Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
10-0009 (RC)
P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description Property Zoning: Application valuation: Applicant: Ce�fi�4[.t�ie 10-00000009 45280 SEELEY DR 604-040-094- - REMODEL - COMMERCIAL TOURIST COMMERCIAL 150000 T4ht 4 4 Qum& BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Architect orEngineer: ��aysT . �/JpC G 270evl- LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class: B License No.: 741137 P' Date/ -//-AD 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).: (_ 1 1, 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.). (_ 1 I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: _ Lender's Address: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/08/10 Owner: EISENHOWER MEDICAL CENT 39000 BOB HOPE DR RANCHO MIRAGE, CA 92270L Contractor: AWDL CONSTRUCTION:74075 EL PASEO, SUITE B PALM DESERT, CA 92260 (760)674-9553 Lic. No.: 741137 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier DELOS INS Policy Number 01DKRM12007667 I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section / 3700 of the Labor /Code, I shall forthwith comply with those provisions. - Date:r°'!r•/O VApplicant: 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 Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1 . Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above -mentioned property for inspection purposes. Date: ` - AW teSignature {Applicant or Agent): � Application Number . . . . . 10-00000009 ------ Structure Information RM E100 - CTR FOR HLTHY LIV T.I. ----- Other struct info . . . . . CODE EDITION 2007 / 2008 FIRE SPRINKLERS YES MIXED -USE OCCUPANCY B OCCUPANT LOAD 15.00 1ST FLOOR SQUARE FOOTAGE 1455.00 2ND FLOOR SQUARE FOOTAGE .00 ---------------------------------------------------------------------------- Permit . . . BUILDING PERMIT - ADA INV FEE Additional desc . . T.I.- 1455 SF OF RM E1OO Permit Fee . . . . 1629.00 Plan Check Fee 529.43 Issue Date . . . . Valuation . . . . 150000 Expiration Date . . 7/07/10 Qty Unit Charge Per Extension BASE FEE 1279.00 50.00 7.0000 THOU BLDG 100,001-500,000 350.00 ---------------------------------------------------------------------------- Permit . . . ELECT - ADD/ALT/REM INV FEE Additional desc . . Permit Fee . . . . 197.50 Plan Check Fee 24.69 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 7/07/10 Qty Unit Charge Per Extension BASE FEE 30.00 87.00 1.5000 PER ELEC DEVICE/FIXTURE 1ST 20 130.50 1.00 37.0000 EA ELEC SVC <=600V/<=200A 37.00 ---------------------------------------------------------------------------- Permit . . . . . . Additional desc . . Permit Fee . . . . Issue Date . . . . Expiration Date . . MECHANICAL INV FEE 48.00 Plan Check Fee 6.00 Valuation . . . . 0 7/07/10 Qty Unit Charge Per Extension BASE FEE 30.00 2.00 9.0000 EA MECH VENT INST/ DUCT ALT 18.00 ---------------------------------------------------------------------------- Permit . . . Additional desc . . Permit Fee . . . . Issue Date PLUMBING INV FEE 42.00 Plan Check Fee . . 5.25 Valuation . . . . 0 LQPERMIT Application Number . . . . . 10-00000009 Permit . . . . . . PLUMBING INV FEE Expiration Date . . 7/07/10 Qty Unit Charge Per Extension BASE FEE 30.00 2.00 6.0000 EA PLB WATER INST/ALT/REP 12.00 ---------------------------------------------------------------------------- Special Notes and Comments T.I. - 1455 SF "CENTER FOR HEALTHY LIVING" PORTION OF RM. E100 (PHARMACY). 15 = OCCUPANT LOAD. TYPE II -A FIRE SPRINKLERED. 2007 CBC, CEC, CMC, CPC, 2008 ENERGY CODES. [Investigative Fees assessed for work performed without a permit per CBC Appendix Chapter 1 Section 108.41 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ACCESSIBILITY PLAN REVIEW 52.94 BLDG STDS ADMIN (SB1473) 6.00 ENERGY REVIEW FEE 52.94 Fee summary Charged Paid Credited Due --------------------------------------------------------- Permit Fee Total 1916.50 .00 .00 1916.50 Plan Check Total 565.37 .00 .00 565.37 Other Fee Total 111.88 .00 .00 111.88 Grand Total 2593.75 .00 .00 2593.75 LQPERN1IT Bin #( Permit # ogk 1d� Project Address;Sty City City of La Quinta Building & Safety Division -p ,eZZ&, (!jL,01!Zg,1 P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet _ Owner's Name: A. P. Number- 6o Address:254," ?,A / AD4f1A,- Legal Description: &Qte-� Contractor: W oL. - &zwA r� rj&4!