete, with plumbing, rough ventilation, lan correction sheet."' All o;dnstntctj.6n.3jo.t. offierwise r. A compliance -guide is attached to this p F, . .TION MUST be made upon working days in advance. accordant with the gti�idelines set forth therein. A jNAt,jN§ptC -approved to correction, must be performed in ac pPROVAL to operate shall not be grinted, -or r*rnodeled areas plau finished details A 0 h' been n completed and completion- of work including d "APPLICATION TO OVERAT as. ee e FINAL IN SpEcTION, an 6 facility has pas,56d th ::operate., until th PIMMIT FEES hayd been paid.' working days in advance.- Request for inspection should be made at least five 5) Ph (760 320-1-048-' ry PLANS.. cHEcKED BY Dubin e plans. and gree -tb incorporate [:acknowl icatod on th as indicated tiecorrectionsnoted herein and edge them -durington,§ttuction'. Signature company Date N P.O. Box 1504 78-495 CAL.LI- TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFI_TY D6PARTMGNT (760)777-7012 FAX (760) 777-701 1 To: Greg Butler, Building & Safety Manager To CDD: 9-23,2005 From: Doug Evans, Director -CDD Due Date: 10-5,2005 Status: 2nd Review Building Plans, Approval* (This is an approval to issue a Building Permit) The Community Development Department has reviewed the Building Plans for the following project: Description: Address or General Location Applicant Contact: SAM'S CLUB 79-315 HWY 111 JAY WNUK 1-626-917-6800 The.Community Development Department finds that: ❑ ...these Building Plans do not require Community Development Dep ent approval. these Building Plans are approved by the Community Development Department. ❑ ...these Building Plans require corrections. Please forward a copy of the attached corrections to the applicant. When the corrections are made please return them to the Community Development Department for review. g Evans, Directe'CDD Date La Quinta 05-2636 July 14, 2005 SPECIAL INSPECTION PROGRAM ADDRESS OR LEGAL DESCRIPTION: 79-315 Hwy 111 PLAN CHECK NUMBER: 05-2636 . OWNER'S NAME: Sams I, as the owner, or agent of the owner (contractors may not employ the special inspector), certify that I. or the architectlengineer of record, will be responsible for employing the special inspector(s) as requi y nif uilding Code (UBC) Section 1701.1 for the construction project located a e ve- UBC Section 106.3.5. Signed I, as the engi �r/architect of record, certify that I have prepared the foliowing special Inspection program as required by UBC Section 106.3.5 for: the construction pro the site listed above. ROF SS/O ,c? I�I� 42 ,7 7 Signed e« /� a+assc�:+:, tk v 1. List of work requiring special inspection: ® Soils Compliance Prior to Foundation Inspection ® Field Welding 0 Cps\.\�O ® Structural Concrete Over 2500 PSI High Strength Bol ❑ Prestressed Concret® Expansion/Epoxy Anchors FYJ Structural Masonry ' ❑ Sprayed -On Fireproofing Designer Specified ❑ Other 2. Name(s) of individual(s) or firm(s) responsible for the special inspections listed C, above: ' JOL g_ • C. 3. Duties of the special Inspectors for the work listed above: Ar special Inspectors s"ii eneck in witfi the Cityand present their•credentiais for approval prior to beginning work on the job site. T00/ T00'd 9096# dU007I-M 9LST09susa LZ:60 SOOZ'Zo'AOH J.w / `P + �g3 s ARCHITECTS rs September 12, 2005 1AU;11i7 Mr. David Salas — eff-V RA&M-M DEPARTMENT OF BUILDING & SAFETY 78-495 Calle Tampico La Quinta, CA 92253 Via Fax: 760-776-6392 _RE:._ .STRUCTURAI,_QBSERVATION _ SAM'S CLUB.#4941--' LA QUINTA, CA P+R JOB NO. 05-241.25, 5.2 Mr. Salas: �X-J'.A1"bakX"11■ A R C H I T E C We authorize Elmer Marapao, P.E., of Twining Laboratories, Inc. to conduct the structural observations for the foundations. Mr. Marapao is a licensed civil engineer and available to conduct this portion of work. If you have any -questions, please call me at 562-628-8000 or Elmer at 951-847- 0460. Thank you. Sincerely, RUTH ARCHITECTS Project Manager cc: Sam Sanchez, Wal-Mart Sheila Saul, Wallace Harry Moore, Twining ElmerxMarapao; Twining Rob Roy, even Western SA1Projects\05\05241-Sams-La. Quinta\Idr\Bidg 05-0912-GKdoc 111 West Ocean Blvd, Suite 2100 Long Beach, CA 90802 0,562.628.8000 562.628.8001 fax 4 www. prarchitects.com'`= , rx!'s7i�jF*PW I ha N �•R sa• ,. COUNTY OF RIVERSIDE COMMUNITY HEALTH AGENCY DEPARTMENT OF ENVIRONMENTAL HEALTH ENVIRONMENTAL HEALTH SERVICES SUPPLEMENTAL REPORT TO SAN. FORM # DATE SUBJECTS t C IL'' PERMIT NO. ADDRESS INSPECTOR ✓OS o �-' Y REMARKS: O N ©✓ r r/1 -6r+r C' P✓ h Gl o f c f c i G t P (/'( i�ly� �- 0 pp i e a;R A� �r a 'DEHSAN-118 (Rev.B/02) „� ' ;r; �. Y s'} R ; + . �} , < Distnbution. WHITE--0ffice CANARY—Owner; PINK—Office r: 4�iF " v :'s. �r{. �`''�� ' �fr''1`;x + :r'*'' 3�C;.yxf-x r�'„'''a.+�'""� in�� vs i,� �"�` �' -t� + TuyZi.'1d.v...� i�.�r F r1 > ..:'(.�� "•'- �'n) 9 � +`�' �i �3 ; kC'";. r �:f John R. Hawkins Fire Chief- Proudly serving the Unincorporated Areas of Riverside County and the Cities of. Banning Beaumont Calimesa Canyon Lake Coachella Desert Hot Springs Indian Wells Indio Lake Elsinore La Quinta Moreno Valley Palm Desert Perris Rancho Mirage San Jacinto Temecula Board of Supervisors Bob Buster, District 1 John Tavaglione, District 2 Jim Venable, District 3 Roy Wilson, District 4 Marion Ashley, District $ RIVERSIDE COUNTY FIRE DEPARTMENT In cooperation with the California Department of Forestry and hire Protection 210 West San Jacinto Avenue • Perris, California 92 • ax (909) 940-6910 Date City of LaQuinta Building Department RE 15all-S Su,6 The Riverside Coynty_, Eke Del location—_ — - Please call if you should have ng the Fire clearance for the following uestions 760-863-8886 0 Respectfully Terry DeSo y Fire Syste s Inspector Y EMERGENCY SERVICES DWISION • PLANNING SECTION • INDIO OFFICE 82-675 Highway 111, 2"4 R., Indio, CA 92201 • (760) 863-8886 • Fax (760) 863-7072 04-15-2005 02:42po Fru-CVWD PD 'IVE +7803919838 • T-303 P.00ZA04, F-353 COACIMLLA VALLEY WA77R DISTR;Cr ASSES 0" PARA= NUMBER 85-995 Avenve 53 CoacbcIta, Cal farms 92236 --" (760) 398-2691 APPLICATION YOR WASTEWATER INTIM(TWOR/SEPARATOR APPROVAL APPLKAM. Subc* this farm with a copy era SCALm pmt PL'M (I ` - 20' to 1"-41Y SCALA driven W pig spacifioedattt. A nomcehmda>,►lb ELLm Avis mptb d wbmma 8W wiidn is mhmiKod Chmk vAM bo tmdrr pnyabk to the milia Yaky Wats Distr> Approval of tbis 1pplkatieo eW tean+va vM fora period not to exceed am (1) yew ftm date of pgmnmL Pim (�eekNa w6mt, Camttaerar, Contact Paso Ad&mc SU 1 City Sze[e � TeiepJwae Jo► WV)uK 1000 LaVes Drive. Covirih 9-1�1p � —08DO owuft Ciw Smte Yip Tc]Vboaa Wal 1' SiDw I m. Zoo I SE 1011 St. BCMj'bItivi l(e , A It 121110 $0115 ,a, Pmpnd Q - 1r�t VanipOvo DBA SA - cLK PLEASE COMPLETE THIS SECTION FOR REMW OF FOOD ESTABLISMEMS NOTE: PLANS WILL NOT BE ACCEYM UNLESS THIS APPLICATION 16 COMPLEM AND THE PLANCMCCKiE6 IS PAM GENERAL (ONSTRUCTION: 77pe of CAtWrsdiao: • Ncw Food FacWty RRmodd of Fjdstint Food Emmbr•t=cst Bmw oropoaricm Scadus oacity; Iatalom— > 1 iatiUm Sml3 vftMtam awMmtm ___ BarwA Food Suvim 9srNou&*d Service Nates Sofmccr Ser Acc MuMuxvks (ramble) �ogk Sttyice (di�orablrJ OWNURM OSFl rAT" DECLAkA'TMON: I certify Ihat I ban n W the actlnc application sad cm- that all iW brmatioa is correct I rmdoomd th d tbo amomu of fins; paid is baaod oa AW declaauw ofinfonnatiian oa Idris form a+rd tart Ioeaetoet Fa6ormation is tpeuads fhr dieoiai of the aubmittcd pLms. 7 also uadmataad tLit pleas veil! bd disaMed picked up within cixty(60) dar ofappw W or dta W and &a no inspmdae of my "sab9aza t willbccoadwtad. or aPP � +� a]I Props M"Uftrd bas aeeeivad mad plum bow hem appcaved and �®d. PM ..Ar i. %d!�:.y,;"'li -.,�•.�OR�D76'TIiICY'iUSE:•�OJ�tI:.�'�< �.�'•�,�t`t�;�: •� M. of syncmw 7y" Of 9stnuo) Na Dwd ft Usitsa., 06 O &cm Insavepuw Waivw —/ f (� TScbtios Fi�ceaetlalm B'�Mt �A.IGe eu{; C] lits T p ri j a fth0fiag ❑ Addfdm M Asa Scr of ce Deli t O CMkUWrmsCWCV GmL It�MAwrs: - - Y t 1 Awm%md o tmiod ❑ c�adifimdAw&vw Fag d �jc� `d?.?to� Date lWdd --� • S CV%fj ni 04-15-2005 02:42pa Fru-CVWD PD SATE* +7003910638 • T-303 P-002/004 F-353 COACIMLLA VALLEY WATER DLSMUCi' A9SE9 OR'S IPARM 1WMHER 8$-995 Avenve 83 Coacbeft. CaMmia 92236 (760) 398 -2651 --`— APPLICATION FOtt WASTEWATER INTIMCF-MRISEPARATORAPPROVAL APPL,#AW. Subc* this fci= wkb a copy ot'e $CA= pmt pL-(I`- 20'10 1--41y SCALE) dq wn m VhVWt spwAcffdamc. A ncaAmdabl Eft 6a io mnqubvd whm Qts 4Vdkstion is auhmittod Chcuk ttm be tmda payable to the Cmchft Va q WaterD!