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BCOM2019-004278-495 CALLE TAMPICO D lePrKiM�AJ LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT Permit Type/Subtype: BUILDING COMMERCIAL/REMODEL Application Number: BCOM2019-0042 Property Address: 78995 HIGHWAY 111 STE 3 APN: 643020051 Application Description: DR. NIETO D.D.S / 1,500SF DENTAL OFFICE TENANT IMPROVEMENT Property Zoning: Application Valuation: $150,000.00 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner: WASHINGTON 111 LTD 80618 DECLARATION AVE INDIO, CA 92253 Date: 8/28/2019 Applicant: Contractor: TOMAS HAN - T H N ENTERPRISES INC T H N ENTERPRISES INC 2751 SATURN STREET STE B D X2751 SATURN STREET STE B BREA, CA 92821 BREA, CA 92821 AUG 28 2019 (714)835-2088 Llc. No.: 868348 ciTy Of I[AQUM" ------------------------------ 65SIM&AiIEWFJlENTMPARTM fIT------------------------------------- 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: B License No.: 868348 Date: Z-9 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 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 Nam Lender's Address: WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. have and will maintain workers' compensation insurance, as required by Sect.qr3700 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: NORGUARDINSURANCE MPANY Policy Number: THWC006195 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 oft Labor Code, I shall forthwith comply with those provisions. Date: r / 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 relati o building construction, and hereby authorize representatives of this city to enter n the above - mentioned proper[ far inspection purposes. Oates �' Z� Signature (Applicant or Agent): Date: 8/28/2019 Application Number: BCOM2019-0042 Property Address: 78995 HIGHWAY 111 STE 3 APN: 643020051 Application Description: DR. NIETO D.D.S / 1,500SF DENTAL OFFICE TENANT IMPROVEMENT Property Zoning: Application Valuation: $150,000.00 Applicant: TOMAS HAN - T H N ENTERPRISES INC 2751 SATURN STREET STE B BREA, CA 92821 Owner: WASHINGTON 111 LTD 80618 DECLARATION AVE INDIO, CA 92253 Contractor: T H N ENTERPRISES INC 2751 SATURN STREET STE B BREA, CA 92821 (714)835-2088 Llc. No.: 868348 Detail: DR. NIETO D.D.S. / 1,500SF TENANT IMPROVEMENT/VB/B-OCC/30-OL/SPRINKLED. THIS PERMIT DOES NOT INCLUDE BUILDING SIGNAGE OR HVAC EQUIPMENT REPLACEMENT. VERIFY PATH OF TRAVEL COMPLIANCE IN FIELD. TUMF ASSESSMENT NOT TRIGGERED PER 2018 HANDBOOK. 2016 CALIFORNIA BUILDING CODES. DESCRIPTION ACCOUNT QTY AMOUNT ART IN PUBLIC PLACES - COMMERCIAL REMOD 270-0000-43201 0 $250.00 Total Paid for ART IN PUBLIC PLACES - AIPP: $250.00 DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $6.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $6.00 DESCRIPTION ACCOUNT QTY AMOUNT Credit Card Fee 101-0000-43505 0 $2.25 Total Paid for Credit Card Fee: $2.25 DESCRIPTION ACCOUNT QTY AMOUNT NON-RESIDENTIAL, FIRST 2,000SF 101-0000-42403 0 $120.07 DESCRIPTION ACCOUNT QTY AMOUNT NON-RESIDENTIAL, FIRST 2,000SF, PC 101-0000-42600 0 $92.86 Total Paid for ELECTRICAL - NEW CONSTRUCTION: $212.93 DESCRIPTION ACCOUNT QTY AMOUNT FIRE COMMERCIAL TI 101-0000-42421 0 $160.00 DESCRIPTION ACCOUNT QTY AMOUNT FIRE COMMERCIALTI PC 101-0000-42420 0 $240.00 Total Paid for FIRE FEES: $400.00 DESCRIPTION ACCOUNT QTY AMOUNT OTHER MECHANICAL EQUIPMENT 101-0000-42402 0 $40.02 DESCRIPTION ACCOUNT QTY AMOUNT OTHER MECHANICAL EQUIPMENT PC 101-0000-42600 0 $40.02 DESCRIPTION ACCOUNT QTY AMOUNT VENT FAN 101-0000-42402 0 $13.34 DESCRIPTION ACCOUNT QTY AMOUNT VENT FAN PC 101-0000-42600 0 $5.34 Total Paid for MECHANICAL: $98.72 DESCRIPTION ACCOUNT QTY AMOUNT PLAN CHECK DEPOSIT - ADDITION/REMODEL 101-0000-42600 1 $125.00 Total Paid for PLAN CHECK DEPOSIT - ADDITION/REMODEL: $125.00 DESCRIPTION ACCOUNT QTY AMOUNT FIXTURE/TRAP 101-0000-42401 0 $120.06 DESCRIPTION ACCOUNT QTY AMOUNT FIXTURE/TRAP PC 101-0000-42600 0 $120.06 DESCRIPTION ACCOUNT QTY AMOUNT WATER HEATER/VENT 101-0000-42401 