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BCOM2016-0025LICENSED 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, C-9, A. C27, C30 License No.: 743112 Date: -7_S— L—Contractor` & ro-es 1' 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 11, 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.). U 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 contractors) 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: WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of:he following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700,:)f the Labor Code, for the performance of the work for which this permit is issued: 0 I have and will maintain workers' conpensation insurance, as required by Section 3700 of the Labor Code, for the perforr ance of the work for which this permit is issued. My workers' compensation insurance carrier and polity number are: Carrier: INSURANCE COMPANY OF THE WEST Policy Number: WSD503542000 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: '2q Applicant: ry—�Q ICA^i"-,L- W ' ARNING: ` 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 ($100,0001 IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR 1+1 SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWJ-EDGEMENT IMPORTANT: Application is hereby made to the 3uilding Official for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this applica=ion 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 Cfiy 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 applicaton becomes null and void if work is not commenced within 180 days from date of issJance of such permit, or cessation of work for 180 days will subject permit to cancellafon. ' 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 representati.es of this city to enter upon the above-mentioned property for inspection purposes. Date: 6945- a Signature (Applicant orAgent): , VOICE (760) 777-7125 78-495 CALLE TAMPICO D FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT 9/25/2017 Date: Permit Type/Subtype: BUILDING COMMERCIAL/REMODEL Owner: z Application Number: BCOM2016-0025 EISENHOWER MEDICAL CEN ER F Property Address: 45280 SEELEY DR 39000 BOB HOPE JR r` Q a o APN: 604630053 RANCHO MIRAGE, CA 92253 C==,CD Application Description: EISENHOWER MEDICAL CENTER /T.I. STORAGE TO OFFICE SPACELM o Property Zoning: o Application Valuation: $300,000.00 � rid Applicant: Contractor: IRICH PETERSEN DOUG WALL CONSTRUCTIO 39000 BOB HOPE DR 78450 AVENUE 41 LA QUINT, CA 92253 BERMUDA DUNES_ CA 92203 (760)772-8446 Llc. No.: 743112 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ' - - - - - - - - - - - - - - - - - - - - - - _ - - - - - - - - - - - - - - - - - - - - - - - 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, C-9, A. C27, C30 License No.: 743112 Date: -7_S— L—Contractor` & ro-es 1' 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 11, 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.). U 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 contractors) 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: WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of:he following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700,:)f the Labor Code, for the performance of the work for which this permit is issued: 0 I have and will maintain workers' conpensation insurance, as required by Section 3700 of the Labor Code, for the perforr ance of the work for which this permit is issued. My workers' compensation insurance carrier and polity number are: Carrier: INSURANCE COMPANY OF THE WEST Policy Number: WSD503542000 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: '2q Applicant: ry—�Q ICA^i"-,L- W ' ARNING: ` 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 ($100,0001 IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR 1+1 SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWJ-EDGEMENT IMPORTANT: Application is hereby made to the 3uilding Official for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this applica=ion 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 Cfiy 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 applicaton becomes null and void if work is not commenced within 180 days from date of issJance of such permit, or cessation of work for 180 days will subject permit to cancellafon. ' 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 representati.es of this city to enter upon the above-mentioned property for inspection purposes. Date: 6945- a Signature (Applicant orAgent): I i _ J , Date: 9/25/2017 Application. Number:,, BCOM2016-0025 Owner: Property Address: 45280 SEELEY DR EISENHOWER MEDICAL CENTER APN: 604630053 39000 BOB HOPE DR Application Description: EISENHOWER MEDICAL CENTER / T.I. STORAGE TO OFFICE SPACE RANCHO MIRAGE: CA 92253 Property Zoning: Application Valuation: $300,000.00 Applicant:. - Contractor: IRICH PETERSEN DOUG WALL CON iTRUCTION INC 39000 BOB HOPE DR 78450 AVENUE 41 LA QUINT, CA 92253 BERMUDA DUNE!" CA 92203 (760)772-8446 ------------------------------------------- -------------------------------------------------- Llc. No.: 743112' Detail: REMODEL OF THIRD FLOOR WAITING AREA (PARTIAL) AND STORE ROOMS CONVERTING INTO OFFICE SPACES. REMODEL AREA = 613 SF.. OCCUPANT LOAD OF NEW OFFICE.SPACES = 7 (OCCUPANT LOAD OF AFFECTED WAITING AREA = 20; TOTAL NET OCCUPANT LOAD = -13) 2013 BUILDING CODES. ' Total Paid for ART IN PUBLIC PLACES - AIPP: $1,000.00 DESCRIPTION DESCRIPTION ACCOUNT -QTY QTY DEVICES, ADDITIONAL AMOUNT BSAS SB1473 FEE $62.92 101-0000-20306 ACCOUNT 0 AMOUNT $12.