�-Zj J ove- City, ST, Zip: 24-IJEft M-RCA5,05 (14 9 2- Z 7 0 Telephone: ME Address:=u 1-3 2 5- EL BQXIW Project Description: City, ST, Zip: F ALm Pizeer 0-4 9zz6o — Telephone: 7&p _ ! 115-1 State Lic. #: 71111 1 City Lic. #,: Ow Arch., Engr., Designer: J-Al#j Address: b-?:)-)o 15.4,,,,774rj S7- S It ��W _3 City, ST, Zip: C-4 Telephone: ti-g C4 b-z,. s Y?'�) State Lic. #-.e 2,7 oot4 Name of Contact Person: Construction Type: Z Occupancy: Project type (circle one): New Add Alter Repair Demo Sq. Ft.: # Stories: #Units: Telephone # of Contact Person: Z-.-rd 8129 Estimated Value of Project- D%000 I too APPLICANT: DO NOT WRITE BELOW THIS LINE Submittal Req'd I Ree'd PERMIT FEES Plan Sets 64'&W�&jfd) Plan Check submitted J m Amount Structural Cal - cs. Reviewed, ready for co r i JAN an Check Deposit Truss Cates. Called Contact Person Pan Check Balance Title 24 Cates. Plans picked up By —_Uonstruction Flood plain plan Plans resubmitted Mechanical Grading plan 2d Review, ready for correcti issue Electrical Subcontactor List Called Contact Person t Plumbing Grant Deed Plans picked up H.O.A. Approval Plans resubmitted Grading IN HOUSE:- Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date or permit issue School Fees Total Permit Fees 2 5- .70 115 5 Tdf 4 4aubtrw P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT (760) 777-7012 FAX (760) 777-7011 To: Greg Butler, Building & Safety Manager To CDD: From: Les Johnson, Director -Planning Due Date: Permit #: Status: JJ — /0 oQsAP Building Pleas Approval (This is an approval to issue a Building Permit) The Planning Department has reviewed the Building Plans for the following project: Description: deotZ -L, f vot ,. Address or General Location: Applicant Contact: (JU4L�& P- 8 ZQG The Planning Department finds that: ❑ ...these Building Plans do not require Planning Department approval. ...these Building Plans are approved by the Planning Department. ❑ ...these Building Plans require corrections. Please forward a copy of the attached corrections to the applicant. When the corrections are made please return them to the Planning Department for review. a Les Johnson, Director -Planning AN t' '=G 1 0 Date c iij" of Lo Qu4i to 1' u r ping Departm ofd APPLICATION # ADDRESS BY VALUATION SQ . FT. 19t FLOOR _ 2nd FLOOR COVERED PATIO �- GARAGE - -- TYPE CONST: OCCUPANCY A/C FIRE SPRINKLER # OF BEDROOM 1 FLOOD ZONE "1 # OF _UNITS CODE EDITION 2�p ROOF TYPE MECHANICAL # VENT FANS # EXHAUST HOOD _ A/C -<3 TON A/C >3 TON FAU <100,000 BTU FAU >100,000 BTU DUCT ALTERATION .PLU BXATG OF FIXTURES SEWER SEPTIC SYSTEM ROOF DRAINS WATER HEATER WATER PIPING LAWN SPRINKLER GAS PIPING 1-4 GAS PIPING >4 GAS METER UNIT COUNTS -GAS TOILETS BIDET SHOWERS BATHTUBS SINKS BAR SINK BBQ OVEN RANGE _ cooKTOF DRINKING F UN WASHER DRYER WATER HE ER ROOF DRA NS FLOOR D INS k KITCHEN SINK VEG - S LAUNDR SINK FIREP ACE ELECTRICAL SQ: FT. LIV GARAGE SQ. FT TEMP POWER FIXTURE # 1-52 4 3 -lzn 11"T /Ite, r_ 0 n n rKrr-v <50 CU YDS >50 CU YDS CDD APPR ENGINEER John R. Hawkins Fire Chief Proudly serving the unincorporated areas of Riverside County and the Cities of: Banning Beaumont 4. Calimesa 4. Canyon Lake 4• Coachella Desert Hot Springs 4. Indian Wells 4. Indio 4. Lake Elsinore 4. La Quinta 4. Moreno Valley .;. Palm Desert 4- Perris 4. Rancho Mirage 4. Rubidoux CSD 4. San Jacinto Temecula Board of Supervisors Bob Buster, District I John Tavaglione, District 2 Jeff Stone, District 3 Roy Wilson, District 4 Marion Ashley, District 5 RIVERSIDE COUNTY FIRE DEPARTMENT In cooperation with the California Department of Forestry and Fire Protection 77-933 Las Montanas Rd STE 201 • Palm Desert, CA 92211 • (760) 863-8886 • Fax (760) 863-7072 January 11, 2010 RE: TENANT