14330 (CSCS)P.O. BOX 1504 No. 14330
Building 76-822 111 LA QUINTA, CALIFORNIA92253
Address •
Owner Washington/Adams 'Partnership
BUILDING: TYPE CONST. VN OCC: GRP. R3Mailin'
Address 2.377 Crenshaw Blvd., Ste. 300 643-080-021
- A.P. Number
.City ZipTel. + ' '
Torrance, CA, 905:01 (310) 61i# --3G00 Legal Description
Contractor Single story medicaloft ice --
Desert citi@13 Deliimlopmenc Project Description
Address -
shell only. Exterior wails, 2 restroomsF
"59725 Garant, :ate. B
y> Desert, czip 9226(? Teif619)-345-2472
State Lic. B 620242 City 2149
& Classif. Lic. #
Arcn., hngr., MG Arcl ecta
'Designer
Address
s.0dvl Van Karman, Ste. 2
14) 553--1117
City Zip State
.Irvine, cA • 12715 iLic.# c5684
.LICENSED CONTRACTOR'S 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 isin full force and
effect.
SIGNATURE DATE
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, after, improve, demolish, or repair any -structure, prior to its issuance also•
requires the applicant for such permit to 81e a -signed. statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
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 penalty of not more than five hundred dollars (8500).
O 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, Auisness 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. If, however, -the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or knprove for the purpose of sale.) .
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner or property who builds or improves thereon, and who contracts .for
such projects with a contractors) (loensed pursuant to the.Contractor's License Law.) . •
O 1 am exempt under Sec B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
.Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy Is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE -
(This section need not be completed H the permit is for one hundred dollars ($100) valuation
or less.)'
I certify that In the perfomrance of the work for which this -permit is -issued, I shall not •
employ any person in any mannerso as to become subject to the Workers' Compensation
Laws of California
Date' Owner
NOTICE TO APPLICANT: N, after 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. -
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.
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days. . • t, .
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 city to .enter the above -.-
n
entioned property for inspection purposes. ..
Signature of applicant Date
Mailing.Address
City, State, Zip
ti•
site work.
Sq. Ft. 874 3 No. No. Dw.
Size Stories Units
New 0 Add.O Alter O Repair ❑ Demolition O
REMARKS
VA ;
ZONE: BY: 1 '�' Jam•
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street.Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
Estimated Valuation '
$664,124.00
PERMIT -
AMOUNT '
Plan Chk. Dep.
] a 7.5fl .Elft
Plan Chk. Bal
2,064.2'_
Const.
2,534.50
Mech.,
96.00
Electrical
189.86
Plumbing
63.50
S.M.I.'
134.47
Grading
.00
Driveway Enc.
.00
Infrastructure
.00
Arts in Public Places
1,410.31
TOTAL -
8,242.90
6,492.94)
REMARKS
VA ;
ZONE: BY: 1 '�' Jam•
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street.Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SQ. FT. @ $
UNITS
ROUGH PLUMB. BONDING
2ND FL. SO. FT.
STORAGE TANK
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
REINF. STEEL
DRAINAGE PIPING
WALL SQ. FT.
DRINKING FOUNTAIN
SO. FT. ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
GRADING
INAL INS cu. yd.
INAL INSP,/// $ plus x$
_ ff REMARKS:
Slye r7GL �� L �l-��` I
ca v (v,,- S j ,r �-- 3- °7 - g5
WATER PIPING
NOTE: Not to be used as property tax valuation
FRAMING �/
OOFING �' ,
S
FLOOR DRAIN
MECHANICAL FEES
FIREPLACE`'—
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINISH GRADING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FENCE FINAL
LAUNDRYTRAY
AIR HANDLING UNIT CFM
GARDEN WALL FINAL
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK S4
ly -6/
OUND PLUMBI UNDERGROUND r�
ORLAB
A.C. UNIT
COLL. AREA
GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWER OR SE C f ROUGH WIRING
DUCT WORK
ROCKSTORAGE
jg�FOUND. REINF.
GAS (ROUGH) 0 N METER LOOP
6eIVEMP.
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
AS (FINAL) �r POLE '?5
GROUT
WATER HEATEER// SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
INAL INS cu. yd.
INAL INSP,/// $ plus x$
_ ff REMARKS:
Slye r7GL �� L �l-��` I
ca v (v,,- S j ,r �-- 3- °7 - g5
=$
L BER GR.AA5�
FRAMING �/
OOFING �' ,
S
VENTILATION
FIRE ZONE ROOFING
FIREPLACE`'—
SPARK ARRESTOR
GAR. FIREWALL
LATHING 1` V
MESH
NSULATIONISOUN<,,--� `/rF
FINISH GRADING
INAL INSPECTIO l�
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated 619-775-3560
Date 2/2/95 Type of Permit I La Quinta
No. 113288 Permit #
Log
Owner Name Washington/ Adams Partnership
N o. 78-822 Street Highway 111
City La Quints Zip 92253 Study Area 232
APN # 643-080-021 Tract # I Lot # 0 Square Footage 18743
Type of Development lCommercial No. of units 0
Comments
At the present time, the Desert Sands Unified School District does not collect fees on
garages/carports, covered patios/walkways, residential additions under 500 square feet,
detached accessory structures or replacement mobilehomes. It has been determined
the above-named owner is exempt from paying school fees at this time due to the
following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080
in the -amount of .28 x 8 743 or $ 2,448.04 have been paid to D.S.U.S.D. for
the property listed above and that building permits and/or Certificates of Occupancy for
this square footage in this proposed project may now be issued.
