07-2694 (MFD5)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA
92253
Application Number:
07-00002694
Property Address:
47795 DUNE PALMS RD
APN:
600-020-030- - -
Application description:
DWELLING - 5 OR MORE FAMILY
Property Zoning:
1.EGIONAL COMMERCIAL
Application valuation:
8121618
Applicant:
Architect or Engineer:
1 -14
I
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 Class: 13 License No.: 396120
Date: Contractor:
OWNER -BUILDER DECLARATION
1 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).:
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 1, 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:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/07/08
Owner:
COACHELLA VALLEY HOUSING COALI
45701 MONROE ST 1-G
INDIO, CA 92201
Contractor:
BROWN CONSTRUCTION, INC.
PO BOX 980700
WEST SARAMENTO, CA 95798
(916)373-9300
Lic. No.: 396120
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.
_ 1 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 AMER INC Policy Number 3424477
I certify that, in the performance of the work for which this permit is issued, 1 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 provistgps.—.
Date: Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS! L4WFUL, AN[0—SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP T0, f E f9UNDRED THOUSAN0
DOLLARS AS PROVIDED FOR IN
DOLLARS (5100,000). IN ADDITION TO THE COST OF COMPENSATION, D AG
W/
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.(
APPLICANT ACKNOWLEDGEINT
IMPORTANT Application is hereby made to the Director of Building and Saf ty for a prmf 'subjectto the
'
conditions and restrictions set forth on this application.-
1. Each person upon whose behalf this application is made, each person at who5eti�tjt�F and��or �`..
whose benefit work is performed under of pursuant to any permit issued as a result of this-ea)Ilieation,
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 to enter upon the above -mentioned property for inspection purposes.
Date: Signature (Applicant or Agent):
�I
Application Number . . . . . 07-00002694
Permit . . . . . . ELEC-NEW RESIDENTIAL
Qty Unit Charge Per
Extension
BASE FEE
15.00
81191.00 .0300 ELEC NEW RES - MULTI FAMILY
2435.73
56455.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL
----------------------------------------------------------------------------
1129.10
Permit . . . PLUMBING
Additional desc .
Permit Fee . . . . 5445.00 Plan Check Fee
1361.25
Issue Date . . . . Valuation . . . .
0
Expiration Date . . 8/05/08
Qty Unit Charge Per
Extension
BASE FEE
15.00
574.00 6.0000 EA PLB FIXTURE
3444.00
2.00 15.0000 EA PLB BUILDING SEWER
30.00
20.00 6.0000 EA PLB ROOF DRAIN
120.00
68.00 7.5000 EA PLB WATER HEATER/VENT
510.00
68.00 3.0000 EA PLB WATER INST/ALT/REP
204.00
136.00 .7500 EA PLB GAS PIPE >=5
102.00
68.00 15.0000 EA PLB GAS METER
----------------------------------------------------------------------------
1020.00
Permit . . . GRADING PERMIT
Additional desc . .
Permit Fee . . . . 15.00 Plan Check Fee
.00
Issue Date . . . . Valuation . . . .
0
Expiration Date . . 8/05/08
Qty Unit Charge Per
Extension
' BASE FEE
15.00
----------------------------------------------------------------------------
Special Notes and Comments
144,751SF .[TYPE:J-1/J-2/GARAGE]/V-1HR,
I-FR/RES-1, S-3/68 - DWELLING UNITS
- ALLOWABLE AREA INCREASES: MULTISTORY /
FIRESPRINKLERS / SIDEYARD [3STORIES./
49,140SF MAX] CBC311.2.2.1 - GROUP S-3
WITH GROUP R-1 ABOVE, MIXED USE. THIS
PERMIT DOES NOT INCLUDE SITEWALLS, SITE
LIGHTING, CARPORTS OR TRASH ENCLOSURES.