*iat. Apporvel of this applkttiou oMdl ttauem regd fare peeiod act m e:cmd otte (1) y� 4wa dvc ofpayme�t Pied Check N& Abet, Ceavagw. Cmtsa Pam Address t Cin 3tue ZO (D 2(oT&Ahods a ►oc)zpc DreSt omnk Ch a1-1110 a -1- mkoD Wal-Mart- Sibres 2-A0I 5E Sf. P --&n onv lle A m 12 `�Tc-w 1 �� -aso ttwy i clw LA Civ lvl*ti?A ZIP Levet laesorip m 1 1- r�� w1r5 �`u F7 PLEASE COMPLETE THIS SECTION FOR REVIEW OF FOOL} ESTABLISEM MS NOM PLANS WDLL NOT BE ACCEMD UNLESS MUS APPLCA71ON 16 COMPLETE AND 77TH PLAN C HMCK FEE IS PAID. GENERAL CONSTRUMON: 7ppe of Corratr.edm New Food ✓ FaoUky Remodel of Exutiot Food EstmWW=mt _ Bmw aropaaoic q Seados hu mat Edema! B49Md Seaft orHmtaa _ Barwnth Food Sesviae BarNombod Service_ Water 9ofterer+- SeMcc M-Mtavlm (seeable) MA* $cM6# (disposable) *WNBR/RA ti>E3EftATM DEGLAXATM: I cadry that I bun m►d the aadn application nerd cram that all filammatian is eareaet I rmdaetaud dart tba ataoeot of foo pefd is hated an �r dadaatioa of iefbtnrrttion oa this fovea atq that 1nCOtreFt Falbtmati0a is srouada !br deeial of tha wbmittod pLma, 1 alto andat uW dw pkm will b$ diseatded if up within sixty(60) days cEtrrppovd or denial and that no mupeadae of my atablitlmrcat wm bcwadvotok err appmvalstaetadio opus% mm an props "mod bw bbam ar$ pl&w !raver ben approved wA raemrod. /�, V " Sire�toto l No. of Syst= Yypa of synwo) Na Dwtdtiap Chita ❑ saad/t]il Q dem torevepmrw.ivw FiorAae Unite [ramp brtmt mm ❑ ftu C3AdMm [l um Ave SV1G�C.{C. C3cUffift L L3 C'baaoct to SMAM ►�u,r /DOD til. >w�MAtu�s: 0A 4 Thls."== UA Amwvca omiad ❑ nCoadaonatApp svnp Q FeerS _ ! 2 --w&410�- `o79,0 - C6esk ldo. •� Dab u �T S Data C'VWtW21 04-15-2005 02:42p11 FrWCVWD PD We +7803210638 • T-303 P.00Z/004, F-353 COACIMLLA VALLEY WATER ]DISTRICT ASSES OR'S PAPJ= NUMBER 85-995 Avenue 52 Caatbe&. Califamie 9223$ (760) 398-2661 APIPLICA77ON FOR WASTEWATER INTMUTOR/SEPARATORA FROVAL APPUCAM., Submit ibis foam with a copy of* $CALM Plat PLM (1 `- "' to I- - 4a SCAU) dgwn to Diuiat spwjgwdoas. A aamceb d&Wfli s 6e is squbw whm Qw ail &Mian is whmimad Chcak WAM be medts payable to the Coachella vaDdy Wats nistriaL Appurval Of1his aipjflioatfon abelt toimsm valid fora pdrlod W to moved ore (I) ycubm datcofpsymt Pied Cisectc Na Ccmtrarta C4qagt Pmon Addtetct t l City State Tjp 02UP Telephone MAW. Iobo Lake r. lest' \jthm CA 01 i� an-�aBoo w-N�a S e Ad&= CitySante20�-la 3Tdcphoac 2.mI cE LO -h+ Si. ;evrbnvi Ile. 14a. 12'11 to 2: — 8ol6 Iob Psvyo(vAddnsse -� Ow rQ,v \ n -1M 1.e�t pestdigioc D11J► Sc,,m,-s' Club PLEASE COMPLETE THIS SECTION FOR REVIEW OF FOOL} ESTABLISHMENTS NOTE: PLANS WILL NOT BE ACCEPTED UNLESS TMS APFUCA71ON 16 COMPISIB AND ME PLAN COCK HM 19 PAID, GENERAL CONSTiitUMON: iyp, of Canetrvcdm Ncw Food F=Mty Rtmodd of Em5ft Food EMmh a, ma4 HMw of opmfica sm%g cmp&ip . kamma Sx amu Dtieteat Seotiiagwdrh Misteas arikntoa _ -- Barw M Food ScrAw BsrNocdbod Servioe'�- Wats 9oftener�� Sasvlt� Muhisavfr: (saatsble) Single Sctvfca (dipos Vc) OWNFR/XVM5WrATM DBCLAUTM: I cmtffy that I tan read the actino applimdon mad erase that all inftmatioo is caraett I imdattavd thm tW asaooat of fcc paid is based on my dedamdoc of infbn wion an *6 form ana that ioUMW bf meti0n is Wounds fbr dcaW of Iba and mkW pbm,, a go vadetamo MM proms wilt bo disratded if eat up wid" catty (60) days ofopptoval or denial aed that no bcpaatfan of my vasblidnacut Witt becoadwtad. or oppmval si0w to op.aea, uaNl aa Props M d Eat baro p1w��haw approved end set�,d, j Sis't>+cmta '�="�ORDIb'�RICX'iUSE; No. of Syst m bw of eynwo) Na DwainS Um1s Sand/OD ❑Dia brauq*wwalvw Fatena>Jda ❑ c3nai.l<uatoepoor I �*' o g�tt ❑ Repbxmeat Cl Addldm C7 tlis'1n.p ❑ Cisi6er ❑ Conocet to scow 660 d GaL 5ervt[e- lEiEMA><i:KB: L 'PP Approved O DtdW ❑ Candia" App avW Fee 9 •gao Romet>a Cheek Na Dna lultld " S Duo CM►wn,g11 Area.# IV COUNTY OF RIVERSIDE COMMUNITY HEALTH AGENCY DEPARTMENT OF ENVIRONMENTAL HEALTH PLAN CORRECTION Plan Check # IVN05-072 Date 9/26/05 DBA Sam's Club Address 78950 Hwy 111, La Quinta Plans Submitted by Jay Wnuk Phone 626-917-6800 Owner Walmart Stores, Inc. Address 2001 S.E. 1 01h St., Bentonville, AR Phone 479-273-4627 The plans are now approved subject to the conditions listed below and the attached compliance sheet. 1. This plan does not include sewage or water service approval. Prior to the final inspection provide a grease interceptor sizing form from your local water agency. For more information call County of Riverside Land Use at 760)863-7000. 2. All floor, wall and ceiling finishes in food service areas must be smooth and easily cleanable including waitress and self service stations such as drink dispensers. 3. The mop sink must be of the floor basin style. Behind all sinks in the splash zone the finish must be water proof to a height of 8' (e.g. FRP/tile) 4. The trash enclosure must meet current standards and be finished so that the interior floor and walls are smooth and easily cleanable. Seal these interior surfaces with an approved two part epoxy. 5. All exterior and restroom doors must be self closing. Exterior doors must also be sealed against entry by vermin. Service windows such as drive through windows must likewise be self closing and if greater than 216 square inches have dedicated air curtains. The delivery door air curtain must deliver air at a velocity of 1600 fpm at a height of 3' above the floor. 6. A construction guide has been issued with this plan correction. All issues not otherwise addressed by this plan correction must be resolved according to the guidelines set forth therein. 7. The number of lockers provided shall be equal, or greater than the number of workers assigned to a peak shift 8. The soda line must have an RP style anti -backflow device mounted upstream of the carbonator. From the RP onward all piping or tubing must be non reactive such as PVC. 9. Snack Bar, Bakery, Deli/Rotisserie and Meat Department Preparation areas must be fully enclosed within the warehouse setting. 10. Certified air balance reports will be required for the snack bar and rotisserie area exhaust hoods prior to final approval. CONSTRUCTION INSPECTIONS: Contact the Plan Checker for a Preliminary Inspection when constriction is approximately 80% complete, with plumbing, rough ventilation, and rough equipment installed. Request for inspection should be made at least five (5) working days in advance. A compliance guide is attached to this plan correction sheet. All construction not otherwise addressed on the plan correction must be performed in accordance with the guidelines set forth therein. A FINAL INSPECTION MUST be made upon completion of ALL work including finished details. APPROVAL to operate shall not be granted, or remodeled areas approved to operate, until the facility has passed the FINAL INSPECTION, and "APPLICATION TO OPERATE" has been completed and PERMIT FEES have been paid. Request for inspection should be made at least five (5) working days in advance. PLANS CHECKED BY Jerry Dubin Phone (760) 320-1048 1 acknowledge the corrections noted herein and as indicated on the plans and agree to incorporate them during construction: 1 ` Signature VV Company �� rx, 'yo, Date !�• f�•Ci`J 05/18/2006 09:21 9516880599 ADKAN ENG PAGE 02/02 aldk CIVIL ENGINEERING -. SURVEYING. • PLANNING ENGINEERS 6820 AIRPORT DRIVE, RIVERSIDE, CA 92504 TEL: (951) 688-0241 • FAX: (951) 688-0599 e-mail: mail@adkan.com May 18, 2006 CITY OF LA QUI.NTA P.O. Box 1504 La Quinta; CA 92253 t Regarding: Sam's Club, La Quinta Subject: Pad Certification (Pad Elevation ='63.77 + Dear Sir or Madam: Per a field survey performed under my supervision. on May 1.5, 2006, we have. found the aforementioned pad at the above -referenced project ha:: been completed substantially in conformance with the approved plans. This certification constitutes an expression of professional opinion regarding the facts contained herein, and'does not constitute 'a warranty or guarantee, ei.Nier.expressed or implied (reference Business and Professions Code Section 67355). If you have any questions, contact Ford McDonald of this office. Sincerely, adkoin ENGINEERS ChOssa .A. Leach, P.E. RICE 53390 CL:FM:Ie 7025a revised.crt J.,c No, 53390 s Exp. 6-30-01 \\ OF "Celebrating 20 years. of client Satisfaction' 05/15/2006 09:18 9516880599 ADKAN ENG PAGE 02/02 1 CIVIL ENGINEERING • SURVEYING •PLANNING ENG 0 N E E R $ 6820 AIRPORT DRIVF_' RIVERSIDE, CA 92504 TEL: (951) .688-0241 • FAX. (951) 688.0599 e-mail: ma 0 adMn.com May 15, 2006 . . CITY OF LA QUINTA P.O. Box 1504 La Quinta. CA 92253 Regarding: Sam's Club, La Quinta Subject: Pad.Certification Dear Sir or Madam: . Per a field survey performed under my supervision on May 15, 2006; we "have found the aforementioned pad at the above -referenced project has been completed substantially in conformance with the approved plans. This certification constitutes an expression of professional opinion regarding the facts. contained herein, and does not constitute a warranty or guarantee, either expressed or implied (reference Business and Professions Code Section 6735.5). If you have any questions, contact Ford McDonald of this office. Sincerely, adi(i�i11!SA44. Ql� FES /® ENGINEERS NQ. 5339c m Chanssa J.A. Leach; P.E. t9f C RCE. 53390 CLTMae AM =AM lmnwp�z 11(razan-& ASSOCIATES INC. GEOTECHNICAL ENGINEERING s. ENVIRONMENTAL ENGINEERING CONSTRUCTION TESTING.