0 $13.34 DESCRIPTION ACCOUNT QTY AMOUNT WATER HEATER/VENT PC 101-0000-42600 0 $8.00 DESCRIPTION ACCOUNT QTY AMOUNT WATER SYSTEM INST/ALT/REP 101-0000-42401 0 $13.34 DESCRIPTION ACCOUNT CITY AMOUNT WATER SYSTEM INST/ALT/REP PC 101-0000-42600 0 $13.34 Total Paid for PLUMBING FEES: $288.14 DESCRIPTION ACCOUNT CITY AMOUNT 101-0000-42600 ($21.00) DESCRIPTION ACCOUNT CITY AMOUNT RECORDS MANAGEMENT FEE - MAJOR 101-0000-42416 0 $21.00 Total Paid for RECORDS MANAGEMENT FEE - MAJOR: $0.00 DESCRIPTION ACCOUNT QTY AMOUNT 101-0000-42600 ($57.00) DESCRIPTION ACCOUNT CITY AMOUNT REMODEL, EA ADDITIONAL 500 SF 101-0000-42400 0 $72.03 DESCRIPTION ACCOUNT CITY AMOUNT REMODEL, EA ADDITIONAL 500 SF PC 101-0000-42600 0 $57.63 DESCRIPTION ACCOUNT CITY AMOUNT REMODEL, FIRST 100 SF 101-0000-42400 0 $54.43 DESCRIPTION ACCOUNT CITY AMOUNT REMODEL, FIRST 500 SF PC 101-0000-42600 0 $57.00 DESCRIPTION ACCOUNT CITY AMOUNT REMODEL, FIRST 500 SF PC 101-0000-42600 0 $91.89 Total Paid for REMODEL: $27S.98 DESCRIPTION ACCOUNT CITY AMOUNT 101-0000-42600 ($42.00) DESCRIPTION ACCOUNT QTY AMOUNT SMI - COMMERCIAL 101-0000-20308 0 $42.00 Total Paid for STRONG MOTION INSTRUMENTATION SMI: $0.00 DESCRIPTION ACCOUNT CITY AMOUNT 101-0000-42600 ($5.00) DESCRIPTION ACCOUNT CITY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $0.00 i c� PERMIT #Bc O d"(ZO( 1 D 0 4 Z W - -- C U_Ilt)��l.E PLAN LOC:AT'IDN : Project Address: c.} Project Description: APN #: 4 ' j� J N (� (04 C� �l.tc «• �-�7 �Jc v Applicant Name:,�,� Address: 2 7r C� City, ST, Zip: r-e!,� C4 Z S--Z- Telephone: ) y- � 3�-ZUg�3-7tg'g Email: Project Valuation of Pro $ 0 U �' i �rAJgnITE P" (5 Es I �� j nJ 1= Architect/Engineer Name: 1 Address: City, St, Zip Telephone: Email: f State Lic: �'^ S—SU City Bus Lic: Property Owner's Name: ' Address: -3 Lua -D RC„., L4d City, ST, Zip rcc►.. (H rS`Fvp►ca (E �� Telephone: Email: Construction Grading: Bedrooms: upancy: ies: 11 I # On its: \,i New Commercial / Tenant Improvements: Total Building SF 2- - Construction Type: O-ppancy: 7Q 78495 CALLE TAMPICO LA QUINTA, CA 92253 760-777-7000 OFFICE USE ONLY # Submittal Required Received } Plan Sets Structural Calcs Truss Calcs Title 24 Calcs Soils Report Grading Plan (PM10) Landscape Plan Subcontractor List --f Grant Deed HOA Approval School Fees Burrtec Debris Plan Planning approval Public Works approval Fire approval City Business License Washington 111 Ltd . 30240 Rancho Viejo Road r Suite B San Juan Capistrano, California 92675 Phone (949) 443-1234 Ext 124 Fax (949)443-1233 Email tarr@cox.net City of La Quinta 78-495 Calle Tampico La Quinta, CA 92253 July 25, 2019 RE: No Objection Letter; THN Enterprises; Dr. Angelica M. Nieto To Whom It May Concern: I Jack Tarr, Managing General Partner of Washington 111, Limited, Owner of the freestanding Pad 1, building, located at 78-995 Highway 111, southern portion of Unit 3, La Quinta, CA 92253 have no objection to THN Enterprises submitting plans to the City for approval, and constructing the proposed office renovations, on behalf of Dr. Angelica M. Nieto who has solely contracted for said renovations with THN Enterprises. Washington 111, Limited has no contractual relationship with THN Enterprises Signed: Jack Tarr Managing General Partner Washington 111, Limited (Owner) Phone: (949) 443-12343 Ext. 124 Address: 30240 Rancho Viejo Road, Suite B, San Juan Capistrano, California 92675 RECEIVED JUL 2 6 2019 CITY OF LA QUINTA DESIGN AND DEVELOPMENT DEPARTMENT comdev From: Tom Han < Sent: Thursday, July 25, 2019 11:53 AM To: comdev Subject: Letter of Authorization ** EXTERNAL: This message originated outside of the City of La Quinta. Please use proper judgement and caution when opening attachments, clicking links or responding to requests for information. ** 1111r EI.. I ". :"1 sot, NO*. CA •,. , :.vnvr Wil i,�w.er� � � 6aY}rir[1 i rtpN r�ryti 1�tYrw[r v1 Narr�atYa a'P lir ryyrr "W LAY use R I t., a, 1lK dAr . �+1+cr[n tr� yt� �� by dr eueurn�gny rar � tirnAwwaft r..,.,, •c. •n p.,l,Kr. M.