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BCOM2019-0038
78-495 CALLE TAMPICO T4ht DQ.�i Ilill6P Qu4a VOICE (760) 777-7125 LA QUINTA, CAt'IFORNIA 92253 FAX (760) 777-7011 DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 10/3/2019 Permit Type/Subtype: BUILDING COMMERCIAL/REMODEL Owner: Application Number: BCOM2019-0038 WASHINGTON 111 LTD Property Address: 46520 WASH INGTON ST STE 2 80618 DECLARATION AVE APN: 643020060 INDIO, CA 92253 Application Description: MY THAI / 1,300SF RESTAURANT EXPANSION/VB/A-2/39-OL/SPRINK Property Zoning: Application Valuation: $75,000.00 Applicant: GABRIEL LUJAN & ASSOCIATES 77530 ENFIELD LANE BLDG.1 SUITE 101 PALM DESERT, CA 92211 PQ0 OCT 0 3 2019 D on OF IADUINTA DESIGN & DEVELOPMENT DEPARTMENT LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 {commencing with Section 70001 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 Pr fessions Cade) or that hear she is exempt therefrom and the basis for the 411 exemption.Any violation aF Section 70315any applicant farapermit the applicant [o a civil penaltyofnotmore than Fie hundred dollars($500).:wner of the prprtymyemployeeswithwagesastheirlsatian, will do the work, and the structure is not intended or offered far 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 e n t tended or offered for sale. If, however, the building or improvement is sold wit Niape year of completion, the owner -builder will have the burden of proving that he a -sh d not bu€Id or improve for the purpose of sale.). ( owner of the property, am exclusively contracting with licensed contractors to canstr ct the project. (Sec. 7044, Business and Professions Code: The Can tractors' 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. P.C. for t s reaso ,zA97_1_ Date: Ow er: ' CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Na Lender's Add Contractor: OWNER BUILDER - DAVE HENDERSON 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 Se 37 of the Labor Code, for the performance of the work for which this permit is is ued. workers' compensation insurance carrier and policy number are: rri r: Policy Number:_ I ertify that in the performance of the work for which this permit is issued, I shall of employ any person in any manner so as to become su ject to the workers' compensation laws of California, a agree at, if I ould me subAt to the workers' compensation provision of Section 700 f t e La Code, I h II forthwith comply with those provisions. Date: I C Applicant: L r� 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 i correct. I agree to comply with all city and county ordinances a ate laws re tang .11ding construction, and hereby authorize representati f this cit to ente u o above - mentioned property for inspection purposes. C Date: �- — Signature (Applicant orAgent): P , I Date" I0/3/2019 Application Number: BCOM2019-0038 Owner: Property Address: 46520 WASH INGTON ST STE 2 WASHINGTON 111 LTD APN: 643020060 80618 DECLARATION AVE Application Description: MY THAI / 1,300SF RESTAURANT EXPANSION/VB/A-2/39-OL/SPRINK INDIO, CA 92253 Property Zoning: Application Valuation: $75,000.00 Applicant: Contractor: GABRIEL LUJAN & ASSOCIATES OWNER BUILDER - DAVE HENDERSON 77530 ENFIELD LANE BLDG.1 SUITE 101 PALM DESERT, CA 92211 Llc. No.: Detail: 1,300SF BAR AREA EXPANSION INTO ADJACENT SUITE AT EXISTING RESTAURANT [VB/A-2/39-OL/NON-SEPARATED/SPRINKLED] THIS PERMIT DOES NOT INCLUDE REMODEL TO EXISTING RESTAURANT SPACE OR KITCHEN ALTERATIONS. NO TUMF IMPACT BASED ON 2018 FEE UPDATE. PATH OF TRAVEL UPGRADES FOR RESTROOM ACCESSIBILITY ONLY. 2016 CALIFORNIA BUILDING CODES. DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $3.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $3.00 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 2018: $212.93 DESCRIPTION ACCOUNT QTY AMOUNT FIRE COMMERCIAL TI 101-0000-42421 0 $160.00 DESCRIPTION ACCOUNT QTY AMOUNT FIRE COMMERCIAL TI 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 2018: $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 $53.36 DESCRIPTION ACCOUNT QTY AMOUNT FIXTURE/TRAP PC 101-0000-42600 0 $53.36 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 QTY AMOUNT WATER SYSTEM INST/ALT/REP PC 101-0000-42600 0 $13.34 Total Paid for PLUMBING 2018: $154.74 DESCRIPTION ACCOUNT QTY 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 CITY AMOUNT 101-0000-42600 ($99.00) DESCRIPTION ACCOUNT QTY 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 $99.00 DESCRIPTION ACCOUNT CITY AMOUNT REMODEL, FIRST 500 SF PC 101-0000-42600 0 $49.89 Total Paid for REMODEL 2018: $233.98 DESCRIPTION ACCOUNT CITY AMOUNT SMI - COMMERCIAL 101-0000-20308 0 $21.00 Total Paid for STRONG MOTION INSTRUMENTATION SMI: $21.00 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 + fi - GEM 1,A, DESERT - 2 Q PERMIT # �C o M 2 o l "— 0 0✓ V PLAN LOCATION: (p- szc> S. Wis HIiIX�Tc,-) --ar. Proj ect Address: a,,Tes Z LA go, WA. CA Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech APN #: A P B MEP r lv l TD A tJ EXL'�fi Mro 9KM0?.Ak5T 1000 sue- r-T Applicant Name: MY 'rtj A J Address: (O' cjw 't• L()Aq)i ( O&TDf,) S. City, ST, Zip: LA Q Q QTA) C, • CL 22�% Telephone: (PD �j�j�j q^GII Email: Valuation of Project $19 D Contractor Name: T e4;> New SFD Construction: I ?>� 16P, f7, Address: Conditioned Space SF City, St, Zip Garage SF Telephone: Patio/Porch SF Email: Fire Sprinklers SF Lstate Lic: City Bus Lic: Arch/Eng Name: OAWi L0,1, L_t,_)Af J * A-5W6, Construction Type: Occupancy: Address:""- �,jt, 5NAN C O LQ, 9X06 , Grading: City, St, Zip QO�L#J� DJ�gepc -CA 2Z11 Telephone: -jtol> VT4 S1 00 Bedrooms: Stories: # Units: Email: V AM l� dl a1GS 1 DU GD State Lic: City Bus Lic: Property Owner's Name: New Commercial / Tenant Improvements: Address: Total Building i7 SF bKPAWS16PA City, ST, Zip Construction Type: V pj Occupancy: Telephone: Email: 78495 CALLE TAMPICO LA QUINTA, CA 92253 760-777-7000 OFFICE USE ONLY # Submittal Req'd Rec1d Plan Sets Structural Calcs Truss Calcs Title 2.4 Calcs Soils Report Grading Plan (PM10) Landscape Plan Subcontractor List Grant Deed HOA Approval School Fees Burrtec Debris Plan Planning approval Public Works approval Fire approval City Business License FIRST AMENDMENT TO [INDENTURE OF LEASE This FIRST AMENDME O INDE TORE OF LEASE (this "Amendment") is entered into to be effective as of �Ne, Ir _ . 2019 (the "Effective Date"), by and between WASHINGTON-111, LTD., a California limited partnership ("Landlord"), and ISAAN KITCHEN GROUP, LLC, a California limited liability company, dba My Thai Restaurant ("Tenant"), with reference to the facts set forth in the Recitals below. RECITALS: A. Landlord and Tenant entered into that certain indenture of Lease dated as of February 25, 2015 (the "Existing Lease"), with respect to certain premises consisting of approximately 2,200 square feet and commonly known as 46-520 Washington Street, Suite 3, La Quinta, California (the "Existing Premises"). The Existing Lease and this Amendment are hereinafter sometimes collectively referred to as the "Lease". B. All initially capitalized defined terms used in this Amendment but not defined herein shall have the meanings set forth in the Existing Lease. C. Tenant's obligations under the Existing Lease have been guaranteed by David Henderson and Sathin Henderson, husband and wife, jointly and severally (collectively, the "Guarantors") pursuant to that certain Guaranty of Lease dated as of February 6, 2015. D. Landlord and Tenant desire to amend the Existing Lease, subject to the terms and conditions set forth herein, to (i) expand the Existing Premises; (ii) extend the Term; and (iii) make certain other modifications to the Existing Lease, all as more particularly set forth below. AGREEMENT: NOW, THEREFORE, in consideration of the foregoing Recitals, the mutual covenants contained herein and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, Landlord and Tenant agree as follows: 1. I I'all"utt! o-1, FXD ing I'rLmi ems. The Existing Premises shall be expanded to include that certain premises containing approximately 1,388 square feet of Floor Area directly adjacent to the Existing Premises, commonly known as 46-520 Washington Street, La Quinta, California and depicted as "SITE" on