& INSPECTION CITY OF LA QUINTA DEPARTMENT OF BUILDING AND SAFETY .ENGINEER'S CERTIFICATE OF COMPLIANCE FOR EARTHWORK OBSERVATIONS LOCATION OF INSPECTION: Sam's Club Store #4941 PROJECT ADDRESS: 79-315 Hwy 111 TESTING AND INSPECTION AGENCY:. Krazan & Associates, Inc. PROPERTY OWNER'S NAME: Wal-Mart Stores, Inc OWNER'S. ADDRESS 2001 SE 10`h Street Bentonville, AR 72716 PER REPORT ON OUR PROJECT NO: 116-06017 DATE PROJECT STARTED: February 22, 2006 DATE PROJECT'COMPLETED: May 13, 2006 DATE OF THIS CERTIFICATE: May 13, 2006 TO THE SUPERINTENDENT OF BUILDING: * I hereby certify that I have personally observed and tested the items listed below for the above subject property, and on the basis of those observations and tests, it is my opinion that the same was placed in conformity with the requirements of the City of La Quinta, and the CALIFORNIA BUILDING CODE. * EARTHWORK (Building Pad) * For the purpose of this Certificate, to "have personally observed and tested" shall include observation and testing performed by any person or persons responsible to the licensed engineer signing this certificate. RCE No. 50233 / RGE No. 24 Project Engineer 4221 Brickell Street - Ontario, California 91761 - (909) 974-4400 - FAX (909) 974-4022 Willi Offices Serving the Western United States EsGil Corporation In Partnership with Government forBuifding Safety DATE: October 3, 2005 O APPLICANT JURIS. JURISDICTION: La Quinta O PLAN REVIEWER ❑ FILE PLAN CHECK NO.: 05-2636 SET: III PROJECT ADDRESS: 79-315 Hwy 111 PROJECT NAME: SAM'S CLUB ❑ The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's building codes. ® The plans transmitted, heremith'will substantially comply with the jurisdiction's building codes when minor deficiencies identified in the attached list are resolved and checked by building department staff. ❑ The plans transmitted herewith have significant.deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. ❑ The check list transmitted herewith is for your information. The plans are being held at Esgil Corporation.until corrected plans are submitted for recheck. ❑ The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. ® Esgil Corporation staff did not advise the applicant that the plan check has been completed. ❑ Esgil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: Telephone #: Date contacted: (by: ) Fax #: Mail Telephone Fax In Person . ❑ REMARKS: By: Abe Doliente Enclosures: Esgil Corporation ❑ GA ❑ MB ❑ EJ ❑ PC 9/26/05 trnsmn.dot 9320 Chesapeake Drive, Suite 208 ♦ San Diego, California 92123 ♦ (858) 560-1468 ♦ Fax (858) 560-1576 Bin •4 Coot �ti Permit # �. � ��1;?(- City of La Quinta a Building & Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Project Address: / ' (� Owner's Name: 7 A. P. Number: Address: Legal Description: City, ST, Zip: ` i Contractor:" 5 % — Telephone: � �s'r Address: . _ Project Description:. ' City, ST, Zip: Telephone: '' k i State Lie. # : City Lie. #: LiT� Arch., Engr., Designer: Address: n ,, i City, ST, Zip: Telephone.,' Construction Type: Occupancy: State Lie. #: Project type (circle on . New�dd'n Alter Repair Demo Name of Contact Person: Sq. Ft.: # Stories: #Units: Telephone # of Contact Person: / _ o Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted 9 Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Energy Calcs. Plans picked up Construction Floodplain plan Plans resubmitted Mechanical Grading plan 2"" Review, ready for correctio fissue I� Electrical Subcontactor List Called Contact Person Ib Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted . Grading .IN HOUSE:- 'Review, ready for corrections/issue Developer Impact Fee. . Planning Approval Called Contact Person A.I.P..PP. Pub. Wks. Appr Date of permit issue School Fees 14 i/1 n /l/ � Yt^_•i� � i Total Permit Fees coo I'(e)l6arnha-I Ply) NDIL 1 aP3l 0(c EW 1 L �)-ffEavcv 4 ' 4 1 Rp -Gty of La Quinta �I'✓ Building a Safety Division Permit f P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760)'777-7012 Building Permit Application and Tracking Sheet Project Address: O� I f Owner's Name: al _ r•}. S•i-ore5 A. P. Number: Address: O $ Legal Description: City, ST, Zip: 1 72-71 Z Contractor. • "-'t' O✓1 Telephone: Address: -50 r bq s ' #� I Project Description: '�Vl S1.P11S �� X13 • .City, � ST, Zip: A Y Vt nei CA Z b Ila' 1. FI r1 A d P h Pa' d1'>7 Telephone-.049)..3 $0 "qp0 � . C-ha es Ac 11 State Lie. 1: City Lia #: 2 • ReY� i� CEi h • Arch, Engr., Designer: 1 Address: 1 T QJ? Li hce. 'veru► ov City,: ST, Zip: SG Telephone: State Lie. #: coon T Occupancy: r ! b e Project type {circle one): New Ad( n epau emo Name of Contact Person: 1/ Sq: FL:#Stones: # Units: Telephone # of Contact Person: _ pp Est6aled value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING .. PERMIT FEES Plan Sets Pian Check submitted pb Item Amount Structural Cates. Reviewed, ready for corrections Plan-Check Deposit Truss Cales Called Contact Person Plan Check Balance Energy Cates. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading.plan2" Review, ready for eorrections/usue /.,� Electrical Subcontactor Llst Called Contact Person �yyi7 Plumbing Grant Deed Plaits picked tip II.O.A. Approval Plass resubmitted . k✓ 11; / IN ROUSE;_ Grading Review, ready for correcti Issue D Developer Impact Feb: Planning Approval Called Contact Person Pub. Wks. Appr Date of permit issu School Fees Total.Permit Fees .• .. •. YOL 0/t 4.0 30/ao /L��S R Z ��ss� i-o0—'`��Cr►C SPP -sem^' �. 6-/T- • I Bin # CDA 4P. M OS 0 ity Of La Quinta, Permit # r Project Address: `7 _3i 5 A. P. Number: Building 9. Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet ill Lf,1 L�UI -Legal Description: Owner's Name: ct Contractor: Address: SF - City, ST, Zip: City, ST, Zip: Qj Telephone: State Lic. # : City Lic. #: Arch., Engr., Designer: Project Description: ReY I S 1 OnS +0 a l�vea Q h S Address: ccp 16 - r-IrIC11 City, ST, Zip: GCO 1 -add - bn Telephone: State Lic. #: Name of Contact Person: Tares Alda v� Telephone # of Contact Person: Z(p 1-7 _ (pU Project type (circle one): New Add'n Alter Repair Demo APPLICANT: DO NC # Submittal Req'd Recd 3 Plan Sets Plan Check submit Structural Calcs. Reviewed, ready Co Truss Calcs. Called Contact Per Energy Cala. Plans Picked up Flood plain plan Plans resubmitted Gradiog.pixa' 2" Review, ready fi Subcontactor List Called Contact Per, Grant Deed Plans picked up H O.A. Approval Plans resubmitted IN HOUSE:- Review, —re ady Co Planning Approval Called Contact Per, Pub. Wks. Appr Date of permit issue School Fees Mechanical 2-1V4R,ex771vF9 r eorrectlo ssue LE7i�9 Electrical 912 49 IC77 a 0 �n h Dose) Owner's Name: ct Mcl y � S Ye S kc— Address: 2O0 i, SF - City, ST, Zip: Qj 0 1 G AR -- Telephone: Project Description: ReY I S 1 OnS +0 a l�vea Q h S ccp 16 - r-IrIC11 GCO 1 -add - bn f Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: # Stories: 1.4 Units: Estimated Value of Project: ,T WRITE BELOW THIS UNE TRACIQNG . PERMIT FEES ed Item Amount . corrections d� .� iv p Plan Check Deposit °Op p Plan Check Balance Construction ,"e aLex t 01 Mechanical r eorrectlo ssue 111 p Electrical on ►N1S �l Plumbing S.M.I. Grading correctionssue Developer Impact Fee on A.LP.P. Total Permit Fees 0 4`' "- r Certificate of Occupancy O p �� U+coero&A= C� OF 9w5 Building & Safety Department a — This Certificate is issued pursuant to the. requirements of Section 109 of the California Building I Code, certifying that, at the time of issuance, this structure was in compliance with the E s provisions of the Building Code and the various ordinances of the City regulating building construction and/or use. r e BUILDING ADDRESS: 79-315 HIGHWAY 111 Use classification: COMMERCIAL RETAIL (SAM'S CLUB) Building Permit No.: 05-2636 Occupancy Group: M/S-3 Type of Construction:. TYPE VN Land Use Zone: CR Owner of Building: WALMART STORES, INC. Address: 2001 SE 10T" STREET City, ST, ZIP- BENTONVILLE, AR 72716 By: STEVE TRAXEL �l c► Date: SEPTEMBER 20, 2007 Building Official POST IN A CONSPICUOUS PLACE 30 -DA Y TEMPORA R Y 0 0 -a Certificate of Occupancy L � 5w4� EXPIRES APRIL 26, 2007 OF T9� �IGGl�iit/ Building & Safety Department This Temporary Certificate, issued pursuant to the requirements of Section 109 of the California Building Code, and with the concurrence of the Public Works Department and Community Development Department, certifies that the SAM'S CLUB STORE, at the time of issuance, was in compliance with the provisions of the Building Code and the various ordinances of the City regulating building construction and/or use. BUILDING ADDRESS: 79-315 HIGHWAY 111 Use classification: COMMERCIAL RETAIL (SAM'S CLUB) Building Permit No.: 05-2636 Occupancy Group: M/S-3 Type of Construction: TYPE VN Land Use Zone: CR Owner of Building: WALMART STORES INC Address: 2001 SE 10th STREET City, ST, ZIP: BENTONVILLE, AR 72716 By: STEVE TRAXEL Date: MARCH 28 2007 Building Official POST IN A CONSPICUOUS PLACE 30 -DAY TEMPORARY Certificate of Occupancy LOF �Ayr■'Ka"mrr i av wvv ■ Mm�rvv:Y ' Building & Safety Department This Temporary Certificate, issued pursuant to the requirements of Section. 