10-0832 (RC)P.O. BOX 1504 4
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 10-00000832 Owner:
Property Address: 47647 CALEO BAY STE 260 ACCRETIVE LA QUINTA
APN: 643-200-004- - - 1 PARK PLAZA #340
Application description: REMODEL - COMMERCIAL IRVINE, CA 92614
Property Zoning: COMMUNITY COMMERCIAL
Application valuation: 300000
Contractor:
Applicant: N A� ! Architect or Engineer: DIFFENBAUGH INC, J D
6865 AIRPORT DRIVE
i'l_ Ivy RIVERSIDE, CA 92504
(951)351-6.865
LiC. No.: 181805
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 Professionals Code, and my License is in full force and effect.
License Cla : AIB C8 C27 i rise No.: 1 805
Date: ontractor:
ER -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 (commericing 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).:
1 _ 1 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.).
1 _ 1 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.1.
Lender's Name: _
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760)'777-7011
INSPECTIONS (760) 777-7153
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 TRAVELERS INS Policy Number VTC2JUB17L77210
_ 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
37 0 of the Labor CoV, I shall forthwith c with those provisions.
Date: AD bp4ant:
WARNING: FILURE TO SECURE WORKER ' C PENSATION ERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PE TIES AND CIVIL ES 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 Director of Building and Safety 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 county o ent upon the above-mentioned property inspection purposes.
Date: �ure (Applicant or Agent):
Application Number . . . . . 10-00000832
------ Structure Information 3594 SF MED OFFC T.I. SUITE.260
-----
Construction Type . .
. . . TYPE V, UNPROTECTED
Occupancy Type . .
. . . BUSINESS <50.
Other struct info . .
. •. . CODE EDITION 2007/08
ENERGY
FIRE SPRINKLERS YES
OCCUPANT LOAD
43.00
-----------_-----------------------------------------------------------------
2ND FLOOR SQUARE FOOTAGE
3594.00
Permit . . .
BUILDING PERMIT
Additional desc
COMP. CANCER CTR SUITE 260
Permit Fee
1339.50 Plan Check Fee
870.68
Issue Date . . . .
Valuation . . . .
300000
Expiration Date
4/23/11
Qty Unit Charge
Per
Extension
BASE FEE
639.50
200.00 3.5000
----------------------------------------------------------------------------
THOU BL6G'100,001-500,000
700.00
Permit . . .
ELECT - ADD/ALT/REM
Additional.desc .
Permit Fee . . . .
224.55 Plan Check.Fee
56.14
Issue Date
Valuation . . . .
0
Expiration Date.
4/23/11
Qty Unit Charge'
Per
Extension
BASE FEE
15.00
20.00 .7500
PER ELEC DEVICE/FIXTURE 1ST 2.0
15.00
3.00 37.5000
EA ELEC SVC <=600V/>200A/<=1000A
112..50
3.00 11.0000
EA ELEC MISC
33.00
109.00 .4500
- -------------------------------------------------------
EA ' ELEC DEVICE/FIXTURE >20
=--------------------
49.05
Permit . . .
MECHANICAL
Additional desc .
Permit Fee
55.50 Plan Check Fee
13.88
Issue Date . .
Valuation
0
Expiration Date
4/23/11
Qty Unit Charge
Per.
Extension
BASE FEE
15.00
1.00 16.5000
EA MECH B/C >3-1'5HP/>100K-500KBTU
16.50
1.00 11.0000
EA MECH AH >10K CFM
11.00
2.00 6.5000
----------------------------------------------------------------------------
EA MECH VENT FAN
13.00
Permit . . .. . . . PLUMBING
LQPERMIT
Application Number . . . . . 10-00000832
Permit . . . PLUMBING
Additional desc .
Permit Fee . . . . 112.50 Plan Check Fee
28.13
Issue Date . . . . Valuation . . . .