Exhibit :1 attached hereto (the "Expansion Space"). The Existing Premises and the Expansion Space are referred to hereinafter, collectively, as the "Expanded Premises". The lease of the Expansion Space shall be upon all the terms and conditions of the Existing Lease, except as otherwise provided for herein. All references in the Existing Lease to the "Premises" shall mean the Expanded Premises. Provided that Tenant has delivered to Landlord the first monthly installment of Minimum Rent and additional rent payable with respect to that Expansion Space (as provided in Section ; below), the additional amount of the Security Deposit (as provided in Section _ 8 below) and the certificates of insurance as required in the Existing Lease with respect to the entire Expanded Premises, then as soon as commercially practicable after the Effective Date, Landlord shall deliver physical possession of =•K i RECEIVED 4557343v8 � 0;4474,0127 JUL 2 2 2019 CITY OF LA QUINTA DESIGN AND DEVELOPMENT DEPARTMENT the Expansion Space to Tenant in its "As Is" condition with Landlord's Work (as described below) substantially complete (the "Delivery Date"). As used herein, the terns "Substantial completion" is the date Landlord's Work in the Expansion Space is complete to the extent required to permit Tenant to begin Tenant's Work without unreasonable interference from Landlord's contractor(s). "Landlord's Work" means, collectively, the following: (i) the heating, ventilating and air conditioning system serving the Expansion Space shall be in proper working condition, (ii) the roof above the Expansion Space shall be free of leaks, (iii) those ceiling tiles that are water stained or otherwise damaged as of the Effective Date shall be replaced with new ceiling tiles, (iv) tite vertical employee locker that belongs to the former tenant of the Expansion Space shall be removed, (v) the double -entry front doors shall be replaced. Except as specifically set forth herein, Tenant shall accept the Expansion Space in its "As -Is" condition, and all work to be performed at the Expanded Premises shall be performed by Tenant at Tenant's sole cost and expense. 2. Term. Landlord and Tenant agree that the Term is hereby modified and extended for a period commencing on the Rent Commencement Date (as defined below) and ending on ,august 31, 2025 (the "Extension Term"). The Extension Term shall be on the same terms and conditions as set forth in the Existing Lease, except as they may be modified or amended as set forth in this Amendment. In addition, Landlord and Tenant hereby acknowledge and agree that any and all provisions of the Existing Lease providing for an extension or renewal of the Term are hereby deleted in their entirety and the only applicable provisions relating to any extension or renewal of the Extension Term are as expressly set forth in this Amendment. The "Rent Commencement Date" is the date one hundred twenty (120) days after the Delivery Date. 3. Mini€huts bent. Tenant's obligation to pay Minimum Rent and additional rent shall commence with respect to the entire Expanded Premises as of the Rent Commencement Date, pursuant to the terms of the Existing Lease, provided, however, upon its execution of this amendment, Tenant shall pay to Landlord, by cashier's check or certified check, the sum of $3,960.37, for the first month's Minimum Rent and additional rent payable with respect to the Expansion Space. Notwithstanding the foregoing, Tenant shall continue to pay Minimum Rent and additional rent and perform all obligations under the Lease with respect to the Existing Premises until the Rent Commencement Date. Minimum Rent for the Expanded Premises during the Extension Term and the Option Period (if exercised pursuant to the terns below) shall be as follows: i1.4r►ntlts roll} ,±; tltr lte€lt CommencerrtPnt Date Per Month Rent Commencement Date to end $8,535.00 of Month 12 following the Rent Commencement Date: Months 13-24: $8,791.05 Months 25-36: $9,054.78 Months 37-48: $9,326.42 Months 49-60: $9,606.22 Page 2 4567393YS 014474,,11-27 Months 61-72: $9,894.40 Months 73 -84: $10,191.24 O ti�riod Months 85-96: $10,496.97 Months 97-108: $10,811.88 Months 109-120: $11,136.24 Months 121-132: $11,470.33 Months 133-144: $11,814.43 Months 145-156: $12,168.87 Months 157-168: $12,533.93 4. QMion_ Period. Provided that (i) Tenant is not in default at the time Tenant exercises its option under this Amendment (as provided in this Section), (ii) Tenant is in actual, physical possession of the Expanded Premises, and (iii) Tenant is open for business in the entire Expanded Premises for the Permitted Use, Tenant may extend the Term for one (1) option period of seven (7) years (the "Option Period") by giving notice of exercise thereof ("Option Notice") to Landlord at least one (1) year before the date the Extension Term would otherwise expire. If Tenant is in default on the date of giving the Option Notice, at Landlord's option, such Option Notice shall be null and void; and if Tenant is in default on the date the Option Period is to commence, such Option Period shall not commence, and the Lease shall expire at the end of the Extension Term. The Option Period shall be personal to Tenant and may not be transferred or assigned. All of the terms and conditions of the Lease (except the foregoing right to extend the Term, any rental concession, construction allowance or other concession previously granted to Tenant) shall apply to the Option Period so far as applicable with Minimum Rent adjusted in accordance with Section 3 above. 5. Use of Exi mmion Snaec. The Expansion Space shall only be used for the Permitted Use, as defined in, and pursuant to the terms of, the Existing Lease. Subject to the terns of the Existing Lease, the Expansion Space may be used for additional seating, kitchen expansion, storage, office, and the installation of a bar in conjunction with the operation of the My Thai Restaurant located in the Existing Premises, and for no other purpose without the express, prior written consent of Landlord, which consent shall not be unreasonably withheld, conditioned or delayed. 6. �I'e_na _s. Work in the Expansion Space. Subject to the terns of L:.xli' i E to the Existing Lease, Tenant shall construct and remodel the interior of the Existing Premises and the Expansion Space (collectively, "Tenant's Work") in accordance with plans and specifications that Tenant shall have prepared by a California licensed architect and which must be pre - approved in writing by Landlord and the City of La Quinta prior to the date Tenant commences (or causes the commencement of) any construction in the Expanded Premises, Tenant's Work will include the construction of two openings from the Existing Premises to the Expansion Space, the installation of a bar, back bar, flooring and counters. The kitchen that serves the Existing Premises will also serve the Expansion Space for onsite dining and take-out orders. Page 3 4 56 i 3 4 3 v.S / 0 i 4474.v027 Tenant shall, within thirty (30) days of the date that Tenant receives the original buildout drawings for the Expansion Space from Landlord, deliver complete plans and specifications for Tenant's Work to Landlord for its review and comment or approval. David Henderson and Sathin Henderson have full authority to construct Tenant's Work acting in the capacity of owner/contractor, as long as they comply with all laws, rules, regulations and local building codes, and first obtain all permits and approvals required by the City of La Quinta and any and all other agencies that have authority to approve all or any portion of the Tenant's Work. 7. Tenant Imp gygment Allowance. Landlord shall provide Tenant with an improvement allowance in the amount of $18,330.00 ("Tenant Improvement Allowance") toward the design and construction of Tenant's Work in the Expansion Space, but excluding the cost of Tenant's signs, equipment or merchandise. Provided that Tenant is not in- default under the Lease, the Tenant Improvement Allowance shall be due and payable to Tenant within thirty (30) days after all of the following conditions have been satisfied: (a) Tenant is open for business with the public in the entire