�r� � 1 IIIrd r�r� u[ Mer[11r��' tW h •1.[ 4.e. al! WPW O 4 rNlr/L.n rrf ' � ferwN M, wry[ fW ■ �Y Hr [ . Prlwet l�tr wri rf71 lb AlIMk7i � rninn ![� lV[ tt1k7 s!'� Mlles Yt [� .pyppR.W 4 Yrk or ar rM1 Fru�[K k.n nCf♦tnf, j 1rr'R �• �0 [MA a gp}{�4.��r Fx Yaa al lwR 1" 10kv 0* u1•� Ri.t rar:�r.* PAYW I AMJCAIi�r�{rr X1rrr art r Pq.er.an hKW rrr�+�.r �Y+ Ya lie ciao � NrwYa+ae�yqy a�+d i{�+�a b111 awe oldgn drlgcd A 1 i+ 5 � "• + levp�ri w+i! M�•r�* Y'�1 Oftww N pn -w[.S .•ask Lsra1 +[ 7XM4� CA 91211 Tom Han THN Enterprises Inc. 2751 Saturn Street <:�'i (�t�je t> OW$J Y-- { "OWLEGEMeWF W O N W U-) N s J G W � Brea Ca 92821 714-835-2088 714-493-7088 I BUILDING ENERGY ANALYSIS REPORT PROJECT: Dr. Nieto Dental 78995 CA-111 #3 La Quinta, CA 92253 Project Designer: THN Enterprises ��'2�� " 00q Z 2751 Saturn St. # ICY �JF LA QUANTA Brea, CA 92821 BUILDING DIVISION 714-835-2088 REVIEWED FOR CODE rOMPLIANCE Report Prepared by p p PP CFr-lC'f—: _ PJP Engineering, Inc 13231 Acoro Place Cerritos, CA 90703 562-404-2695 W Job Number: > C= W N s 2019-5 ' ` J o v � Date: W 7/20/2019 0 The EnergyPro computer program has been used to perform the calculations summarized in this compliance report. This program has approval and is authorized by the California Energy Commission for use with both the Residential and Nonresidential 2016 Building Energy Efficiency Standards This program developed by EnergySoft Software — www.energysoft com l< TABLE OF CONTENTS I Cover Page 1 Table of Contents 2 Form MCH-01-E Prescriptive - Mechanical Systems 3 Form MCH-02-E Prescriptive - HVAC System Requirements 7 Form MCH-03-E Prescriptive - Mechanical Ventilation and Reheat 10 Form MCH-04-E Prescriptive - Required Acceptance Tests 12 STATE OF CALIFORNIA MECHANICAL SYSTEMS CEC-NRCC- MCH-01-1 RevSed 01116 CALIFORNIA ENERGY COMMISSION —41W— CERTIFICATE OF COMPLIANCE NRCC-MCH-01-E Mechanical Systems (Page 1 of 4) Project Name: Dr. NIeto Dental Date Prepared: 7/20/2019 A. MECHANICAL COMPLIANCE DOCUMENTS & WORKSHEETS (check box if worksheet is included) For detailed instructions on the use of this and all Energy Efficiency Standards compliance forms, refer to the 2016 Nonresidential Manual Note: The Enforcement Agency may require all forms to be incorporated onto the building plans. YES NO Comp. Doc./Worksheet# Title ❑ ❑ NRCC-MCH-01-E (Part 1 of 3) Certificate of Compliance, Declaration. Required on plans for all submittals. IZI ❑ NRCC-MCH-01-E (Part 2 of 3) Certificate of Compliance, Required Acceptance Tests (MCH-02-A to 11-A). Required on plans for all submittals. ❑ ❑ NRCC-MCH-01-E (Part 3 of 3) Certificate of Compliance, Required Acceptance Tests (MCH-12-A to 18-A). Required on plans where applicable. IZI ❑ NRCC-MCH-02-E (Part 1 of 2) Mechanical Dry Equipment Summary is required for all submittals with Central Air Systems. It is optional on plans. E) ❑ NRCC-MCH-02-E (Part 2 of 2) Mechanical Wet Equipment Summary is required for all submittals with chilled water, hot water or condenser water systems. It is optional on plans. Mechanical Ventilation and Reheat is required for all submittals with multiple zone heating and cooling systems. It is optional on plans. �] ❑ NRCC-MCH-03-E ❑ ® NRCC-MCH-07-E (Part 1 of 2) Power Consumption of Fans. Required on plans where applicable Power Consumption of Fans, Declaration. Required on plans where applicable ❑ 0 NRCC-MCH-07-E (Part 2 of 2) CA Building Energy Efficiency Standards = 2016 Nonresidential Compliance January 2016 STATE OF CALIFORNIA MECHANICAL SYSTEMS CEC-NRCC-MCH-01-E (Revised 01116) CERTIFICATE OF COMPLIANCE Mechanical Systems Project Name: Dr. Nieto Dental Date Prepared: 7/20/201 n IA ENERGY COMMISSION} Is NRCC-MCH-01-E (Page 2 of 4) B. MECHANICAL HVAC ACCEPTANCE FORMS (check box for required compliance documents) Test Performed By: Designer: This compliance document is to be used by the designer and attached to the plans. Listed below are all the