14-0120 (MFD5)COACHELLA VALLEY WATER DISTRICT ASSESSOR'S PARCEL NUMBER
85-995 Avenue 52
Coachella, California 92236 604------- 630------- 027
(760)398-2651
APPLICATION FOR WASTEWATER INTERCEPTOR/SEPARATOR APPROVAL
APPLICANT: Submit this form with a copy of s SCALED plot plan (1" = 20' to 1" = 40' SCALE) drawn to District specifications. A nonrefundable filing fee h required when the
application is submitted. Check must be made payable to the Coachella Valley Water District. Approval of this application shall remain valid for a period not to exceed one (1) year from date
ofpayment. NOTE: ALL BUSINESSES PRODUCING FAT, OIL, AND/OR GREASE, LOCATED IN A DiUI TI-SUITE BUILDING WILL REQUIRE A SEPARATE LATERAL
OFF THE MAIN SEWER LINE FOR GREASE INTERCEPTOR CONNECTION.
Plan Check No.
Agent, Contractor, Contact Person
Address City State Zip
Telephone
Ron Jackson, Lenity Architecture
3150 Kettle Court SE Salem, OR 97301
503)399-1090
Owner La Quinta Assisted Living Limited
Address City State Zip
Telephone
Partnership, a Washington limited partnership
9310 NE Vancouver Mail Dr #200 Vancouver WA 98662
(503)586-7217
Job ProCity Zip
Property 45190 Seeley Drive La Quinta, CA 92253
Legal Description Section 19, T5S, WE SBBM
DBALa Quinta Assisted Living Limited Partnership
PLEASE COMPLETE THIS SECTION FOR REVIEW OF FOOD ESTABLISHMENTS
NOTE: PLANS WILL NOT BE ACCEPTED UNLESS THIS APPLICATION IS COMPLETE AND THE PLAN CHECK FEE IS PAID.
GENERAL CONSTRUCTION:
Type of Construction:
New Food Facility X Remodel of Existing Food Establishment NA Hours of Operntion 7am-7pm Seating Capacity: Internal 134 External NA
External Seating with Misters or Heaters NA Bar with Food Service NA . Bar Nonfood Service NA Water Softener yes
Service:
Multiservice (reusable) Single Service (disposable)
OWNER/REPRESENTATIVE DECLARATION: I certify that I have read the entire application and state that all information is correct. I understand that the amount of fee paid is based on
my declaration of information on this form and that incorrect information is grounds for denial of the submitted plans. I also understand that plans will be discarded if not picked up within
sixty (60) days of appro ial and that no inspection of my establishment wi ducted, or approval granted to operate, until all proper information requested has been received and
plans have b ro d returned.
tore Date
FOR
DISTRICT USE ONLY
No. of Systems
Type of System(s)
No. Dwelling Units
Sand/Oil Li Grease Interceptor Waived
Fixture Units
Grease Interceptor
New Rddo
Replacement Addtio n
Adi
Liar Trap
Clarifier
Connect to Sewer
Gal.
REMARKS:
ry
AnLl1Rf
ems` i' h r 4o
This application is:
C f
Approved Denied Conditional Approval*
Fee $ J Check No.
'See Remarks
Date Initial
LSignature
Date lofl -7 i
Certificate of Occupancy
LW
.I
� OF �
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.
BUILDING ADDRESS: 45160 SEELEY DR
Use classification: MIXED USE — ASSISTED LIVING/MEMORY CARE FACILITY Building Permit No.: MFD5-14-120
Occupancy Group: R-2.1/1-2/A-2/A-3/B Type of Construction: VA Land Use Zone: RM
Code Edition: 2013/2010 ENERGY Sprinkler Installed: YES Occupant Load: 888
By: KIRK.KIRKLAND Owner of Building. LA QUINTA ASSISTED LIVING t.
Date- 12/15/2015 LIMITED PARTNERSHIP
Address: 9310 NE VANCOUVER DR #200
Building Official: BURT HANADA City, ST, ZIP: VANCOUVER, WA 98662
POST IN A CONSPICUOUS PLACE