Expanded Premises and has paid the first month's rent and increased amount of the Security Deposit as provided in S-Lcflojis 3 avid h below. (b) Tenant has delivered to Landlord original affidavits, final unconditional waivers of lien rights and invoices and paid receipts for all of Tenant's Work from Tenant's contractors, subcontractors and suppliers. (c) Tenant has delivered to Landlord a permanent Certificate of Occupancy (or its equivalent) from the City of La Quinta. (d) Landlord has received from Tenant and approved a copy of a HVAC maintenance agreement as required in the Existing Lease. (e) Landlord has received certificates of insurance as required in the Existing Lease with respect to the entire Expanded Premises. (t) Tenant has delivered to Landlord evidence that Tenant has paid its utility deposits and local governmental impact fees. (g) Tenant has delivered to Landlord one (1) complete set of "as built" plans depicting Tenant's Work as actually constructed or installed and confirming compliance with the Americans with Disabilities Act of 1990, as amended. (h) Tenant has delivered to Landlord a Form W-9, Request for Taxpayer Identification Number and Certification, completed and executed by Tenant. (i) Tenant has installed its permanent signage on the exterior of the Expanded Premises, 8. SLcuriyQcoysil. Upon execution of this Amendment, Tenant shall pay to Landlord, by cashier's check or certified check, the sum of $3,960,37, to be added to the Security Deposit in the sum of $6,204.00 held by Landlord as a deposit under the Existing Lease, such Page 4 45673U,,-S ' 014474 0027 that the aggregate amount of the Security Deposit held by Landlord as of the Effective Date shall be $10,164.37. 9. Building Operating C't- Controlling over any contrary provision of 5ectiom l um l(ii l). of the Existing Lease, as of the Runt Commencement Date, Landlord may charge a percentage of costs of fifteen percent (15%), incurred under Article X of the Existing Lease as anadministrative fee thereunder. 10, Maintenance 6y Landlord. Controlling over any contrary provision of Sedgn 12.02(b of the Existing Lease, Landlord, at its sole cost, shall be responsible for the maintenance and repair of the structural portions of the Building, including the structural portions of the roof, exterior walls a:ul floor slab. Notwithstanding anything to the contrary contained in the Lease, Landlord shall not be liable to Tenant for failure to make repairs as herein specifically required of Landlord, unless Tenant has previously notified Landlord in writing of the need for such repairs, and landlord has failed to commence and complete such repairs within the time periods set forth in 5crtiun 26. l 5 of the Existing Lease. 11. Mgld Conditions. The tern "Hazardous Substances" as used in the Lease shall also include, without limitation, any form of (i) multieellular fungi that live on plant or animal matter and/or in an indoor environment (including, without limitation, Cladosporium, Penicillium, Alternaria, Aspergillus, Fusarium, Trichoderma, Memnoniella, Mucor, and Stachybotrys chartarum (SC) often found in water damaged building materials), (ii) spores, scents or byproducts produced or released by fungi, including mycotoxins, and (iii) microbial matter which reproduces through mold, mildew and viruses, whether or not such microbial matter is living (collectively, "Mold"). Tenant acknowledges and agrees that Landlord has removed any Mold that existed in the Expansion Space and remediated any conditions in the Expansion Space that might lead to Mold therein. Tenant acknowledges and agrees that Mold and conditions that might lead to additional Mold existing in the Existing Premises as of the Effective Date, and that Tenant, at its sole cost and expense, is obligated to remove such Mold and such conditions, and shall promptly commence performing such removal and the remediation of the Existing Premises no later than July 15, 2019 and shall thereafter diligently perform such removal and remediation to completion in compliance with all Applicable Laws, all pursuant to remediation, repair and restoration plans approved in writing by Landlord, using a licensed contractor approved in writing by Landlord. Tenant may cease operations of its restaurant business for the period from July 15, 2019 to August 15, 2019 to complete such remediation. Tenant shall also, at least once a month, inspect the Expanded Premises (either itself or a licensed professional) to determine whether any Mold exists at or about the Expanded Premises and/or whether there are any conditions that might lead to Mold at or about the Expanded Premises. If any Mold or conditions that might lead to Mold at or about the Expanded Premises is/are discovered by or on behalf of Tenant, or if Tenant learns thereof, then Tenant shall immediately notify Landlord thereof in writing. if Tenant or its employees, agents, contractors or (while in the Expanded Premises) invitees (collectively, the "Tenant Parties") cause any Mold or any conditions that might lead to Mold at or about the Expanded Premises or other portions of the building in which the Premises is located ("Building") during the Tern, Tenant shall, at its sole cost and expense, remove such Mold, remedy the conditions that might lead to Mold and remediate, repair and restore the Expanded Premises and other affected portion(s) of the Building (collectively, the "Remediation Work") in compliance with all Page 5 4567303-:3 1014474 0:127 Applicable Laws, pursuant to remediation, repair and restoration plans approved in writing by Landlord, using a licensed contractor approved in writing by Landlord; provided, however, if the Remediation Work affects areas other than solely the interior, nonstructural portions of the Expanded Premises, then Landlord shall have the right, in its sole and absolute discretion, to perform some or all of the Remediation Work and all reasonable costs therefor incurred by Landlord shall be immediately due and payable by Tenant to Landlord. If any lender or governmental agency shall ever require testing to ascertain whether or not any Mold or conditions that might lead to Mold exist at or about the Shopping Center, then the reasonable costs thereof shall be reimbursed by Tenant to Landlord upon demand as additional rent if such requirement is as a result of the acts or omissions of Tenant or the Tenant Parties. In addition, Tenant shall execute affidavits, representations and the like from time to time at Landlord's request concerning Tenant's best knowledge and belief regarding the presence of Mold or conditions that might lead to Mold at the Expanded Premises. In all events, Tenant shall indemnify, defend (with counsel reasonably acceptable to Landlord) and hold Landlord and its employees, partners, officers, agents, lenders and contractors harmless from and against any and all liabilities, claims, damages, fines, lawsuits, fees and penalties arising out of or relating to Mold or conditions that might lead to Mold which are a result of the acts or omissions of Tenant or the Tenant Parties during the Term of the Lease. The within covenants shall survive the expiration or earlier termination of the Lease. Landlord shall indemnify, defend (with counsel reasonably acceptable to Tenant) and hold Tenant and its employees, partners, officers, agents, lenders and contractors harmless from and against any and all liabilities, claims, damages, fines, lawsuits, fees and penalties arising out of or relating to Mold on the Expanded Premises which first comes into existence after the Effective Date or conditions that are first created after the Effective Date that might lead to Mold on the Expanded Premises, which in each case are a result of the acts or omissions of Landlord, its contractors, agents or employees during the Terrn of the Lease and are not due to the regeneration or expansion of Mold in the Expanded Premises as of the Effective Date. The within covenants shall survive the expiration or earlier termination of the Lease. 