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9812-046 (BLCK)U) N W W O ch W ~o Z c(0 O. o P:C:) _JU � U Z C0 ... N O0) U Q Z LO - 0 0 J J mUU O n LO `t Z obry V Q J LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of r,hapter 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 722460 C10 MM/00 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). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code)., () I4am exempt under Section B&P.C. for this reason pate t 1) 1 - Z -C, Signature of Owner"= 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. :J 2,ATP A M,b t,t �•L:'".+�\i^l1eiJ.1V.E'! (This section need not be completed if the permit valuation is for $100.00 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, 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. JDate: w �' - r-1 APPlicant rR�, c.: �1+�� sem. �•� — Warning: Failure to secure Workers' Compensation coverage Istunlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction; and hereby authorize representatives of this City to enter upon the above mentioned property for inspection purposes. ,$ignature (Owner/Agent.). 11 r, r�'^. .�.��it' a I• .�:r'Date V e.r14 \A, Y I ,Zvi . _ „lw • " l ' �. \J \ BUILDING PERMIT PERMIT# #81� �M6 DATE �1l++�� W" VALUATION. $24,050.00 ++„,n // LOT TRACT JOB SITE APN ADDRESS U-441 1HCH.WAY. 111 - - OWNER CONTRACTOR/DESIGNER/ENGINEER 1!+ftrI3.11R.l P11KIT j1!fA*.A5: "A..0E. V 1!,, '. LLC :\TE1-Mu ." .-Lic"7°.l c, mc. 1721 W JAV LIAL I°1:4ii' i Sl"I %i 83-791 45 #f2 L,:A .IfA13.1tA CA. 9_ W3I I1VUO CA 92201 (7(f))342-61377 CBIr# 1069 USE OF PERMIT IEfVALL 50 Ir W G c�!rA:(i'3'M 4SM 42.L.P. 6" GARDEN- WALLNPLk APPIZOVED PLAX VsVAiATION 0 47T.. WALL 13,000,00 L' .1 #f.FS"Y'F'.TL,FiI:, �?1d ti?I•I}Q�l-'120-it0f► ��S.i�t4 �wrra�°t��f:fr^crnl\t user? I(1� �1I}f) ��R-QOt► �."�f.fif► Sd.,1Ft-:rOT-AL C°OM I:R-LICi'ION AN1..'1 PLAN t°NRCK. LESS PRE--IIAM F'r. ES F03 s Ls : GI) RECEIPT I DATE I BY / " I DATE FINALED J INSPECTOR �;{0fi,�3fl INSPECTION RECORD 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 8 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 Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Nonce (Perm) COMMENTS: APPROVED By CO WALJ- j FAc1 u, Nr EXHIBIT CASE NO. ,-SLOCK W ALL--tz�- - \ k�Cq, UIP Imo- Q � � Imo. ����� �� 1��. -7eA41 L-A nk u I 14TAt� 22 -Orl bo- G4- i -76"7H b I 1A 017 a i 1161, (q )( k 0 X. Lo aLocK. 4 %X- (Q Y. B FQE B A0.1 I u" c>J C&Z. ua Rcb*kg, tN IZJQ�' Tf C -L V -MOH PROPERTY MANAGEMENT LLC October 20, 1998 1721 W. Imperial Highway, Suite G LaHabra, California 90631 Ph: (562) 691-5996 Fax: (562) 691-2172 Dr. Arthur Platt 78-437 Hwy'. 111 La Quinta, CA 92262 RE: Plaza La Quinta Unit #32-20 La Quinta, CA. Dear Dr. Platt: In order to obtain your Medicate certification, please be advised that you may install your 6' x 4' x 4', 50,000 watt diesel generator behind your facility subject to City ,permit(s) and proof of insurance for your installation. Sincerely, M&H PROPERTY MANAGEMENT, INC. on behalf of M&H R 1 Partners II L.P. in s D. Hought c. Bo 'e Loza b sten Fie F t a 11/20/98 13:28 FAX 619 942 6319 LA Q (NTA SURGERY CENT R A MEDICAL CORPOR/�p� (760) 564-'SUCRG IA44 i High�;,av I I I - La Quinti, CA 92253 - Fax (760) 564-5116 NEPTUNE/PRAGER Z002 ��rc(lore ars e�r,l� C.