14-0699 (RC)78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
PONTIUS ARCHITECTURE
18643 HWY 18 STE 15
APPLE VALLEY, CA 92307
`ter °F 4Qum&
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
RC -14-699
47647 CALEO BAY SUITE 110
643200004
TENET HEALTH SYST MEDICAL OFFICE T.I.
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 Professions Code,
and my License is in full force and effect.
License Class: B License No.: 565731
�
Date:1 �% -ja Contractor
OWNER -B IL ER DECLARATION
I hereby affirm under penalty of perjJVhat 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 net more than five hundred dollars
($500).:
(_) 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 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.).
(_) 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
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/22/2014
Owner:
ACCRETIVE LA QUINTA PARTNERS
19752 MACARTHUR BLV 240
IRVINE, CA 92253
Contractor:
J B SPECIALTY
22989 ROUND
APPLE VALLEY
(760)953-384(
Llc. No.: 5657;
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.
6L 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: —Policy Number: _
-J&ff 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.
Otte Applica� t:
WARNING: FAILURE TO SECURE WO S' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYE T 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 Building Official 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 city to enter upon the above-
mentioned property for inspection purposes. �f
Dat��'�- Signature (Applicant or Agen h • '��—�
k� y
FINANCIAL INFORMATION
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
ART IN PUBLIC PLACES - COMMERCIAL
REMOD
270-0000-43201
0
$25.00
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid forART IN PUBLIC PLACES - AIPP: $25.00 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
BSAS SB1473 FEE
101-0000-20306
0
$5.00
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $5.00 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
DEVICES, FIRST 20
101-0000-42403
0
$23.83
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
DEVICES, FIRST 20 PC
101-0000-42600
0
$23.83
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
FIXTURES, FIRST 20
101-0000-42403
1
$23.83
$0.00
PAID BY
METHOD
RECEIPT'#
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
FIXTURES, FIRST 20 PC
101-0000-42600
1
$23.83
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for ELECTRICAL: $95.32 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
APPLIANCE REPAIR/ALTERATION
101-0000-42402
0
$11.92
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
APPLIANCE REPAIR/ALTERATION PC
101-0000-42600
0
$4.77
$0.00
.PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for MECHANICAL: $16.69 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
FIXTURE/TRAP
101-0000-42401
0
$47.68
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
FIXTURE/TRAP PC
101-0000-42600
0
$47.68
$0.00
PAID BY
METHOD
RECEIPT # -
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
WATER HEATER/VENT PC
101-0000-42600
0
$28.60
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
WATER SYSTEM INST/ALT/REP
101-0000-42401
0
$11.92
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
WATER SYSTEM INST/ALT/REP PC
101-0000-42600
0
$11.92
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for PLUMBING FEES: $147.80 $0.00
TOTALS:0-
Bin #City
of La Quinta
Building tai Safety Division
P.O. Box 1504, 78-495 Calle Tampico.
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
j
!•�
Project Address:
Owner's Name:
Addressliso l
A. P. Number: -
Legal Description:
City, ST, Zip:
Contractor: �,
Telephone:
Address: Ozqto
Project Description:
City, ST, Zip: � ,� 1250-1
W2t4 -. %j
Telephone: �� x::...;..,.,;,;:;::..;..:::..;.
State Lic. City Lie. C.
Arc Engr., Designer:
Address: 14L720 BW 2245
City, ST, Zip: 30-1
Telephone::<:;;>.:
State Lic. #• i 3 O...................:.................
.. ............
N
Construction Type: Occupancy:
—
ProJject e circle one): New Add'n Alter Repairair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person:Q �[�
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitte
Item
Amount
Structural Cates.
Reviewed, ready f corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
10
Plan Check Balance
Title 24 CAlcs.
Jr
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2' Review, ready for correctionissue 71y5
Electrical
Subcontactor List
Called Contact Person j
Plumbing
Grant Decd
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN IiOUSE:-
'"' Reyiew, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue 411 1 �Y
School Fees
.
4•�
/
Total Permit Fees
cipp8
?13 ,fie. ASAP
7/3
PROUDLY SERVING THE
UNINCORPORATED AREAS
OF RIVERSIDE COUNTY
AND THE CITIES OF:
BANNING
BEAUMONT
CALIMESA
CANYON LAKE
COACHELLA
DESERT HOT SPRINGS
EASTVALE
INDIAN WELLS
INDIO
JURUPA VALLEY
LAKE ELSINORE
LA QUINTA
MENIFEE
MORENO VALLEY
NORCO
PALM DESERT
PERRIS
RANCHO MIRAGE
RUBIDOUX CSD
SAN JACINTO
TEMECULA
WILDOMAR
BOARD OF
SUPERVISORS:
KEVIN JEFFRIES
DISTRICT I
JOHN TAVAGLIONE
DISTRICT 2
JEFF STONE
DISTRICT 3
JOHN BENOIT
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 92211-4131 • Phone (760) 863-8886
• Fax (760) 863-7072
www.rvcfire.org
June 12TH,2014
Mike Pontious, AIA
14343 Hwy 18,Suite 5
Apple Valley, CA 92307
Re: LAQ- I 4 -TI -020 47-647 Caleo Bay,Ste.I l0,La Quinta, CA
Medical Oxygen System
The plans you submitted for the above referenced project have been reviewed by the
Riverside County Fire Department and are approved with the following conditions:
The Fire Department Planning Division staff shall witness the following
inspections/tests:
Acceptance Test
1) 24 hour pressure test, at 150 PSI using dry (NF) nitrogen.