12. l.imi tci Izoo r Acc ess. Promptly following the Effective Date, Tenant may obtain and keep during the term of the Lease one (1) key from Landlord for Tenant or its contractors to access the roof above the Expanded Premises in the event of an emergency, such as a power outage or failure of refrigeration units serving the Expanded Premises, in order to cure such power outage, failure or other similar eiergency. Tenant shall indemnify, defend and hold Landlord harmless from and against any and all claims, demands, actions, damages, liability, losses and expense (including reasonable attorneys' fees and costs of investigation with respect to any claim, demand or action) in connection with access or entry by Tenant, its employees', agents' or contractors' to the roof, loss of the key, or failure to lock the access to the roof, including, but not limited to, any damage to the roof or rooftop equipment resulting therefrom. Tenant's indemnity obligations under Section 13.03 of the Existing Lease shall apply to Tenant's obligations under this Section and shall survive the expiration or earlier termination of the Lease. Tenant shall not make copies of the key for roof access, and shall return the key to Landlord upon the expiration or earlier termination of the Lease. 13. Certified Access Specialist. Pursuant to Section 1938 of the California Civil Code, Landlord hereby advises Tenant that as of the Effective Date, the Expanded Premises has not undergone inspection by a Certified Access Specialist (a "CASp") during Landlord's Page 6 ownership of the Shopping Center, nor, to Landlord's actual knowledge (without any duty of inquiry), as of the Effective Date, prior to Landlord's ownership of the Shopping Center. Further, pursuant to Section 1938 of the California Civil Code, Landlord notifies Tenant of the following: "A Certified Access Specialist (CASp) can inspect the subject premises and determine whether the subject premises comply with all of the applicable construction -related accessibility standards under state law. Although state law does not require a CASp inspection of the subject premises, the commercial property owner or lessor may not prohibit the lessee or tenant from obtaining a CASp inspection of the subject premises for the occupancy or potential occupancy of the lessee or tenant, if requested by the lessee or tenant. The parties shall mutually agree on the arrangements for the time and manner of any such CASp inspection, the payment of the fee for the CASp inspection and the cost of making any repairs necessary to correct violations of construction -related accessibility standards within the premises." Therefore and notwithstanding anything to the contrary contained in this Amendment, Landlord and Tenant agree that (a) Tenant may, at its option and at its sole cost, cause a CASp to inspect the Expanded Premises and determine whether the Expanded Premises complies with all of the applicable construction - related accessibility standards under California law, (b) the parties shall mutually coordinate and reasonably approve of the timing of any such CASp inspection so that Landlord may, at its option, have a representative present during such inspection, (c) Tenant shall be solely responsible for the performance and cost of any repairs necessary to correct violations of construction -related accessibility standards within the Expanded Premises, any and all such alterations and repairs to be performed in accordance with Article XI of the Existing Lease, all to be performed by Tenant prior to the earliest date required for completion pursuant to (i) applicable laws, codes and regulations, or (ii) governmental requirements, and (d) if anything done by or for Tenant in its use or occupancy of the Expanded Premises shall require repairs to the Building or the Shopping Center (outside the Expanded Premises) to correct violations of construction -related accessibility standards, and Landlord does not, in good faith, dispute such requirement, then Landlord shall perform such repairs prior to the earliest date required for completion pursuant to (i) applicable laws, codes and regulations, or (ii) governmental requirements, and Tenant shall reimburse Landlord within ten (10) days after demand, as additional rent, for the actual and reasonable costs incurred by Landlord to perform such repairs. 14. Utilities. Tenant agrees to reasonably cooperate with Landlord to the extent required by Landlord to comply with California Public Resources Code Section 25402.10 including, without limitation, providing or consenting to any utility company providing Tenant's energy consumption information for the Expanded Premises to Landlord. 15. CoWident_ ighiy. The provisions of this Amendment are confidential and shall remain confidential unless disclosed by Landlord, in its discretion. Tenant represents, warrants and covenants that Tenant, its agents, employees, and contractors (collectively, "Agents"), have not published or disclosed and shall not publish or disclose to any third party any of the provisions of this Amendment. Tenant acknowledges that any disclosure to a third party made by Tenant or its Agents may substantially harm Landlord's marketing efforts in the Shopping Center in that as a result of such disclosure, Landlord may have to provide potential tenants and/or any tenant occupying space in the Shopping Center with lease concessions which would not have been provided by Landlord but for such disclosure by Tenant or its Agents. Any such disclosure by Tenant or its Agents, shall, at the option of Landlord, constitute a non -curable default by Tenant for which Landlord may elect either to (a) terminate the Lease and/or this Page 7 4567393A'G 4474.N,27 Amendment (b) keep the Lease and/or this Amendment in full force and effect and require Tenant to refund in full to Landlord within thirty (30) days the difference between the new lower rental amounts and the rental amounts under the Existing Lease. After the difference has been refunded to Landlord in full, Landlord has an option, at Landlord's sole and absolute discretion, to revert back to enforcing the Existing Lease rental rate structure. 16. i.szolippj. Tenant hereby certifies to Landlord as follows: (a) all conditions of the Existing Lease necessary for the enforceability of the Existing Lease have been satisfied or waived, (b) Landlord is currently not in default under the Existing Lease, (c) as of the date hereof, there are no existing claims, defenses or offsets that Tenant has against Landlord nor, to Tenant's knowledge, have any events occurred that would constitute a default on the part of Landlord under the Existing Lease, and (d) Landlord is not required to perform, nor contribute any allowance for, any additional improvements to the Expanded Premises. 17. Brokers. Landlord and Tenant hereby warrant to each other that (i) they have had no dealings with any real estate broker or agent in connection with the terms of this Amendment, and (ii) they know of no real estate brokers or agents that are entitled to a commission in connection with the tens of this Amendment, except for Keller Williams Realty (Chris Clark) ("Tenant's Broker"), which represents Tenant exclusively, and Coldwell Banker Commercial Lyle & Associates ("Landlord's Broker"), which represents Landlord exclusively. By the execution of this Amendment, Landlord and Tenant are executing the confinmation of such agency relationships. By the execution of this Amendment, each of Landlord and Tenant hereby acknowledge and confirm (a) receipt of a copy of a Disclosure Regarding Real Estate Agency Relationship conforming to the requirements of California Civil Code 2079.16, and (b) the agency relationships specified in this Section, which acknowledgement and confirmation is expressly made for the benefit of Tenant's Broker. Landlord will be solely responsible for the payment of any commissions owed to Tenant's Broker (pursuant to a separate written agreement among Landlord and Tenant's Broker) and to Landlord's Broker (pursuant to separate written agreement among Landlord and Landlord's Broker). Each party agrees to defend, indemnify and hold harmless the other party from and against any claim for commission or finder's fee by any entity that claims or alleges that they were retained or engaged by the first party or at the request of such party in connection with this Amendment. 