0
Expiration Date 4/23/11
Qty. Unit Charge Per
Extension
BASE FEE
15.00
14.00 6.0000 EA PLB FIXTURE
84.00
1.00 7.5000 EA PLB WATER HEATER/VENT
7.50
1.00 3.0000 EA PLB WATER INST/ALT/REP
3.00
1.00 3.0000 EA PLB FIXTURE DRAIN/VENT REP/ALT
3.00
----------------------------------------------------------------------------
Special Notes and Comments
T.I. FOR COMPREHENSIVE CANCER CLINIC
SUITE 260. "B" OCCUPANCY TYPE V -B
CONSTR. 3594 SF. 43 OCCUPANT LOAD.2007
CODES 2008 ENERGY.CLINIC IS LICENSED
THRU DESERT.REGIONAL MEDICAL CENTER =
SUBJECT TO OSHPD 3 REVIEW &
INSPECTION.(DESERT REGIONAL MEDICAL CTR..
1155 N. INDIAN CANYON ROAD. PALM
SPRINGS, CA 92262 TEL. 760-428-6769)
----------------------------------------------------------------------------
Other Fees . . . . . . . . . ACCESSIBILITY PLAN REVIEW
87.07
ART IN PUBLIC PLACES -COM
1480.00
BLDG STDS ADMIN (SB1473)
12.00
ENERGY REVIEW FEE
87.07
STRONG MOTION (SMI) - COM
63.00
Fee summary Charged Paid. Credited
---------------------------------------------------------
Due
Permit Fee Total 1732.05 .00 .00
1732.05
Plan Check Total 968.83 .00 .00
968.83
Other Fee Total 1729.14 .00 .00
1729.14
Grand Total 4430.02 .00 .00
4430.02
LQPER 11T
1
Bin #
City Of La QUinta
Building a Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # �A
Project Address: 41 ,4 7 C teo ga
Owner's Name: -Q¢SCr'� Q
A. P. Number:
Address: $o el Tad ' r ' Ie-
GLegal
LegalDescription:City,
ST, Zip:
Contractor:(1 0 e-+
Telephone: p 1 f
Address: j JC3 G
Project Description:
City, ST, Zip: rot
4e n- t%k1 I -W e 6 see ko&A4
Telephone: 21¢0 7 3 33G /
r awt e . ensi�e
State Lie. #
City Lie. C Y
e ar-
Arch., Engr., Designer. �� .� 64 e-.
Address: -2 OZ ZS kwj%4 III +e- 1
City, ST, Zip: �' Z 2,�;6
Telephone: /op 3Z $ - 5 Z Sb
Construction Type: v_ Occupancy: - .
State Lie. #: (p
Project type (circle one): New Add'n Alter Repair Demo
Sq. F'L:3 51 1( # Stories: Z # Units: 'Z (o a
Name of Contact Person: u 6e i �A
-p r
Telephone # of Contact Person: '1 jLo2>Z 8 - f; Z S b
Estimated Value of Project:S -3 ccr
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd Recd
PERMIT FEES
Plan SetsPlan
Check submitted
Item Amount
IX
Structural Cales.
Reviewed, ready fo c o 2J0,1 -
Plan Check Deposit
Truss Cales.
Called Contact P a
Plan Check Balance
Title 24 Calcs.
Plans picked
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2'' Review, ready to eorrectio .e
Electrical
Subcontactor List
Called Contact Person {� �/L
Plumbing
Grant Deed
Plans picked up /��i
S.M.I.
R.O.A. Approval
Plans resubmitted 1044.Grading
IN HOUSE:-
7nd Review, ready for correction issue L
Developer Impact Fee
Planning Approval
Called Contact Person `p 2"
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
R
.i -LL 5
S
Total Permit Fees4.4
g.a ,�: -.; 0,t"'�
T/Y f Re Ai°P .
d4AZ 9/q
�� 20 S'¢-►-u,�7'. � .
e r.
i '4 z. -
CERTIFICATION FORM FOR CLINICS AND FREESTANDING OUTPATIENT CLINIC
SERVICES OF A HOSPITAL
I certify that. the following facility conforms to current applicable edition of the'California
Building. Standards Code* and as such meets the applicable clinic standards (OSHPD
3) propounded by the Office of Statewide Health Planning and Development.