2001 CBC, CPC, CMC, 2004 CEC, 2005
ENERGY CODE. [BUILDING: 9100/9200 -
TYPE: J-2, 9300/9400 - TYPE: J-1,
PARKING GARAGE]
January 31, 2008 11:11:12 AM.AORTEGA
Application Number . . . . . 07-00002694
------ Structure Information 97,076SF/V-1HR,I-FR/R-1,S-3[J-1/J-2+GAR]-----
Other struct info . . CODE EDITION 2001/2004/2005
# BEDROOMS 148.00
FIRE SPRINKLERS FULLY
FLOOD ZONE NO
GARAGE SQ FTG 43778.00
PATIO SQ FTG 7105.00
NUMBER OF UNITS 68.00
1ST FLOOR SQUARE FOOTAGE 29954.00
2ND FLOOR SQUARE FOOTAGE 29098.00
3RD FLOOR SQUARE FOOTAGE 22139.00
----------------------------------------------------------------------------
Permit . . . BUILDING PERMIT
Additional desc . .
Permit Fee . . . . 17783.50
Issue Date . . . .
Expiration Date . . 8/05/08
Plan Check Fee 11559.28
Valuation 8121618
Qty
Unit Charge
Per
Extension
BASE
FEE
3539.50
7122.00
----------------------------------------------------------------------------
2.0000
THOU BLDG
1,000,001 - UP
14244.00
Permit
. . .
MECHANICAL
Additional
desc . .
Permit Fee
. . . .
2318.00
Plan Check Fee
579.50
Issue Date
. . .
Valuation
0
Expiration
Date . .
8/05/08
Qty
Unit Charge
Per
Extension
BASE
FEE
15.00
68.00
4.5000
EA MECH
VENT INST/ DUCT ALT
306.00
68.00
9.0000
EA MECH
B/C <=3HP/100K BTU
612.00
2.00
16.5000
EA MECH
B/C >3-15HP/>100K-500KBTU
33.00
70.00
6.5000
EA MECH
AH <=10K CFM
455.00
70.00
6.5000
EA MECH
VENT FAN
455.00
68.00
----------------------------------------------------------------------------
6.5000
EA MECH
EXHAUST HOOD
442.00
Permit
. . . ELEC-NEW RESIDENTIAL
Additional
desc .
Permit Fee
. . . .
3579.83
Plan Check Fee
894.96
Issue Date
Valuation
0
.Expiration
Date . .
8/05/08
Qty Unit Charge
Per
Extension
r
Application Number . . . . . 07-00002694
------------------------------------------------------------------
Other Fees . . . . . . . . . ACCESSIBILITY PLAN REVIEW 1155.93
Fee summary Charged
Permit Fee Total 29141.33
Plan Check Total 14394.99
Other Fee Total 209588.06
Grand Total 253124.38
ART IN PUBLIC PLACES-RES 19804.04
DIF COMMUNITY CENTERS-RES 4964.00
DIF CIVIC CENTER - RES 15572.00
ENERGY REVIEW FEE 1155.93
DIF FIRE PROTECTION-RES 2176.00
DIF LIBRARIES - RES 23664.00
DIF PARK MAINT FAC - RES 1428.00
DIF PARKS/REC - RES 59568.00
STRONG MOTION (SMI) - RES 812.16
DIF STREET MAINT FAC-RES 2652.00
DIF TRANSPORTATION - RES 76636.00
Paid Credited
00 .00
00 .00
00 .00
00 .00
Due
29141.33
14394.99
209588.06
253124.38
o``
F
CITY OF LA-QUINTA
BUILDING & SAFETYUEPARTMENT
OF'f '
(760) 777-7012,-_ . t.
INSPECTION REdUEgtoNE
(760) 777-7153i' 'Ei g
- �L9
Owner C0AC'HFi
T A VAU1,F,YNOiT9YNG
Contractor RRO
WN C 0N�T1RLTCTT()N
j
Permit Number
07 7F9d _ !
POST ON
JOB IN C6N0kQtjIOUS GLACE
INSPECTOR
MUST SIGN ALL APPLICABtl SPACES
JOB ADDRESS
(OVER)
TYPE OF INSPECTION I DATE I INSP.