18. C_owticiparts. This Amendment may be executed in multiple counterparts, all of which together shall constitute one and the same Amendment. Landlord, Tenant and Guarantor, if applicable, agree that electronic signatures, including those delivered by PDF or signed through the electronic signature system known as "DocuSign", shall have the same effect as originals. All parties to this Amendment waive any and all rights to object to the enforceability of this Amendment based on the form or delivery of signature. 19. Agfl ornt . Each party executing this Amendment on behalf of such party hereby represents and warrants that such party is a duly formed and existing entity qualified to do business in the State of California and that such party has full right and authority to execute and deliver this Amendment and that each person signing on behalf of such party is authorized to do so. Page 8 20. #tubs of C opstnictiot . The provisions of this Amendment shall be construed and enforced in accordance with the laws of the State of California. Each party hereto acknowledges that (a) each party hereto is of equal bargaining strength; (h) each such party has actively participated in the drafting, preparation and negotiation of this Amendment and the transactions contemplated herein; and (c) any rule of construction to the effect that ambiguities are to be resolved against the drafting party shall not apply in the interpretation of this Amendment or any portion hercof. 21. Bjndiqg Effect. This Amendment shall not be effective and shall not be valid or binding on Landlord unless and until a fully executed original counterpart of this Amendment is delivered to Landlord. 22. Effeat of Amendment. Except as provided herein, all terms, covenants and conditions of the Existing Lease remain unmodified and in full force and effect throughout the Term. The Lease constitutes the entire agreement of the parties and no further modification of the Lease shall be binding and effective unless evidenced by an agreement, in writing, signed by both Landlord and Tenant. To the extent of any inconsistency between the terms and conditions of the Existing Lease and the terms and conditions of this Amendment, the terms and conditions of this Amendment shall apply and govern the parties. Under no circumstances shall Tenant be entitled to any rent abatement, improvement allowance, leasehold improvements, or other work to the Premises, or any similar economic incentives that may have been provided to Tenant in connection with entering into the Existing Lease, unless otherwise specifically set forth in this Amendment. [REMAINDER OF PAGE LEFT INTENTIONALLY BLANK] Page 9 4567j';',vX'014474 ni?7 IN WITNESS WHEREOF, Landlord and Tenant have executed this Amendment on the respective dates set forth opposite their signatures, but the Effective Date of this Amendment shall be as of the date first set forth above. "Landlord": WASHINGTON-11 I, LTD., a California limited partnership By: JTDC, I LC, a Delaware limited gTaff pany Its Managi g ne Date: o ! �I By, hart . C- a Its Managing Member "Tenant ISAAN KITCHEN GROUP, LLC, a California limited liability company Date: _ / CJ� By: y-- Name: Title: Date:----- By: Name: Title: Paso 10 4367393v8 / 014474.0027 C OACHELLA VALLEY WATER DISTRICT f 75-515 Ha>:vley Lane Fast Palm Desert, California 92211 (769) 398-2651 APPLICATION FOR WASTEWATER SOURCE CONTROL TROL, PLAN APPROVAL, ,iPPLiCAtiT• Subrnii this limn wn$ a copy of SCAI.F.D plw plan (I" 20' to 1" 40' SCALE) i'•rawn I Disirn,t specifientiom A nonretkwdabiv Filing lac is required when the application is suhmined. Chczk must be made payable to the Coaehclla Valle Water District Approval o' this ipphuition shall remain vslid for a pt.7iod not to rrcced one i I) ycw from date of paytacnl- NOTE: ALL USERS DISCHARGING FAT, OIL, ANDJOR f.PFASE, LOCATED IN A N'IUI,TI- SUITE BUILDING INILl. REQUIRE A SFPAR-ATF, LATFRAL OFFTHF, MAIN SEWER LINT, FOR GREASE IA7ERCEPTOR CONNECTION. ( -% AID Source Control %ill incpcer the :bposed greair plumhing and the Inst>a11ed interceptor. Pleaw cull 060) 399-2661 X-1536 49 hours in advxnec to echrdule ins eetion s, ,wi.cmtrsctur,Ciiiawpwwa :,U—i Qnr state 7m Tei�-PMW NMcr C„ Iv stow Zip TC,'pbnlx - e4 , ,, i ; l d� Z&::,'�R �; d , �f/ r / / City Zip .f{.[J O°1 it (. �L! �l��p�✓f,�l _.f <C y� 71s'.f". '1 �7 Iivamim Type Tknng 13ntiaC, As NOTF: NO PLAN. A111-1, BF. APP32Ci1 ED iJNTH, I'FUS APPOCATION IS COMPUTE AIND PLAN CHECK FELS ARE PAiI). •I { pe. III Construction: 0 New 19 Remodel I lours oft ration: Caoltnl fo\vcf s) ❑ For Vehicle Service, For Food Senice: ❑ Wand Bays ❑ Trcneh Drains f w h) ❑ Water Softener 0 Garbage Grindcr(s) ❑ Digcstr;r(s) ❑ Roll over t-7. Servux bay(s) - NJU1hservace (rcusablej 100 % Sing.x Service (disposable) % O Tunnel(s) _ ❑ Parts Wishes Reating Cipaciry. Internal -43— Fxtemal ❑ SpEl Containment (Solvent 0 Aqueous ❑ } Seating with.haters or llewers ❑ Hydraulic Lift(s) ❑iVWork Sinks Bar Scaung liar Scattng with hood Service U Vhb[t/RbPRI.SF,Iv I A l 1S' F !)'a,LARA I ION: I certify that I h,lw read the cntlre apph«tion and slate that all infornwiiun is CtltrceL I Un SttiliM71 the flee amount is srd on my declaration of information on this form and that incorrect intorination is grounds for rejection of the mtiY be el,scarded tfnot picked up within sixty (60) days ofapproval or return and that no District 3u nutted pltrt I also ets td nt p3nd it pextion ufiti ' staltl't, rn n uil be etrd unfit all requested infrinnation has ben and plans have been approved: llveived 3t snare Date {'(_ FOR DISTRICT USE ONLY No. of Systems Type ut'syslcnn(s) Pretreatment Equipment: / Gd� Grease Interceptor Grease Interceptor Waived ❑ New PJ F,xtstin.g ❑ sand/Oki ❑ Connect to Sewer ❑ Addition ❑ Lint Trap ❑ Point of Connection Simple Station ❑ Replacement ❑ Clarifier CJ Lhgestcr(s) Size 1 aoa gals � unt t, flu' application is � �y PLJ��O30?a 0 t Conditionally Approved* � Approved l,fI)840T1 /—?73 ^� *Sec Reniarki , lit Fee S - (;heck No. I Si , store /- p Date - 9 /(!/ f �- 0 w� lni6j Date C -WD-921 Re, I ID RECEIVED SEP 10 2019 CITY OF LA QUINTA DESIGN AND DEVELOPMENT DEPARTMENT 00ACHELLA VALLEY WATER DISTIUCT 75-515 HDvley Lane last Palm Desert, California 92211 (760) 398-2651 Z�_M_00 APPLICATION FOR WASTEWATER SOURCE CONTROL PLAN APPROVAL APPLICANT: Submit this rinn ivirh a copy nfa SCA1,I-.D p1w pbn (I" 20' (q) 1" 40' SCALC) ;rrawn to Dishier specifications A nonrcnu,dable filing fee is required wlim the application is submitted, Chcck must be mace payable to the Cnachclla Valley Water Disuiei Approval or diis apphcaruon shall remain valid for a p,aiod not to exceed one (1) year from date of paytnerit. NOTE: ALI. USERS DISCHARGING PAT, Oil., ANDIOR GRF.ASF LOCATED IN A MULTI - SUITE BUILDING WILL REQUIRE A SF.PARXIT, LATERAL OFF THE MAIN SEWER LINE FOR GREASE.IA"PERCEYTOR CONNECTION. C%VD Source Control ?Lill ins1wei the exposed grease plumbing and the InstoOed interceptor. Please cull (760) 39A-266i XiSM 311 hnurs in advrince to xchMult. ins ection s . AWnt, Con,rmtor, CotkW3IN, %*A AilJsra* t:ny stale irp Trt<plrrrx 01'Mcr Atkhcz C:ly Maw 'Lip Tcl:•.p1wna JAn i zip uvuwf+ TyTw Ming Rminec, As Nryr r. NO PLANS II1 1, RE ,►PPRU etti ti rit-THIS AY 1CATIUN I5 COMPI. -FE AND PLAN CHECK f•'t{MS ARE PAID. Ty c of Construction: ❑ New 9 iRctuadel 1 dears of U ninon: Ccsehn fmvci i For Vehicle Service: For Foot) Service: ❑ Wand Bays._ ❑'french Drains (fl) O Watcr Softener 0 GarbageOruider(s) ❑ DtgC!,WT(s) ❑ Roll over ❑ Service bey(s) _ _ 'Multisemce (reusable) 100 % Singe Service (disposable) % ❑ Tunnei(s) ❑ Parts Washer Seating (rapacity• Intemal _q..