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $12.00 DESCRIPTION ACCOUNT -QTY AMOUNT DEVICES, ADDITIONAL 101-0000-42403 0 $62.92 DESCRIPTION. ACCOUNT QTY AMOUNT DEVICES, ADDITIONAL PC 101-0000-42600 0 $15.60 DESCRIPTION ACCOUNT QTY AMOUNT DEVICES, FIRST 20 101-0000-42403 0 $24.17 DESCRIPTION ACCOUNT QTY AMOUNT DEVICES, FIRST 20 PC 101-0000-42600 0 $24.17 Total Paid for ELECTRICAL: $126.86 DESCRIPTION ACCOUNT QTY AMOUNT OTHER MECHANICAL EQUIPMENT PC 101-0000-42600 0 $36.26 Total Paid for MECHANICAL:. $36.26 DESCRIPTION ACCOUNT QTY AMOUNT PARTITION 101-0000-42400 0 $362.60 DESCRIPTION ACCOUNT QTY AMOUNT PARTITION PC 101-0000-42600 0 $667.15 Total Paid for PARTITION: $1,029.75 DESCRIPTION ACCOUNT QTY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 (Q°in�# City of La• Quint8 Building 8&' Safety Division .78-495 Calle.Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit#) ProjectAddressE_I2�C7 �.� Or Owner's Name: -E A. P. Number: } l Address: '31 pQo Legal Description: t City?ST, Zip: Contractor: (' C Telephone: 700 Ya I ':" 3z <<<i .; �.; Address: ^Project Description': '� �rd br City, ST, Zip: � y -i Telephone: le one: P YV cQ C State Lic. # : City Lie. Arch.`, Engr., Designer:'� 3 Address: ���f S► Wry ► ` 1GL ce` City., ST, Zip: �jv� Z 2— Telephone: S 57 _ ' :a C n tructi n Type: Occupancy: Lic. 2D7 Alter Repair DemoState Project type (circle one): New Add'n Name of Contact Person: T(2:\ Sq. Ft.: #Stories: # Units: Telephone # of Contact Person: �� 3 Yo 3 I1 9/g7�" Estimated Value of Project: coy (D L 1 3r40 (0"71 M'1-0 APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets _ Plan Check submitted • Item Amount - Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance. Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2nd Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '^' Review, ready for corrections/issue Developer Impact Fee Planning Approval 1s 'Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees, Total Permit Fees PROUDLY SERVING THE UNINCORPORATED AREAS OF RIVERSIDE COUNTY AND THE CITIES OF: BANNING BEAUMONT CALIMESA CANYON LAKE COACHELLA DESERT HOT SPRINGS EAST'VALE 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 1 JOHN TAVAGLIONE DISTRICT 2 JEFF STONE DISTRICT 3 JOHN BENOIT DISTRICT 4 MARION ASHLEY DISTRICT 5 CAL FIRE - RIVF,`-St��E UNIT 'KIVERSIDE COUNTY FIRE VEPARTMENT OFFICE OF THE FIRE MARSHAL 77-933 Las Montanas Rd., Ste. #201, Palm Desert, CA 92211-4131 • Phone (760) 863-8886 • Fax (760) 863-7072 www.rvcfire.org February 21", 2017 Doug Wall Construction 78451 Avenue 41 Bermuda Dunes, CA 92203 Re: Building Tenant Improvement — Argyros Health Center LAQ-17-TI-004 45280 Seeley Drive 31 Floor La Quinta, CA Fire Department personnel have reviewed and have approved the plans you submitted for the above referenced project. Please be advised the following conditions apply as a part of the conditions for the issuance of a building permit. The following conditions must be met prior to occupancy: Deferred Submittals Required: 1) Fire Sprinkler — Tenant Improvement plans must be submitted and reference the installing contractor performing the work. Permit fees in the amount of $614.00 will be required. 2) Fire Alarm — Tenant Improvement plans must be submitted and reference the installing contractor performing the work. Permit fees in the amount of $627.00 will be required. 3) High -Pile & Rack Storage — Tenant Improvement plans must be submitted showing the changes of layout and type of racks and shelving as affected by this tenant improvement. Permit fees in the amount of $348.00 will be required. (If applicable) Buildings/facilities 1) Install Knox Key Lock box, mounted per recommended standard of the Knox Company. If the building/facility is protected with a fire alarm system or burglar alarm system, the lock boxes will require "tamper" monitoring. Special forms are available from this office for the ordering of the Key Switch. This form must be authorized and signed by this office for the correctly coded system to be purchased. 2) Provide keys to the tenant space for inclusion in the main building Knox Box. Key(s) shall have durable and legible tags affixed for identification of the correlating tenant space. 3) Approved building address shall be placed in such a position as to be plainly visible and legible from the street and rear access if applicable. Building address numbers shall be a minimum of 12". Minimum 6" tall suite addressing shall be provided to both the front and rear entrances. All addressing must be legible and of a contrasting color with the background and adequately illuminated to be visible from the street at all hours. Other requirements: 1) Install portable fire extinguishers per Title 19, but not less than 2AIOBC in rating. All new and existing portable fire extinguishers shall have current annual servicing performed and tagged. 2) Applicable room door(s) shall be posted "ELECTRICAL ", "FACP", "FIRE RISER" and "ROOF ACCESS" on the outside of the door so it is visible and in a contrasting color. 3) A durable sign stating "This door to remain unlocked during business hours" shall be placed on or adjacent to the front exit doors. The sign shall be in letters not less than one inch high on a contrasting background. 4) Illuminated Exit Signage and Egress Illumination placement and functional test will be witnessed by OFM Fire Inspector at time of final inspection. 5) Each room with an occupancy load of over fifty people shall be posted in a conspicuous place on an approved. 6) All egress doors shall comply with the California Building Code for proper door hardware. The Fire Department approved plans and conditions letter must be at the job site. Applicant/installer shall be responsible to contact the Fire Department to schedule inspections. Requests for inspections are to be made at least 72 hours in advance and may be arranged by calling (760)863-8886. SUBJECT TO FIELD INSPECTION - Nothing in our review shall be construed as encompassing structural integrity. Review of this plan does not authorize or approve any omission or deviation from all applicable regulations. Final approval is subject to field inspection. ' All questions regarding the meaning of these conditions should be referred to the Office of the Fire Marshal staff at (760)863-8886. Lisa Nottingham — Fire Safety Specialist