109 of the California Building Code, and with the concurrence of -the Public Works Department and Community Development Department, certifies that the _ SAM'S CLUB STORE, at the time of issuance, was in compliance with the provisions of the Building Code and the various ordinances of the .City regulating building construction and/or use. BUILDING ADDRESS: 79-315 HIGHWAY 111 Use classification: COMMERCIAL RETAIL (SAM'S CLUB) . Occupancy Group: M/S-3 Type of Construction: TYPE VN Owner of Building: WALMART STORES INC Building Official Building* Permit No.: 05-2636 Land Use Zone: CR Address: 2001 SE 10th STREET City, ST, ZIP: BENTONVILLE, AR 72796 By: STEVE TRAXEL Date: "uly 26 2007 30wDAYTEMPORARY Certificate of. Occupancy Building & Safety Department This Temporary Certificate, .issued pursuant to the requirements .of Section 109 of the California Building Code, and with the . concurrence . of the Public Works Department and Community Development Department, certifies that the. SAM'S CLUB STORE, at the time of issuance, was in compliance with the provisions of the Building Code and the various ordinances of the City regulating building construction and/or use. BUILDING ADDRESS: 79-315 HIGHWAY 111 Use classification: COMMERCIAL RETAIL.(SAM'S CLUB) Occupancy Group: MIS -3 Type of Construction: TYPE VN Owner of Building: WALMART STORES INC . arm. Building Official Building Permit No.: -05-2636 Land Use Zone: CR Address: 2001 SE 101.h STREET City, -ST, ZIP: BENTONVILLE, AR 72716 By: STEVE TRAXEL Date: APRIL 26 2007 ROST 1A A CONSPICI• MCE .......,...�...xra�.,--_�:J-a-,saa�� src.scara;:.�:aa,-s-c;:.r—.•ewe.�c�.s�.szw.7n�.r.-'s:..:.�:.:r._�-.�.-.�•:a�N•,_:ca�srs¢:.xcuvr:............._,.—___._.._._. 30-L Ce [YTEMPORARY(ExTENSI.Q' N) ificate of Occ'u'p'-an'c-y ly TA ' �GGl�iiV Building & Safety Department. This Temporary. Certificate, issued pursuant to the requirements of Section 109 of the California Building Code, and with the concurrence of the Public. Works Department and Community Development Department, certifies that .the SAM'S CLUB STORE, at the time of issuance, was in compliance with the' provisions of the Building Code and the various ordinances of the City regulating building construction and/or use. BUILDING ADDRESS. 79-315 HIGHWAY 111 Use classification: COMMERCIAL RETAIL (SAM'S CLUB) Building Permit No.: 05-2636 Occupancy Group: M/S-3 Type of Construction: TYPE VN Land Use Zone: CR Owner of Building: WALMART STORES INC Address: 2001 SE loth STREET City, ST, ZIP: BENTONVILLE, AR 72716 . By: STEVE TRAXEL- `��dt Date: AUGUST 23, 2007 Building Official POST IN A CONSPICUOUS PLACE CEaRTIFICATE OF COMPLIIANCE' Part 1 of 3 FI MECH-1 OJECT NAME. Sam's Club #4941 La Quinta, C.A. DATE 6/27/2005 PROJECT ADDRESS Building Permit # Checked by7l3_aTe_ EnforcementAgency Use PRINCIPAL DESIGNER -MECHANICAL Roy R. Payne, Jr. TELEPHONE 479-636-5004 DOCUMENTATION AUTHOR Ken Haven TELEPHONE 479-636-5004 GENERAL INFORMATION DATE OF PLANS 6/27/2005 BUILDING CONDITIONED FLOOR AREA 128,615 BUILDING TYPE (] NONRESIDENTIAL ❑ HIGH RISE RESIDENTIAL ❑ HOTEUMOTEL GUEST ROOM PHASE OF CONSTRUCTION (] NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION ❑ UNCONDITIONED (file affidavit) METHOD OF MECHANICAL COMPLIANCE [D PRESCRIPTIVE ❑ PERFORMANCE PROOF OF ENVELOPE COMPLIANCE ❑ PREVIOUS ENVELOPE PERMIT (] ENVELOPE COMPLIANCE ATTACHED STATEMENT OF COMPLIANCE I nus certificate of compliance lists the owaing teatures ana performance specifications need to comply with I Itle 24, Farts 1 and 6 of the California Code of Regulations. This certificate applies only to building mechanical requirements. The documentation preparer hereby certifies that the documentation is accurate and complete. DOCUMENTATION AUTHOR SIGNATURE DATE Ken Haven For Kcv4 14aver1 16/27/2005 The Principal Mechanical Designer hereby certifies that the proposed building design represented in this set of construction documents is consistent with the other compliance forms and worksheets, with the specifications, and with any other calculations submitted with this permit application. The proposed building has been designed to meet the mechanical requirements contained in the applicable parts of Sections 110 through 115, 120 through 124, 140 through 142, 144 and 145. Please check one: O I hereby affirm that I am eligible under the provisions of Division 3 of the Business and Professions Code to sign this document as the person responsible for it's preparation; and that I am licensed in the State of California as a civil engineer or mechanical engineer, or I am a licensed architect. ❑ I affirm that I am eligible under the exemption to Division 3 of the Business and Professions Code by Section 5537.2 or 6737.3 to sign this document as the person responsible for its preparation; and that I am a licensed contractor performing this work. O I affirm that I am eligible under the exemption to Division 3 of the Business and Professions Code to sign this document because it pertains to a structure or type of work described pursuant to Business and Professions Code sections 5537, 5533, and 6737.1. These sections of the Business and Professions. Code are printed in full in the Nonresidential Manual. PRINCIPAL MECHANICAL DESIGNER -NAME SIGNATURE DATE LIC. # RoyR. Payne, Jr. G/i y aS M-32957 MECHANICAL MANDATORY MEASURES Indicate location on plans of Note Block for Mandatory Measures EC2 INSTRUCTIONS TO APPLICANT For Detailed instructions on the use of this and all Energy Efficiency Standards compliance forms, please refer to the Nonresidential Manual published by the California Energy Commission. MECH-1: Required on plans for all submittals. Part 2 maybe incorporated in hede{es-a��-plaas MECH-2: Required for all submittals, but may be incorporated in schedules o+ul�r O� �Pt. �.n MECH 3: Required for all submittals unless required ventilation rates and a/rflowu� �v Q��.4! MECH-4: Reoulred for all prescriptive submittals. I . _ _ — � JUN 2 S 2005 Nonresidential By —� FOR CONSTF IAT BY. MECH-1 (1) �C�-�aT January 2001 7 MECHANICAL SYSTEMS 3 ton RTUs 5 ton RTUs -TF 10 ton RTUs NOTE TO FIELD [SYSTEM NAME (Note 1) 11 (Note 1) (Note 1) Bldg. Dept. Use TIME CONTROL SETBACK CONTROL ISOLATION ZONES HEAT PUMP THERMOSTAT? ELECTRIC HEAT? FAN CONTROL VAV MINIMUM POSITION CONTROL? SIMULTANEOUS HEAT/COOL? HEAT AND COOL SUPPLY RESET? HEAT REJECTION CONTROL VENTILATION OUTDOOR DAMPER CONTROL? ECONOMIZER TYPE DESIGN O.A. CFM (MECH-3, COLUMN H) HEATING EQUIPMENT TYPE HIGH EFFICIENCY? I IF YES ENTER EFF. # MAKE AND MODEL NUMBER COOLING EQUIPMENT TYPE HIGH EFFICIENCY? IF YES ENTER EFF. # MAKE AND MODEL NUMBER PIPE INSULATION REQUIRED? PIPE/DUCT INSULATION PROTECTED? HEATING DUCT LOCATION R -VALUE COOLING DUCT LOCATION R -VALUE VERIFIED SEALED DUCTS IN %FAN FLOW CEILING/ROOF SPACE S B 0 N/A N N/A N/A N N/A N/A Note 1 A A Note 1 Gas RTU (2) N Integrated Packaged RTU N Lennox LGE036H N/A N/A Conditioned (3) Conditioned (3) Y S B 0 N/A N N/A N/A N N/A N/A Note 1 A A Note 1 Gas RTU (2) N Integrated Packaged RTU N Lennox LGE060H N/A N/A Conditioned (3) Conditioned (3) Y S B 0 N/A N N/A N/A N N/A N/A Note 1 A A' Note 1 Gas RTU (2) N Integrated Packaged RTU N Lennox LGE120H N/A N/A Conditioned (3) Conditioned (3) Y CODE TABLES: Enter code from table below into columns above. Y:Yes N:No HEAT PUMP THERMOSTAT? ELECTRIC HEAT? VAV MINIMUM POSITION CONTROL? SIMULTANEOUS HEAT/COOL? HEAT AND COOL SUPPLY RESET? " HIGH EFFICIENCY? PIPE INSULATION REQUIRED? PIPE/DUCT INSULATION PROTECTED? SEALED DUCTS IN CEILING/ROOF SPACE? TIME CONTROL SETBACK ISOLATION FAN CONTROL CTRL. ZONES S: Prog. Switch H: Heating Enter number I: Inlet Vanes O: Occupancy C: Cooling of Isolation P: Variable Pitch Sensor B: Both Zones V: VFD M: Manual Timer O: Other C: Curve VENTILATION OUTDOOR ECONOMIZER DESIGN O.A. DAMPER CFM B: Air Balance A: Auto A: Air Enter Design C: Outside Air Cert. G: Gravity W: Water Outdoor Air CFM. M: Outside Air N: Not Note: This shall be Measure Required no less than D: Demand Control Column H on N: Natural MECH-3. Notes: 1) Refer to Rooftop Unit Schedule or Air Handling Unit Schedule. 2) Except for cooling only units. Refer to Rooftop Unit Schedule. 3) Except for dropped ceiling areas ("attic") . Refer to Enlarged HVAC Plans (R=3.3 installed, per Specifications). Nonresidential Compliance Form MECH-1 (2) January 2001 k MECHANICAL SYSTEMS 20 ton RTUs 10 ton RTU 30 ton AHU NOTE TO FIELD SYSTEM NAME (Note 1) 11 (Note 1) 1 (Note 1) Bldg. Dept. Use TIME CONTROL SETBACK CONTROL ISOLATION ZONES HEAT PUMP THERMOSTAT? ELECTRIC HEAT? FAN CONTROL VAV MINIMUM POSITION CONTROL? SIMULTANEOUS HEAT/COOL? HEAT AND COOL SUPPLY RESET? HEAT REJECTION CONTROL VENTILATION OUTDOOR DAMPER CONTROL? ECONOMIZER TYPE DESIGN O.A. CFM (MECH-3, COLUMN H) HEATING EQUIPMENT TYPE HIGH EFFICIENCY? I IF YES ENTER EFF. # MAKE AND MODEL NUMBER COOLING EQUIPMENT TYPE HIGH EFFICIENCY? IF YES ENTER EFF. # MAKE AND MODEL NUMBER PIPE INSULATION REQUIRED? PIPE/DUCT INSULATION PROTECTED? HEATING DUCT LOCATION R -VALUE COOLING DUCT LOCATION R -VALUE VERIFIED SEALED DUCTS IN %FAN FLOW CEILING/ROOF SPACE S B 0 N/A N N/A N/A N N/A N/A Note 1 A A Note 1 Gas RTU (2) N Integrated Packaged RTU N Lennox LGE240H N/A N/A Conditioned (3) Conditioned (3) 94 S B 0 N/A Y N/A N/A N N/A N/A Note 1 A A Note 1 Electric N Integrated Packaged RTU N Lennox LCE120H N/A N/A Conditioned (3) Conditioned (3) Y CODE TABLES: Enter code from table below into columns above. Y:Yes N:No HEAT PUMP THERMOSTAT? ELECTRIC HEAT? VAV MINIMUM POSITION CONTROL? SIMULTANEOUS HEAT/COOL? HEAT AND COOL SUPPLY RESET? HIGH EFFICIENCY? PIPE INSULATION REQUIRED? PIPE/DUCT INSULATION PROTECTED? SEALED DUCTS IN CEILING/ROOF SPACE? S B 0 N/A N N/A N/A N N/A N/A Note 1 A A Note 1 Gas AHU N Integrated Packaged AHU N Munters HCU N/A N/A Conditioned Conditioned Y TIME CONTROL SETBACK CTRL. ISOLATION ZONES FAN CONTROL S: Prog. Switch H: Heating Enter number I: Inlet Vanes O: Occupancy C: Cooling of Isolation P: Variable Pitch Sensor B: Both Zones V: VFD M: Manual Timer Required O: Other D: Demand Control C: Curve VENTILATION OUTDOOR DAMPER ECONOMIZER DESIGN O.A. CFM 8: Air Balance A: Auto A: Air Enter Design C: Outside Air Cert. G: Gravity W: Water Outdoor Air CFM. M: Outside Air N: Not Note: This shall be Measure Required no less than D: Demand Control Column H on N: Natural MECH-3. Notes: 1) Refer to Rooftop Unit Schedule or Air Handling Unit Schedule. 