IMPROVEMENT PLAN CHECK LAQ-I0-TI-001 Center For Healthy Living 45-280 Seeley Dr. La Quinta You have been issued a release for a tenant improvement on an existing building. THIS IS NOT AN OCCUPANCY PERMIT. It is prohibited to use/process or store any materials in this occupancy that would classify it as an "H" occupancy per Sec. 307 of the 20007 UBC. THE FOLLOWING CONDITIONS MUST BE MET PRIOR TO INSPECTION: Install door hardware and exit signs as per Chapter 10 of the 2007 UBC. A minimum 2A1 OBC Fire Extinguisher, (State Fire Marshal Approved) must be mounted in a visible location within 75' walking distance from any point in your building or suite. Fire extinguishers can be installed by a licensed extinguisher company with a State Fire Marshal service tag attached to the extinguisher, or purchased from a retail store with a sales receipt attached. A licensed fire extinguisher company must service extinguisher yearly. All breakers must be labeled and a clearance of 36 inches must be maintained around the panel at all times. A durable sign stating "This door to remain unlocked during business hours" shall be'placed on or adjacent to the front exit door. The sign shall be in letters not less than one inch high on a contrasting background. Provide key(s) to the tenant space for inclusion in the main building Knox Box. Key(s) shall have durable and legible tags affixed for identification of the correlating tenant space. Key(s) shall be provided at time of final inspection. An approved audible interior notification alarm device shall be provided in approved locations. A C-10 licensed contractor must submit plans, designed in accordance with NFPA 72, 2002 Edition, to the Fire Department for review and approval prior to installation. As may be necessary to maintain proper fire sprinkler protection due to constructions changes, fire sprinkler system plans for the tenant improvement area may be required to be submitted to the Fire Department for review, along with a plan/inspection fee. The sprinkler system will have to be modified and designed in accordance with NFPA 13, 2002 Edition. A licensed C-16 contractor shall do all sprinkler work and certification. The approved plans, with Fire Department Job card must be at the job site for all inspections. Approved suite address shall be placed in such a position to be plainly visible and legible from the street. Said numbers shall contrast with their background. Applicant/installer shall be responsible to contact the Fire Department to schedule inspections. A re - inspection fee will be required if more than one (1) inspection is necessary. Requests for inspections are to be made at least 72 hours in advance and may be arranged by calling (760) 863-8886. All questions regarding the meaning of these conditions should be referred to the Fire Department Planning & Engineering Staff at (760) 863-8886. Sincerely, By: ]as tubble Fire Safety Specialist Mn R C ENGINEERING, INC, January 7, 2010 Burt Hanada City of La Quinta 78-495 Calle Tampico La Quinta, CA 92253 Re: T.I. Suite 100 45-380 Seeley Dr. La Quinta, CA 92253 Plan Check #: 010-09 Dear Burt, Pain Desert Irvine I Son Diego The following is an annotated response list to the plan check correction list pertaining to the electrical drawings dated January 6, 2010: Section A — General Item 1— (3) sets of wet sealed revised drawings and Title 24 lighting compliance forms are being provided. Item 8 —The quantity of luminaires and occupancy sensors have been coordinated between sheet E2.0 and the Title 24 lighting forms. In doing so, the quantity of type'L72' luminaires had to be reduced. Item 9—The luminaire'L-17B' has been revised to'L-18A' on sheet E2.0. All revisions have been clouded an indicated with a delta 1. Thank you, a�_ Victor Leon Project Engineer JAN 0 8 2010 Professional Engineers & Lighting Consuitants 72-880 Fred Waring Drive, Sufe C_11, Palm Desert, CA 92260 1 o: 760-340-9006 f: 760-340-9100 1 WWWIMM-elcom JAIN MALKIN INC. 5070 Santa Fe Street Suite C San Diego CA 