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010912 (CSCS)LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. License Class Lic. Number Date Contractor OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5,�Business and Professions Code: Any city or county which requires a permit to construct. alter, improve, demolish, or repair any structure, prior to its issuance. also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7DOO) a! Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for .the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally'of not moie than live hundred dollars (M).): n 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. 7D44. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who does such work himself or through his own employees. provided that such improvements are not intended or offered for sale. 11. however. the building or improvement is sold within one year of completion. the owner -builder will have the burden at proving that he did not build or improve for the purpose of sale.). P1. as owner of the property. am exclusively contracting with licensed contractors to construct the project (Sec 7044 Iness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds a; improves thereon. and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.). F] I am exempt under Sec. B. & P. C. (Attach Certilicate). Date Owner WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance. or a certified copy thereof (Sec. 3800. Lab. C.): Policy No. —Company Certified copy is hereby furnished. . Certified copy is filed with'the County Building Inspection Department or County Date Applicant Department. _�i�PPC16A�T'NAME (L, F, MI) H-"1q1J6W WYNNE ADDRESS ,*I'' ;34''R PLU G S' E UM rtnmi I RrrLRA 1111111 -y­ JOB SITE ADDRESS/SPACE CITY/cOMMUNITY/STATE/ZIP LAI QU,ENTA 'n'250,30000 BOK PAG 6,13-, 412-- Cou nt of Riverside C JWN 0 13 1:19 Department Y Building and Safety SE 4080 Lemon St. 2nd Floor 135 N. Alessandro Rd. Rm. 203 880 N. State Street 227 North "0" Street 46-209 Oasis St. Rm. 310 160 N. Broadway Riverside, CA 92501 Banning, CA 92220 Hemet. CA192343 Perris, CA 92370 Indio, CA 92201 Blythe. CA 92225 Ph: 787-6146 Ph: B49-7312 Ph: 65B-4464 Ph: 657-3898 Ph: 342-8271 Ph: 922-2670 This permit becomes void it work not commenced within 180 days from date of issuance. OR. if work has been suspended or abandoned for a period of 180 days. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. License Class Lic. Number Date Contractor OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5,�Business and Professions Code: Any city or county which requires a permit to construct. alter, improve, demolish, or repair any structure, prior to its issuance. also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7DOO) a! Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for .the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally'of not moie than live hundred dollars (M).): n 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. 7D44. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who does such work himself or through his own employees. provided that such improvements are not intended or offered for sale. 11. however. the building or improvement is sold within one year of completion. the owner -builder will have the burden at proving that he did not build or improve for the purpose of sale.). P1. as owner of the property. am exclusively contracting with licensed contractors to construct the project (Sec 7044 Iness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds a; improves thereon. and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.). F] I am exempt under Sec. B. & P. C. (Attach Certilicate). Date Owner WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance. or a certified copy thereof (Sec. 3800. Lab. C.): Policy No. —Company Certified copy is hereby furnished. . Certified copy is filed with'the County Building Inspection Department or County Date Applicant Department. _�i�PPC16A�T'NAME (L, F, MI) H-"1q1J6W WYNNE ADDRESS ,*I'' ;34''R PLU G S' E UM C,IT Y/COMMUNITY/STATE/ZIP JOB SITE ADDRESS/SPACE CITY/cOMMUNITY/STATE/ZIP LAI QU,ENTA 'n'250,30000 BOK PAG 6,13-, 412-- jPRC 01215 1 C JWN 0 13 1:19 RNG 0 SE S ty, TRACT 0010:0,0 1 LOT 1 1 - OD Oil I M SB 'TRACT NAME S�: 1/2 OWNER &EL. F. MI) SAVINGS I)OWIT CONTRACTOR -FIRM NAME ADDRESS CITN'!COMMUNITY/STATE/ZIP PHONE # LICNC ARC/ENG FIRM NAME ADDRESS CITY/COMMUNITY/STATE/ZIP PHONE # LICNC 4 USE -OF PERMIT SAVING',4', tk LOAN BLDG BLt 00 I 160, I FSB a 10 SSB 01-0 . SSB 0.14 RSB, 010 IND J ZONE ORD # P P.J$,, LOT SZ END SIDE CERTACATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if the permit is for one hundred (SIDO) or less. I certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. ' le — Applicant NOTICE TO APPLICANT: It, alter making this Certificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shall be deemed revoked. DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no buildin8 