�jj . e*1.� I j- 1 ale UN Ld Q Qf Z (ferfif 'Trait By this certificate it is declared that is qualified as a Vh t-ra ertif irr who has satisfactorily fulfilled the conditions of Wig ,ibility in accordance with procedures formulated and approved by the Piping Industry Progress and Education Examination Boardil U) M t � 4M ��.. .�n i#nese l�erEaf, #�j,e unaersigz�a 4abre affixth f4eir strgntttu#es N -4 N +• :0 (D T a) -� m tl* T firate n. a By this certificate it is declared;that irik is qualified as �ReDirttl (�tts ±lns#�rrtur who has satisfactorily fulfilled the conditions of eligibility in accordance with procedures formulated and approved by the Piping Industry Progress and Education Examination Board. LD a, LO o) 1 ' lD T. Ln LD the. unbrersi ne'b 'J ijtti�e tt#fixe tf�etr sintttues r ry; U') .. 1 Un o m LL, a a w: !�f#ite of �b#�tef���� ��# �tt n2zili and PAyelopment THIS IS TO CERTIFY THAT PURSUANT TO THE PROVISIONS OF w� ujT• uj ME HOSPITAL SEISMIC SAFETY ACT OF 1983 ECKERT AND•ASSOCIATES T ` 1206 Sanford Street w sn Los Angeles, CA 90066 cn a .,• y • iv Z MILLIAK ECIERT MEDICAL .GAS CERTIFIPB f ' aJ w ?iti T�mfBCi as 8' car • r� .' y • �u P S � t n � au II tii �t.tt 2t � .. � r -,.i 1 for Aulth facilities LD 0...�� grit ` n LoQ� g Lr)CO n f .° 00 Aftp IS ENTITLEQ T4 {It,�. THE RIGHTS ANO PRIVILE COW011$0-11N SAIO ACT N AEGIS?RAT10N Nb, — TCIOOI6 A " ;AiITNI3SS ©.pR 6A'iJll HAND AND M co7. �. �• O) H T Q1 -4 9T WIDE CONI UCTION CH&F m 07/19/1998 23:00 760-564-5116 LA QUINTA SURGERY CE t%AL.IFORNIA DEPARTMENT OF FORESTRY RIVERSIDE COUN'T'Y FIRE DEPARTMENT 210 WEST SAN JACINTO PERRIS, CA. 92370 (714) 657-3183 (619) 347-2480 FACILITY NAME ADDRESS 76-y INSPECTION LOG COMPLIANCE ORDER City Page I of ) Notice No- Date.. o-Date: Phone: The items listed below are in violation of one of the following: PAGE 01 UNIFORM FIRE CODE .14q UNIFORM BUILDING CODE- :H RIVERSIDE COUNTY FIRE ORDINANCE CALIF. HEALTH & SAFETY CODE (TITLE 2q) OTHER ..�:a-:��c-zf,.�,r�7!��L.J.-al��L✓�sz�.:-��c-�,.'.. a., •.��i�'�'r'T�i�.'L Measures shall-� taken to correct listed violations. A reinspection will be conducted on or about ILURE TO COMPLY MAY S� RESULT INLEGALACTION. Received B Titl�_(�Zl y>or— tow I Fire In FOR FURTHER INFORMATION PLEASE CALL Phone - ROo leas Iwev_ JIM 07/19/1998 22:57 760-564-5116 LA OUINTA SURGERY CE CALIFORNIA DEPARTMENT OF FORESTRY RIVERSIDE COUNTY FIRE DEPARTMENT 210 WEST SAN JACINTO PERRIS; CA. 92370 (714) 657-3183 (619).347-2480 FACILITY NAME ADDRESS_ -7g-, iGa1 INSPECTION LOG COMPLIANCE ORDER ty Page 1 of Notice No: Date: I19 Phones The items listed below are in violation of one of the following: PAGE 02 UNIFORM FIRE CODE JR4 UNIFORM BUILDING CODE: RIVERSIDE COUNTY PIKE ORDINANCE CALIF. HEALTH & SAFETY CODE (TITLE) OTHER Measures shall be taken to correct listed violations. A reinspection will be conducted on or about 19 .FAILURE TO COMPLY MAY RESULT IN LEGAL ACTION. Received By OL 2itlec� INIS`TQdToQ . 