2) Except for cooling only units. Refer to Rooftop Unit Schedule. 3) Except for dropped ceiling areas ("attic") . Refer to Enlarged HVAC Plans (R=3.3 installed, per Specifications). Nonresidential Compliance Form MECH-1 (3) January 2001 I MECHANICAL EQUIPMENT SUMMARY (Part 1 of 2) MECH-2 PROJECT NAME neTr- Sam's Club #4941 La Quinta, CA CHILLER AND TOWER SUMMARY PIIMPR 6/27/2005 Equipment Effi- Name Equipment Type Qty. ciency ' Tons Total Qty. GPM BHP Motor Eff. Drive Eff. Pump Control N/A System Name System Type Distribution Type Qty. Rated Input Vol. (Gals.) Refer to Water Heater Schedule DHW / BOILER SUMMARY CENTRAL SYSTEM RATINGS System Name . System Type Qty. N/A CENTRAL FAN SUMMARY -System Name ®� •• 104 TANK INSUL. External R -Val COOLING Effi- Output Sensible ciency Economizer Type Nonresidential Compliance Form MECH-2 (1) January 2001 Energy Factor or Recovery Efficiency Standby Loss or Pilot System Name System Type Distribution Type Qty. Rated Input Vol. (Gals.) Refer to Water Heater Schedule CENTRAL SYSTEM RATINGS System Name . System Type Qty. N/A CENTRAL FAN SUMMARY -System Name ®� •• 104 TANK INSUL. External R -Val COOLING Effi- Output Sensible ciency Economizer Type Nonresidential Compliance Form MECH-2 (1) January 2001 EXHAUSTFAN Room Name Qty. CFM BHP Motor Eff. Drive Eff. Notes: 1) Refer to Table B -8A for efficiency (Standard Fan Motor Efficiency) - 1.0 for direct drive, 0.97 for belt drive Nonresidential Compliance Form MECH-2 (2) January 2001 MECHANICAL VENTILATION MECH-3 1 Sam's Club #4941 La Quinta, CA 16/27/2005 MECHANICAL VENTILATION o© a o o a© a a a a ZONE/ SYSTEM RTU # 1 4 5 7 10 14 15 18 19 13 12 20 22 Totals (For Mech-4) OCCUPANCY BASIS AREA BASIS COND AREA SF CFM PER SF MIN. CFM B X C 240 0.15 36 1,524 0.15 229 665 0.15 100 2,540 0.15 381 2,108 0.15 316 694 0.15 104 270 0.15 41 766 0.15 115 78,866 0.15 11,830 649 0.15 97 347 0.15 52 3,765 0.15 565 1,116 0.15 167 550 0.15 83 Totals (For Mech-4) OCCUPANCY BASIS NO. OF PEOPLE CFM PER PERSON MIN. CFM E X F 2 15 40 8 15 110 3 15 50 17 15 250 4 15 60 3 15 50 3 15 40 8 15 110 789 15 11,830 6 15 100 3 15 50 8 15 110 11 15 170 2 15 30 867 REQ'D. O.A. (MAX. OF D OR G) DESIGN OUTDOOR AIR CFM VAV MIN. CFM N/A N/A N/A N/A' N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 40 120 229 400 100 120 381 400 316 400 104 500 41 120 115 120 11,830 '16,400 100 200 52 120' 565 400 170 200 83 200 14,124 19,700 (Refer to [K)) Notes: 1) Unit(s) provided with a CO2 sensor to monitor and limit the CO2 level to a maximum of 800 ppm as recommended by ASH RAE 62. Above 800 ppm, the economizer is activated (100% O.A.) to increase the outside air ventilation rate above the minimum setpoint to decrease CO2 level below 800 ppm. C Minimum ventilation rate per Section § 121, Table 1-F. E Based on expected number of occupants or at least 50% of Chapter 10 1997 UBC occupant density Must be greater than or equal to H, or use Transfer Air. Design outdoor air includes ventilation from supply air system & exhaust fans which operate at design conditions. Must be greater than or equal to (H - 1), and, for VAV, greater than or equal to (H - J). Nonresidential Compliance Form MECH-3 January 2001 I MECHANICAL SIZING AND FAN POWER MECH-41 Sam's Club #4941 La Quinta, CA 6/27/2005 SYSTEM NAME FLOOR AREA RTU1 (Vision Center) 240 NOTE: Provide one copy of this form for each mechanical system when using the Prescriptive Approach. SIZING and EQUIPMENT SELECTION 1. DESIGN CONDITIONS: - OUTDOOR, DRY BULB TEMPERATURE - OUTDOOR, WET BULB TEMPERATURE - INDOOR, DRY BULB TEMPERATURE 2. SIZING (APPENDIX C) (APPENDIX C) (See Chap. 8, ASHRAE handbook, 1993) - DESIGN OUTDOOR AIR 120 CFM (MECH 3; COLUMN 1) - ENVELOPE LOAD Btu/Hr (Env -2 Part 2 of 5 Column E) - LIGHTING 2.00 W / SF (Adjusted Actual Watts -LTG -2) -PEOPLE 2 # OF PEOPLE (MECH 3; COLUMN E) O - MISCELLANEOUS EQUIPMENT 0.00 WATTS / SF - OTHER (Describe) - OTHER (Describe) - OTHER (Describe) OTHER LOADS/SAFETY FACTOR (1.21 for cooling, 1.43 for heating) MAXIMUM ADJUSTED LOAD (TOTALS FROM ABOVE x OTHER LOAD SAFETY FACTOR) 3. SELECTION: INSTALLED EQUIPMENT CAPACITY IF INSTALLED CAPACITY EXCEEDS MAXIMUM ADJUSTED LOAD, EXPLAIN Next largest standard size RTU (3 -ton, 5 -ton, 10 -ton, 20 -ton). Gas heater size standard with RTU. COOLING HEATING 101 34 68 - 74 70 3 5 6 6 2 - 1 0 TOTALS 12 10 1.21 1.43 14 15 36 75 KBtu / Hr KBtu / Hr IFAN POWER CONSUMPTION I This section is not applicable - Fan system do not exceed 25 HP. NOTE: Include only fan systems exceeding 25 HP (see § 144). Total Fan System Power Demand may not exceed 0.8 Watts/CFM for constant volume systems or 1.25 Watts/CFM for VAV systems. Nonresidential Compliance Form MECH-4 (1) January 2001 I IV,IECHANICAL SIZING AND FAN POWER MECH-4 Sam's Club #4941 La Quinta, CA 6/27/2005 SYSTEM NAME FLOOR AREA RTU4 Bakery 1524 NOTE: Provide one copy of this form for each mechanical system when using the Prescriptive Approach. SIZING and EQUIPMENT SELECTION 1. DESIGN CONDITIONS: - OUTDOOR, DRY BULB TEMPERATURE - OUTDOOR, WET BULB TEMPERATURE INDOOR, DRY BULB TEMPERATURE 2. SIZING (APPENDIX C) (APPENDIX C) (See Chap. 8, ASHRAE handbook, 1993) - DESIGN OUTDOOR AIR 400 CFM (MECH 3; COLUMN 1) - ENVELOPE LOAD Btu/Hr (Env -2 Part 2 of 5 Column E) - LIGHTING 2.00 W / SF (Adjusted Actual Watts -LTG -2) -PEOPLE 8- # OF PEOPLE (MECH 3; COLUMN E) - MISCELLANEOUS EQUIPMENT 2.86 WATTS / SF - OTHER (Describe) - OTHER 79 (Describe) Baking/Cook Equip - OTHER (Describe) OTHER LOADS/SAFETY FACTOR (1.21 for cooling, 1.43 for heating) MAXIMUM ADJUSTED LOAD (TOTALS FROM ABOVE x OTHER LOAD SAFETY FACTOR) 3. SELECTION: INSTALLED EQUIPMENT CAPACITY IF INSTALLED CAPACITY EXCEEDS MAXIMUM ADJUSTED LOAD, EXPLAIN Electric heater size standard with RTU FAN POWER CONSUMPTION I 113 a LIWn w 11%Ja a'J1./11li0U1C - ran JyDtelll UV nUL eRGeeO AD nl-. NOTE: Include only fan systems exceeding 25 HP (see § 144). Total Fan System Power Demand may not exceed 0.8 Watts/CFM for constant volume systems or 1.25 Watts/CFM for VAV systems. COOLING HEATING 101 34 68 74 70 8 16 12 6 10 4 15 79 TOTALS 129 22 1.21 1.43 •156 31 120 102 KBtu / Hr KBtu / Hr 9 Nonresidential Compliance Form MECH-4 (2) January 2001 MECHANICAL SIZING AND FAN POWER MECH-4 PROJECT NAME DATE Sam's Club #4941 La Quinta, CA 6/27/2005 SYSTEM NAME FLOOR AREA RTU5 Demo/Fresh Audit 665 NOTE: Provide one copy of this form for each mechanical system when using the Prescriptive Approach. SIZING and EQUIPMENT SELECTION 1. DESIGN CONDITIONS: - OUTDOOR, DRY BULB TEMPERATURE - OUTDOOR, WET BULB TEMPERATURE - INDOOR, DRY BULB TEMPERATURE 2. SIZING (APPENDIX C) (APPENDIX C) (See Chap. 8, ASHRAE handbook, 1993) - DESIGN OUTDOOR AIR 120 CFM (MECH 3; COLUMN 1) - ENVELOPE LOAD Btu/Hr (Env -2 Part 2 of 5 Column E) - LIGHTING 2.00 W / SF (Adjusted Actual Watts -LTG -2) -PEOPLE 3 # OF PEOPLE (MECH 3; COLUMN E) - MISCELLANEOUS EQUIPMENT 23.71 WATTS / SF - OTHER (Describe) - OTHER (Describe) - OTHER (Describe) OTHER LOADS/SAFETY FACTOR (1.21 for cooling, 1.43 for heating) MAXIMUM ADJUSTED LOAD (TOTALS FROM ABOVE x OTHER LOAD SAFETY FACTOR) 3. SELECTION: INSTALLED EQUIPMENT CAPACITY IF INSTALLED CAPACITY EXCEEDS MAXIMUM ADJUSTED LOAD, EXPLAIN Gas heater size standard with RTU FAN POWER CONSUMPTION i nis section is not applicable - Fan system do not exceed 25 HP. NOTE: Include only fan systems exceeding 25 HP (see § 144). Total Fan System Power Demand may not exceed 0.8 Watts/CFM for constant volume systems or 1.25 Watts/CFM for VAV systems. COOLING HEATING 101 34 68 74 70 3 5 11 7 5 2 54 TOTALS 73 12 1.21 1.43 89 17 36 75 KBtu / Hr KBtu / Hr Nonresidential Compliance Form MECH-4 (3) January 2001 1, MECHANICAL SIZING AND FAN POWER ` MECH-4 -1 rnwr_�'1 114AMM DATE Sam's Club #4941 La Quinta, CA 6/27/2005 SYSTEM NAME FLOOR AREA RTU7 (Auto Center Sales) 2540 NOTE: Provide one copy of this form for each mechanical system when using the Prescriptive Approach. (SIZING and EQUIPMENT SELECTION —_1 1. DESIGN CONDITIONS: - OUTDOOR, DRY BULB TEMPERATURE - OUTDOOR, WET BULB TEMPERATURE - INDOOR, DRY BULB TEMPERATURE 2. SIZING. (APPENDIX C) (APPENDIX C) (See Chap. 8, ASHRAE' handbook,1993) - DESIGN OUTDOOR AIR 400 CFM (MECH 3; COLUMN 1) - ENVELOPE LOAD Btu/Hr (Env -2 Part 2 of 5 Column E) - LIGHTING 2.00 W / SF (Adjusted Actual Watts -LTG -2) -PEOPLE 17 # OF PEOPLE (MECH 3; COLUMN E) - MISCELLANEOUS EQUIPMENT 0.00 WATTS / SF - OTHER (Describe) - OTHER (Describe) - OTHER (Describe) OTHER LOADS/SAFETY FACTOR (1.21 for cooling, 1.43 for heating) MAXIMUM ADJUSTED LOAD (TOTALS FROM ABOVE x OTHER LOAD SAFETY FACTOR) 3. SELECTION: INSTALLED EQUIPMENT CAPACITY / IF INSTALLED CAPACITY EXCEEDS MAXIMUM\ ADJUSTED LOAD, EXPLAIN Next largest standard size RTU (3 -ton, 5 -ton, 10 -ton, 20 -ton). Gas heater size standard with RTU. FAN POWER CONSUMPTION This section is not annlicable - Fan system do not exceed 25 HP. NOTE: Include only fan systems exceeding 25 HP (see § 144). Total.Fan System Power Demand may not exceed 0.8 Watts/CFM for constant volume systems or 1.25 Watts/CFM for VAV systems. COOLING HEATING 101 34 68 74 70 8 16 35 20 17 8 0 TOTALS 70 36 1.21 1.43 84 52 120. 