Facility
Street Address t &zq SLUL4e
City ta QQ-L ✓L+q X25
Type of Facility
❑ Chronic Dialysis Clinic (see note 1)
❑ Surgical Clinic (see note 1)
❑ • Rehabilitation Clinic
❑ Primary Care Clinic
❑ Birthing Clinic
❑ Psychology Clinic
Out Patient Clinic S rvice of a Hospital
Service(s)- U M 9YY—te'rLSt
Name
Title l.� u- t 1 d t VIA '--
Street Address
City
`p,ep* 1Q-S3a
/A- QUI 1 �J
"2006 IBC and 2007 California Amendments (07 California Building Code — Part 2, Title 24, CCR)
2005 NEC and 2007 California Amendments (07 California Electrical Code — Part 3, Title 24, CCR)
2006 UMC and 2007 California Amendments (07 California Mechanical Code — Part 4, Title 24, CCR)
2006 UPC and 2007 California Amendments (07 California Plumbing Code — Part 5, Title 24, CCR)
2006 IFC and 2007 California Amendments (07 California Fire Code — Part 9, Title 24, CCR)
Also see attached amended CAN 1.
Note 1: Per Health and Safety Code § 129885 certification of chronic dialysis and surgical services are
required to be provided by city or county building department with jurisdiction over the project. If the
building jurisdiction will not be providing this certification, plans shall be submitted to OSHPD for
certification
review.
State of California Office of Statewide Health Planning and Development
FILE NO. CAN 1
CODE APPLICATION NOTICE DATE: September 5,1989
Accessibility for Existing Buildings - Valuation Threshold for Unreasonable Hardship
The valuation threshold amount for unreasonable hardship referred to in the 2001 California
Building Code (CBC) Section 11348.2.1, Exception 1 is updated on an annual basis. As of
January 1, 2007, this threshold is $116,837.68.
Enforceable Codes
The following are the enforceable codes for facilities under the authority of the Alfred E. Alquist
Hospital Facilities Seismic Safety Act of 1983:
Application means the submission of a Preliminary or Final Application for Plan Review
APPLICATION
All applications submitted
2007
on or after January 1, 2008
2007
2007
2007
2007
2007
All applications submitted between 2007
March 17, 2007 and December 31,
2007. 2001
2001
2001
2001
2001
REVISION: August 20, 2007
CODE
Calffomia Building Standards Administrative Code
Part 1, Title 24, California Code of Regulations (CCR)
California Building Code
Part 2, Title 24, CCR
(2006 IBC and 2007 California Amendments)
California Electrical Code
Part 3, Title 24, CCR)
(2005 NEC and 2007 California Amendments)
California Mechanical Code
Part 4, Title 24, CCR
(2006 UMC and 2007 California Amendments)
California Plumbing Code
Part 5, Title 24, CCR
(2006 UPC and 2007 California Amendments)
Califomia Fire Code
Part 9, Title 24, CCR)
(2006 IFC and 2007 California Amendments)
California Building Standards Administrative Code
Part 1, Title 24, CCR
California Building Code
Part 2, Title 24, CCR)
(1997 UBC and 2001 Califomia Amendments)
California Electrical Code
Part 3, Title 24, CCR
(2002 NEC and 2004 California Amendments)
Calffomia Mechanical Code
Part 4, Title 24, CCR .
(2000 UMC and 2001 California Amendments)
California Plumbing Code
Part 5, Title 24, CCR)
(2000 UPC and 2001 California Amendments)
California Fire Code
Part 9, Title 24, CCR)
(2000 UFC and 2001 California Amendments)
State of California
All applications submitted between
August 1, 2005 and Mlarch 16, 2007
Office of Statewide Health Planning and Development
2001
2001
2004
2001
2001
2001
All applications submitted between 2001
November 1, 2002 and July 31, 2005
. 2001
All applications submitted
between July 1, 1899 and
October 31, 2002
REVISION: August 20, 2007
2001
2001
2001
2001
1888
1898
1888
1898
1898
1998
California Building Standards Administrative Code
Part 1, Title 24, CCR
California Building Code
Part 2, Title 24, CCR
(1997 UBC and 2001 California Amendments)
California Electrical Code
Part 3, Title 24, CCR
(2002 NEC and 2004 California Amendments)
California Mechanical Code
Part 4, Title 24, CCR)
(2000 UMC and 2001 California Amendments)
California Plumbing Code
Part 5, Title 24, CCR) .