— Fxtcmal ❑ Spil Containment (Solvent ❑ Aqueous ❑) Seating with Misters or heaters ❑ II ydraulie U c ❑Wordc Sinks liar Scaun g bar Staking with Food.Service UWhER/RL PRIiSFiI+ fA"I IVF Ua =LLARATION: I certify that I IUIYc read the enure application and shut: that all mfornuaiun is correct- t Un9al7C f—tt t)L'It the fee amount is red on my declaration of information on this form and that incorrect inf'onnation is grounds for rejection of the su netted plui I also iP4Mqhj rtl pllut �nuty be discarded if not picked up within sixty (fi0) days of approval or return and that no District in be information has be: have pedien 0f rrs cstabli un rr wii cond L `tl until all requested n received and plans been approved Siguaiurc 4 Date FOR DISTRICT USE ONLY No- of Systems Type o(System(s) Pretreatment Equipment: ` ❑ NewSJ F,xi5ling Grease Interceptor El Grease Interceptor Waived ❑ Sand/Oil ❑ Conned to Sewer ❑ Addilion ❑ hint-l'rtp ❑ Point ofConnec6nn Sample Station ❑ Repiuccment ❑ Clarifier ❑ Digestcr(s) _ Sizc. 13000 pals ltl? 7ARlKS: _ -if, 1,cxn ik►�►�>n�+ i e+� �;-- rrsixi it; r a rru.5 _�s�'__ Op It ahr _scC:Lno4 71 application is: Pz �q / _"41�0 !?t 737J Conditionally Approved* ❑ Appioved M r-_-L t�t�. LID CJg *See Remarks Fcc Y 50 k No.�� TM Chico. I— L�Cl Si nature _ p Date 9 /�/� / Initial Date CVW11.47t Re, 1 19 n BUILDING ENERGY ANALYSIS REPORT PROJECT: MY THAI BAR T.I. (addition only) 46520 EAST WASHINGTON STREET STE B LA QUINTA, CA 92253 Project Designer: GABRIEL LUJAN AND ASSOCIATES 77-530 ENFIELD BLGD 1 STE 101 PALM DESERT, CA 92211 760 578-8545 Report Prepared by: Armando Chavez 44890 SEELEY LA QUINTA, CA 92253 760 278.1840 Job Number: 19- GLA - 007 Date: CITY CIFL6 (' U F', °:' TA BUILDING DI\/iSION REVIEWED FOR CODE COMPLIANCE G`l 'Beaty u 1- ec&% RECEIVED SEP 2 4 2019 CITY OF LA QUINTA 9/23/2019 DESIGN AND DEVELOPMENT DEPARTMENT 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. I TABLE OF CONTENTS I Cover Page Table of Contents Form LTI-01-E Indoor Lighting Form LTI-02-E Indoor Lighting Controls Form LTI-03-E Indoor Lighting Power Allowance 1 2 3 9 12 I EnergyPro 7.1 by EnergySoft Job Number: ID: 19- GLA - 007 User Number: 20648 1 STATE OF CALIFORNIA INDOOR LIGHTING CEC-NRCC-LTI-01-E Revised 04/16) CALIFORNIA ENERGY COMMISSION! CERTIFICATE OF COMPLIANCE NRCC-LTI-01-E Indoor Lighting (Page 1 of 6) Project Name: MY THAI BAR T.I. (addition only) Date Prepared: 9/23/2019 A. General Information Climate Zone: Conditioned Floor Area: 1,300 15 Unconditioned Floor Area: 0 Building Type: ❑ Nonresidential ❑ High -Rise Residential ❑ Hotel/Motel ❑ Schools ❑ Relocatable Public Schools ❑ Conditioned Spaces ❑ Unconditioned Spaces Phase of Construction: ❑ New Construction ❑ Addition In Alteration Method of Compliance: ❑ Complete Building ❑ Area Category ❑ Tailored Project Address:46520 EAST WASHINGTON STREET STE B B. Lighting Compliance Documents (select yes for each document included) For detailed instructions on the use of this and all Energy Efficiency Standards compliance documents, refer to the Nonresidential Manual published by the California Energy Commission. YES NO COMP. DOC. TITLE 10 ❑ NRCC-LTI-01-E Certificate of Compliance. All Pages required on plans for all submittals. Q ❑ NRCC-LTI-02-E Lighting Controls, Certificate of Compliance, and PAF Calculation. All Pages required on plans for all submittals. k] ❑ NRCC-LTI-03-E Indoor Lighting Power Allowance ❑ (c7 NRCC-LTI-04-E Tailored Method Worksheets ❑ p NRCC-LTI-05-E Line Voltage Track Lighting Worksheets ❑ ❑ NRCC-LTI-06-E Indoor Lighting Existing Conditions CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance April 2016 STATE OF CALIFORNIA INDOOR LIGHTING 0EC-NRCC-LTI-01-E [Rev+sea 04n6% CALIFORNIA ENERGY COMMISSION r CERTIFICATE OF COMPLIANCE NRCC-LTI-01-E Indoor Lighting (Page 2 of 6) Project Name: MY THAI BAR T.I. (addition only) Date Prepared: 9/23/2019 C. Summary of Allowed Lighting Power Conditioned and Unconditioned space Lighting must not be combined for compliance Indoor Lighting Power for Conditioned Spaces Indoor Lighting Power for Unconditioned Spaces Watts Watts Installed Lighting 685 Installed Lighting 0 01 NRCC-LTI-01-E, Table H, page 5 + NRCC-LTI-01-E, Table H, page 5 + 02 Portable Only for Offices + NRCC-LTI-01-E, Table G, page 4 03 Minus Lighting Control Credits 0 Minus Lighting Control Credits 0 NRCC-LTI-02-E, page 2 NRCC-LTI-02-E, page 2 04 Adjusted Installed Lighting Power _ 85 Adjusted Installed Lighting Power = 0 (row 1 plus row 2 minus row 3) (row 1 minus row 3) Complies ONLY if Installed <_ Allowed (Box 04 < Box 05) Complies ONLY if Installed <_ Allowed (Box 04 < Box 05) Allowed Lighting Power Allowed Lighting Power Conditioned NRCC-LTI-03-E, page 1 Unconditioned NRCC-LTI-03-E, page 1 05 1,430 0 Alterations with replacement luminaires that have at least Alterations with replacement luminaires that have at least 50/35% 50/35% lower power compared to the original existing luminaires, lower power compared to the original existing luminaires, may may instead use the allowed wattage from NRCC-LTI-06, page 2 instead use the allowed wattage from NRCC-LTI-06, page 2 D. Declaration of Required Certificates of Installation Declare by selecting yes for all of the Certificates that will be submitted. (Retain copies and verify forms are completed and signed.) YES NO Compliance Document/Title �j ❑ NRCI-LTI-01-E - Must be submitted for all buildings ❑ Field Inspector ❑ m NRCI-LTI-02-E - Must be submitted for a lighting control system, or for an Energy Management Control System (EMCS), ❑Field Inspector to be recognized for compliance. ❑ ® NRCI-LTI-03-E - Must be submitted for a line -voltage track lighting integral current limiter, or for a supplementary ❑Field Inspector overcurrent protection panel used to energize only line -voltage track lighting, to be recognized for compliance. ❑ NRCI-LTI-04-E - Must be submitted for two interlocked systems serving an auditorium, a convention center, a © conference room, a multipurpose room, or a theater to be recognized for compliance. ❑Field Inspector ❑ El NRCI-LTI-05-E - Must be submitted for a Power Adjustment Factor (PAF) to be recognized for compliance. ❑ Field Inspector ❑ NRCI-LTI-06-E - Must be submitted for additional wattage installed in a video conferencing studio to be recognized for © ❑Field Inspector compliance. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance April 2016 STATE OF CALIFORNIA INDOOR LIGHTING CEC-NRCC-LTI.01-E {Revised 04/16) _ CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTI-01-E Indoor Lighting (Page 3 of 6) Project Name: MY THAI BAR T.I. (addition Only) Date Prepared: 9/23/2019 E. Declaration of Required Certificates of Acceptance Declare by selecting yes for all of the Certificates that will be submitted. (Retain copies and verify forms are completed and signed.) YES NO Compliance Document/Title ❑ Q NRCA-LTI-02-A - Must be submitted for occupancy sensors and automatic time switch controls. ❑ Field Inspector ❑ Q NRCA-LTI-03-A - Must be submitted for automatic daylight controls. ❑ Field Inspector ❑ NRCA-LTI-04-A - Must be submitted for demand responsive lighting controls. ❑ Field Inspector ❑ [3 N RCA-LTI-05-A — Must be submitted for institutional tuning power adjustment factor (PAF). ❑ Field Inspector A Separate Lighting Schedule Must Be Filled Out for Conditioned and Unconditioned Spaces. Installed Lighting Power listed on this Lighting Schedule is only for: ❑ CONDITIONED SPACE ❑ UNCONDITIONED SPACE F. Indoor Lighting Schedule and Field Inspection Energy Checklist ❑ The actual indoor lighting power listed on the next 2 pages includes all installed permanent and planned portable lighting systems. ❑ When Complete Building Method is used for compliance, list each different type of luminaire on separate lines. ❑ When Area Category Method or Tailored Method is used for compliance, list each different type of luminaire by each different function area on separate lines ❑ Also include track lighting in schedule, and submit the track lighting compliance document (NRCC-LTI-05-E) when line -voltage track lighting is installed. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance April 2016 STATE OF CALIFORNIA INDOOR LIGHTING CEC-NRCC-LTI-01-E [Revised 04/16] CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTI-01-E Indoor Lighting (Page 4 of 6) Project Name: MY THAI BAR T.I. (addition only) Date Prepared: 9/23/2019 G. Installed Portable Luminaires in Offices — Exception to Section 140.6(a) ❑ This section shall be filled out ONLY for portable luminaires in offices (As defined in §100.1). All other planned portable luminaires shall be documented on next page of this compliance document. ❑ This section is used to determine if greater than 0.3 watts of portable lighting is planned for any office ❑ Fill out a separate line for each different office. Small offices that are typical (having the same general and portable lighting) may be grouped together. This allowance shall not be traded between offices having different lighting systems. Office Portable Luminaire Schedule Office Installed Portable Luminaire W/W Office Location Field Inspector 1 2 3 4 5 6 7 8 9 10 If G06 <_ Installed Watts portable .