92109 858/ 454-3377 858/ 272-6199 Fax www.jainmalkin.com L E T T E R To: Burt T. Hanada O F T R A N S M I T T A L City of La Quinta - Building and Safety Dept. Senior Plans Examiner 78-495 Calle Tampico La Quinta, CA 92253 Purpose of Transmittal: ❑ For Review and Comment ❑ Correct and Resubmit Dale- 7 January 2010 Re Plan Check Revisions Job No: 974.02 Sent via: Mail ❑ For Approval ❑ As Requested ❑ For Your Use Date No. of Copies Dwgs Prints Specs Other Description 1.7 3 X Revised - Wet Signed Construction Documents J i - Corrections: A0.01 Revised reference to code years 2007 CEC and 2008 California Energy A5.01 Corrected L-1713 references in plan at emergency fixture to match schedule / legend below. Now fixtures in plan are correctly identifiedx,Sig; ;�- By: Joost H. Bende, Copies: Denise Burkett and file OF C Transmittal Page 1 of 1 WDLTransmittal Project [07007.1] - EACC 1st Floor TI CONSTRUCTION WDL Construction 45280 Seeley Drive La Quinta, CA 92253 Transmittal No. 07007.1- Phone: (760) 345-3500 02876 Fax: (866) 697-2139 To Charles Morris Date 1/7/2010 Eisenhower Medical Center Items listed are being sent 39-000 Bob Hope Drive Enclosed Rancho Mirage, CA 92270 Phone: (760) 773-1830 Under Separate Cover Fax: (760) 774-1449 Via Hand Delivered From Syed Shah (WDL Construction) Subject CFHL - Drawings For City Permit (2nd Submittal) cc Shaun Evans (WDL Construction), Shawn Martin (WDL Construction), Donald G. Willcox (WDL Construction) We are transmitting the following to you: F Product Data Samples Shop Drawings O&M Manuals Plans Architectural Drawings Letters Specifications Prints i Addenda Engineering Drawings IF Change Orders r Submittal Items No. I Description Copies Reason Action Due 1 CFHL - Architectural, Mechanical, Electrical Drawings (wet 3 For Your Action stamped) Use Needed 2 CFHL - Fire Sprinkler Drawings 3 For Your Action Use Needed 3 CFHL - Architectural, Mechanical, Electrical Drawings (1st 2 For Your Action 'submittal) Use Needed Remarks Charlie, Enclosed are 3 set of Center For Healthy Living Drawings revised per city comments for cii permit. I have also enclosed 2 sets of original submittal. N M n F n T 1� Please let me know if you have any question. Received By Printed Name Date https:Hsecure.construetware.comICommonNiew/Document Display.asp?DocumentType=1... 1/7/2010 CITY OF LA QUINTA BUILDING & SAFETY DEPARTMENT (760) 777-7012 7 µ INSPECTION REQUEST LINE =fyo� (760) 777-7153 Owner EISENHOWER MEDICAL CENTER Contractor WDL CONSTRUCTION Permit Number 10-09 POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES JOB ADDRESS 45- 280 SEELEY DR. T.I. - 1455 SF "CENTER FOR HEALTHY LIVING" PORTION OF RM. E100 (PHARMACY). "B" OCC. 15 = OCCUPANT LOAD. TYPE II -A CONSTR. W/ TYPE OF 114SPECTION I DATE I INSP. TEMPORARY POWER SETBACKS U/G PLUMBING / WASTE U/G ELECTRICAL / GROUNDING FOOTINGS / STEEL CONCRETE SLAB DO NOT POUR CONCRETE UNTIL ABOVE SIGNED ROOF NAIL / PRE -ROOF OKAY TO WRAP FRAMING COMBINATION ROUGH ELECTRIC ROUGH PLUMBING ROUGH MECHANICAL INSULATION COVER NO WORK UNTIL ABOVE SIGNED INTERIOR GYP. BD. (DRYWALL) EXTERIOR LATH CAS TEST SEPTIC ABANDONMENT SEWER CONNECTION SEPTIC / GREASE INTERCEPTOR MASONRY INSPECTIONS FOOTINGS 1 STEEL BOND BEAM POOL / SPA / WATER FEATURE INSPECTIONS PRE-GUNITE / SETBACKS UIG PLUMBING UIG GAS UIG ELECTRICAL PRE -PLASTER CALARMS! BARRIERS _ DECK BONDING FINAL INSPECTIONS TEMP. USE OF PERMANENT POWER ELECTRICAL PLUMBING MECHANICAL PUBLIC WORKS DEPARTMENT COMMUNITY DEVELOPMENT DEPT FINAL / Joe COMPLETED FIRE SPRINKLERS 2007 CBC, CEC, CMC, CPC, 2008 ENERGY CODES. [Investigative Fees assessed for work performed without a permit per CBC Appendix Chapter I Section 108.41 ABOVE APPROVALS DO NOT INCLUDE RIGHT TO TURN ON UTILITIES OR OCCUPY BUILDING I BUILDING ENERGY ANALYSIS REPORT PROJECT: La Quinta Ambulatory Care Center Center for Healty Living. 