TEMPORARY POWER
U/G PLUMBING / WASTE
U/G ELECTRICAL / GROUNDING
FOOTINGS / STEEL
CONCRETE SLAB
DO NOT POUR CONCRETE UNTIL ABOVE SIGNED
ROOF NAIL / PRE -ROOF
'Z- Z. '40
OKAY TO WRAP
• O
FRAMING COMBINATION
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH MECHANICAL
t
INSULATION
Ir
COVER NO WORK UNTIL ABOVE SIGNED
INTERIOR GYP. BD. DRYWALL 3 l O
EXTERIOR LATH
GAS TEST
SEPTIC ABANDONMENT
SEWER CONNECTION
SEPTIC / GREASE INTERCEPTOR
� I I
MASONRY INSPECTIONS
FOOTINGS / STEEL
BOND BEAM
POOL / SPA / WATER FEATURE INSPECTIONS
PRE-GUNITE / SETBACKS
U/G PLUMBING
U/G GAS
U/G ELECTRICAL
PRE- CASTER ALARMS / BARRIERS
/l�� _ mod! .L✓ . CIAIAI IIJCDFf_TI�1NC
MP. USE OF P RMANENT POWER
ELECTRICAL
PLUMBING
MECHANICAL
PUBLIC WORKS DEPARTMENT
COMMUNITY DEVELOPMENT DEPT.
FINAL / JOB COMPLETED
d
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
m,rr�� Lla �tr F
2 -Cal � AS'L-- 0 zs 56z
GN c m z
I_je-st
144,751SF [TYPE:J-1/J-2/GARAGE]N-1HR, I-FR/RES-1, S-3/68 -
DWELLING UNITS
- ALLOWABLE AREA INCREASES: MULTISTORY /
FIRESPRINKLERS / SIDEYARD [3STORIES / 49,140SF MAX]
CBC311.2.2.1 - GROUP S-3 WITH GROUP R-1 ABOVE, MIXED
USE. THIS PERMIT DOES NOT INCLUDE SITEWALLS, SITE
LIGHTING, CARPORTS OR TRASH ENCLOSURES.
2001 CBC, CPC, CMC, 2004 CEC, 2005 ENERGY CODE.
[BUILDING: 9100/9200 -
TYPE: J-2, 9300/9400 - TYPE: J-1, PARKING GARAGE]
January 31, 20088� 11:11:12 AM AORTEGA
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RiP• RE
MNAl10NACOUNCILL INTERNATIONAL
CODE- CODECOUNCIC
Mark J. Blakely Mark J. Blakely
Spray -Applied Fireproofing Special Inspector Prestressed Concrete Special Inspector -Legacy
The individual named hereon is CERTIFIED in the category
shown, having been so certified pursuant to successful
completion of the prescribed written requirem ts.
Expiration date: Januar 30, 2009
No. 0840463.86 by cer ate holder.
Not valid unl Sig
ICC certification attests to competen knowledge of codes and standards.
lOU CDE CONCI TERNAT )NAL
Mark J. Blakely
Structural Steel & Welding Special Inspector
The individual named hereon is CERTIFIED in the category
shown, having been so certified pursuant to successful
completion of the prescribed written requirements.
Expiration date: January, 30 2009
No. 0840463-85
Not v d u e signed by cer . to holder.
ICC certification attests to competen knowledge of codes d standards.
The individual named hereon is CERTIFIED in the category
shown, having been so certified pursuant to successful
. L mpletion of the prescribed written requirements.
Expiration date: Januar 30, 2009
No. 0840463-89
Not v li unl ss igne y certi to holder.
ICC certification attests to competent nowledge of codes d standards.
IN
_, WIN
(%®�I INTERNATIONAL
Mark J. Blakely
Reinforced Concrete Special Inspector -Legacy
The individual named hereon is CERTIFIED in the category
shown, having been so certified pursuant to successful
completion of the prescribed written requiremen
Expiration date: January 30, 2 09
No. 0840463-88
Not valid unless si d b rtificat der
ICC certification attests to competent knot dge of codes and sta dads.
ai
INTERNATIONAL
CODECOUNCIL•
Mark J. Blakely
Structural Masonry Special Inspector
The individual named hereon is CERTIFIED in the category,
shown, having been so certified pursuant to successful
completion of the prescribed written requireVe
Expiration date: January 30, 2009
No. 0840463 84 %%%n..t: / �_
I�
J
HAM
I
I
INnnNanDNnE
CUDECOUNCID
Miles U vvoouaru
Reinforced Concrete Special Inspector M
The individual named hereon is CERTIFIED in the category
shown, having been so certified pursuant to successful
completion of the prescribed written requirements.
