FSINSP2019-0004ADDITIONAL SITES
CHRONOLOGY
CONTACTS
NAME TYPE NAME ADDRESS1 CITY STATE ZIP PHONE FAX EMAIL
APPLICANT JOHN EDGINGTON 82544 HUGHES DR.INDIO CA 92201
OWNER LA QUINTA COVE PROP 4 RICHLAND PL PASADENA CA 92253
CONDITIONS
Description: JOHN EDGINGTON
Type: FIRE SPECIAL INSPECTION Subtype: Status: FINALED Applied: 7/3/2019 AHI
Parcel No: 774052001 Site Address: 77595 CALLE CHIHUAHUA LA QUINTA,CA 92253 Approved: 7/16/2019 KHET
Subdivision: SANTA CARMELITA VALE LA QUINTA
UNIT 21
Block: 219 Lot: 24 Issued:
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled:
Valuation: $0.00 Occupancy Type: Construction Type: Expired:
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: DPSS 850 request for 4 Non-Ambulatory ARF R-3
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT #CHECK #METHOD PAID BY CLTD
BY
Credit Card Fee 101-0000-43505 0 $2.97 $2.97 7/3/19 R51107 0001 CREDIT
CARD JOHN EDGINGTON AHI
Total Paid for Credit Card Fee: $2.97 $2.97
Printed: Tuesday, February 14, 2023 10:38:19 AM 1 of 3
Permit Details
City of La Quinta
PERMIT NUMBER
FSINSP2019-0004
BOND INFORMATION
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED
DATE
COMPLETED
DATE
RESULT REMARKS NOTES
FINAL FOR OCCUPANCY EGO 7/9/2019 7/9/2019
APPROVED
W/EXCEPTIO
N
FSS E GONZALEZ - "APPROVED FOR 4
AMBULATORY IN ANY BEDROOM. NO
BEDRIDDEN OR NON-AMBULATORY"
ALLOWED.
REVIEWS
REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED
DATE
STATUS REMARKS NOTES
1ST PERMIT TECH (1
DAY)
AARON
HICKSON
7/3/2019 7/5/2019 7/5/2019 COMPLETE
1ST FIRE (2 WK)EDGAR
GONZALEZ 7/3/2019 7/17/2019 7/16/2019 APPROVED-
CONDITIONS Please see file created for further details.
PARENT PROJECTS
DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT #CHECK #METHOD PAID BY CLTD
BY
FIRE SPECIAL
INSPECTION 101-0000-42421 0 $160.00 $160.00 7/3/19 R51107 0001 CREDIT
CARD JOHN EDGINGTON AHI
Total Paid for FIRE FEES: $160.00 $160.00
TECHNOLOGY
ENHANCEMENT FEE 502-0000-43611 0 $5.00 $5.00 7/3/19 R51107 0001 CREDIT
CARD JOHN EDGINGTON AHI
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 $5.00
TOTALS:$167.97 $167.97
Printed: Tuesday, February 14, 2023 10:38:19 AM 2 of 3
Permit Details
City of La Quinta
PERMIT NUMBER
FSINSP2019-0004
ATTACHMENTS
Attachment Type CREATED OWNER DESCRIPTION PATHNAME SUBDIR ETRAKIT ENABLED
DOC 8/22/2019 KAYLI ALFORD
77595 CALLE
CHIHUAHUA - STD
850.pdf
77595 CALLE
CHIHUAHUA - STD
850.pdf
0
Printed: Tuesday, February 14, 2023 10:38:19 AM 3 of 3
Permit Details
City of La Quinta
PERMIT NUMBER
FSINSP2019-0004
STATE OF CALIFORNIA - FORESTRY AND FIRE PROTECTION
FIRE SAFETY INSPECTION REQUEST
STD-.850(_REVL4-2000) See instructions on reverse.
AGENCY CONTACT'S NAME TELEPHONE NUMBER REQUEST DATE PROGRAM
Department of Social Services
Centralized Applications Bureau ^aioj o3i-/yu4 8/20/2019 Adult and Senior Care Program
EAVLUATOR-S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE
NICOLE ROUSE 331880747
LICENSING
AGENCY
NAME AND
ADDRESS
Community Care Licensing Division
Centralized Applications Bureau
744 P Street, MS 8-3-91
Sacramento, CA 95814
Fax:(916)651-7916
Email: cclascpcau@dss.ca.gov
AMBULATORY
CAPACITY PREVIOUS
CAPACITY
4 N/A
FACILITY NAME
CHIHUAHUA HOME
STREET ADDRESS (Actual Location)
77595 CALLE CHIHUAHUA
CITY
LA QUINTA
FACILITY CONTACT PERSON'S NAME
WEST COAST CARE PROVIDERS LLC
x
x
x
NONAMBULATORY
CAPACITY PREVIOUS
CAPACirr
0 N/A
BEDRIDDEN
CAPACITY PREVIOUS
CAPACITY
0 N/A
1A
CODES
1. ORIGINAL A. FIRE CLEARANCE
2. RENEWAL B. LIFE SAFETY
3. CAPACITY CHANGE
4. OWNERSHIP CHANGE
5. ADDRESS CHANGE
6. NAME CHANGE
7.OTHER
TOTAL CAPACIFf
SPECIAL
CONDITIONS
FACILITY CONTACT PERSON'S TELEPHONE NUMBER
(909) 659-7404
Please specify - special instructions X
- rooms approved for non-ambulatory X
- rooms approved for bedridden X
TO BE COMPLETED BY INSPECTING AUTHORIFf
LICENSE
CATEGORY
NUMBER OF
BUILDINGS
RESTRAINT
HOURS
ARF
1
N/A
24/7
- approval of delayed egress
- approval of secured perimeter
- approval of secure locked perimeter
FIRE
AUTHORITY
NAME AND
ADDRESS
The City of La Quinta fire station 32
78111 Avenue 52
La Quinta, CA 92253
INSPECTOR'S NAME
(Typed or Printed)
INSPECTION DATE
TELEPHONE NUMBER CFIRS
NUMBER
INSPECTOR'S SIGNATURE (Typed or Printed)
CLEARANCE/
DENIAL CODE
CODES
1. FIRE CLEARANCE GRANTED
2. FIRE CLEARANCE DENIED
A. EXITS
B. CONSTRUCTION
C. FIRE ALARM
OCCUPANCY D. SPRINKLERS
CLASS E. HOUSEKEEPING
F. SPECIAL HAZARD
G. OTHER
EXPLAIN DENIAL OR LIST SPECIAL CONDITIONS
EDGAR GONZALEZ 760-777-7074 33-052 R-3
7/9/2019 Kohl Hetrick on behalf.
1
Capacity 1 BedBedroom # I14X19SmokeDetectorBathroomLaundryroomSliding DoorEmergency Egress#3Ki tchenSmokeDetectordICouchSmofcaDetectorT Firev lacSarageSmoliaDetectorBedSmokeOefceatoBsdroom # 210X13Capacity 1. SmokeDatsctorBathroomSnokaCetectorFoyerSliding DoorEmergency Egress#2BedSnnkeDa Lac torBedroom # 312X13Capacity 1SmokeDataetorBadroom # 410X13Capacity 1BedFront DoorEmergency Egress #1
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITy CARE LIC&ISiNG
FACILIT/ SKETCH (Floor Plan)
Chihuahua Home T?^ ^,i» ^:....... . " . . _. ___ -
La Quinta CA 92253
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