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BPLB2014-101578-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: BPLB2014-1015 c6i«r 4 4Qumrw COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Property Address: 47647 CALEO BAY SUITE 110 APN: 643200004 Application Description: MEDICAL GAS PIPING Property Zoning: r� Application Valuation: $10,000.00 Applicant: OCT 2 `r i' RX PIPING - RAPHAEL PEREZ 8309 LAUREL CANYON BLVD #153CRY OF LA Qu)N1°A SUN VALLEY, CA 91352 COMMUNITY DEVELOPMENT DEPARTMtNt 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: C36 License No.: 841435 bate:/ — — I!X tractor: .0—GL .� OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 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 not 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 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 Name: Lender's Address: — � lip( VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 10/20/2014 Owner: ACCRETIVE LA QUINTA PARTNERS 19752 MACARTHUR BLV 240 IRVINE, CA 92253 Contractor: RX PIPING - RAPHAEL PEREZ 8309 LAUREL CANYON BLVD #153 SUN VALLEY, CA 91352 (818)749-1788 Llc. No.: 841435 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 and policy number are: Carrier: _ Policy Number: 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. Date: ! 7-4-�,-p ant:' 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. 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 inspect* purposes. :/O —20 — /� rgnature (Applicant or Agent): o- . FINANCIAL INFORMATION DESCRIPTION - ACCOUNT CITY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 PAID BY METHOD. RECEIPT # CHECK # CLTD BY Total Paid for BUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00 DESCRIPTION ACCOUNT ;_ CITY. AMOUNT ' PAID PAID DATE HOURLY CHARGE - CITY STAFF 101-0000-42600 1 $143.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forCITY STAFF - PER HOUR: $143.00 $0.00 DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE PERMIT ISSUANCE 101-0000-42404 0 $90.57 $0.00 PAID BY 'METHOD RECEIPT # CHECK # CLTD BY Total Paid for PERMIT ISSUANCE: $90.57 $0.00 TOTALS:$0.00 Description: MEDICAL GAS PIPING ADDITIONAL Type: PLUMBING Subtype: Status: SUBMITTED Applied: 9/3/2014 BHA Approved: Parcel No: 643200004 Site Address: 47647 CALEO BAY SUITE 110 LA QUINTA,CA 92253 Subdivision: PM 27892 Block: Lot: 4 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $10,000.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: MEDICAL GAS PIPING FROM BULK SOURCE INTO BUILDING AND TO EQUIPMENT KAY HENSEL Printed: Monday, October 20, 2014 10:50:21 AM 1 of 3 ADDITIONAL CHRONOLOGY CHRONOLOGY TYPE STAFF NAME ACTION DATE COMPLETION DATE NOTES PLAN CHECK READY FOR KAY HENSEL 9/3/2014 9/3/2014 PICK UP PLAN CHECK SUBMITTAL BURT HANADA 9/3/2014 9/3/2014 LIQUID OXYGEN TANK SUBMITTED FOR REVIEW. CONDITIONS CONTACTS NAME TYPE NAME ADDRESSI CITY STATE ZIP PHONE FAX EMAIL APPLICANT RX PIPING - RAPHAEL PEREZ 8309 LAUREL CANYON SUN VALLEY CA 91352 BLVD #153 CONTRACTOR RX PIPING - RAPHAEL PEREZ 8309 LAUREL CANYON SUN VALLEY CA 91352 BLVD #153 OWNER ACCRETIVE LA QUINTA PARTNERS 1. 19752 MACARTHUR IRVINE CA 92253 BLV 240 Printed: Monday, October 20, 2014 10:50:21 AM 1 of 3 FINANCIAL INFORMATION SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED DATE DATE RESULT REMARKS NOTES PLUMBING FINAL" PARENT PROJECTS CLTD DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPY # CHECK # METHOD PAID BY DUE DATE RETURNED DATE BY BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 REVIEWS STATUS Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $0.00 BSA: HOURLY CHARGE -CITY 101-0000-42600 1 $143.00 $0.00 LIQUID OXYGEN TANK & ENCLOSURE NON-STRUCTURAL BURT HANADA g/11/2014 STAFF 8/27/2014 APPROVED W/CONDITIONS INFORMATION REQUIRED. 10/07/2014 Corrections have been made. . Total Paid forCITY STAFF - PER HOUR: $143.00 $0.00 PERMIT ISSUANCE 101-0000-42404 1 0 $90.57 $0.00 ' FIRE Total Paid for PERMIT ISSUANCE: $90.57 $0.00 TOTALS:00 INSPECTIONS SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED DATE DATE RESULT REMARKS NOTES PLUMBING FINAL" PARENT PROJECTS Printed: Monday, October 20, 2014 10:50:21 AM 2 of 3 1CR7w ........ PARENT PROJECTS REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED DATE REVIEWS STATUS REMARKS NOTES LIQUID OXYGEN TANK & ENCLOSURE NON-STRUCTURAL BURT HANADA g/11/2014 8/25/2014 8/27/2014 APPROVED W/CONDITIONS INFORMATION REQUIRED. 