acceptance tests for HVAC systems. The designer is required to check the applicable boxes for all acceptance tests that apply and list all equipment that requires an acceptance test. All equipment of the same type that requires a test, list the equipment description and the number of systems. Installing Contractor: The contractor who installed the equipment is responsible to either conduct the acceptance test themselves or have a qualified entity run the test for them. If more than one person has responsibility for the acceptance testing: each person shall sign and submit the Certificate of Acceptance applicable to the por tion of the construction or installation for which they are responsible. Enforcement Agency: Plancheck —The NRCC-MCH-01-E compliance document is not considered a completed document and is not to be accepted by the building department unless the correct boxes are checked. Inspector - Before occupancy permit is granted all newly installed process systems must be tested to ensure proper operations. Test Description MCH-02-A MCH-03-A MCH-04-A MCH-05-A MCH-06-A MCH-07-A MCH-08-A MCH-09-A i MCH-10-A MCH-11-A Equipment # of Outdoor Single Zone Air Demand Economizer Control Supply Fan Valve Leakage Supply Water Hydronic System Automatic Demand Shed Requiring Testing Units Air Unitary Distribution Controls Ventilation VAV Test Temp. Reset Variable Flow Control or Verification Ducts (DCV) Control j0 ❑ 0 ❑ 0 ❑ 0 0 Cl 0 0 0 0 0 0 0 0 0 0 CI 0 El El ❑ 0 Cl J ❑ 0 0 ❑ ❑ 0 ❑ CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 STATE OF CALIFORNIA MECHANICAL SYSTEMS 0.,. CEC-HRCC-INCH-01-E Revised 01/16 CALIFORNIA ENERGY COMMISSION —Mop— CERTIFICATE OF COMPLIANCE NRCC-MCH-01-E Mechanical Systems 1 (� (Page 3 of 4) " Proje"ame: Dr. Nieto Dental Date Prepared: 7/20/2019 C. MECHANICAL HVAC ACCEPTANCE FORMS (check box for required compliance documents) Test Performed By: Designer: This compliance document is to be used by the designer and attached to the plans. Listed below are all the acceptance tests for HVAC systems. The designer is required to check the applicable boxes for all acceptance tests that apply and list all equipment that requires an acceptance test. All equipment of the same type that requires a test, list the equipment description and the number of systems. Installing Contractor: The contractor who installed the equipment is responsible to either conduct the acceptance test themselves or have a qualified entity run the test for them. If more than one person has responsibility for the acceptance testing, each person shall sign and submit the Certificate of Acceptance applicable to the portion of the construction or installation for which they are responsible. Enforcement Agency: Plancheck —The NRCC-MCH-01-E compliance document is not considered a completed document and is not to be accepted by the building department unless the correct boxes are checked. Inspector - Before occupancy permit is granted all newly installed process systems must be tested to ensure proper operations. Test Description MCH-12-A MCH-13-A MCH-14-A MCH-15-A MCH-16-A MCH-17-A MCH-18-A Equipment # of Fault Detection & Automatic Fault Detection & Distributed Energy Thermal Energy Supply Air Condenser Water Requiring Testing Units Diagnostics for DX Diagnostics for Air & Storage DX AC Storage (TES) Temperature Reset ECMS Reset Controls or Verification Units Zone Systems Systems Controls ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 STATE OF CALIFORNIA MECHANICAL SYSTEMS CEC•NRCC-MCH-01-f Revised 01/18 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-MCH-01-E Mechanical Systems (Page 4 of 4) Project Name: Dr. Nleto Dental Date;Impamd 7/20/2019 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: PP Documentation Author Signature: Company: PJP Engineering, Inc signature Date: 7/20/2019 Address: 13231 Acoro Place CEA/ HERS Certification Identification (if applicable): M026245 City/State/Zip: Cerritos, CA 90703 Phone: 562-404-2695 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Compliance is true and correct. 