� 4 p 0.3, enter per Complete Luminaire Description p p Watts per ° �' a`, luminaire CU - o zero; square Identify Office area in (i.e., LED, under cabinet, furniture mounted n C a (G05 x G07) which these portable Pass Fail direct/indirect) Luminaire E watts in this " foot if G06 > luminaires are installed z' office o (G04 / (G02 x G03) G05) 0. (G06- 0.3) j 1 ❑ ❑ ❑ ❑ Total installed portable Luminaire watts that are greater than 0.3 W/ftz per office:Enter sum total of all pages into NRCC-LTI-01-E; Page 1 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance April 2016 STATE OF CALIFORNIA INDOOR LIGHTING CEC-NRCC-L7I-01-E Revised Darts CALIFORNIA ENERGY COMMISSION r CERTIFICATE OF COMPLIANCE NRCC-LTI-01-E Indoor Lighting (Page 5 of 6) Project Name: MY THAI BAR T.I. (addition only) Date Prepared: 9/23/2019 A Separate Lighting Schedule Must Be Filled Out for Conditioned and Unconditioned Spaces. Installed Lighting Power listed on this Lighting Schedule is only for: 0 CONDITIONED SPACE ❑ UNCONDITIONED SPACE H. Indoor Lighting Schedule and Field Inspection Energy Checklist Luminaire Schedule Installed Watts Location Field Inspector 1 01 02 03 04 05 06 07 08 How wattage was o determinedcu v a, Name or Complete Luminaire Description a`, 2 Q '� �, m o t x Primary Function area in which o Item Tag (Le, 3 lamp fluorescent troffer, E � w z o E- : 'E c " x — •`— m these luminaires are installed Pass Fail F32T8, one dimmable electronic ballast) �j i J a E - o z = o Y ++ U O U U L O m J O 2 Q LED 25 W LED 17W 25.0 ❑ ❑ 7 175 Comp Bldg Restaurant ❑ ❑ ❑ 17.0 IZI ❑ 30 510 Comp Bldg Restaurant ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 1 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 685 Enter sum total of all pages into INSTALLED WATTS PAGE TOTAL: NRCC-LTI-01-E; Page 2 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance April 2016 STATE OF CALIFORNIA INDOOR LIGHTING r-rl CEC-NRCC-LTI-61-E Revised D4116) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTI-01-E Indoor Lighting (Page 6 of 6) Project Name: MY THAI BAR T.I. (addition only) Date Prepared: 9/23/2019 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Armando Chavez Documentation Author Signature: Signature Date: 9/23/2019 Company: Address: 44890 SEELEY CEA Certification Identification (if applicable): City/State/Zip: LA QUINTA, CA 92253 Phone: 760 278.1840 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 w i I I ensure that a cornp)eted signed copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the building, and made avaHal ble to the enforcement agency for all applicable inspections. I understand that a completed signed copy of this Certificat omplian is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: Responsible Desi er S' Company: GABRIEL LUJAN AND ASSOCIATES Date Signed: 2'3 L License: Address: 77-530 ENFIELD BLGD 1 STE 101 city/state/zip: PALM DESERT, CA 92211 Phone: 760 578-8545 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance April 2016 STATE OF CALIFORNIA INDOOR LIGHTING - LIGHTING CONTROLS I q-; CEC-NRCC-LTI-02-E Revised 01/16CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTI-02-E Indoor Lighting - Lighting Controls (Page 1 of 3) Project Name: MY THAI BAR T.I. (addition only) Date Prepared 9/23/2019 A. Mandatory Lighting Control Declaration Statements (Indicate if the measure applies by checking yes or no below.) YES NO Control Requirements ❑ ❑ Lighting shall be controlled by self-contained lighting control devices which are certified to the Energy Commission according to the Title 20 Appliance Efficiency Regulations in accordance with Section 110.9. ❑ ❑ Lighting shall be controlled by a lighting control system or energy management control system in accordance with §110.9. An Installation Certificate shall be submitted in accordance with Section 130.4(b). ❑ ❑ One or more Track Lighting Integral Current Limiters shall be installed which have been certified to the Energy Commission in accordance with §110.9 and §130.0. Additionally, an Installation Certificate shall be submitted in accordance with Section 130.4(b). ❑ A Track Lighting Supplementary Overcurrent Protection Panel shall be installed in accordance with Section 110.9 and Section 130.0. Additionally, an Installation Certificate shall be installed in accordance with Section 130.4(b). ❑ All lighting controls and equipment shall comply with the applicable requirements in §110.9 and shall be installed in accordance with the manufacturer's instructions in accordance with Section 130.1. C� ❑ All luminaires shall be functionally controlled with manually switched ON and OFF lighting controls in accordance with Section 130.1(a). General lighting shall be separately controlled from all other lighting systems in an area. Floor and wall display, window display, case display, ornamental, ❑ ❑ and special effects lighting shall each be separately controlled on circuits that are 20 amps or less. When track lighting is used, general, display, ornamental, and special effects lighting shall each be separately controlled; in accordance with Section 130.1(a)4. ❑ The general lighting of any enclosed area 100 square feet or larger, with a connected lighting load that exceeds 0.5 watts per square foot shall meet the multi -level lighting control requirements in accordance with Section 130.1(b). ❑ [a All installed indoor lighting shall be equipped with controls that meet the applicable Shut -OFF control requirements in Section 130.1(c). ❑ ❑' Lighting in all Daylit Zones shall be controlled in accordance with the requirements in Section 130.1(d) and daylit zones are shown on the plans. ❑ a Lighting power in buildings larger than 10,000 square feet shall be capable of being automatically reduced in response to a Demand Responsive Signal in accordance with Section 130.1(e). Before an occupancy permit is granted for a newly constructed building or area, or a new lighting system serving a building, area, or site is operated for d normal use, indoor lighting controls serving the building, area, or site shall be certified as meeting the Acceptance Requirements for Code Compliance in accordance with Section 130.4.(a). The controls required to meet the Acceptance Requirements include automatic daylight controls, automatic shut -OFF controls, and demand responsive controls. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 STATE OF CALIFORNIA INDOOR LIGHTING — LIGHTING CONTROLS Fri) CEC-NRCC-LTI-02-E (Revised 01116) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTI-02-E Indoor Lighting - Lighting Controls (Page 2 of 3) Project Name: MY THAI BAR T.I. (addition only) Date Prepared: 9/23/2019 A separate document must be filled out for Conditioned and Unconditioned Spaces. This page is used only for the following: ❑ CONDITIONED SPACES ❑ UNCONDITIONED SPACES B. Mandatory and Prescriptive Indoor Lighting Control Schedule, PAF Calculation, and Field Inspection Checklist PAF Credit Calculation ` a, U O O O O a) OOo O +, J f6 L SZ .a U Q 1 v" w Standards Complying With o J t° V Lighting Control Schedule (✓ all that apply, or enter'E' if Exempted) u ~ iz 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 Type/Description of Lighting Control (Le.: occupancy sensor, # ° : v o a; 4 - Location in Building automatic time switch, of o 6 0 0 0 1D o dimmer, automatic daylight, Units O a LL to)wMr-11 etc...) FRONT Manual Area 5 ❑ ❑ ❑ ❑ ❑ ❑ ✓ ❑ ❑ Control Credit PAGE TOTAL (Sum of Column 13): 0 IF MULTIPLE PAGES ARE USED, ENTER SUM TOTAL OF Control Credit for all pages HERE (Sum of all Column 13): U Enter Control Credit total into NRCC-LTI-01-E; Page 1. 