2) Cross check system operation and purge all outlets.
3) Final test: standing pressure test
4) Third party certification report/verification for proper installation.
The installer shall provide all needed testing equipment to complete the final alarm
inspection.
The Fire Department Job Card, approved plans and conditions letter must be at the job
site or no inspection will be performed.
Applicant/installer shall be responsible to contact the Fire Department to schedule
inspections. Requests for inspections are to be made at least 24 hours in advance and
may be arranged by calling (760) 863 -0886.
Should there be need for further information and/or clarification, please contact the
undersigned. Thank you for your continuing cooperation in advance.
Lisa Nottingham, Fire Safety Specialist
11•G41 CRIPtAq
601% AVOW699
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
Permit Number: RC -14-699
Applied: 5/28/2014
Issued: 7/22/2014
Status: ISSUED
Parent Permit:
Parent Project:
Approved: 7/11/2014
Finaled:
Description: TENET HEALTH SYST MEDICAL OFFICE T.I.
Site Address: 47647 CALEO BAY SUITE 110
City, State Zip Code: LA QUINTA, CA 92253
Applicant: PONTIUS ARCHITECTURE
Owner: ACCRETIVE LA QUINTA PARTNERS
Contractor: J B SPECIALTY CONTRACTOR
Details:
MEDICAL OFFICE T.I. SUITE 110
MEDICAL OFFICE T.I. SUITE 110 - 2998 SF. 30= OCCUPANT LOAD. DEFERRED SUBMITTAL ITEMS: MBA, LIQUID OXYGEN TANK &
ENCLOSURE; HYPERBARIC CHAMBER & PIPING EQUIPMENT. 2013, 2010 ENERGY CODES.
08/11/2014 REVISION #1 WHILE UNDER CONSTRUCTION SUBMITTED FOR GAS PIPING. PROCESSED ON 08/29.1 WEEK LIST PER BH
LIST OF REVIEWS
RETURNED
SENT DATE
DUE DATE TYPE'
CONTACT STATUS
REMARKS .
DATE
.
Review Group: BLDG IST (1WK)
8/29/2014
9/3/2014
9/4/2014
NON-STRUCTURAL
BURT HANADA
APPROVED
NEED FIRE DEPT
W/CONDITIONS
CLEARANCE.
Notes: — -- - -- - -
REVISION #1 MEDICALGAS PIPING (UNDERGROUND) FROM LIQUIDOXYGEN,TANK LOCATION TO SUITE 110. 2013 CODES. PROTECT EXISTING
ASPHALT PAVING AND,SIDEWALK.
Review Group: BLDG 2ND REVIEW
7/3/2014
7/8/2014
7/9/2014
PLANNING
JAY WUU
REVISIONS
NEED MBA
REQUIRED
Notes:
7/3/2014
7/10%2014
FIRE
FIRE BUCKET
REVISIONS
NO COMMENT
REQUIRED
Notes: - - - -- -- —
Building Tenant Improvement-Denied(Need to resubmit
Med Gas-Denied(Need to resubmit)
7/16/20147/16/2014
7/23/2014
NON-STRUCTURAL
BURT HANADA
APPROVED
W/CONDITIONS
Notes: - - - - - - - - — ---
MBA, OXYGEN TANK WITH ENCLOSURE AND BARYATRIC CHAMBER ARE DEFERRED SUBMITTAL ITEMS
Printed: Wednesday, 03 September, 2014 1 of 1
3.f 47 Lf 9..! SY57[MS
Certificate of Occupancy
Twf oF 4 Q"
Community Development Department
This Certificate is issued pursuant to the requirements of Chapter 1 Section 111 of the California
Building Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDINGADDRESS: 47-647 CALEO BAY,, STE 110
Use classification: BUSINESS —MEDICAL OFFICE Building Permit No.: 14-0699
Occupancy Group: B Type of Construction: VB Land Use Zone: CC
Code Edition: 2013 Sprinkler Installed: YES Occupant Load: 30
By: KIRK KIRKLAND
Date: OCTOBER 15, 2014
Building Official: TOM HARTUNG (INTERIM)
POST IN A CON
Owner of Building: ACCRETIVE LQ PARTNERS
Address: 19752 MACARTHUR BLVD, #240
City, ST, ZIP: IRVINE, CA 92612