2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer). 3. The energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations. 4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. 5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a completed signed copy of this Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: PP Responsible Designer Signature: company- PJP Engineering Date Signed: Address: 13231 Acoro Place License: _ City/State/Zip: Cerritos, CA 90703 Phone: 562-404-2695 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 STATE OF CALIFORNIA HVAC DRY & WET SYSTEM REQUIREMENTS GEC-N_RCC-MCH-02-E [Revised 01/16Y CALIFORNIA ENERGY COMMISSION �r CERTIFICATE OF COMPLIANCE NRCC-MCH-02-E HVAC Dry & Wet System Requirements (Page 1 of 3) Project Name: Dr. Nieto Dental Date Prepared: / A. Equipment Tags and System Description' - Dry Systems MANDATORY MEASURES T-24 Sections Reference to the Requirements in the Contract Documents1 Heating Equipment Efficiency 110.1 or 110.2(a) Cooling Equipment Efficiency 110.1 or 110.2(a) HVAC or Heat Pump Thermostats 110.2(b), 110.2(c) Furnace Standby Loss Control 110.2(d) Low Leakage AHUs 110.2(f) Ventilation 120.1(b) Demand Control Ventilation 120.1(c)4 Occupant Sensor Ventilation Control' 120.1(c)5, 120.2(e)3 Shutoff and Reset Controls 120.2(e) Outdoor Air and Exhaust Damper Control 120.2(f) Isolation Zones 120.2(g) Automatic Demand Shed Controls 120.2(h) Economizer FDD 120.2(i) Duct Insulation 120.4 PRESCRIPTIVE MEASURES Equipment is sized in conformance with 140.4(a & b) Y/N Y/N Y/N 140.4(a & b) Supply Fan Pressure Control 140.4(c) Simultaneous Heat/Cool 140.4(d) Economizer 140.4(e) Heat and Cool Air Supply Reset 140.4(f) Electric Resistance Heating 140.4(g) Duct Leakage Sealing and Testing 140.4(I) Notes: 1. Provide equipment tags (e.g. AHU 1 to 10) and system description (e.g. Single Duct VAV reheat) as appropriate. Multiple units with common requirements can be grouped together. 2. Provide references to plans (i.e. Drawing Sheet Numbers) and/or specifications (including Section name/number and relevant paragraphs) where each requirement is specified. Enter "N/A" if the requirement is not applicable to this system. 3. The referenced plans and specifications must include all of the following information: equipment tag, equipment nominal capacity, Title 24 minimum efficiency requirements, and actual rated equipment efficiencies. Where multiple efficiency requirements are applicable (e.g. full- and part -load) include all. Where appliance standards apply (110.1), identify where equipment is required to be listed per Title 20 1601 et seq. 4. Identify where the ventilation requirements are documented for each central HVAC system. Include references to both central unit schedules and sequences of operation. If one or more spaces is naturally ventilated identify where this is documented in the plans and specifications. Multiple zone central air systems must also provide a MCH-03-E compliance document. 5. If one or more spaces has demand controlled ventilation identify where it is specified including the sensor specifications and the sequence of operation. 6. If one or more space has occupant sensor ventilation control identify where it is specified including the sensor specifications and the sequence of operation 7. If the system is DDC identify the sequences for the system start/stop, optimal start, setback (if required) and setup (if required). For all systems identify the specification for the thermostats and time clocks (if applicable). 8. Identify where the heating, cooling and deadband airflows are scheduled for this system. Include a reference to the specification of the zone controls. Provide a MCH-03-E compliance document. 9. Enter N/A if there is no electric heating. If the system has electric heating indicate which exception to 140.4(g) applies. 