45-280 Seely Drive La Quinta, CA 92253 Project Designer: Report Prepared by: Victor Leon MRC Engineering, Inc. 72-880 Fred Waring Drive, Suite C-11 Palm Desert, CA 92260 760-340-9005 Job Number: 9099.00 Date: 1 /7/2010 CITY O� gyp, �l�INTA G & vED VOS CONSTRuC f ION MA"""IMMM 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 the Nonresidential 2008 Building Energy Efficiency Standards. This program developed by EnergySoft, LLC — www.energysoft.com. LEneMPro 5.0 by EnergySoft User _Nurnber: 7 74 6 RunCode: 2010-01-07T09:48:0 ID: 9099.00 1 TABLE OF CONTENTS I Cover Page Table of Contents Form LTG-1-C Certificate of Compliance Form LTG-2-C Lighting Controls Credit Worksheet Form LTG-3-C Indoor Lighting Power Allowance Form LTG-MM Lighting Mandatory Measures 1 2 3 7 8 9 EnergyPro 5.0 by Energy5oft Job Number: ID: 9099.00 User Number: 7746 1 CERTIFICATE OF COMPLIANCE Part 1 of 4 LTG-1 C Project Name Date La Quinta Ambulatory Care Center - Center for Healty Living 11712010 Project Address Climate Zone Total Cond. Floor Area Unconditioned Floor Area 45-280 Seely Drive La Quinta 15 1,457 0 GENERAL INFORMATION Building Type: m Nonresidential ❑ High -Rise Residential ❑ Hotel/Motel Guest Room ❑ School ❑ Relocatable Public m Conditioned Spaces ❑ Unconditioned Spaces School Phase of Construction: ❑ New Construction ❑ Addition m Alteration Method of Compliance: ❑ Complete Building m Area Category ❑ Tailored Documentation Author's Declaration Statement I certify that this Certificate of Compliance documentation is accurate and com lete. Name Signature Victor Leon Company Date MRC Engineering, Inc. 11712010 Address EA # 72-880 Fred Waring Drive, Suite C-11 CEPE # City/State/Zip Phone Palm Desert, CA 92260 760-340-9005 The Principal Lighting Designer's Declaration Statement • 1 am eligible under Division 3 of the California Business and Professional Code to accept responsibility for the lighting design. • This Certificate of Compliance identifies the lighting features and performance specifications required for compliance with Title 24, Pages 1 and 6 of the California Code of Regulations. • The design features represented on this Certificate of Compliance are consistent with the information provided to document this design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. Name Signature ' / Randall V. Moss l{I V. Y%�.M Company Phone MRC Engineering, Inc. 760-340-9005 Address License # 72-880 Fred Waring Drive, Suite C-11 City/State/Zip Date Palm Desert, CA 92260 1 "1 /2.010 Lighting Mandatory Measures Indicate location on building plans of Mandatory Measures Note Block:. LIGHTING COMPLIANCE FORMS & WORKSHEETS check box if worksheets is included For detailed instructions on the use of this and all Energy Efficiency Standards compliance forms; please refer to the Nonresidential Manual published by the California Energy Commission. © LTG-1C Pages 1 through 4 Certificate of Compliance. All Pages required on plans for all submittals. © LTG-2C Lighting Controls Credit Worksheet 0 LTG-3C Indoor Lighting Power Allowance ❑ LTG-4C Pages 1 through 4 Tailored Method Worksheet ❑ LTG-5C Pages 1 and 2 Line Voltage Track Lighting Worksheet Ener Pro 5.0 by EnergySoft User Number: 7746 RunCode: 2010-01-07T09:48:0 ID: 9099.00 Page 3 of 9 CERTIFICATE OF COMPLIANCE (Part 2 of 4) LTG-1 C Project Name La Quinta Ambulatory Care Center - Center for Healty Living Date 11712010 INDOOR LIGHTING SCHEDULE and FIELD INSPECTION ENERGY CHECKLIST Installation Certificate, LTG-1- INST (Retain a coey and verify form is completed and signed.) Field Inspector ❑ Certificate of Acceptance, LTG-2A (Retain a copy and verify form is completed and si ned.) Field Inspector ❑ A separate Lighting Schedule Must Be Filled Out for Conditioned and Unconditioned Spaces Installed Lighting Power listed on this Liqhtinq Schedule is only for: m CONDITIONED SPACE ❑ UNCONDITIONED SPACE m The actual indoor lighting power listed below includes all installed permanent and portable lighting systems in accordance with §146(a). Only for offices: Up to the first 0.2 watts per square foot of portable lighting shall not be required to be included in the m calculation of actual indoor lighting power