10/07/2014 Corrections have been made. . Approved 3rd set of submittals.Lisa N. LISA ' FIRE NOTTINGHA 9/3/2014 9/18/2014 10/7/2014 MED GAS PIPING M NON-STRUCTURAL BURT HANADA 9/3/2014 9/10/2014 9/3/2014 APPROVED W/CONDITIONS FIRE DEPT APPROVAL REQUIRED PRIOR TO PERMIT ISSUANCE. Printed: Monday, October 20, 2014 10:50:21 AM 2 of 3 1CR7w ........ NON-STRUCTURAL BURT g/3/2014 9/10/2014 9/3/2014 APPROVED Approved 3rd submittal of Medical Gas and CREATED HANADA DESCRIPTION PATHNAME SUBDIR W/CONDITIONS DOC Hyperbaric Chamber System..... Lisa N. LISA NOTTINGHAM LISA LAQ-I4-TI-020 MED 0 FIRE NOTTINGHA 10/7/2014 10/21/2014 10/7/2014 APPROVED LAQ-I4-TI-020 MEDICAL LAQ-I4-TI-020 MEDICAL -DOC 10/7/2014 W/CONDITIONS GAS 3RD GAS 3RD M SUBMITTAL.docx SUBMITTAL.docx Printed: Monday, October 20, 2014 10:50:21 AM 3 of 3 ATTACHMENTS Attachment Type CREATED OWNER DESCRIPTION PATHNAME SUBDIR ETRAKIT ENABLED DOC 9/18/2014 LISA NOTTINGHAM LAQ-14-TI-020 MED LAQ-I4-TI-020 MED 0 GAS.docx GAS.docx LAQ-I4-TI-020 MEDICAL LAQ-I4-TI-020 MEDICAL -DOC 10/7/2014 LISA NOTTINGHAM GAS 3RD GAS 3RD 1 SUBMITTAL.docx SUBMITTAL.docx Printed: Monday, October 20, 2014 10:50:21 AM 3 of 3 DESCRIPTION • QTY PAID PermitTRAK $234.57 BPLB2014-1015 Address: 47647 CALEO BAY SUITE 110 Apn: 643200004 $234.57 BUILDING STANDARDS ADMINISTRATION BSA $1.00 BSAS SB1473 FEE 101-0000-20306 0 $1.00 CITY STAFF - PER HOUR $143.00 HOURLY CHARGE - CITY STAFF 101-0000-42600 1 $143.00 PERMIT ISSUANCE $90.57 PERMIT ISSUANCE 101 0000 42 0 404 TOTAL . .. $90.57 Date Paid: Monday, October 20, 2014 Paid By: RX PIPING - RAPHAEL PEREZ Cashier: KHE Pay Method: CHECK 4460 MODULE #1 CTIONS EN LINE URE - LOW EN LINE URE HIGH OXYGEN =L LOW I RESERVE USE I RESERVE =L LOW USED— r USED -- r USED -- r USED -- r USED -- r USED -- r USED -- r USED -- r USED -- f USED -- r USED-- 2 t UROUND PRESSURE SWITCH •- -------------- 02 3 ' L---------f,,,T----1-J APPff6ViAL-------- RIVERSIDE COUNTY FIRE DEPARTMENT BY. LISA NOTTINGHAM, FSS DATE. ° "Ll y CASE*__LA__Q2y ° �a RECEIVED THE FIRE DEPT APPROVAL FOR PLANS VALID FOR ONE YEAR -SUBJECT TO (See Ci COMPLIANCE WITH APPLICABLE CODES Skee�rs� S Ep 26 2014 IERGENCY POWER TO ALARM %S MANIFOLD CONTROL D VACUUM PUMP CONTROL R MAY, AT HIS DISCRETION, )CAL PRESSURE SENSORS AT S WITH 1/4" SENSOR PIPING INS INDICATED ON FLOOR. EMOTE SENSOR LOCATIONS. 31TE DRAWINGS (BY OTHERS) TERMINATION POINTS OF ARM WIRING. RIVERSIDE COUNTY FIRE PROPALM DESERT �PLANNING 86 KEY NOTES: O1 HIGH & LOW PRESSURE SWITCH O2 BULK SYSTEM CONTROL PANEL. O3 OXYGEN RESERVE, MANIFOLD. MASTER ALARM PANEL WIRING DIAGRAM SCALE —( ♦ 1 NONE I MEDICAL GAS EQUIPMENT SUPPLIED AND INSTALLED BI MEDICAL GAS RESOURCES 5592 BUCKINGHAM DRIVE HUNTINGTON BEACH CA 92649 PHONE: (888) 743-8298 0 J Bin # City of La Quinta Building & Safety Division Permit #,rye 1 P.O. Box 1504, 78-495 Calle Tampico. 10 La Quints,CA 92253 - (760) 777-7012. �.�Building Permit Application and Tracking Sheet Project Address: Z,/ 7— G' q7 en ro Owner's Name: 4 Y -r t'v e L �(l ,�✓�� A. P. Number: Address: g 7 S Z 2 - Legal Description: Legal City, ST, Zip: r. r V N if Z 2 S Contractor' / x �� 6 GN Telephone: `.` 4. Address: U f o a/ Z a "-,l �� v p II/(,� ( Project Description: City, ST, Zip: Svc, val�t �i4 / 35'2 e one 1 h p - %ter /%� ;7, •�// � I /�c�d V e •I V 4 � /-7 State Lic. # : (/ zy S City Lie. #; Arch., Engr., Designer. �� Address: S L/ 6' �a�1 7� �I�'l� �V� Sv;� e!Od . City., ST, Zip: Telephone: D Q """'" " " Construction T e: Occu ane p �9y ��l ;,r.., yp P 9 State Lic. #: Name of Contact Person:t��G��,�z Project type (circle one):. New Add'n Alter Repair Demo Sq. Ft.: # Stories: # Units: Telephone #,of Contact Person �j/v ( / —(7900 Estitn teed Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE t/ Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted �� Item Amount Structural Calcs. Reviewed,, ready for corrections Plan Check Deposit Truss Cala. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, ready for correction issue Electrical SubeontactorList Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '`" Review, ready for correctionslissue Developer Impact Fee i Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees V� I