10. If duct leakage sealing and testing is required, a MCH-04-A compliance'document must be submitted. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 STATE OF CALIFORNIA HVAC DRY &WET SYSTEM REQUIREMENTS CEC-NRCC-MCH-02-E Revised 01/16 CERTIFICATE OF COMPLIANCE HVAC Dry & Wet System Requirements Project Name: Dr. Nieto Dental CALIFORNIA ENERGY COMMSStON �& NRCC-MCH-02-E (Page 2 of 3) Date Prepared: 7/20/201 n B. Equipment Tags and System Description — Wet Systems MANDATORY MEASURES T-24 Sections Reference to the Requirements in the Contract DocumentS2 Heating Hot Water Equipment Efficiency 110.1 Cooling Chilled and Condenser Water 110.1, 140.4(i) Equipment Efficiency3 Open and Closed Circuit Cooling Towers 110.2(e) 1 conductivity or flow -based controls Open and Closed Circuit Cooling Towers Maximum Achievable Cycles of 110.2(e) 2 Concentration (LSI)6 110.2(e) 3 Open and Closed Circuit Cooling Towers Flow Meter with analog output Open and Closed Circuit Cooling Towers 110.2(e) 4 Overflow Alarm Open and Closed Circuit Cooling Towers 110.2(e) 5 Efficient Drift Eliminators Pipe Insulation 120.3 PRESCRIPTIVE MEASURES Cooling Tower Fan Controls 140.4(h)2, 140.4(h)5 Y/N Y/N Y/N Cooling Tower Flow Controls 140.4(h)3 Centrifugal Fan Cooling Towers 140.4(h)4 Air -Cooled Chiller Limitation 140.40) Variable Flow System Design 140.4(k) Chiller and Boiler Isolation 140.4(k) CHW and HHW Reset Controls 140.4(k) WLHP Isolation Valves 140.4(k) VSD on CHW, CW & WLHP Pumps >5HP 140.4(k) DP Sensor Location 140.4(k) Notes: 1. Provide equipment tags (e.g. CH 1 to 3) or system description (e.g. CHW loop) as appropriate. Multiple units with common requirements can be grouped together. 2. Provide references to plans (i.e. Drawing Sheet Numbers) and/or specifications (including Section name/number and relevant paragraphs) where each requirement is specified. Enter "N/A" if the requirement is not applicable to this system. 3. The referenced plans and specifications must include all of the following information: equipment tag, equipment nominal capacity, Title 24 minimum efficiency requirements, and actual rated equipment efficiencies. Where multiple efficiency requirements are applicable (e.g. full- and part -load) include all. For chillers operating at non-standard efficiencies provide the Kadj values. For chillers also note whether the efficiencies are Path A or Path B. 4. Identify if cooling towers have propeller fans. If towers use centrifugal fans document which exception is used. 5. If air-cooled chillers are used, document which exceptions have been used to comply with 140.4(j) and the total installed design capacity of the air-cooled chillers in the chilled water plant. 6. Identify the existence of a completed MCH-06-E when open or closed circuit cooling towers are specified to be installed, otherwise enter "N/A". CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 STATE OF CALIFORNIA HVAC SYSTEM REQUIREMENTS GkI (;-NKCC-MCN-02-E Revised 06/14CALIFORNIA ENERGY COMMISSION T CERTIFICATE OF COMPLIANCE NRCC-MCH-02-E HVAC Wet SystemRequirements (Page 3 of 3) Project Name: Dr. N1eto Dental Date Prepared: 7/20/2019 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: PP Documentation Author Signature: Company: PJP Engineering, Inc Signature Date: 7/20/2019 Address. 13231 Acoro Place CEA/ HERS Certification Identification (if applicable): M026245 City/State/Zip: Cerritos, CA 90703 Phone: 562-404-2695 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Compliance is true and correct. 2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer). 3. The energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations. 4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. 