1 t 1 � 1 _ %— Fire Inspector FOR FURTHER INFORMATION PLEASE CALL Phone 863'- S�94, -I James M. Wright Fire Chief Proudly serving the unincorporated areas of Riverside County and the cities of: Beaumont O Calimesa O Canyon Lake O Coachella O Desert Hot Springs O Indian Wells O Indio O Lake Elsinore O La Quinta Moreno Valley O Palm Desert O Perris O Rancho Mirage San Jacinto O Temecula Board of Supervisors Bob Buster, District 1 John Tavaglione, 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 and Fire Protection 210 West San Jacinto Avenue • Perris, California 92570 • (909) 94D43900 • FAX (909) 940.6910 July 16, 1998 City of La Quinta Building Department Re: Fire and Life Safety Clearance The Riverside County Fire Department is granting a fire 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 Respectfully, FRANK KAWASAKI Chief Fire Department Planner By 'xA Walter Brandes Fire Safety Specialist EMERGENCY SERVICES DIVISION O PLANNING SECTION O INDIO OFFICE 43-209 Oasis St., 2nd FI., Indio, CA 92201 O (760) 863-8886 O Fax (760) 863-7072 07/21/1998 00:47 760-564-5116 07/21/1998 10:55 ^o1^c7a91.37t3 E KERT & . A�OCIATES medical gas qual(ty assurance LA QUINTA SURGERY CE EUCU1d I LV•IUAa �Ul, l RA 1 L::) LAQUINTA SURGERY CENTER 78441 HIGHWAY 111 LAQUINTA, CALIFORNIA 92253 CITY OF RIVERSIDE PERMIT NO. 9803,142 INSPECTION OF THE MEDICAL GASES SYSTEM BY ECKERT AND ASSOCIATES PAGE 13 r "kM 14923 Oxnard Street, van Nuys, California 91411 10 1111 779-0672 18001 253-1010 FAX (819) 779-1378 ,► 07/21/1998 00:47 07;'^1/1998 '10:55 760-564-5116 Fxkert dt AsWdaW 14923 Oxnard Street Van Nuys, CA 91411 (818) 719-0672 OSHM No. TC10016 LA QUINTA SURGERY CE LUKtK I r-5 PAGE 02 l NVl_ V.d pt mit No. 9803.142 Date: July 16, 1"s Facility: ioquiMA Surma Center Addrm: 78441 Highway 111 I,oquints. California 92253 _ F4kctt and Associates has inspected the medical gas piping systems at: L aquinta Surgery Center 76441,1iighway t i 1 Uquinta, California specifically the areaa/rooms listed on the attached forms, dated: July 16, 1998 and has made the following determinations, that on the above date and time of inspection: 1) All medical gas outlets listed on the report forms are labeled correctly in all material respects. for the service intended unims otherwise noted in the discrepancy column of said form(s). 2) The gases) delivered at each medical gas outlet originated at the correct source point, i.e., that there are no crossed medical gas pipelines servicing the outlets inspected, as listed on the report forms unless otherwise noted in the discrepancy column of said fonn(s). 3) That the medical gas outlets listed on the report forms are functioning in accordance with their design specifications unless otherwise noted in the discrepancy column of said form(s). 4) 'The percentage of oxygen delivered at each oxygen outlet is as indicated on the report forms) unJess otherwise noted in the discrepancy column of said fommn(s). 5) That all medical gas warning systems listed on the report forms) are functioning in. accordance with their design specification and are installed as required by the National Fire Protection Association, NFPA 99, Chapter 4 of the 1993 Edition unless otherwise noted in the discrepancy column of said form(s). 