235 KBtu / Hr • KBtu / Hr Nonresidential Compliance Form MECH-4 (4) January 2001 NOTE: Provide one copy of this form for each mechanical system when using the Prescriptive Approach. 1SIZING and EQUIPMENT SELECTION —� 1. DESIGN CONDITIONS: - OUTDOOR, DRY BULB TEMPERATURE - OUTDOOR, WET BULB TEMPERATURE - INDOOR, DRY BULB TEMPERATURE 2. SIZING COOLING HEATING (APPENDIX C) 101 34 (APPENDIX C) 68 (See Chap: 8, ASHRAE handbook, 1993.) 74 70 - DESIGN OUTDOOR AIR 1 400 CFM (MECH 3; COLUMN 1) - ENVELOPE LOAD - LIGHTING -PEOPLE - MISCELLANEOUS EQUIPMENT - OTHER - OTHER -OTHER . Btu/Hr (Env -2 Part 2 of 5'Column E) 2.00 W / SF (Adjusted Actual Watts -LTG -2) 4 # OF PEOPLE (MECH 3; COLUMN E) 0.00 WATTS / SF (Describe) (Describe) (Describe) OTHER LOADS/SAFETY FACTOR (1.21 for cooling, 1.43 for heating) MAXIMUM ADJUSTED LOAD (TOTALS FROM ABOVE x OTHER LOAD SAFETY FACTOR) 3. SELECTION: INSTALLED EQUIPMENT CAPACITY IF INSTALLED CAPACITY EXCEEDS MAXIMUM ADJUSTED LOAD, EXPLAIN Gas heater size standard with RTU FAN POWER CONSUMPTION This section is not applicable - Fan systenn do not exceed 25 HP. NOTE: Include only fan systems exceeding 25 HP (see § 144). Total Fan System Power Demand may nqt exceed 0.8 Watts/CFM for constant volume systems or 1.25 Watts/CFM for VAV systems. 81 16 38 24 14 2 0 TOTALS 62 40 1.21 1.43 76 57 12011 130 KBtu / Hr KBtu / Hr Nonresidential Compliance Form MECH-4 (5) January 2001 _�!] MECHANICAL SIZING AND FAN POWER MECH-4 PROJECT NAME DATE Sam's Club #4941 La Quinta, CA 6/27/2005 SYSTEM NAME FLOOR AREA RTU14 Snack Bar 69.4 NOTE: Provide one copy of this form for each mechanical system when using the Prescriptive Approach. SIZING and EQUIPMENT SELECTION 1. DESIGN CONDITIONS: - OUTDOOR, DRY BULB TEMPERATURE - OUTDOOR, WET BULB TEMPERATURE - INDOOR, DRY BULB TEMPERATURE 2. SIZING - DESIGN OUTDOOR AIR -ENVELOPE LOAD - LIGHTING -PEOPLE - MISCELLANEOUS EQUIPMENT - OTHER - OTHER - OTHER (APPENDIX C) (APPENDIX C) (See Chap. 8, ASHRAE handbook, 1993) 500 CFM (MECH 3; COLUMN 1) Btu/Hr (Env -2 Part 2 of 5 Column E) 2.00 W / SF (Adjusted Actual Watts -LTG -2) 3 # OF PEOPLE (MECH 3; COLUMN E) 3.24 WATTS / SF (Describe) (Describe) (Describe) OTHER LOADS/SAFETY FACTOR (1.21 for cooling, 1.43 for heating) MAXIMUM ADJUSTED LOAD (TOTALS FROM ABOVE x OTHER LOAD SAFETY FACTOR) 3. SELECTION: INSTALLED EQUIPMENT CAPACITY IF INSTALLED CAPACITY EXCEEDS MAXIMUM ADJUSTED LOAD, EXPLAIN Next largest standard size RTU (3 -ton, 5 -ton, 10 -ton, 20 -ton). Gas heater size standard with RTU. [FAN POWER CONSUMPTION This section is not applicable - Fan system do not exceed 25 HP. NOTE: Include only fan systems exceeding 25 HP (see § 144). Total Fan System Power Demand may not exceed 0.8 Watts/CFM for constant volume systems or 1.25 Watts/CFM for VAV systems. COOLING HEATING 101 34 68 74 70 11 20 11 6 5 2 8 TOTALS 36 25 1.21 1.43 43 36 60 11 125 KBtu / Hr KBtu / Hr Nonresidential Compliance Form MECH-4 (6) January 2001 MECHANICAL SIZING AND FAN POWER MECH-4 PROJECT NAME DATE Sam's Club #4941 La Quinta, CA 6/27/2005 SYSTEM NAME FLOOR AREA RTU15 Computer 270 NOTE: Provide one copy of this form for each mechanical system when using the Prescriptive Approach. SIZING and EQUIPMENT SELECTION 1. DESIGN CONDITIONS: COOLING HEATING - OUTDOOR, DRY BULB TEMPERATURE (APPENDIX C) 101 34 - OUTDOOR, WET BULB TEMPERATURE (APPENDIX C) 68 - INDOOR, DRY BULB TEMPERATURE (See Chap. 8, ASHRAE handbook, 1993) 74 70 2. SIZING' - DESIGN OUTDOOR AIR 120 CFM (MECH .3; COLUMN 1) 3 5 - ENVELOPE LOAD Btu/Hr (Env -2 Part 2 of 5 Column E) 5 3 - LIGHTING 2.00 W / SF (Adjusted Actual Watts -LTG -2) 2 -PEOPLE 3 # OF PEOPLE (MECH 3; COLUMN E) 1 - MISCELLANFOUS EQUIPMENT 0.00 WATTS / SF 0 - OTHER (Describe) - OTHER (Describe) - OTHER (Describe) OTHER LOADS/SAFETY FACTOR (1.21 for cooling, 1.43 for heating) MAXIMUM ADJUSTED LOAD (TOTALS FROM ABOVE x OTHER LOAD SAFETY FACTOR) 3. SELECTION: INSTALLED EQUIPMENT CAPACITY IF INSTALLED CAPACITY EXCEEDS MAXIMUM ADJUSTED LOAD, EXPLAIN Next largest standard size RTU (3 -ton, 5 -ton, 10 -ton, 20 -ton). Gas heater size standard with RTU. FAN POWER CONSUMPTION This section is not applicable - Fan system do not exceed 25 HP. 01 NOTE: Include only fan systems exceeding 25 HP (see § 144). Total Fan System Power Demand may not exceed 0.8 Watts/CFM for constant volume systems or 1.25 Watts/CFM for VAV systems. TOTALS 11 8 1.21 1.43 13 11 36 75 KBtu / Hr KBtu / Hr Nonresidential Compliance Form MECH-4 (7) January 2001 NOTE: Provide one copy of this form for each mechanical system when using the Prescriptive Approach.. (SIZING and EQUIPMENT SELECTION 1. DESIGN CONDITIONS: - OUTDOOR, DRY BULB TEMPERATURE - OUTDOOR, WET BULB TEMPERATURE - INDOOR, DRY BULB TEMPERATURE 2. SIZING (APPENDIX C) (APPENDIX C) (See Chap. 8, ASHRAE handbook, 1993) - DESIGN OUTDOOR AIR 120 CFM (MECH 3; COLUMN 1) - ENVELOPE LOAD Btu/Hr (Env -2 Part 2 of 5 Column E) - LIGHTING 2.00 W / SF (Adjusted Actual Watts -LTG -2) -PEOPLE 8 # OF PEOPLE (MECH 3; COLUMN E) - MISCELLANEOUS EQUIPMENT 0.00 WATTS/SF - OTHER (Describe) - OTHER (Describe) - OTHER (Describe) OTHER LOADS/SAFETY FACTOR (1.21 for cooling, 1.43 for heating) MAXIMUM ADJUSTED LOAD (TOTALS FROM ABOVE x OTHER LOAD SAFETY FACTOR) 3. SELECTION: INSTALLED EQUIPMENT CAPACITY IF INSTALLED CAPACITY EXCEEDS MAXIMUM ADJUSTED LOAD, EXPLAIN Next largest standard size RTU (3 -ton, 5 -ton, 10 -ton, 20 -ton). Gas heater size standard with RTU. FAN POWER CONSUMPTION This section is not applicable - Fan system do not exceed 25 HP. NOTE: Include only fan systems exceeding 25 HP (see § 144). Total Fan System Power Demand may not exceed 0.8 Watts/CFM for constant volume systems or 1.25 Watts/CFM for VAV systems. COOLING HEATING 101 34 68 74 70 3 5 11 6 5 4 0 TOTALS 23 11 1.21 1.43 27 15 36 75 KBtu / Hr KBtu / Hr Nonresidential Compliance Form MECH-4 (8) January 2001 �J NOTE: Provide one copy of this form for each mechanical system when using the Prescriptive Approach. ISIZING and EQUIPMENT SELECTION 1. DESIGN CONDITIONS: - OUTDOOR, DRY BULB TEMPERATURE - OUTDOOR, WET BULB TEMPERATURE - INDOOR, DRY BULB TEMPERATURE 2. SIZING (APPENDIX C) (APPENDIX C) (See Chap. 8, ASHRAE handbook, 1993) - DESIGN OUTDOOR AIR 16,400 CFM (MECH 3; COLUMN 1) -ENVELOP ELOAD Btu/Hr (Env -2 Part 2 of 5 Column E) - LIGHTING 2.00 W / SF (Adjusted Actual Watts -LTG -2) -PEOPLE 789 # OF PEOPLE (MECH 3; COLUMN E) - MISCELLANEOUS EQUIPMENT 0.66 WATTS / SF - OTHER 1000 (Describe) Infiltration - OTHER (Describe) - OTHER (Describe) OTHER LOADS/SAFETY FACTOR (1.21 for cooling, 1.43 for heating) MAXIMUM ADJUSTED LOAD (TOTALS FROM ABOVE x OTHER LOAD SAFETY FACTOR) 3. SELECTION: INSTALLED EQUIPMENT CAPACITY IF INSTALLED CAPACITY EXCEEDS MAXIMUM ADJUSTED LOAD, EXPLAIN Values adjusted for sensible capacity. FAN POWER CONSUMPTION This section is not applicable - Fan systenn do not exceed 25 HP. NOTE: Include only fan systems exceeding 25 HP (see § 144). Total Fan System Power Demand may not exceed 0.8 Watts/CFM for constant volume systems or 1.25 Watts/CFM for VAV systems. COOLING HEATING 101 34 68 74 . F 70 498- 641 575 273 538 174 177 30 39 TOTALS 1,993 953 1.21 1.43 2,412 1,363 2,236 2,220 KBtu / Hr KBtu / Hr Nonresidential Compliance Form MECH-4 (9) January 2001 -MECHANICAL SIZING AND FAN POWER MECH-4 PROJECT NAME DATE Sam's Club #4941 La Quinta, CA 6/27/2005 SYSTEM NAME FLOOR AREA RTU 19 (Cash/Tele/Training) 649 NOTE: Provide one copy of this form for each mechanical system when using the Prescriptive Approach. (SIZING and EQUIPMENT SELECTION 1: DESIGN CONDITIONS: COOLING HEATING - OUTDOOR, DRY BULB TEMPERATURE (APPENDIX C) 101 34 - OUTDOOR, WET BULB TEMPERATURE (APPENDIX C) 68 - INDOOR, DRY BULB TEMPERATURE '(See Chap. 8, ASHRAE handbook, 1993) 74 70 2. SIZING - DESIGN OUTDOOR AIR 200 CFM (MECH 3; COLUMN 1) 4 8 - ENVELOPE LOAD Btu/Hr (Env -2 Part 2 of 5 Column E) 4 2 - LIGHTING 2.00 W / SF (Adjusted Actual Watts -LTG -2) 4 -PEOPLE 6 # OF. PEOPLE (MECH 3; COLUMN E) 3 - MISCELLANEOUS EQUIPMENT 11.56 WATTS / SF 26 - OTHER (Describe) - OTHER (Describe) - OTHER (Describe) TOTALS 42 11 10 OTHER LOADS/SAFETY FACTOR (1.21 for cooling, 1.43 for heating) 1.21 1.43 MAXIMUM ADJUSTED LOAD (TOTALS FROM ABOVE x OTHER LOAD SAFETY FACTOR) 50 14 3. SELECTION: INSTALLED EQUIPMENT CAPACITY 60 125 KBtu / Hr KBtu / Hr IF INSTALLED CAPACITY EXCEEDS MAXIMUM ADJUSTED LOAD, EXPLAIN Next largest standard size RTU (3 -ton, 5 -ton, 10 -ton, 20 -ton). Gas