density in accordance with the Exception to §146(a). All portable lighting in excess of 0.2 watts per square foot is totaled below. Luminaire (Type, Lamps, Ballasts Installed Watts A B C D E F G H None or Item Taa Complete Luminaire Description' Le, 3 lamp fluorescent troffer, F32T8, one dimmable electronic ballasts 2 =3 a `� aFz E `� n J How wattage Was determined 0 ` EE > :3 Z J�- LL x �V vN F#etd Ins ector2 CEC Default From NAB m p a �v GM o 0 o Q ~ co L2 35w Low Voltage Halogen ❑ 38 ® ❑ 6 228 ❑ ❑ L3A (1) 26w Compact Fluorescent Triple 4 Pin Elec ❑ 28 ® ❑ 8 224 ❑ ❑ OB (1) 26w Compact Fluorescent Triple 4 Pin Elec ❑ 28 m ❑ 2 56 ❑ ❑ L 17 (2) 14w Linear Fluorescent T5 Elec ❑ 34 ❑ ❑ 3 102 ❑ ❑ L18 (2) 28w Linear Fluorescent T5 Elec ❑ 60 ® ❑ 7 420 ❑ ❑ L18A (2) 14w Linear Fluorescent T5 Elec ❑ 34 ® ❑ 2 68 ❑ ❑ L67A 35w Low Voltage Halogen ❑ 38 m ❑ 3 114 ❑ ❑ L72 35w Low Voltage Halogen ❑ 38 ® ❑ 4 152 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ j ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ , ❑ ❑ ❑ ❑ Installed Watts Page Total: 1,364 Building total number of pages: Installed Watts Building Total Sum of all a es 1,364 Enter into LTG-1 C Page 4 of 4 1. Wattage shall be determined according to Section 130 (d and e). Wattage shall be rating of light fixture, not rating of bulb. 2 . If Fail then describe on Page 2 of the Inspection Checklist Form and take appropriate action to correct. Verify building plans if necessary. Ener Pro 5.0 b Ener Soft User Number: 7746 RunCode: 2010-01-07T09,,48:01 0: 9099.00 Page 4 of 9 CERTIFICATE OF COMPLIANCE Part 3 of 4 LTG-1 C Project Name La Quinta Ambulatory Care Center - Center for Healty Living Date 11712010 INDOOR LIGHTING SCHEDULE and FIELD INSPECTION ENERGY CHECKLIST Fill in controls for all spaces: a) area controls, b) multi -level controls, c) manual daylighting controls for daylit areas > 250 ft2, automatic daylighting controls for daylit areas > 2,500 ft2, d) shut-off controls, e) display lighting controls, f) tailored lighting controls — general lighting controlled separately from display, ornamental and display case lighting and g) demand responsive automatic controls for retail stores > 50,000 ft2, in accordance with Section 131. MANDATORY LIGHTING CONTROLS - FIELD INSPECTION ENERGY CHECKLIST Field Inspector Type/ Description Number of Units Location in Building Special Features Pass Fail SPsT ❑ ❑ ❑ �1MMER S 5 no�A /oFF>5 ❑ ❑ ❑ C�CC uPAtaL 1 oF��Ces ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ SPECIAL FEATURES INSPECTION CHECKLIST See Page 2 of 4 of LTG-1C The local enforcement agency should pay special attention to the items specified in this checklist. These items require special written justification and documentation, and special verification. The local enforcement agency determines the adequacy of the justification, and may reject a building or design that otherwise complies based on the adequacy of the special justification and documentation submitted. Field Inspector's Notes or Discrepancies: EnergyPro 5.0 by Ener vSoft User Number: 7746 RunCode: 2010-01-07T09:48:0 ID: 9099.00 Page 5 of 9 CERTIFICATE OF COMPLIANCE Part 4 of 4 LTG-1 C Project Name Date La Quinta Ambulatory Care Center - Center for Healty Living 1 11712010 CONDITIONED AND UNCONDITIONED SPACE LIGHTING MUST NOT BE COMBINED FOR COMPLIANCE Indoor Lighting Power for Conditioned S aces Indoor Lighting Power for Unconditioned Spaces Watts Watts Installed Lighting 1,364 Installed Lighting o from Conditioned LTG-1 C, Page 2 from Unconditioned LTG-1 C, Page 2 Lighting Control Credit _ 147 Lighting Control Credit 0 Conditioned Spaces from LTG-2C Unconditioned Spaces from LTG-2C Adjusted Installed 1,217 Adjusted Installed 0 T Li htin Power Li hUn Power Complies if Installed < Allowed Complies if Installed < Allowed Allowed Lighting Power Allowed Lighting Power Conditioned Spaces from LTG-3C or PERF-1 1,238 Unconditioned Spaces from LTG-3C 0 Required Acceptance Tests Designer: This form is to be used by the designer and attached to the