Fees Paid By Desert Cities Development Telephone
Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Mitch Moldenhauer
Signature eAYM-Izz-f
619-34572472
Payment Received _ }
,� / .114,.4,....« � �•��
Check No�5582`�w
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept. /Applicant Copy - Applicant/Receipt Copy - Accounting
—
!
1, .'-•c {� .,�7 J
"�
��_
Payment Received _ }
,� / .114,.4,....« � �•��
Check No�5582`�w
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept. /Applicant Copy - Applicant/Receipt Copy - Accounting
Developers Project Approvals Form
Prior to the issuance of the Building Permit for 7— ZZ
the following Departmental clearances must be
obtained. Please return completed form to the Building and Safety Department at your earliest
convenience to expedite the permit process.
Planning and Development Department
Name/Title
C k, LL�b fie+" cov„pl�,-dao@., bv� �, a. Date
C in . r.-aw"D
Name/Title
Building and Safety Department
Name/Tit
Health Department
Fire Department
Date
Date
Dat
Date
F �'-F-�S�n,�`'^K'r".'Yrt^�'�+-:.�+-Yds:e-+rvY�'K`a'`A"til%^�.i�S-�^+.vi:�r+.f'[�"`�`'��-...'""''^"r'�.".y�`."ob'.y�f.-ern'`��'--+1tr-,r.+-•.*^^.kr.;•w`w,r�+r+✓,-.
x
ASSESSOR'S PARCE~NUMBER
OUNTY OF RIVERSIDE HEALTH SERVICES AGENCY
ARTMENT OF ENVIRONMENTAL HEALTH . .
RMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM �
APPLICANT: Submit this form with four copies of a SCALED plot plan (1-20 SCALE) drawn to County specificettlons as indicated on the attached check list.
A non-refundable filing fee is required when the application is submitted. Check must be made payable to the County, of;,�Riverside.,troy of this eipplica b
' I, troy
Ll
.i
tion shall remain valid for a period not to exceed one year from date of payment.
73148 '$22. 0
//
LOG # �y7Y 0f, /A 774' fDiK $22.. 00
Agent, Contractor, Contact Person
Address Ctly State Zip
Telephone{ / y
`�!/
,QEC/c b Zp v / C J A15i-, 114,dJf--'6 P
((�__ ,+�
96,0s' .X 4A N iO,f/ IPW#—?O 0 S'l N 9/E60 C4,
Owner
Address i City State Zip
Telephone,
Q
C. %S�'NI•ftlw�lc. /1?llJ� t� /?fNTG_ /L
�/,,
J3 9000 6v,0//v" �I , /C.4,.,&,,4/�/iit
Z
Job Property Address
'els- Sam l6
City
14 0141,7-,4
Zip
0
U
LLJX
Lot Size
ater Agency efF'
FJ
Use of Permit, PIP, SUP, PUP, etc.
M,�F014,Y(A'k.- (r!• 44 F0d
Liegal Description
_ r ff„/NowF� NF�IPA�
i r �nl
Cv4r4a44 (/Atc<i
Wit yl- � r s r>), i1`A�
13wel�ig;1MM�.Site3i?rep eta
�
Signature of Applicant yF ' " ca w/fCF, rrr.• le.77,� .7.7777
Date
CHECK BOX IF REQUIRED
' VgL14' ilAirr Cc Ca4a,4cc iLEGvN/2Ca, P17ra,t 7L` 41%"V4, ZGOE.✓,
❑ Holding Tank Agreements Completed
❑ Detailed Contour Plot Plans Required (1 to 5 foot interval) t
❑ Certification of Existing S.D. System Required
❑ Grading Handout Provided
ca
❑ WQCB Clearance Required
❑ Staff Specialist Lot Inspection Required
Z
(Attach For DOH -SAN -007, Santa Ana Region Only
O
❑ Lot Inspection
ULISoils
Percolation Report Required
W
kn
❑ Special Feasibility Boring Report Required
❑ Date Lot Inspection Completed: Initials
;
C,U•W.L CLPArri.I, e 'k�,�"�l /�%.roe ip TS tun�rC
Remarks:
OF
® gAZ4A60usn1ntFA1AL5 CtFA124Wcr /F4�ur o//��l.uA 7o/�t�nc�n.
Q Maintenance Booklet Provided
�'O. p Pca ,
Initials Date - /7-94'_ 9J''
�•
❑ Final Inspection by Department of Environmental Health is required.