Expiration date: June 11, 200
No. 5077516-49
Not va id unless signed by ertificate holder. I'
ICC certification attests to competent knowledge of codes and standards.
rr�
IH1fP11nn011A1
MILES O WOODARD cootrnuftcic
STRUCTURAL MASONRY SPECIAL INSPECTOR
The individual named hereon Is CERTIFIED in the category shown,
having been so certified pursuant to successful completio
Prescribed written examinations, n of the
Expiration date: April 4 011
No. 5077618-84
ICC certification , Not Vail Unless signed y cenlncate hol~—
lttosts to competent knowledge of codes and standards
ROOF CONSULTANTS INSTITUTE
1500 Sunday Drive, suite 204 • Raleigh, NC 27607
Tel. (919) 859-0742 Fax (919) 859 1328
hereby recognizes
Miles Woodard, RRO
as a
Registered Roof Observer (RRO)
Type(s): 1,3
E _ + 12/31/06
0472
EXPIRATION DATE
REGISTRATION NUMBER
*Explanation on back of card Y a
Jt" �FNFWAL DFPT
5360 WORKMAN MILL RD
WHITTLER, CA 90s0j
wreu+enouu
CODECOUNCIr
Miles D Woodard .
Prestressed Concrete Special Inspector
The individual named hereon is CERTIFIED in the category
shown, having been so certified pursuant to successful
completion of the prescribed written requirem�s.
Expiration date: June 11, 2
No. 5077516-92 Not lidunless signed y ceholder. d
' ICC certification attests to competent knowledge nt codes and standards.
Miles D Woodard
nratu S, .1
Building Inspector C
UBC
The individual named hereon Is CERTIFIED in the categot.own,
having been so certified pursuant to successful compleil ''of the
Prescribed written requirements.
Expiration date: July 23, 2010 �•`
No.5077516-10
Not alld unless
/CC certification attests to competent knowledge of cc s oI older.
� con rat'
Daily Inspection Log
Permit -407-2694
Steve Traxel. &
A.J. Ortega Building Inspector II
DUNE PALMS NEIGHBORHOOD
4 7- 79 5 DUNE PALMS, BUIILDING J
Date Inspection
3/6/08
Inspected East FTG for building "J". Elevator pit and shear wall footings not
ready at this point. By ST & AJ
3/17/08
Elevator pits (2) and shear wall footings OK for East wall Building J. West
wall footing OK minus all locations for stem wall footings.
3/24/08
North/East Basement Wall — I" Lift Bond Beam OK
3/27/08
Inspected first 4' high grout lift at 2 elevator pits on east wall and 2 sections
(601f) of high lift grout north east corner.
Inspected remainder of footings at west side of building, including all colum
footings.
4/2/08
Inspection for sand clarifier at south end of parking garage OK
4/3/08
Bond Beam inspection @ east wall of building for bottom 4 foot height plus
elevator pit Ist lift
4/408
colum steel OK for interior colums only.
4/7/08
Bond beam for west wall bottom 4' only
IN1155
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/
BUILDING DEPARTMENT
CITY OF LA QUINTA
OFFICE: (760) 777-7012 INSPECTION REQUESTS: (760) 777-7153
TO: if�I Co. DATE: S'2-q• eam
ADDRESS: �i�•�I�Jt eoft
CORRECTION NOTICE
INSPECTION:
PERMIT NO.:
STATE OF CALIFORNIA
DEPARTMENT OF INDUSTRIAL RELATIONS
DIVISION OF OCCUPATIONAL SAFETY AND HEALTH
TEMPORARY PERMIT TO OPERATE AN ELEVATOR
(Sections 7300-7322 of the Labor Code)
Responsible Party:
k
Elevator Number \�� g �A
Date of Inspection Void After
Location
Streets and Number City or Town
Load Permissible
*� Pounds Persons Inspector
c
Passenger, Frei ,etc. Cable Hydraulic
STATE OF CALIFORNIA
DEPARTMENT OF INDUSTRIAL RELATIONS
DIVISION OF OCCUPATIONAL SAFETY AND HEALTH
THIS TEMPORARY PERMIT MUST BE POSTED IN ELEVATOR CAR
' (01/98)
97 37013
ThyssenKrupp Elevator
ACCEPTANCE
Branch: Los Angeles
Job No.: 041- C
State No.: rQ
Serial Number. ' S- -p
On this day 2 d the undersigned has received the possession and use ofC
elevator(s), designated as elevator _ �7'J furnished and installed b-
ThyssenKrupp Elevator Corporation (rKE) in the building known a�6q QLI,02-
and located at
contact between
AKE, dated
pursuant to a
Recognizing this agreement will be relied upon by TKE in releasing custody and control of the
elevator, the undersigned, who is authorized to do so by his/her firm, hereby accepts the elevator
equipment noted above which has been fully inspected and examined by the undersigned, and
certifies that such equipment is satisfactory and in all respects in accordance with the terms and
conditions of said contract, and that the final contract price will be paid on time without back
charges, withholds or other offset to full payment.