heater size standard with RTU. i FAN POWER CONSUMPTION i nis secuun is nut appncabie - ran system oo not exceea za tiv. NOTE: Include only fan systems exceeding 25 HP (see § 144). Total Fan System Power Demand may not exceed 0.8 Watts/CFM for constant volume systems or 1.25 Watts/CFM for VAV systems. Nonresidential Compliance Form MECH-4 (10) January 2001 ' -MECHANICAL SIZING AND FAN POWER MECH-4 PROJECT NAME DATE Sam's Club #4941 La Quinta, CA 6/27/2005 SYSTEM NAME FLOOR AREA RTU13 Receiving Office 347 NOTE: Provide one copy of this form for each mechanical system when using the Prescriptive Approach. SIZING and EQUIPMENT SELECTION 1. DESIGN CONDITIONS: COOLING HEATING - OUTDOOR, DRY BULB TEMPERATURE (APPENDIX C) 101 34 - OUTDOOR, WET BULB TEMPERATURE (APPENDIX C) 68 - INDOOR, DRY BULB TEMPERATURE : (See Chap. 8, ASHRAE handbook, 1993) 74 70 2. SIZING - DESIGN OUTDOOR AIR 120 CFM (MECH 3; COLUMN 1) 3 5 -,ENVELOPE LOAD Btu/Hr (Env -2 Part 2 of 5 Column E) 2 1 - LIGHTING 2.00 W / SF (Adjusted Actual Watts -LTG -2) 2 -PEOPLE 3 # OF PEOPLE (MECH 3; COLUMN E) 2 —MISCELLANEOUS EQUIPMENT 0.00 WATTS / SF 0 - OTHER (Describe) - OTHER (Describe) - OTHER (Describe) TOTALS 9 11 6 OTHER LOADS/SAFETY FACTOR (1.21 for cooling, 1.43 for heating) 1.21 1.43 MAXIMUM ADJUSTED LOAD (TOTALS FROM ABOVE x OTHER LOAD SAFETY FACTOR) 11 8 3. SELECTION: INSTALLED EQUIPMENT CAPACITY .IF INSTALLED CAPACITY EXCEEDS MAXIMUM ADJUSTED LOAD, EXPLAIN Next largest standard size RTU (3 -ton, 5 -ton, 10 -ton, 20 -ton). Gas heater size standard with RTU. FAN POWER CONSUMPTION This section is not applicable - Fan system do not exceed 25 HP. 01 NOTE: Include only fan systems exceeding 25 HP (see § 144). Total Fan System Power Demand may not exceed 0.8 Watts/CFM for constant volume systems or 1.25 Watts/CFM for VAV systems. " 36 J 1 75 KBtu / Hr KBtu / Hr Nonresidential Compliance Form MECH-4 (11) January 2001 MECHANICAL SIZING AND FAN POWER MECH-4 PROJECT NAME DATE Sam's Club #4941 La Quinta, CA 6/27/2005 SYSTEM NAME FLOOR AREA RTU12 Receiving Dock 3765 NOTE: Provide one copy of this form for each mechanical system when using the Prescriptive Approach. SIZING and EQUIPMENT SELECTION 1. DESIGN CONDITIONS: - OUTDOOR, DRY BULB TEMPERATURE - OUTDOOR, WET BULB TEMPERATURE - INDOOR, DRY BULB TEMPERATURE 2. SIZING (APPENDIX C) (APPENDIX C) (See Chap. 8, ASHRAE handbook, 1993) - DESIGN OUTDOOR AIR 400 CFM (MECH 3; COLUMN 1) - ENVELOPE LOAD Btu/Hr (Env -2 Part 2 of 5 Column E) - LIGHTING 2.00 W / SF (Adjusted Actual Watts -LTG -2) -PEOPLE 8 # OF PEOPLE (MECH 3; COLUMN E) - MISCELLANEOUS EQUIPMENT 0.00 WATTS/SF - OTHER 2550 (Descr'ibe) Infiltration - OTHER (Describe) - OTHER (Describe) OTHER LOADS/SAFETY FACTOR (1.21 for cooling, 1.43 for heating) MAXIMUM ADJUSTED LOAD (TOTALS FROM ABOVE x OTHER LOAD SAFETY FACTOR) 3. SELECTION: INSTALLED EQUIPMENT CAPACITY IF INSTALLED CAPACITY EXCEEDS MAXIMUM ADJUSTED LOAD, EXPLAIN FAN POWER CONSUMPTION This section is not applicable - Fan system do not exceed 25 HP. NOTE: Include only fan systems exceeding 25 HP (see § 144). Total Fan System Power Demand may not exceed 0.8 Watts/CFM for constant volume systems or 1.25 Watts/CFM for VAV systems. COOLING HEATING 101 34 68 74- 70 8 16 50 33 26 4 0 54 100 TOTALS 142 148 1.21 1.43 171 212 120 ' 235 KBtu / Hr KBtu / Hr Nonresidential Compliance Form MECH-4 (12) January 2001 NOTE: Provide one copy of this form for each mechanical system when using the Prescriptive Approach. (SIZING and EQUIPMENT SELECTION 1. DESIGN CONDITIONS: - OUTDOOR, DRY BULB TEMPERATURE (APPENDIX C) - OUTDOOR, WET BULB TEMPERATURE (APPENDIX C) - INDOOR, DRY BULB TEMPERATURE (See Chap. 8, ASHRAE handbook, 1993) 2. SIZING - DESIGN OUTDOOR AIR 200 CFM (MECH 3; COLUMN 1) - ENVELOPE LOAD Btu/Hr (Env -2 Part 2 of 5 Column E) - LIGHTING 2.00 W / SF (Adjusted Actual Watts -LTG -2) -PEOPLE 11 # OF PEOPLE (MECH 3; COLUMN E) - MISCELLANEOUS EQUIPMENT 4.03 �NATTS / SF - OTHER (Describe) - OTHER (Describe) - OTHER (Describe) OTHER LOADS/SAFETY FACTOR (1.21 for cooling, 1.43 for heating) MAXIMUM ADJUSTED LOAD (TOTALS FROM ABOVE x OTHER LOAD SAFETY FACTOR) 3. SELECTION: INSTALLED EQUIPMENT CAPACITY IF INSTALLED CAPACITY EXCEEDS MAXIMUM ADJUSTED LOAD, EXPLAIN Next largest standard size RTU (3 -ton, 5 -ton, 10 -ton, 20 -ton). Gas heater size standard with RTU. FAN POWER CONSUMPTION i nis section is not applicable - I -an system do not exceed 25 HP. NOTE: Include only fan systems exceeding 25 HP (see § 144). Total Fan System Power Demand may not exceed 0.8 Watts/CFM for constant volume systems or 1.25 Watts/CFM for VAV systems. COOLING HEATING 101 34 68 74 70 4 8 20 11 8 6 15 TOTALS 53 19 1.21 1.43 64 27 60 125 KBtu / Hr KBtu / Hr Nonresidential Compliance Form MECH-4 (13) January 2001 MECHANICAL SIZING AND. FAN POWER MECH-4 PROJECT NAME DATE Sam's Club #4941 La Quinta, CA 6/27/2005 SYSTEM NAME FLOOR AREA RTU22(Pharmacy) 550 NOTE: Provide one copy of this form for each mechanical system when using the Prescriptive Approach. SIZING and EQUIPMENT SELECTION 1. DESIGN CONDITIONS: - OUTDOOR, DRY BULB TEMPERATURE - OUTDOOR, WET BULB TEMPERATURE - INDOOR, DRY BULB TEMPERATURE 2. SIZING (APPENDIX C) (APPENDIX C) (See Chap. 8, ASHRAE handbook, 1993) - DESIGN OUTDOOR AIR 200 CFM (MECH 3; COLUMN 1) - ENVELOPE LOAD Btu/Hr (Env -2 Part 2 of 5 Column E) - LIGHTING 2.00 W / SF (Adjusted Actual Watts -LTG -2) -PEOPLE 2 # OF PEOPLE (MECH 3; COLUMN E) - MISCELLANEOUS EQUIPMENT 7.73 WATTS / SF - OTHER ' (Describe) - OTHER (Describe) - OTHER (Describe) OTHER LOADS/SAFETY FACTOR (1.21 for cooling, 1.43 for heating) MAXIMUM ADJUSTED LOAD (TOTALS FROM ABOVE x OTHER LOAD SAFETY FACTOR) 3. SELECTION: INSTALLED EQUIPMENT CAPACITY IF INSTALLED CAPACITY EXCEEDS MAXIMUM ADJUSTED LOAD, EXPLAIN Next largest standard size RTU (3 -ton, 5 -ton, 10 -ton, 20 -ton). Gas heater size standard with RTU. FAN POWER CONSUMPTION This section is not applicable - Fan system do not exceed 25 HP. 01 NOTE: Include only fan systems exceeding 25 HP (see § 144). Total Fan System Power Demand may not exceed 0.8 Watts/CFM for constant volume systems or 1.25 Watts/CFM for VAV systems. COOLING HEATING 101 34 68 7470 15 4 8 7 5 4 1 15 TOTALS 31 13 1.21 1.43 37 18 60 125 KBtu / Hr KBtu / Hr Nonresidential Compliance Form MECH-4 (14) January 2001 CERTIFICATE OF COMPLIANCE Part 1 of 2 FNV. 1 PROJECT NAME Sam's Club #4941 La Quinta, CA 16/27/2005 DATE PROJECT ADDRESS TBD Building Permit # Checked byiDa(F Enforcement A enc Use PRINCIPAL DESIGNER -ENVELOPE TELEPHONE 562-628-8000 DOCUMENTATION AUTHOR Ken Haven TELEPHONE 479-636-5004 GENERAL INFORMATION DATE OF PLANS 6/27/2005 IBUILDING CONDITIONED FLOOR AREA 128615 ICLIMATE ZONE 15 BUILDING TYPE El NONRESIDENTIAL ❑ HIGH RISE RESIDENTIAL ❑ HOTEL/MOTEL GUEST ROOM PHASE OF CONSTRUCTION O NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION ❑ UNCONDITIONED (file affidavit) METHOD OF ENVELOPE COMPLIANCE El COMPONENT Q OVERALL ENVELOPE ElPERFORMANCE STATEMENT OF COMPLIANCE This certificate of Gompliance lists the building features and performance specifications need to comply with Title 24, Parts 1 and 6 of the California Code of Regulations. This certificate applies only to building envelope requirements. The documentation preparer hereby certifies that the documentation is accurate and complete. DOCUMENTATION AUTHOR SIGNATURE DATE Ken Haven o For 1Ccvti-4�Vev1 6/27/2005 The Principal Envelope Designer hereby certifies that the proposed building design represented in this set of construction documents is consistent with the other compliance forms and worksheets, with the specifications, and with any other calculations submitted with this permit application. The proposed building has been designed to meet the envelope requirements contained in the applicable parts of Sections 110, 116 through 118, and 140, 142, 143 or 149 of Title 24, Part 6. Please check one: E) I hereby affirm that I am eligible under the provisions of Division 3 of the Business and Professions Code to sign this document as the person responsible for it's preparation; and that I am licensed in the State of California as a civil engineer or mechanical engineer, or I am a licensed architect. ❑ I affirm that I am eligible under the exemption to Division 3 of the Business and Professions Code by Section 5537.2 or 6737.3 to sign this document as the person responsible for its preparation; and that I am a licensed contractor performing this work. ❑ I affirm that I am eligible under the exemption to Division 3 of the Business and Professions Code to sign this document because it pertains to a structure or type of work described pursuant to Business and Professions Code sections 5537, 5538, and 6737.1. (These sections of the Business and Professions Code are printed in full in the Nonresidential Manual.) PRINCIPAL ENVELOPE DESIGNER -NAME ISIGNATURE IDATE JENVELOPE MANDATORY MEASURES Indicate location on plans of Note Block for Mandatory Measures 1INSTRUCTIONS TO APPLICANT q For Detailed instructions on the use of this and all Energy Efficiency Standards compliance forms, please refer to the Nonresidential Manual published by the California Energy