5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a completed signed copy of this Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: PP Responsible Designer Signature: Date signed: Company: PJP Engineering Address: 13231 Acoro Place License: City/State/Zip: Cerritos, CA 90703 Phone: 562-404-2695 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 STATE OF CALIFORNIA MECHANICAL VENTILATION AND REHEAT GEC-NRCC-MCH-03-E (Revised 05116) CERTIFICATE OF COMPLIANCE Mechanical Ventilation & Reheat Project Name: Dr. Nleto Dental CALIFORN Date Prepared: 7/20/201 9 N RCC-MCH-03-E (Page 1 of 2) A. Mechanical Ventilation and Reheat ROOM VAV Reheated Primary VAV Deadband ACTUAL DESIGN INFO (FROM EQUIPMENT SCHEDULES, ETC) AREA BASIS OCCUPANCY BASIS BASIS MINIMUM Air CFM Primary Air CFM 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 z p z z p p O w w z z Z w z< a ❑ Z i z z 3 _ ❑ z ❑ z z } a O w > m z a r m Q r z 3 > w a w o x z w Ui w z m 3 OJ w Y x N m cc a V m a C U a¢ l_l r z r Y ¢ w (J w p a` a m cL w0 d S z U Z it tf CC V C w❑ lJ C U❑ ¢ V 7 u a p O w V Q U a z Z T z a z Z z a r wa v O m� a v Ou O> N JO wp 0 Ui ❑ p W Z l.J z O Z Z z m 2 C x a ' 2 ¢ p x U ❑ Pass ❑ Pass M Pass Dental office 1,578 0.15 237 7.9 15.0 118 237 ❑ Fail ❑ Fail ❑ Fail X N/A X N/A ❑ Pass ❑ Pass Total 237 ❑ Pass ❑ Fail El Fail ❑ Fail ❑ N/A ❑ N/A ❑ Pass ❑ Pass ❑ Pass ❑ Fail ❑ Fail ❑ Fail ❑ N/A ❑ N/A ❑ Pass ❑ Pass ❑ Pass ❑ Fail ❑ Fail ❑ Fail ❑ N/A ❑ N/A ❑ Pass ❑ Pass ❑ Pass ❑ Fail ❑ Fail ❑ Fail ❑ N/A ❑ N/A ❑ Pass ❑ Pass ❑ Pass ❑ Fail ❑ Fail ❑ Fail ❑ N/A ❑ N/A ❑ Pass ❑ Pass ❑ Pass ❑ Fail El Fail ❑ Fail ❑ N/A ❑ N/A CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance May 2016 STATE OF CALIFORNIA MECHANICAL CERTIFICATE OF COMPLIANCE Mechanical Ventilation & Reheat Project Name: Dr. Nieto Dental VENTILATION AND REHEAT 1-11 avisad 05M5) CALIFORNIA ENERGY COMMISSION _ NRCC-MCH-03-E Date Prepared: 7/20/201 9 (Page 2 of 2) DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: PP Documentation Author Signature: Company: PJP Engineering, Inc Signature Date: 7/20/2019 Address: 13231 Acoro Place CEA/ HERS Certification Identification (if applicable): M026245 City/State/Zip: Cerritos, CA 90703 Phone: 562-404-2695 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California- 1. The information provided on this Certificate of Compliance is true and correct. 2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer). 3. The energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations. 4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. 5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a completed signed copy of this Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: PP Responsible Designer Signature: Date Signed: Company: PJP Engineering Address: 13231 ACoro Place License: City/State/Zip: Cerritos, CA 90703 Phone: 562-404-2695 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance May 2016 STATE OF CALIFORNIA REQUIRED ACCEPTANCE TESTS CEC-NRCC•WI0H-f14-E Revised 01116) CERTIFICATE OF COMPLIANCE Required Acceptance Tests Project Name: Dr. Nleto Dental Date Prepared: 7/20/201 n NRCC-MCH-04-E (Page 1 of 3) A. MECHANICAL COMPLIANCE FORMS & WORKSHEETS (indicate if worksheet is included) For detailed instructions on the use of this and all Energy Standards compliance documents, refer to the 2016 Nonresidential Manual Note: The Enforcement Agency may require all compliance documents to be incorporated onto the building plans. The NRCC-MCH-04-E and NRCC-MECH-05-E are alternative compliance documents to NRCC-MCH-01-E, NRCC-MCH-02-E and NRCC-MCH-03-E for projects using only single zone packaged HVAC systems. YES NO Form Title Vol NRCC-MCH-04-E (1 of 2) Certificate of Compliance. Required on plans when used. NRCC-MCH-04-E (2 of 2) Mechanical Acceptance Tests. Required on plans when used. NRCC-MCH-05-E (1 of 2) HVAC Prescriptive Requirements. It is required on plans when used. Mechanical SWH Equipment Summary is required for all submittals with service water heating, pools or spas. It is NRCC-MCH-05-E (2 of 2) required on plans where applicable. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 STATE OF CALIFORNIA REQUIRED ACCEPTANCE TESTS CEC-NRCC-MCH-04-E Revised 01116 CERTIFICATE OF COMPLIANCE Required Acceptance Tests Project Name: Dr. Nieto Dental CALIFORNIA ENERGY COMMISSION Date Prepared: 7/20/201 9 N RCC-MCH-04-E (Page 2 of 3) Designer: This compliance document is to be used by the designer and attached to the plans. Listed below are all the acceptance tests for mechanical systems. The designer is required to check the applicable boxes by all acceptance tests that apply and list all equipment that require an acceptance test. If all equipment of a certain type requires a test, list the equipment description and the number of systems. The NA number designates the Section in the Appendix of the Nonresidential Reference Appendices Manual that describes the test. Since this compliance document will be part of the plans, completion of this section will allow the responsible party to budget for the scope of work appropriately. Enforcement Agency: Systems Acceptance. Before occupancy permit is granted for a newly constructed building or space, or a new space -conditioning system serving a building or space is operated for normal use, all control devices serving the building or space shall be certified as meeting the Acceptance Requirements for Code Compliance. Systems Acceptance. Before occupancy permit is granted. All newly installed HVAC equipment must be tested using the Acceptance Requirements. The NRCC-MCH-04-E compliance document is not considered a completed document and is not to be accepted by the building department unless the correct boxes are checked. The equipment requiring testing, person performing the test (Example: HVAC installer, TAB contractor, controls contractor, PE in charge of project) and what Acceptance test must be conducted. The following checked -off forms are required for ALL newly installed and replaced equipment. In addition a Certificate of Acceptance documents shall be submitted to the building department that certifies plans, specifications, installation certificates, and operating and maintenance information meet the requirements of Section 10-103(b) and Title 24 Part 6. The building inspector must receive the properly filled out and signed compliance documents before the building can receive final occupancy. Test Description MCH-02-A MCH-03-A MCH-04-A MCH-05-A MCH-06-A MCH-07-A MCH-11-A MCH-12-A I MCH-14-A MCH-18-A Test Performed By: Equipment Requiring Testing or Verification # of Units Outdoor Air Single Zone Unitary Air Distribution Ducts Economizer Controls Demand Control Ventilation (DCV) Supply Fan VAV Automatic Demand Shed Control FDD for Packaged DX Units Distributed Energy Storage DX AC Systems Energy Management Control System CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 STATE OF CALIFORNIA REQUIRED ACCEPTANCE TESTS A CEC-NRCC-MCH-04-E Ravised 01/16 CALIFORNIA ENERGY COMMISSION 'qllP' CERTIFICATE OF COMPLIANCE NRCC-MCH-04-E Required Acceptance Tests (Page 3 of 3) Project Name: Dr. N1eto Dental I Date Prepared: 7/20/201 9 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: PP Documentation Author Signature: Company: PJP Engineering, Inc signature Date:7/20/2019 Address: 13231 Acoro Place CEA/ HERS Certification Identification (if applicable): M026245 City/State/Zip: Cerritos, CA 90703 Phone: 562-404-2695 RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Compliance is true and correct. 2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer). 3. The energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of Regulations. 4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. 5. 1 will ensure that a completed signed copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a completed signed copy of this Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: PP Responsible Designer Signature: Company PJP Engineering Date Signed: Address. 13231 Acoro Place License: City/State/Zip: Cerritos, CA 90703 Phone: 562-404-2695 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016