This acceptance does not relieve either party of any remaining obligations or responsibilities to be
performed under said contract.
Free maintenance service and/or defective parts warranty included in said contract providing for a
later effective date for such service and/or warranty is hereby expressly amended so that service
and warranty commence from the date of this acceptance.
On Board Service Tool YES �O
Battery Lowering YES _ NO
HDPE Casing YES NO _
Vista Monitoring YES v NO _
KEYS ISSUED OTY. Company: � Utul(� CcN``�'ISJy�SCM,
Lock Outs - H 1848
Independent- H2395 Title:
Fan & Light - H2395
Fire Service - DH2389 -2o y Signature: A L:=14ti
Car Stop/run--H2M
Printed name
ThyssenKrupp Elevator
ACCEPTANCE
Branch: Los Angeles
Job No.: 041- C
State No.: / -
Serial Number. v
On this day - U l97 _ the undersigned has received the possession and use of
elevator(s), designated as elevator LLB furnished and installed by
ThyssenKrupp Elevator Corporation (TKE) in the building known as,/ f 7 /
and located aty'9 25-%�e'Wt ,P'1h't /P-e2c/x) 44, Califomia Dursuantto a
contact between
and TKE, dated
Recognizing this agreement will be relied upon by TKE in releasing custody and control of the
elevator, the undersigned, who is authorized to do so by his/her firm, hereby accepts the elevator
equipment noted above which has been fully inspected and examined by the undersigned, and
certifies that such equipment is satisfactory and in all respects in accordance with the terms and
conditions of said contract, and that the final contract price will be paid on time without back
charges, withholds or other offset to full payment.
This acceptance does not relieve either party of any remaining obligations or responsibilities to be
performed under said contract.
Free maintenance service and/or defective parts warranty included in said contract providing for a
later effective date for such service and/or warranty is hereby expressly amended so that service
and warranty commence from the date of this acceptance.
On Board Service Tool YES NO
Battery Lowering YES _ NO v
HDPE Casing YES NO _
Vista Monitoring YES / NO _
KEYS ISSUED
QTY.
Lock Outs - L206
Independent -1-203
Fan & Light - L203
Fire Service - L204
,2-
Car Stop/run- L208
-12_
Company: aRIM cw o
Th
Si
P
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: 77-933 Las Montanas Rd., N 201 Palm Desert, CA 92211-41 31 Ph. (760) 863-8886 (760) 86 3-70 72
Fire Department Clearance/Release
Date: f 5
To:
Fax:
Tract/Parcel Map #: W (a-01- 9p- IDS
Permit/Lot #: rI k1b 6 -Ft l a,
Job Site Address: i1 " `5Dune Pd jyh5
Q�
~� Final For Recordation
Release For Building Permit(s)
Shell Final Only (No Tenant)
C 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 P otection
Planning office for further assistance. I
Aut rizir(g Sign ure For Release
I �J�Ur- �6�L-
Print Name
Form C — Revised 8/27/2009
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: 77-933 Las Montanas Rd., of 201 Palm Desert, CA 92211.41 31 Ph. (760) 863-8886 (760) 863-7072
Fire Department Clearance/Release
Date:
To:Lj
Fax:
Tract/Parcel Map #: w (a-01 - IMP - 05
Permit/Lot #: rI ��(� 6 zt ga
Job Site Address: '11 R J LI l m e- P41kys
L. Q,
Final For Recordation
Release For Building Permit(s)
Shell Final Only (No Tenant)
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 R®rizl
ty Fire P otection
Planning office for further assistance.
ure For Release
Print Name
Form C — Revised 8;27/2009
CONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR ABOVEGROUND PIPING Factory
Additional copies of this form are Loss Prevention Publications - Training Resource Center Mutual
table to insured from:
av System
Factory Mutual Engineering and Research. 1 l 51 Boston -Providence Turnpike. P.O. Box 9102, Norwood MA 02062
.EDURE:
Upon completion of work, inspection and tests shall be made by the contractor's representative and witnessed by an owner's representative. All
defects shall be corrected and system left in service before contractor's personnel finally leave the job.