6) That the following components of the medial gas systems perform in accordance with the requirements of the National Fire Protectiori Association, Pamphlets NFPA 50, NFPA 99 of the 1993 Edition, and NFPA 99, "Medical Air Compressor System", (with associated controls), "Medical -Surgical Vacuum System", (with associated controls), "Manifolds and Zone Control halves". This inspection was made in accordance -with the requirements of the National Fie Protection Association, Pamphlets 99, Chapter 4, titled, "System Verification, Eckert and Associates makes no reference to any other inspections, certifications, or any other sections of the National Fire Protection Association, Pamphlet 99, or any other code requirements. 'chis inspection shall be effective with respect to the condition of the system only on the day(s) and at the time of inspection. r ' 07/21/1998 00:47 760-564-5116 07/21/1998 1L^- fib+ 81�; Iy61.3 /8 P LA QUINTA SURGERY CE kk J{t' 1 ] L:n PAGE 03 h':a1it U4 Eckert & Associates Permit No. 9803-142 r 14923 Oxnard Street Date: July 16, 1998 Van Nuys, CA 91411 (ela) T19-0672 0SN7D No. TC 10016 Facility; lAmp vnta Surgery Center ' Address: 78441 Highway 1 11 Laquinta, California 92253 4 Because such a system is subject to change beyond the control of Eckert and Associates, any changes or additions by, or on behalf of any party, whether or not authorized, to the pipe line systems, ager the date and time of inspections, shall be the sole responsibility of the owner/installer for verfication of system integrity and shall immediately end all responsibility of Eckert and Associates with respect thereto. This inspection does not include inspection for medical gas leaks, pipeline leakage, electrical ' hazards, improper labeling of gas pipelines, or any other defects made in the installation of the systems) of any of its components not specifically referred to above. INSPECTED BY: Erik W. Eckert 07/21/1998 00:47 760-564-5116 07/21/1558 19:55 8137DSIS78 LA QUINTA SURGERY CE PAGE 04 ),gut ao Eckert & Associates Permit No, 9803-142 14923 Oxnard gurect Date: July 15, 1998 Van Nuys, CA 91411 Page i. of 9 (818) 779-0672 OSHPD No. TC10016 Facility: Laqulita Surgery Center Address: 78441 ifighway 111 Laquinta, California 92253 PROJECT NAME: Inspection of the Medical Gages SZstems I have inspected the Medical Gases System, as described by the permitted drawings and on the attached report forms, in accordance with the requirements of NFPA 99, 1993 Edition, Chapter 4, Section: 4-5.1.3, titled "System Verification'. The System, described above and on the attached report forms, is Cerdfled for patient treatment use as of July 13, 1998. SIGNED BY: Erik W. Eckert OSI&D Reg. No. TC10001-42 City of Riverside Lc. No. SP9&0020 07/21/1998 00:47 760-564-5116 07/21/1998 10:55 8187+91370 &Juwt do Associates 14923 Oxnard Street Van Nuys. CA 91411 (818) 779-0671 oSHPU No. TC 10016 Facility: LaquluW Suety Cerates Address- 78441 Mghway l l l , L,a uinta, California 92253 LA OUINTA SURGERY CE LQLH'f SaPIUAc JC:1 A I L% - PAGE 05 ra(,t ut permit No. 9803-142 Date: July 15, 1995 page 2 of 9 Discrepancies and Recommendations: INSPECTED BY: Erik W. Eckert 07/21/1998 00:47 760-564-5116 LA QUINTA SURGERY CE PAGE 06 07/21i1998 10:55 S187991.37a EC1<ERTA14DASSiuCIATE, PAGE 07 Eckert & Associates 14923 Oxnard Street Van Nuys, CA 91411 (919) 779-0672 OSHPD No_. TC10016 Permit No. 9803-142 Date: July 15, 1998 Page 3 of 9 Facility. Loquinta. Surgery Center Add==. 