9803-142 (RC)U)
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LICENSED CONTRACTOR 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 # Lic. Class Exp. Date
Date Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale. (Sec. 7044, Business & Professionals Code).
(V) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( )'I am exempt under Section , B&P.C. for this,reason
s
Date �. =.�s I�t'� Signature of Owner.•� t � Al � 4.,^,��
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 & policy no. are:.
Carrier Policy No. .
(This section need not be completed if the permit valuation is for $100.00 or less).
(4) 1 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: :,Q�fki? Applicant
Warning:. Failure to secure Workers' Compensation coverage isrunlawful and
shall subject an employer to criminal penalties and civil fines up to $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.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set. forth on his ..r
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 applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
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 State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes..
Signature (Owner/Agent)�Yy�Irl _.�'.'. �`1. `..A V � � Date "'1\T:�`�(v
14 .
lj BUILDING PERMIT PERMIT ti CONTROLN .c
DATE - VALUATION LOT TRACT .. ;.
1f.9 f 2tftQ39 l�.f'yU6980
JOB SITE `� �Q,(
�y
ADDRESS 1 - 41
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
'rFv137 kil'V V I t
1A Qi1MIA C.A. 92253
C�31;,ti •
USE OF PERMIT
1%0 !NCI,i;MNO SUROJAY 004TIM.
!t
-
MMMON 20, ,.0 L S MAR
2 3 1998',
CITY
OF LA QUINTA
ENA.IY1A 1',0',= ft' i�•k,FN"Y-.YT.l\'C C RIYt
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'PLAN ±1141YC K FEE
C ONA17RTI C`!•303_11.1 f*K 1014004- 84)00 $207.0
N:EOHl NICA9. FEV 1.0.1-000421-000
I'LIfIvl> f M, FEE 1.01 -OW -4.1u-000
31RO NO mfly- NON FF)". - Comm HY11-000-241.000.
SUR-'? 'C' I, COMMA UCs'!."tO.ly .AND MAN C11,L`CKz
�57.ti �1S
LESS I'l l -PAID l=EES
�'_" " 44.00
. Y3 O.I•.�,•Sti.Ra 0D.9v d'� •7 9 FEMS
"i
RECEIPT
DATE
BY j _
DATE FINALED
INSPECTOR
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
Drywall - Int. Lath
—
Final
Final -
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
_
Gas Test
Electric Final
Waste Lines
v O-
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
L. _
`
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final _ AOL--
Utility
✓Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring Pj[
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
I'moke Detectors
Temp, Use of Power
Utility Notice (Perm) V t
COMMENTS:
�'rl �rC !�
S bra j .e--
78-437 HWY 111
La Quinta, CA 92253
(619) 564-1220
PLATT ORTHOPEDICS
ARTHRITIS 6 SPINE CENTER OF THE DESERT
ARTHUR PLATT, M.D. MORRIS PLATT M.D.
Board Certified, American Board of Orthopedic Surgery
228 E. Hobsonway
Blythe, CA 92225
(619) 922-6899
March 19, 1998
To Whom It May Concern:
Please.be advised that Shanna Hottinger is authorized
to sign on my behalf regarding all matters of construction
at 78441 HWY 111 La Quinta, CA 92253. If you have any
questions please do not hesitate to contact my office.
Thank you.
Sinc rely,
t
Morris Platt, M.D.
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Owner/ Builder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the City or County. They are also required by law to put their license number on all permits for which they
apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs)'is $200.00 or more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and Federal Government as an employer and you are subject
to several obligations including State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/Builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits are not required to be signed by property owners unless they are performing their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(760) 777-7012
FAX:) 777-70
,
OWNER'S SIGNATURE/ TE
76,1 Y/ Hwy 0l%,74, e, � ?2,-253
PROPERTY ADDRESS
a�o3-1¢V
PERMIT NUMBER(s)
James M. Wright
Fire Chief
Proudly serving the
unincorporated
areas of Rhnrrslde
County and the
cities of:
Beaumont
e
Calimesa
O
Canyon Lake
e
Coachella
O '
Desert Hot Springs
e
Indian wells
e
Indio,
e
Lake Elsinore
O
La Quinta
O
Moreno Valley
Palm Desert
O
Perris
O
Rancho Mirage
e ,
San Jacinto
O
Temecula
Board of Supervisors
Bob Buder,
District 1
John Tavaplione,
District 2
Jim Venable,
District 3
Roy Wilson,
Diarkt a
Tom Mullen,
District 5
RIVERSIDE COUNTY FIRE DEFAtC 1 iViLi'N t
In cooperation with the
('alifon>ia Depurtmeitt of Forestry and Fire Protection
210 West San Jacinto Avenue Perris, 92570 • (909) p4D.68M a FAX (909) 940-WlO .
July 16, 1998
City of La Quinta
Building Department
Re: Fire and Life Safety Clearance
The Riverside.County Fire Department is granting afire and life safety clearance for the
tenant improvement of the group B occupancy known as the La Quinta Surgery Center
located at 78-437 Highway 111.
release Iq.wpd
By
Respectfully,
FRANK KAWASAKI
Chief Fire Department Planner
Walter Brandes
Fire Safety Specialist
EMERGENCY SERVICES DIVISION a PLANNING SECTION O INDIO OFFICE
43-209 Oasis St., 2nd Ff., Indio, CA 92201 a (760) 863-0888 O Fax (760) 863-7072
James M. Wright
Fire Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
cities of:
Beaumont
.y
Calimesa
Canyon Lake
Coachella
a
Desert Hot Springs
Indian Wells
Indio
'.