A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners and contractor.
It is understood the owner's representatives signature in no way prejudices any claim against the contractor for faulty material, poor workmanship,
or failure to comply with approving authority's re uirements or local ordinance
s.
PROPERTY NAME: La Quinta Dune Palms Neighborhood JOB# 07205 DATE: Julv 21, 2005
PROPERTY ADDRESS: 47795 Dune Palms Road, La Quinta, Ca
ACCEPTED BY APPROVING AUTHORITY'(S) NAMES: Riverside County Fire Dept. Indio/Palm Desert Office
ADDRESS: 77-933 Las Montanas Rd. #210
PLANS
INSTALLATION CONFORMS TO ACCEPTED PLANS I ES X NO
EQUIPMENT USED IS APPROVED (IF NO, STATE DEVIATIONS BELOW) FNO
YES X
HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION OF CONTROL AND
VALVES
INSTRUCTIONS
THE CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? YES X NO
IF NO, EXPLAIN:
HAVE COPIES OF APPROPRIATE INSTRUCTIONS AND CARE AND MAINTENANCE CHARTS BEEN LEFT ON YES X NO
PREMISES?
IF NO, EXPLAIN:
LOCATION OF
SUPPLIES BUILDINGS
SYSTEM
Building J 9200
S 'RINKLERS
MAKE
TYCO
MODEL
YEAR OF
MANUFACTURE
ORIFICE SIZE
QUANTITY
TEMPERATURE
RATING
Concealed
LF-11
2008
1/2"
169
1600
Pendent
TY-FRB
2008
1/2"
14
2000
PIPE & FITTINGS
PIPE CONFORMS TO NFPA #13 STANDARD YES X NO
FITTINGS CONFORM TO NFPA #13 STANDARD YES X NO
ALARM
ALARM DEVICE
MAXIMUM TIME TO OPERATE THROUGH TEST PIPE
VALVE OR
FLOW
INDICATOR
TYPE
WATERFLOW
SWITCH
MAKE
POTTER
MODEL
VSR-F
MIN.
0
SEC.
60
DRY VALVE
Q.O.D.
MAKE
MODEL
SERIAL NO.
MAKE
MODEL
SERIAL NO.
DRY PIPE
OPERATING
TEST
TIME TO TRIP
THRU TEST
PIPE
WATER
PRESSURE
AIR
PRESSURE
TRIP POINT
AIR PRESSURE
TIME WATER
REACHED OUT.
ALARM OPER-
ATED PROPERLY
MIN.
SEC.
PSI
PSI
PSI
MIN.
SEC.
MIN.
SEC.
WITHOUT
Q.O.D.
WITH
Q.O.D.
IF NO, EXPLAIN:
OPERATION
I PNEUMATIC
ELECTRIC
I HYDRAULIC
PIPING SUPERVISED
YES
NO
DETECTING MEDIA
SUPERVISED?
YES
NO
DELUGE AND
DOES THE VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CONTROL?
YES
NO
PREACTION
IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT FOR TESTING?
YES
NO
VALVES
IF NO, EXPLAIN:
DOES EACH CIRCUIT OPERATE
DOES EACH CIRCUIT
MAXIMUM TIME TO
MAKE MODEL
SUPERVISION LOSS ALARM?
OPERATE VALVE
RELEASE?
OPERATE RELEASE
YES
NO
YES
NO
MIN.
SEC.
HYDROSTATIC: HYDROSTATIC TESTS SHALL BE MADE AT NOT LESS THAN 200 PSI (13.6 BARS) ABOVE
STATIC PRESSURE IN EXCESS.OF 150 PSI (10.3 BARS) FOR TWO HOURS. DIFFERENTIAL DRY -
TEST
PIPE VALVE CLAPPERS SHALL BE LEFT OPEN DURING TEST TO PREVENT DAMAGE. ALL ABOVE -GROUND
PIPING LEAKAGE SHALL BE STOPPED.