78441 Highway 111 Laquinta, California 92253 DATA FOR AS SOURCES MANIFOLDS Discrepancies and Recommendations: INSPECTED BY: Erik W. Eckert t Eckert & Associates 14923 Oxnard Stmet Van Nuys, CA 91411 (818) 779-0672 OSHPD No. TC 10016 Facility: laquints Surg y Carter Address: 78441 Highway 1 L l ta, Cafifw" 92253 FLOOR 1 DATA FOR ALARMS Permit No. 9803.142 Date: Juty 15, t996 Page 4 of 9 -.=a'.•a: nt" zk. ,�., .0.:3 •,-s:-+sr.:. y� y� y �qyy,.� y� �e-.•a���.:'a r.: aSa--. .,.e,+ aat. � ,.:. .,c::: ,t..n.n�...T�,.�.. .nv. ....,vn.-.�.n,,....: ....w... ::v _ :r 'a•�^I - - �o,•r�: - :m-�e �!�-. ,.�'� ...ci,•S:-_• .e[l+':,':,,rY:..�a, r.: ,:�,. � 1.:;:., .� .. .:.A ,:..... �Y:Yb. t.,taa.�C+.•-... _ Y.•,j. � rs .sr �£'�:a!•;,1 :r. �. •I.s ; •a .3, >:r .:>+..- .r:t. ' tr .1• t . Jv . • • . -_ 'h ♦1 . 14, 1 •' ' . . FM . t. 'J . I 'I7,A . 1 1F3w in 46M M1-1 . 111 .' 11 . z M.♦ ' :11 INSPECTED BY: Erik W. Eckert Bcicert & Associates 14923 Oxnard Shred Van Nuys, CA -91411 (618) 779-0672 OSHPD No. TC 10015 Facility: LAqubda SnrM7 Ceater Address: 78441 Ki lbwray 111 Laquir" Cs Bemis 92253 FLOOR I DATA FOR GAS SEW -OFF VALVES permit No. 4803-142 Daae: J* 139 19" .Pap 5 of 9 INSPECTED BY: Erik W. Eckert • 07/21/1998 00:47 760-564-5116 07/21/1998 12:05 8187991378 1.1 a it 21 0 LA QUINTA SURGERY CE ECKERTANDASSOMATES Cil a PAGE 09 PAGE 07 Edwrt & Associates 14923 Oxnard Street Vaal Nuy3,FA 91411 (8 18) 7N-Wn OSHPD No. TC 10016 Pa duty: i.aaquinta SurgCFY Caatff Address: 78441 Highway I11 caquinta, California FLOOR 1 OXYGEN DISTRIBUTION SYSTEMS - GRAVAMETRICANALVSIS New IMUNAtiee Imptid Ammai Q memrLicn O mN No. M3-142 Date: July 16, 1998 Page 7 o(9 kD ''QYSPECFI?OR rr'¢; k `- << S ��y it3 N. 2 k k:%.}<Sx `R'ea•+' .r.... .. .r. h_.... ..._...->.. n tl :...... n. ...-........::.: r.cep3•. - - ,�,'�e "Yisz. 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Eckert & Associates 14923 Oxnard Stns Van Nuys, CA 91411 (918) 779-0672 OSHPD No. TC10016 Facility: LaquintaSwrq Center Address: 78441 Highway I I I Uquinta, California 92253 FLOOR I NITROUS OXIDE DISTRIBUTION SYSTEMS - GRAVAMETRIC ANALYSIS New Uddkdm lawwfift QX Am" Peffait No. 9803-142 Date: July 16j 1998 �2 Page 8 of 9 LD ..DLD 'D 00 COURKeft low Paredft.4.43 Wkne. ft - Ne dbe4oratim sated FUtemAcensed- LealbU0.1mlotmatter CA' OR A 1 100 23.052 23.086 mit 1000 lorn x COURKeft low Paredft.4.43 Wkne. ft - Ne dbe4oratim sated FUtemAcensed- LealbU0.1mlotmatter Eckwt & Associates 14923 O%zW StW Van Nuys, CA 91411 (819) 779-0672 OSHPD No. TC 10016 Facility: Uquinta Surgery Center Address: 78441 Highway 111 Laquinta, Caillkwuia 9n53 FLOOR I NITROGEN DISTREBUTION SYSTEM — GRAVAMZTRIC ANALYSIS New Imtdkbm Inspedive Am" Q 1lsedikadn Permit No. 9801142 Date: July 16, 1998 Par 9 of 9 Cmseott "ftr ftaft - W No discoloratim m m - In lien AamW - law thm 113 ing of matter. m W OIL A 1 100 20-993 mg 20.908 mx 1000 ilpm x Cmseott "ftr ftaft - W No discoloratim m m - In lien AamW - law thm 113 ing of matter.