structure, scaffolding, falsework. or demolition or dismantling thereof, will be more than thirty-six (36) feet high. ( hap 3.2, Grp 2. Art 2. Sec 341, Title B. C.A.C.) VAs owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial alety. as noted above, unless such person has a permit to do such work from that division. E) Division of industrial Safety Permit No. Date Applicant CONSTRUCTION LENDING AGENCY: I herebK affirm that there is a construction lending agency for the performance of the work for which this permit is issued ( ec. 3D97, Civ. Q. Lender . s Name Lender's Address I certify that I have read this e�pplication and state that the above information is correct. I agree to comply with all city and county ordinances an state laws relating to building construction. and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. Signature of Applicant or Agent Date . CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have raid this application and state that the information given is correct. I agree to comply with all state laws and county ordinances relating to building con. struction. and authorize a representative of the County of Riverside. Department of Building and Safety to enter upon the property for which I have applied for this permit for the purpose -of making inspions. �7 ;Signature -of Applic�nVor,,Aftnt - Print Applicant/Agent Name APPL/PRMT 0 0 010 617 CR F-STI14ATE-D PLAN, .15ATE 101/M M 41'11� REV Few -SA4 5 r1l I fl - TOTAL —FEE INSPECTOR'S COPY 101091 41VIFWMIT' FOR, $TkUrT09AL P�,AN REVIC tp-T-AL pit, $ 6 415 �MXT COST IS .4$ C ON I Tjwoub" ewr MAT F�',l 'be 0644 as proportm V il� r-1 I ot Vo n Q Or a tip Tvpd 9, Ft bes $ F 4 1% 0 4n­f4lal F. mal0d. val"m of 60" is 1 $645.45 FORM 284-208 (2/81) NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 Set Bock 33 Ventilation System 2 Ftgs & Frms 34 Plenums 8 Ducts 2A Slob Grade 35 Furnace Comport. 3 Steel 36 Inlets & Outlets 4 Grout Blocks 37 Combustion Air 5 Bond Beams 38 Compressor 6 Roof Deck 39 Appl. Clearance 7 Framing 40 Fire Damper t 8 Vents 41 Smoke Detection Device 9 Gauge Fire Wall 42 Commercial Hood 10 Fireplace P. L. 43 Final loA fireplace T. 0. °o ADDITIONAL INFORMATION . --- - SEWAGE SYSTEM SIZE & LOCATION 11 Exterior Loth 12 Internal Loth i 12A Drywall ` 13 Finish Grade INSULATION Thick „RIS Value 7A Walls (Botts) 12B Ceiling (Botts) 12C Ceiling (Blown) 14 Final PLUMBING- APPROVALS- ------------------------------------- 15 Ground Plumb 16 Water Piping 17 Rough Plumb 18 Vents 19 Sewage Disposal 20 Sewer 21 Water Heater 22 Water Softener 23 Water Service 24 Gas Test 25 Final Tank Pit L. Line REAR OF PROPERTY LINE ELECTRICAL APPROVALS PSL P/ 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 298 Bonding 30 Fixtures 31 Service 32 Final 0 STREET NAME James M. Wright Fire Chief Proudly serving the unincorporated areas of Riverside County and the cities of: Banning O Beaumont 0 Calimesa 0 Canyon Lake O Coachella 0 Desert Hot Springs o Indian Wells O Indio O Lake Elsinore 0 La Quinta 0 Moreno Valley., O Palm Desert O Perris 0 Rancho Mirage O San Jacinto a Temecula Board of Supervisors' Bob Buster, District 1 John Tmglione, District 2 Jim Venable, District 3 Roy Wilson, District 4 Tom Mullen, District 5 RIVERSIDE COUNTY FIRE DEPARTMENT In cooperation with the California Department of Forestry mrd Fire Protection 210 West San Jacinto Avenue • Perris, California 92570 • (909) 940-6900 • FAX (9W)94D-6910 November 5, 1998 To: Protection Services Industries 210 N. EI Cielo Palm Springs, CA 92262 Attn: Tom Crelley Re: Platt Orthopedics Fire Alarm Plans This letter is a follow up to our conversation regarding the review of the fire alarm plans that were submitted'for the out patient surgical facility in La Quinta known as Platt Orthopedics. Under the current requirements of the California Building Code for this facility, all Code requirements that are enforceable at the local AHJ level have been met. It is my understanding that current fire alarm plan submittal was initiated to fulfill the facilities' requirements to qualify for licensing under Medicare or Medicaid standards. The Office of State Fire Marshal (OSFM) is contracted with these agencies to enforce their standards as required for licensing. It is my recommendation that the facility owner begin the process of applying for licensing. This would then initiate the process by which the OSFM can receive plans and assure that the proper Standards and criteria are met as required for licensing. Should you have any further questions or concerns regarding this issue, feel free to contact me any time at (760) 863-8886. You may also consider contacting the local OSFM office in West Covina for further direction and/or guidance on this matter. Sincerely, FRANK KAWASAKI Chief Fire Department Planner By Walter Brandes Fire Safety Specialist EMERGENCY SERVICES DIVSION O PLANNING SECTION O INDIO OFFICE 82.675 Highway 111, 2nd FI., Indio, CA 92201 O (760) 863-8886 O Fax (760) 863-7072