plans. Listed below is the acceptance test for the Lighting system, LTG-2A. The designer is required to check the acceptance tests and list all control devices serving the building or space shall be certified as meeting the Acceptance Requirements for Code Compliance. If all the lighting system or control of a certain type requires a test, list the different lighting and the number of systems. The NA7 Section in the Appendix of the Nonresidential Reference Appendices Manual describes the test. Since this form will be part of the plans, completion of this section will allow the responsible party to budget for the scope of work appropriately. Forms can be grouped by type of Luminaire controlled. Enforcement Agency: Systems Acceptance. Before Occupancy Permit is granted for a newly constructed building or space or when ever new lighting system with controls is installed in the building or space shall be certified as meeting the Acceptance Requirements. The LTG-2A form is not considered a complete form and is not to be accepted by the enforcement agency unless the boxes are checked and/or filled and signed. In addition, a Certificate of Acceptance forms shall be submitted to the enforcement agency that certifies plans, specifications, installation certificates, and operating and maintenance information meet the requirements of §10-103(b) of Title 24 Part 6. The field inspector must receive the properly filled out and signed forms before the building can receive final occupancy. A copy of the LTG-2A for each different lighting luminaire control(s) must be provided to the owner of the building for their records. Luminaires Controlled LTG-2A Controls and Sensors and Automatic Number of Daylighting Luminaire Controls Equipment Requiring Testing Description controls Location Acceplance Dimming - Manual 35w Low Voltage Halogen 6 Zone 1 m Occ Sensor - — 250 sgft (2) 28w Linear Fluorescent T5 Elec 7 Zone 1 m Occ Sensor - — 250 sgft (2) 14w Linear Fluorescent T5 Elec 2 Zone 1 El Dimming - Manual 35w Low Voltage Halogen 3 Zone 1 El Dimming - Manual 35w Low Voltage Halogen 4 Zone 1 m EnergyPro 5.0 PX Ener Sofi User Number: 7746 RunCode: 2010-01-07T09:48:0 ID.- 9099,00 Page 6 of 9 LIGHTING CONTROLS CREDIT WORKSHEET Part 1 of 2 LTG-2C Project Name La Quinta Ambulatory Care Center - Center for Healty Living Date 11712010 POWER ADJUSTMENT FACTORS PAF FOR NON -DAYLIGHT CONTROLS A Separate PAF Worksheet Must Be Filled Out for Conditioned and Unconditioned Spaces. Control Credits listed on this schedule are only for: m CONDITIONED SPACES ❑ UNCONDITIONED SPACES A B C D E F G Room # Zone ID Areas Lighting Control Description' Plan Reference Room Area (ft2) Watts of Control Lighting Power Adjustments Factor Control Credit Watts E x F ,Zone 1 Dimming - Manual L2 � 1,457 228 0.10 23 Zone 1 Occ Sensor - — 250 sgft L18 1,457 420 0.20 84 :Zone 1 Occ Sensor - — 250 sgft L 18A 1,457 68 0.20 14 None 1 Dimming - Manual L67A 1,457 114 0.10 11 ;Zone 1 Dimming - Manual L72 1,457 152 0.10 15 PAGE TOTAL 147 Note: Conditioned and Unconditioned Building total of non -daylight control credit watts for all pages of LTG-2C Page 1 of 2 Enter building total of all daylight controls credit watts from LTG-2C Page 2 of 2 Space shall be separately totaled y BUILDING TOTAL OF ALL CONTROL CREDIT WATTS (FOR BOTH NON -DAYLIGHT AND DAYLIGHT CONTROL CREDITS) Enter in LTG-1 C; Page 4: Lighting Control Credit as appropriate for CONDITIONED or UNCONDITIONED Spaces 147 1. Description shall be consistent with Type of Control defined in Table 146-C 2. Power Adjustment Factor taken from Table 146-C EnergyPro 5.0 bZ Ener Soft User Number: 7746 RunCode: 2010-01-07T09:48:01 ID: 9099.00 Pagelof 9 INDOOR LIGHTING POWER ALLOWANCE LTG-3C Project Name La Quinta Ambulatory Care Center - Center for Healty Living Date 11712010 ALLOWED LIGHTING POWER Chose One Method A Separate LTG-3C must be filled out for Conditioned and Unconditioned Spaces. Indoor Lighting Power Allowances listed on this page are only for: ® CONDITIONED SPACES ❑ UNCONDITIONED SPACES COMPLETE BUILDING METHOD BUILDING CATEGORY From §146 Table 146-E WATTS PER ft' X COMPLETE BLDG. AREA = ALLOWED WATTS TOTALS AREA WATTS AREA CATEGORY METHOD BUILDING CATEGORY From §146 Table 146-F WATTS PER(it') X COMPLETE BLDG. AREA = ALLOWED WATTS Comp Bldg Office 0.85 1,457 1,238 TOTALS 1,457 1,238 AREA WATTS TAILORED METHOD Total Allowed Watts using the Tailored Method taken from LTG-4C (Page 1 of 4) Row 3 0 The indoor lighting power allowance using the Tailored Method of compliance shall be determined using the LTG-4C set of forms. A separate set of LTG- 4C forms shall he filled out for CONDITIONED and UNCONDITIONED spaces EnergyPro 5.0 b Ener 5of1 User Number: 7746 RunCode. 2010-01-07T09:48:0 Q 9099.00 Pao 8 of 9 LIGHTING MANDATORY MEASURES: NONRESIDENTIAL LTG-MM Project Name Date La Quinta Ambulatory Care Center - Center for Healty Living 11712010 Indoor Lighting Measures: §131(d): Shut-off Controls For every floor, all interior lighting systems shall be equipped with a separate automatic control to shut off the lighting. 1. This automatic control shall meet the requirements of Section 119 and may be an occupancy sensor, automatic time switch, or other device capable of automatically shutting off the lighting. 2 Override for Building Lighting Shut-off: The automatic building shut-off system is provided with a manual, accessible override switch in sight of the li hts. The area of override is not to exceed 5.000 square feet. §119(h): Automatic Control Devices Certified: All automatic control devices specified are certified, all alternate equipment shall be certified and installed as directed by the manufacturer. §111: Fluorescent Ballast and Luminaires Certified: All fluorescent fixtures specified for the project are certified and listed in the Directory. All installed fixtures shall be certified. Tandem Wiring for One and Three Lamp Fluorescent Fixtures: All one and three lamp fluorescent fixtures are tandem §132: wired with two lamp ballasts where required by Standards Section 132; or all one and three lamp fluorescent fixtures are specified with electronic hi h-fre uencv ballasts and are exempt from tandem wiring requirements. §131(a): Individual Room/Area Controls: Each room and area in this building is equipped with a separate switch or occupancy sensor device for each area with floor -to -ceiling walls. Uniform Reduction for Individual Rooms: All rooms and areas greater than 100 square feet and more than 0.8 watts §131(b): per square foot of lighting load shall be controlled with bi-level switching for uniform reduction of lighting within the room. Daylight Area Control: All rooms with windows and skylights that are greater than 250 square feet and that allow for §131(c): the effective use of daylight in the area shall have 50% of the lamps in each daylit area controlled by a separate switch; or the effective use of daylight cannot be accomplished because the windows are continuously shaded by a building on the adjacent lot. Diagram of shading during different times of the year is included on plans. §131(c): Display Lighting. Display lighting shall be separately switched on circuits that are 20 amps or less.6. Outdoor Lighting Measures: §130(c)1: Mandatory lighting power determination for medium base sockets without permanently installed ballasts §132(a): All permanently installed luminaires with lamps rated over 100 Watts either have a lamp efficacy of at least 60 lumens per Watt or are controlled by a motion sensor. §132(b): All Luminaires with lamps rated greater than 175 Watts in hardscape area, including parking lots, building entrances, canopies, and all outdoor sales areas meet the Cutoff Requirements. §132(c)1: All permanently installed outdoor lighting meets the control requirements listed. §132(c): Building facades, parking lots, garages, canopies, and outdoor sales areas meet the Multi -Level Lighting Requirements listed. EnergyPro 5.0 by EnergySoft User Number: 7746 RunCode: 2010-01-07T09:48:00 ID: 9099.00 Page 9 of 9