C/42 Jsb1 Percolation Boring Report by UcJProJect # Date
Soils Map Page_ Soil Type Approved By ` ate
No of Systems
Type o tam(S)
No. Dwelling Units
(1) Septi
Soil Rate
Grease/Sand
O Holding O Rapt
Bedrooms, Fixture Units
,
Grease IntT,1Urt Trap
O New O Addition
!
ij/O rE fL Gu. f :j
O Existing
Gal.
At T,r/J T, F Gal.
Sq. ! t.
Total Linear
Sldewall Al oe
Leach Bed sq. ft. of
Bottom Area
Ft.
sem_
Bottom Area
ft. rock/ sq. ft. running ft.
Install Une(s) ft. long ft. wide with
Inlet Tested DeptR� NA
min. Inches rock below dralnllnes or
U
Pr Bottom Tested Depth
Z
Leach linsoed =a! design for sl p6'
(3) Pit Diameter
No. Pits
Pit i4low Inlet (BI)
Seepage Pit
Maximum
Other.
p
Total Depth
Allowable
H
Applicable
Depth
U
W
WA Overbu4n Factor
❑ V ❑ V
TD
N
Well R view Approved: Data: WeUDriA ,PetLntt N
SIGNATURE
Grading Plan Approved: Date:
�
SIGNATURE , // // p .I Cf t
�.f//��G �M J• —d 3- 9j ix1�1 r�! b( uddle+ed i�.9,LFV Gk%4/�9 /JT'li{
Sewer Verification A .C.
Approved:9j'
PP Date. / [UE/t,%.:"r�ui�?F.�j�-r -E; � �{-i7-91
REMARKS:
D �
k
This application IsPPR NIEI�fwX� EVRON B
above,.regarding the design of a subsur�ace.diaposab system as indicated on the
FOR OFFICE USE ONLY
acompanied plot plan, using the requirements set forth in SECTION C above. A build-
I,
r7
3 � IFee aa•00
ing permit Is necessary for the installation of the above -designed system. No eonstnw
Revenue code / =
tion is permitted in the reaufrod reserved 100% exoansion area.
(1) Septic Tank must be IW minimum from any wells.
, ,,p//
l:J'Cheek N
(2) Leach lines must be 100' minimum from any wells, Including expansion area.
Date _7- `1J' Initial Ti�J
Z
.!) Sewer lines must be 50' minimum from any wells.
'er(G/ P r /V0'
10
�4) Seepage pits must be 150' minimum from any wells. Including expansion area.
UJ
XAj
Signature of Health Official
'
a �2 3 --
Date
' I .
DOH -SAN 1 Z2 (Rev 9/93) UISUIDuDon: WNI r t---0trice Flle;. YLLLUW—Applicant, PINK—Bldg, D9p1.; GOLDENROL—Plans/Records
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09/14/95 11:47 $714 474 7056 MCG ARCHITECTS iii DESERT CITIES DE 0 002
ANF & ASSOCIATES Consulting Structural Enginecr5
PA
FIELD VISIT REPORT :---ru . x��y
ANF No: 94313
Date: 4/12/95
PORJFCT: Pad 110-311 - Eisenhower Medical Ctr/La Quinta, CA
Weather: Sunny
Owner: Washington/Adams Partnership
Contractor: Desert Cities Development, Inc.
Present: Gred Bakel (D.C.D.)
Andy Yu (AN-?)
Remarks
A field visit was made to the above referenced project. All
structural work has been completed; the roof structure has been
erected and exterior walls completed. In addition to a general
review of the stfa.cture, we checked, at random locations, beam to
beam and beam to column cozzmections, as well as wall anchors.
our observations found three (3) 6x5 posts with minor vertical
cracks along the surface due to dry weather condition.• Mr. Gred
Bakal stated that he would have the sub -contractor to add new
Simpson framing anchors A-35 to cover the crack surfaces. Other
.than the above, we found the workmanship good and the structure
integrity of the building satisfactory.
Submitted by:
ANP &Aqxociates
�nL .
Date
ftptnj9C3;3 _b
9.00 Tdsmr Ave. suite 101 0 Flair Commeme Cenbe a E7 Mo to, CA 91731 • Tek (StB) 44848)82 • Fas (FIX) 419419=
of
a � /
Orr 1'f
t j�g.
fi of 1 (Quinta
This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building
-Code certifying that at the time of issuance this structure was in compliance with the various
ordinances of the City regulating building construction or use. For the following:
BUILDING ADDRESS 78-822 HWY 111
Use Classification MEDICAL OFFICE Bldg. Permit No. 14330
Group B2 Type Construction VN Fire Zone Use Zone CPS
Owner of Building WASTNGTON / ADAMS Address 7R—R22 HWY 111
City LA QUINTA CA RICHARD L KIRKLAND
By.
Date: 9-15-95
POST IN A CONe?ICUOU! PLACIE