1. §130,1(a) = Manual area controls; §130.0(b) = Multi Level; §130.1(c) = Auto Shut -Off,- §130.1(d) = Mandatary Daylight; §130.1(e) = Demand Responsive; §140.6(d) _ Additional lighting controls installed to earn a PAF; §140.6(d) = Prescriptive Secondary 5idefit Daylight Controls. 2. Check Table 140.E-A for correct Factor. PAFs shall not be traded between conditioned and unconditioned spaces. As a condition to earn a PAF, an Installation Certificate is also required to be filled out signed, and submitted. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 STATE OF CALIFORNIA INDOOR LIGHTING - LIGHTING CONTROLS CEC-NRCC-LTI-02-E (Revised 01/16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTI-02-E Indoor Lighting - Lighting Controls (Page 3 of 3) Project Name: MY THAI BAR T.I. (addition only) Date Prepared: 9/23/2019 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Armando Chavez Documentation Author Signature: Signature Date: 9/23/2019 Company: Address: 44890 SEELEY CEA Certification Identification (if applicable): City/State/Zip: LA QUINTA, CA 92253 Phone: 760 278.1840 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 176 f piiance' required to be included with the documentation the builder provides to the building owner at Occupancy. Responsible Designer Name: I Responsible Designer Sig 11re. Company: GABRIEL LUJAN AND ASSOCIATES Date Signed: 23 1 Address: 77-530 ENFIELD BLGD 1 STE 101 License: j City/state/zip: PALM DESERT, CA 92211 Phone: 760 578-8545 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance January 2016 STATE OF CALIFORNIA INDOOR LIGHTING POWER ALLOWANCE CEC- NRCC-LTI-03-E (Revised 04116) CALIFORNIA ENERGY COMMISSION_ CERTIFICATE OF COMPLIANCE NRCC-LTI-03-E Certificate of Compliance - Indoor Lighting Power Allowance (Page 1 of 4) Pfoject Name: MY THAI BAR T.I. (addition only) °ate Prepared: 9/23/2019 A separate page must be filled out for Conditioned and Unconditioned Spaces. This page is only for: ® CONDITIONED spaces ❑ UNCONDITIONED spaces A. SUMMARY TOTALS OF LIGHTING POWER ALLOWANCES ❑ If using Complete Building Method for compliance, use only the total in column (a) as total allowed building watts. ❑ If using Area Category Method, Tailored Method, or a combination of Area Category and Tailored Method for compliance, use only the total in column (b) as the total allowed building watts (a) (b) 01 Complete Building Method Allowed Watts. Documented in section B of NRCC-LTI-03-E (below on this page) 1,430 02 Area Category Method Allowed Watts. Documented in section C-1 of NRCC-LTI-03-E (below on this page) 03 Tailored Method Allowed Watts. Documented in section A of NRCC-LTI-04-E TOTAL ALLOWED BUILDING WATTS. Enter number into correct cell on NRCC-LTI-01, Page 2, Row 1 1,430 ❑ Check here if building contains both conditioned and unconditioned areas. B. COMPLETE BUILDING METHOD LIGHTING POWER ALLOWANCE 01 02 03 04 TYPE OF BUILDING (From §140.6 Table 140.6-B) WATTS PER ftZ X COMPLETE BLDG. AREA = ALLOWED WATTS Comp Bldg Restaurant 1.10 1,300 1,430 Total Area: Total Watts. Enter Total Watts into section A, row 1(Above on this page) IC -1 AREA CATEGORY METHOD TOTAL LIGHTING POWER ALLOWANCES I Watts Total from section C-2. Total from section C-3. Total Watts. Enter Total Watts into section A, row 2 (Above on this page). For Alterations Only— Reduced lighting power option (Total Allowed Watts x 0.85). Enter this value into section A, row 2 if using this option. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance April 2016 STATE OF CALIFORNIA INDOOR LIGHTING POWER ALLOWANCE F1 ;EC-NRCC•LTI-03-E Revised 04/16CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTI-03-E Certificate of Compliance - Indoor Lighting Power Allowance (Page 2 of 4) Project Name: MY THAI BAR T.I. (addition only) Date Prepared: 9/23/2019 A separate page must be filled out for Conditioned and Unconditioned Spaces. This page is only for: m CONDITIONED spaces ❑ UNCONDITIONED spaces C -2 AREA CATEGORY METHOD GENERAL LIGHTING POWER ALLOWANCE ❑ Do not include portable lighting for offices. Portable lighting for offices shall be documented only in Section G of NRCC-LTI-01-E. ❑ Separately list lighting for each primary function area as defined in §100.1 of the Standards. 01 11 02 03 04 AREA CATEGORY (From §140.6 Table 140.6-C) I PER WATTS X AREA Location in Building Primary Function Area per Table 140.6-C TOTALSI 0 Enter sum total Area Category allowed watts into section C-1 of NRCC-LTI-03-E (this compliance document) CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance ALLOWED WATTS WA April 2016 STATE OF CALIFORNIA INDOOR LIGHTING POWER ALLOWANCE M. 1� SEC-NRCC-LTI.03 E(Revised 04I16 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTI-03-E Certificate of Compliance - Indoor Lighting Power Allowance (Page 3 of 4) Pr°jec[Name: MY THAI BAR T.I. (addition only) Date Prepared: 9/23/2019 A separate page must be filled out for Conditioned and Unconditioned Spaces. This page is only for: ® CONDITIONED spaces ❑ UNCONDITIONED spaces C-3 AREA CATEGORY METHOD ADDITIONAL LIGHTING WATTAGE ALLOWANCE (from Table 140.6-C Footnotes) 01 02 03 z 04 05 06 07 ALLOWED Additional Wattage WATTS Primary Sq Ft or Watts Allowance Description(s) and Quantity of Special Total Design Smaller of Function Linear ft z Allowed (02 x 03) Luminaire Types in each Primary Function Area Watts 3 04 or 06 TOTALS —Enter into TOTAL AREA CATEGORY METHOD ADDITIONAL ALLOWANCES —Section C-1 . 0 1. Use linear feet only for additional allowance for white board or chalk board. All other additional Area Category allowances shall use watts per square foot. 2 . Additional watts are available only when allowed according to the footnotes on bottom of Table 140.6-C, which include: Specialized task work; Ornamental lighting; Precision commercial and industrial work; Per linear foot of white board or chalk board; Accent, display and feature lighting; and Videoconferencing studio lighting.. 3. Luminaire classification and wattage shall be determined in accordance with §130.0(c) of the Standards. CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance April 2016 STATE OF CALIFORNIA INDOOR LIGHTING POWER ALLOWANCE MIN CEC-NRCC-LTI-03-E (Revised 04,16) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE NRCC-LTI-03-E Certificate of Compliance - Indoor Lighting Power Allowance (Page 4 of 4) Pfoject Name: MY THAI BAR T.I. (addition only) Date Prepared: 9/23/2019 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Armando Chavez Documentation Author Signature: Signature Date:9/23/2019 Company: Address: 44890 SEELEY CEA Certification Identification (if applicable): City/state/zip: LA QUINTA, CA 92253 Phone: 760 278.1840 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 buildin ermR(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 Certifi of Complian is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: Responsibl Wire: / company: GABRIEL LUJAN AND ASSOCIATES Date Sign !� Address: 77-530 ENFIELD BLGD 1 STE 101 License: City/State/Zip: PALM DESERT, CA 92211 Phone: 760 578-8545 CA Building Energy Efficiency Standards - 2016 Nonresidential Compliance April 2016 CITY OF LA QUINTA SUB -Co RACTOR LIST JOB ADDRESS r7 'ft' �J EFiMIi 1VUMBERv j i'sE14))�SZ>LD BUILDER C)w&)Ee- This form sh be�og;yd�on..the ink with f6.r 1?��i1 q�psp�{4 Card at all times in a rs±s�aouous glace, Only persons appearing on this list or their employees are authorized to work on this job- Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance of building permit- For each applicable trade, all information requested below must be completed by appliscant, "On File' is not an acceptable response. EARTHWORK (C-12) CONCRETE (C-8) FRAMING (C-5) STRU.CT. STEEL (C-51:) MASONRY (C-291 LATH PLASTER (C-35) DRYWALL (C-8) HVAC (C-20) ELECTRICAt IC-1o1 ROOFING (C-39) SHEET METAL (C-43) FLOORING 4C-15) GLAZING (C-17) INSULATION (C-2) SEWAGE DISP: (C-42) PgINTING, (C-33) CERAMIC TILE (C-541 CABINETS (C-6). FENCING (C-13) LANDSCAPING (C-271 Company Name NOW Classification I License Number I Exp. Data I Carrier Name Policy Number I Exp. Date License Number Exp. Date (e.g. A, B, C-81 I (xxxxxx) I (xxlxxlxx) I (e.g: State Fund, CalCompl (Format Varies) Ixx/xxlxx) I (xxxx) I txx/xxlxx) OJOY0Ec) RECEIVED OCT 0,? 2019 CITY OF LA QUINTA DESIGN AND DEVELOPMENT DEPARTMENT l