Lake Elsinore
La Quinta
Moreno Valley
Palm Desert
Perris
Rancho Mirage
S
San Jacinto
Temecula
.Board of Supervisors
Bob Buster, -
District 1
John Tavaglione,
District 2
Jim Venable,
District 3
Roy Wilson,
District 4
Toni Mullen,
District 5
RIVI RSIDE COUNTY 1'IR.I DEPARTMENT
lir cuuperaliuir with the
('alifurnia Uepartme►u of Furesliy on(I F,"it-e Proleciion
210 West San Jacinto Avenue • Perris, California 9270 s (9D9) 940.6900 • FAX (909) 940-6ti10
Mark Valentino, AIA
44-267 Monterey Ave., #B
Palm Desert, CA 92260
Re: , La Quinta Surgery Center TA
March 12, 1998
Fire Department personnel have completed a review of the tenant improvement plans you submitted for
the Group B occupancy at the above referenced location. Please be advised, the. following are
conditions for the approval of the plans.
1. Medical Gas System Installing contractor shall submit separate plans to the Fire Department
for review and approval prior to installation.
2. Fire Alarm System - Installing contractor shall submit separate plans to the Fire Department for
review and approval prior to installation or modifications.
3. Fire Sprinkler System - Installing contractor shall submit separate plans to the Fire Department
for review and approval prior to installation or modifications.
4. Fire/smoke dampers - HVAC ducts that penetrate required 1 hour corridor construction
assemblies shall be provided with Listed fire smoke dampers.
5. HVAC units - The two HVAC units with 2000 cfm ratings shall be provided with Listed smoke
detection devices in the supply air duct(s) to automatically shutdown of units upon detection of
smoke.
6. Fire Extinguishers - Fire extinguisher(s) of a minimum size 2A-1 OBC shall be provided within 75
feet of travel distance and/or every 3000 square feet of floor'area for the entire tenant space,
mounted 3112 to 5 feet above finished floor when measured from the top.
Please, contact the Fire Department Planning & Engineering staff for final inspection prior to occupancy.
Applicantriinstaller shall be responsible to contact the Fire Department to schedule, inspections. A
reinspection fee will be required to be paid if more than one (I) inspection is necessary. Requests for
inspections are to be made at least 24 hours in advance 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,
RAY REGIS
Chief Fire Department Planner
Walter Brandes
FIRE PREVENTION DIVISION Fire Safety Specialist
c: Mark Harold. - LQB&S PLANNING SECTION
INDIOOFFI A. '
43.209 Oasis St., 2nd Fl. Indio. CA 92201
(760) 863-8866 - F." (76U) 863-7072
CITY OF LA QUINTA
SUB -LIST
CONTRACTOR ADDRESS 78437 HWY 111 LA QUINTA, CA 92253
OWNER MORRIS/ARTHUR PLATT, M.D. JOB ADDRESS78441 HWY .111 LA QUINTA, CA
92253
This form shall be posted on the job with the Building Inspection Card at all times in o conspicuous Mace.
It is the responsibility of the General Contractor or the Owner/Builder to monitor the sub -contractors that
are on this list are the same persons performing the work. Any changes to this list must be approved the
City of La Quinta Department of Building & Safety prior to work being performed by a changed sub-
contractor. Failure to comply will result in a stoppage of work and/or the voidance of building permit.
`:TRADE -
'SUB -CONTRACTOR'S
NAME
'TYPE OF
LICENSE .
STATE
CONTRACTOR'S ; ::
LICENSE
NUMBER
'WORKER'''S .
°COMP. NAME/
NUMBER ON 'FILE
CITY
BUSINESS"
LICENSE
NUMBER/
EXP. DATE
GRADE/
EXCAVATE:?'
A/C -12
PIPELINES
C-34
CONCRETE/
FOUNDATIONS
C-8
:ASPHALT
A
FRAMING
INTERIOR SYSTEM/DESIGN
B
626-232 S
GOLDEN 398-0EAGLE0 '
5172 98
STEEL/
STRUCTURAL.
C-51
'MASONRY
C-29
PLUMBING
PRIDE PLUMBING
C-36
47397 3
CALIFORNIA NDEM
LA T HiNG
C-26
DRYWALL
INTERIOR SYSTEM/DESI
N C-9
626-232 8
NWC-480398-00`��
51'T2 ql.Z3 48
PLASTERING
C-36
HVAC ?64
POLAR BARB
C-20
722201 �i9
CALIFORNIA INDEM
N8048731A
4330: 12/31/9
ELECTRICAL
(General)
AZ TECH ELECTRIC
C-10
531003
REPUBLIC INDEMIT
3318-05 21 199
3022:12/98
ROOFING
C-39
SHEET METAL
C-43
-FLOORING'.C-15
GLASS/.:
GLAZING.
C-17
INSULATION
C-2
SEWAGE:DISP.
C-42
PAINTING/
DECORATING.
C-33
TILE
C-54
CABINETS/
INSTALLATION
INTERIOR SYSTEM/DESI
C-6
N
626-232 g 3t q
GOLDEN EAGLE
NWC-480398 �00
5172 q 2 qEg
FENCING
C-13
LANDSCAPING
C-27
POOLS
C-53
OTHER