DESCRIPTION
pNEUMATIC: ESTABLISH 40 PSI (2.7 BARS) AIR PRESSURE AND MEASURE DROP WHICH SHALL NOT
EXCEED 1-1/2 PSI (0.1 BARS) IN PRESSURE TANKS AT NORMAL WATER LEVEL AND AIR PRESSURE
AND MEASURE AIR PRESSURE DROP WHICH SHALL NOT EXCEED ]-1/2 PSI (0.1 BARS) IN 24 HRS.
ALL PIPING HYDROSTATICALLY TESTED AT 200 PSI FOR 2 HRS.
IF NO, STATE REASON:
DRY PIPING PNEUMATICALLY TESTED? YES NO
EQUIPMENT OPERATES PROPERLY? � YES NO
DRAIN READING OF GAGE LOCATED NEAR WATER SUPPLY TEST
RESIDUAL PRESSURE WITH VALVE IN
TESTS
PIPE.
TEST 200 PSI
TEST PIPE OPEN WIDE 200 PSI
UNDERGROUND MAINS AND LEAD-IN CONNECTIONS TO SYSTEM RISERS SHALL BE FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING.
VERIFIED BY COPY OF THE FORM # 85B? YES NO OTHER EXPLAIN
FLUSHED BY INSTALLER OF UNDERGROUND YES NO
SPRINKLER PIPING?
BLANK TESTING
NUMBER USED
LOCATIONS
NUMBER REMOVED
GASKETS
._
WELDED PIPING?
X YES
NO
IF YES...
DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING YES X NO
PROCEDURES
COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS DI0.9, LEVEL AR-3?
WELDING
DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED YES X NO
IN COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR-3?
DO YOU CERTIFY THAT )WELDING WAS CARRIED OUT IN COMPLIANCE WITH A YES X NO
DOCUMENTED QUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISCS ARE
RETRIEVED, THAT OPENINGS IN PIPING ARE SMOOTH, THAT SLAG AND OTHER
WELDING RESIDUE ARE REMOVED, AND THAT INTERNAL DIAMETERS OF PIPING
ARE NOT PENETRATED?
HYDRAULIC
NAMEPLATE PROVIDED? YES
X
NO
DATA NAMEPLATE
IF NO, EXPLAIN:
DATE LEFT IN SER1710E WITH ALL CONTROL VALVES OPEN:
REMARKS
NAME OF INSTALLING CONTRACTOR: CEN-CAL FIRE SYSTEMS, INC.
TESTS WITNESSED BY
FOR PROPERTY OWNER (Signed) TITLE DATE
SIGNATURES
In INSTA NT igned) TITLE DATE
o� L----
ADDITIONAL EXPLA ND E
URAYNER ENGINEERING STRUCTURAL ENGINEERING
I
December 12, 2008
City of La Quinta
Building Department
c/o Interactive Design Corp.
199 S. Civic Center Drive
Palm Springs, CA 92262
RE: Dune Palms Neighborhood
47-795 Dune Palms Road
La Quinta, CA 92253
Building Number:
9200
Building Official:
As the Engineer responsible for the Structural Design, I have performed visual structural observations of
the structural system in compliance with 2001 CBC, Section 1709.
To the best of my knowledge, the construction is in substantial conformance with the Approved Structural
Drawings and is approved to wrap.,
Thank you for your review of this written Statement.
Sincerely,
-�
George H. Grayner, S. E.
Grayner Engineering n(�
AID
rhw4 Rqy Eye
W N .1809 y� m
Exp. 9-30-09
9 rqUC
lFCF CA1.�F��
41105 Vintage Circle . Temecula, CA 92591
Telephone (951) 676-2529 . FAX (951) 699-3591
Certificate of Occupancy
T4t!t 4 o4P4uArw
Building & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 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: 47-795 DUNE PALMS ROAD (BUILDING #9100 - # 9400)
Use classification: GARAGE PLUS 68 DWELLING UNITS (MIXED USE)
Building Permit No.: 07-2694
Occupancy Group: S-3 / R-1 Type of Construction: I-FR / RES-1 Land Use Zone: CR
Owner of Building: COACHELLA VALLEY HOUSING COALI Address: 45-701 MONROE ST 1-G
Building Official
City, ST, ZIP: INDIO, CA 92201
By: STEVE TRAXEL
Date: December 10, 2009
IN A CONSPICUOUS PLACE