Commission. , ENV -1: Required on plans for all submittals. Part 2 may be incorporated in schedules on plans. ENV -2: Used for all submittals: choose appropriate form depending on method of envelope compliance. ENV -3: Optional. Use if default U -factors are not used. Choose appropriate form for assembly U -factor to be calculated. Nonresidential Compliance Form ENV -1 (1) January 2001 CERTIFICATE OF COMPLIANCE (Part. 2 of 2) FNV-1 PROJECT NAME Sam's Club #4941 La Quinta, CA DAA E 6/27/2005 OPAQUE SURFACES Construction lype (e.g., Block, Wood, Surface Type Metal) Area U -factor Azimuth Solar Gains Tilt Y/N Form 3 Reference Location/Comments e.g., NOTE TO Fl=- Suspended Ceiling, For Building Dept Demising, etc.) Use Only Front Wall Block 13,250 0.625 0 90 21 ❑ 8" Solid CMU North Rear Wall Block 11,550 0.625 180 90 El ❑ 8" Solid CMU South Left Wall Block 9,570 0.625 90 90 E) ❑ 8" Solid CMU East Right Wall Block 7,350 0.625 270 90 0 ❑ 8" Solid CMU West Roof Metal 129,103 0.05348 0 0 El ❑ Roof Total Roof ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ a FENESTRATION SURFACES Site Assembled Glazing ❑ Check box if Building is >_ 100,000 f 2 of CFA and >_ 10,000 ft2 of vertical glazing then NFRC Certification is required. Follow NFRC 100 -SB Procedures and submit NFRC Label Certificate Form. Fenestration Type Area U -factor Azimuth SHGC Glazing Type Location / Comments NOTES TO FIELD - For Bldg. Dept. Use Only Windows 220 1.07 180 0.54 Tinted Vestibule Skylights 4,410 0.46 0 0.61 Coated Roof EXTERIOR SHADING Fenestration Exterior Shade Window # Type SHGC Height Width Length Ove hang Hei h LExt. RE,xt. Dist. Left Fin Right Fin Len th Height Dist. Length Height NOTES TO FIELD - For Building Department Use Only Nonresidential Compliance Form ENV -1 (2) January 2001 F OVERALL ENVEL.OPF MFTHOn (p,70 1 of F:) \I PROJECT NAME ^ry v FE T Sarn's Club #4941 La Quinta. C?. 6:27/2005 WINDOW AREA TEST A. DISPLAY PERIMETER B. GROSS EXTERIOR WALL AREA ` C. GROSS EXTERIOR WALL AREA D. ENTER LARGER OF A OR B E. ENTER PROPOSED WINDOW AREA 40 FTx6= SF x 0.40 = SF x 0.10 = DISPLAY AREA . 41,720 SF 41,720 240 SF DISPLAY AREA . 16,688 SF 40% AREA 4,172 SF MINIMUM STANDARD AREA 16,688 SF MAXIMUM STANDARD AREA 220 SF PROPOSED AREA F. WINDOW WALL RATIO = Proposed Window Area Divided by Gross Exterior Wall Area= 1 0.052732502 IF E IS GREATER THAN D OR LESS THAN C, PROCEED TO THE NEXT CALCULATION FOR WINDOW AREA ADJUSTMENT. IF NOT, GO TO PART 2 OF 6. 1. IF E IS GREATER THAN D: MAXIMUM. STANDARD PROPOSED WINDOW WINDOW ADJUSTMENT FACTOR . N/A - N/A = N/A GO TO PART 6 TO CALCULATE ADJUSTED AREAS 2. IF LESS THAN C: MAXIMUM STANDARD PROPOSED WINDOW WINDOW ADJUSTMENT FACTOR 16,688 - 220 = 75.85454545 GO TO PART 6 TO CALCULATE ADJUSTED AREAS SKYLIGHT AREA TEST ATRIUM HEIGHT 20 FT OR IF 5 55 FT IF > 55 FT 0.10 X N/A C N/A 10 0.05 X 128,615 = 6,431 STANDARD % GROSS ROOF AREA STANDARD SKYLIGHT AREA 1 4,410 1 PROPOSED - SKYLIGHT AREA IF THE PROPOSED SKYLIGHT AREA IS GREATER THAN THE STANDARD SKYLIGHT AREA, PROCEED TO THE NEXT CALCULATION FOR THE SKYLIGHT AREA ADJUSTMENT. IF NOT, GO TO PART2 OF 6. 1. IF PROPOSED SKYLIGHT AREA z STANDARD SKYLIGHT AREA: STANDARD SKYLIGHT PROPOSED SKYLIGHT SKYLIGHT ADJUSTMENT N/A - N/A = N/A -GO TO PART 6 TO CALCULATE ADJUSTED AREAS Nonresidential Compliance Form ENV -2 (1) January 2001 9-P.:All FNVFI.nPF MFTHOr lam: Y' t`- l E�1�I ,'ROJECT NAME DA i E Gam's Club #..I: • 1 ; ;_lima, ;\ 6/27/2005 . OVERALL HEAT LOSS - 0 0 o a o a a o PROPOSED STANDARD TABLE ASSEMBLY NAME HEAT VALUES? UA AREA' UA (e.g. Wall -1, Floor -1) AREA CAPACITY U -FACTOR (B x D) (Adjusted) U -FACTOR (F x G) Y N Front Wall 13,250 17.71 0.625 ❑ ED 8,281 -3,438 0.4 0 rn J < ❑ 121 ❑ O ❑ O Rear Wall 11,550 17.71 0.625 7,219 11,550 0.4 4,620 Left Wall 9,570 17.71 0.625 5,981 9,570 0.4 3,828 Right Wall 7,350 17.71 -0.625 4,594 7,350 0.4 2,940 O ❑ ❑ ❑ Roof 129,103 0.13 0.0535 0 D 6,904 129,103 0.057 7,359 Z ❑ ❑ z LU U U) LL ❑ ❑ ❑ ❑ ❑ ❑ O N H ❑ ❑ U. W ❑ ❑ ❑ ❑ W ❑ ❑ O O ❑ ❑ LL ❑ ❑ Windows 2 220 N/A 1.07 ❑ 0 235 16,688 0.49 8,177 CO .0O _Z W Q d LL 0 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ N/A N/A N/A N/A N/A ❑ ❑ Skylights 2 4,410 N/A 0.46 ❑ O 2,029 4,410 1.1 4,851 1— c7 '� N W ZN/A a W ❑ ❑ 1:1 El, ❑ ❑ ❑ ❑ N/A N/A N/A N/A ❑ ❑ " If Window and/or Skylight Area Adjustment is Required, use adjusted areas from part 6 0 35,243 Column E shall be 31,775 6 no greater than TOTAL column H TOTAL Nonresidential Compliance Form ENV -2 (2) January 2001 JV�ERA�L+L: ENVL._C�Q !VIT �. PRO.,L:CT NAME Sam's CI_::, ,1.1941 La QUinta, C,'- OVERALL ,'OVERALL HEAT Gari ❑A ❑B ❑c 1 ❑E r � D..','! E /'?005 ❑F Z I❑ El If Window and/or Skylight Area Adjustment is Required, use adjusted areas from part 1,556,421 SUBTOTAL �- PROPOSED AREA a O w ' ~ < HEAT CAPACITY U -FACTOR TABLE VALUES? HEAT GAIN (BxCxE) ASSEMBLY NAME (e.g. Wall -1, Floor -1) Y N Front Wall 13,250 43 17.71 0.625 ❑ 0 356,094 ❑ ED Rear Wall 11,550 43 17.71 0.625 310,406 JLeft < ❑ ❑ ❑ ❑ Wall 9,570 43 17.71 0.625 257,194 Right Wall 7,350 43 17.71 0.625 197,531 ❑ ❑ Roof -1 129,103 45 0.1275 0.05348 ❑ O 310,6.76 z ❑ ❑ w ❑ ❑ U N ❑ ❑ O ❑ ❑ ❑ ❑ U. � ❑ ❑ ❑ O co ❑ ❑ O O ❑ O LL ❑ ❑ Windows 2 220 55 N/A 1.07 ❑ 0 12,947 C0 O W Q ❑ ❑ ❑ ❑ N/A N/A. Z LL O ❑ ❑ ❑ ❑ N/A N/A N/A ❑ ❑ Skylights 2 4,410 1 55 1 N/A 0.46 ❑ E1 111,573 Cn W ❑ ❑ N/A Q ❑ ❑ N/A J cY d LL � ❑ ❑ ❑ ❑ N/A N/A N/A ❑ ❑ If Window and/or Skylight Area Adjustment is Required, use adjusted areas from part 1,556,421 SUBTOTAL 1,478,246 SUBTGTAL Nonresidential Compliance Form ENV -2 (3) January 2001 �- 1,478,246 SUBTGTAL Nonresidential Compliance Form ENV -2 (3) January 2001 nor - I. RfrrT� ems►- ,�- f r� � � ^,1' NAME #49,11 I -n n, _... - OVERALL HEAT GAIN FROM RADIATION OPAQUE SURFACES FA] o a o -_a a s ASSEMBLY NAME (e.g. Roof -1) Roof Column G must be less than column K PROPOSED SOLAR WEIGHT. ABSORP HEAT GAIN AREA FACTOR FACTOR U -FACTOR a (BxCxDxExF) 129,103 123 0.92 0.053476 0.7 546,872 546,872 SUBTOTAL STANDARD AREA ABSORP HEAT GAIN (Adjusted)' U, -FACTOR rt (CxDxHxlxJ) 129,103 0.057 0.7 582,911 582,911 SUBTOTAL Nonresidential Compliance Form ENV -2 (4) January 2001 Sam's Club #4941 La Quuila, CA 6 _RALL HEAT GA.1 F FA. a aoEEl r ( r n 1 DATE 6/27/2005 . If Window and/or Skylight " Only SHGC Part 3 Subtotal 1,556,421 than column Area Adjustment is Required, is used for Column t must n Part 4 Subtotal 546,872 less use adjusted areas from part 6 Skylights M Part 5 Subtotal 766,634 f 6. TOTAL 7869,927 WINDOW/SKYLIGHT NAME (e.g Window -1, Sky -1) WEIGHTING FACTOR 2 z Windows 0.61 F- U) Q LU O F- 0 F- U) W U) H 2 0 J Y Skylights 2.29 r ( r n 1 DATE 6/27/2005 . If Window and/or Skylight " Only SHGC Part 3 Subtotal 1,556,421 than column Area Adjustment is Required, is used for Column t must n Part 4 Subtotal 546,872 less use adjusted areas from part 6 Skylights M Part 5 Subtotal 766,634 f 6. TOTAL 7869,927 Nonresidential Compliance Form ENV -2 (5) January 2001 AREA Nonresidential Compliance Form ENV -2 (5) January 2001 0VE R A L. L. E N V E L 0 P r r, �t r 7-! �- . J _ _ r) F b •J ..J ? PRWEC; NA wlc DAi Sam's Club #4'J -t 1 La Quinta, CA ❑ CHECK IF NOT APPLICABLE (see Part 1 of 5) IE WALL NAME ORIENTATION (e.g. Wall -1, Wall -2) N E S W Front Wall 0 ❑ ❑ 1:3 Rear Wall 0 ❑ 121 ❑ Left Wall ❑ E1 ❑ ❑ Right Wall ❑ ❑ ❑ 121 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑B GROSS AREA 13,250 11,550 9,570 7,350 0 DOOR AREA 0 0 0 0 ❑DWINDOW WINDOW AREA 220 0 0 0 a El El . ADJUSTMENT FACTOR (From Part 1) ADJUSTED WINDOW AREA (DxE) aDJUSTED WALL AREA B-(F+C) 75.85454545 16,688 -3,438 75.85454545 0 11,550 75.85454545 0 9,570 75.85454545 0 7,350 TOTALS: 41,720 0 220 16,688 25,032 SKYLIGHT AREA ADJUSTMENT CALCULATIONS ❑ CHECK IF NOT APPLICABLE (see Part 1 of 5) ❑E .. ❑F M ROOFNAME (e.g. Roof -1, Roof -2) N/A TOTALS: I N/A N/A N/A I N/A Nonresidential Compliance Form ENV -2 (6) January 2001 SKYLIGHT ADJUSTMENT FACTOR (From Part 1) ADJUSTED SKYLIGHT AREA . (CxD) ADJUSTED ROOF AREA (B - E) GROSS AREA SKYLIGHT AREA N/A N/A N/A N/A N/A TOTALS: I N/A N/A N/A I N/A Nonresidential Compliance Form ENV -2 (6) January 2001 NT DESCRiF � w 0 )u W _ :D O SKETCH OF ASSEMBLY WALL RNALUE and HEAT CAPACITY WALL UNIT THICKNESS 8 NOMINAL INCHES ASSEMBLY NAME Exterior Wall DESCRIPTIO OFASSEMBL 18" concrete block with grout filled cells k, MATERIAL TYPE NW CMU (LW CMU,MW CMU, NW CMU, CLAY UNIT, CLAY BRICK, CONCRETE.) CORE TREATMENT GROUTED (SOLID, GROUTED, EMPTY, INSULATED, NA) WALL R -VALUE 1.60 Rw (FROM TABLE B-4 or B-5) - ASHRAE Tables WALL HEAT CAPACITY 17.71 HC (FROM TABLE B4 or B-5) FURRING/INSULATION LAYER INSIDE and/or OUTSIDE IF ANY FURRING FRAMING MATERIAL None (WOOD, METAL, NONE) FURRING FRAMING SIZE - NOMINAL INCHES FURRING SPACE INSULATION - TYPE EXTERIOR INSULATING AREA - TYPE - ACTUALINCHES R -VALUE { r -7R-VALUE FURRING ASSEMBLY EFFECTIVE R -VALUE EXTERIOR INSULATING LAYER R -VALUE INSULATION LAYER R -VALUE - + - _ - Rf (FROM TABLE B-7) (FROM MANUFACTURER) WALL ASSEMBLY RNALUE and U -VALUE INSULATION LAYER R. WALL R -VALUE WALL ASSEMBLY R -VALUE WALL ASSEMBLY U -VALUE VALUE 0 + 1.60 = 1.60 G 0.625 Rf Rw Rt I lRt Nonresidential Compliance Form ENV -3 January 2001