(2000 UPC and 2001 California Amendments)
California Fire Code
Part 9, Title 24, CCR
(2000 UFC and 2001 California Amendments)
California Building Standards Administrative Code
Part 1, Title 24, CCR
California Building Code
Part 2, Title 24, CCR.
(1997 UBC and 2001 California Amendments)
California Electrical Code
Part 3, Title 24, CCR
(1999 NEC and 2001 California Amendments)
Calffomla Mechanical Code
Part 4, Title 24, CCR
(2000 UMC and 2001 California Amendments)
California Plumbing Code
Part 5, Title 24, CCR
(2000 UPC and 2001 California Amendments)
California Fire Code
Part 9, Title 24, CCR
(2000 UFC and 2001 California Amendments)
California Building Standards Administrative Code
Part 1, Title 24, CCR
Calffomia Building Code
Part 2, Title 24, CCR
(1997 UBC and 1998 Caldomia Amendments)
California Electrical'dode
Part 3, Title 24, CCR
(1996 NEC and 1998 Califomia Amendments)
California Mechanical Code
Part 4, Title 24, CCR
(1997 UMC and 1998 California Amendments)
California Plumbing Code
Part 5, Title 24, CCR
(1997 UPC and 1998 California Amendments)
California Fire Code
Part 9, Title 24, CCR
(1997 UFC and 1998 California Amendments)
Riverside County Fire Department Fire Protection Planning Section
Riverside Office: 2300 Market St., Ste. 150, Riverside, CA 92501 Ph. (951) 955-4777 Fax (951) 955.4886
Murrieta Office: 39493 Los Alamos Rd.. Ste A. Murrieta, CA 92563 Ph. (951) 600-6160 Fax (951) 600-6164
Palm Desert Office: 7 7-93 3 Las MontaRas Rd., A 201 Palm Desert, CA 92 21 1-4131 Ph. (760) 863-8886 (760) 863-7072
Fire Department Clearance/Release
Date: 0 /11
To: Ld Oyih+d Kv1`1di'n Li
Fax:
Tract/Parcel Map #: A k—! U— T I. 1131 I
Permit/Lot #: L v mpreklen5iye C'dy�ter len 1 i2K
Job Site Address:
q1-647 id leo ad,i sp 26 o
Final For Recordation
Release For Building Permit(s)
Shell Final Only (No Tenant)
AMbAd Final For Occupancy
Building Plan Check Fees Paid
Building Plan Check Fees Not Paid
Other Fees
Fees Not Required
If you should have any questions, please contact the appropriate Riverside County Fire Protection
Planning office for further assistance.
Aut rl ing.Signature For Release
0n.
Print Name
30 -DAY TEMPORARY
o� °
Certificate of Occupancy
Expires: 2/10/2011
I�
,9
OF
Building & Safety Department
This- Certificate is issued pursuant to the requirements of Appendix Chapter 1 Section 110 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.
BUILDING ADDRESS: 47-647 CALEO BAY, SUITE 260
Use classification: OFFICE — COMPREHENSIVE CANCER CENTER Building Permit No.: 10-0832
Occupancy Group: B Type of Construction: VB Land Use Zone: CC
Code Edition: 2007/2008 Sprinkler Installed: YES Occupant Load: 43
Owner of Building: ACCRETIVE LA QUINTA PARTNERS
Address: 1 PARK PLAZA, SUITE 340
City, ST, ZIP: IRVINE, CA 92614
By: AJ ORTEGA
Building Official Date: JANUARY 11, 2011
POST IN A CONSPICUOUS PLACE