0106-408 (CSCS)M
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LICENSED CONTRACTOR 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 # Lic. Class Exp. Date
744091 B 12/31 /2(
Date. Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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 & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( ) I am exempt under Section , B&P.C. for this reason
Date Signature of Owner
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 & policy no. are:
Carrier STATE FUND Policy No. 229-02-0020714
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) 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: Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $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. v -
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
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 applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
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 State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
0106-408
DATE VALUATION $625,035.60 LOT 90 TRACT 28470-1
JOB SITE
ADDRESS 78-164 AVENUE 52
APN 770-190-001
OWNER
CONTRACTOR/DESIGNER/EN (NEER
CHAPMAN GOLF DEVELOPMENT
SUN VISTA DEVELOPMENT CORP.
78505 OLD AVE 52
PO BOX 1144
LAQUINTA CA 92253
LAQUINTA CA 92253
(760)771-4722 CBL4i 5393
USE OF PERMIT
COMIVIERCLkL
PALMER'S RESTAURANT (TYPEV-1HR, A-3); PERMIT INCLUDES
GREASEINTERCEPTOR
PORCH/PATIO 1,704,00 SF
SPRINKLER 9,777.00 SF
A/C -- COMMERCIAL 7,561.00 SF
CANOPY 1,120.00 SF
RESTAURANT (TYPEV-1HR) 7,561.00 SF
ESITMATED COST OF CONSTRUMON
625,035.60
PERAdIT FEE SUMMARY
CONSTRUCTION FEE 101-000-418-000 52,417.50
PLAN CHECK FEE 101-000-439-315 $2,155.46
FEE DEPOSIT 101-000-439-318 41,500,00
MECHANICAL FEE 101-000-421-000 $262.50
ELECTRICAL FEE 101.000-420.000 $248,72
PLUMBINO FEE 101-000-419-000 $568.00
STRONG MOTION FEE- COMM 100.000-241-000 $131,26
DEVELOPER IMPACT FEE $19,461.49
PRECISE PLAN 101-000-441-345 $100.00
ART IN PUBLIC PLACES - COMP 270-000-445-000 $3,125.18
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$28,470.11
LF,9S PRE -PAID FEES
-$1,500,00
TOTAL PERNIIT FEES DUE NOW
$26,970.11
111111111111111111111101 62
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RECEIPT
DATE
BY
DATE FINALED •
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- C
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
-oT jg:?�
Exhaust Fans
O. K. to Wrap
- Z a3
F.A.U.
Framing
_
30 Irla o
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
;ZZ - E
Heater Final
Water Piping
_
Plumbing Final
Plumbing Top Out
Equipment Enclosure
`Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
_
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Appliances
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
GAJ^ /00
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LA QUINTA
kFETY DEPARTMENT
►7-7012
N REQUEST LINE
i7 -7153.x._......_
LF DEVELOPMENT
SUN VISTA DEVELOPMENT CORI
Contractor 106-408
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST,.$,IGN ALL APPLICABLE SPACES
JOB ApRp NT (TYPE V-iHR, A-3);
PERMIT INCLUDES GREASE INTERCEPTOR
TYPE OF INSPECTION DATEJINSR
TEMPORARY POWER
SETBACKS —
U/G PLUMBING / WASTE -
U/G ELECTRICAL / GROUNDING
FOOTINGS
CONCRETE SLAB - 3
DO NOT POUR CONCRETE UNTIL A VE SIGNED
ROOF NAIL / PRE -ROOF
OKAY TO WRAP
FRAMING COMBINATION
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH MECHANICAL
COVER NO WORK UNTIL ABOVE SIGNED
INTERIOR GYP. BD. DRYWALL
EXTERIOR LATH
GAS TEST
SEPTIC ABANDONMENT
SEWER CONNECTION
SEPTIC / GREASE INTERCEPTOR
-
MASONRY INSPECTIONS
FOOTINGS / STEEL
BOND BEAM
POOL / SPA / WATER FEATURE INSPECTIONS
PRE-GUNITE / SETBACKS
f U/G PLUMBING
U/G GAS
U/G ELECTRICAL
PRE -PLASTER ALARMS / BARRIERS
FINAL INSPECTIONS
TEMP. USE OF PERMANENT POWER _
° ELECTRICAL U
PLUMBING
MECHANICAL
j PUBLIC WORKS DEPARTMENT
r: I COMMUNITY DEVELOP
FINAL / JOB COMPLETED 6� -
ABOVE APPROVALS DAWID41)
TURN ON UTILITIES OR OCCUPY G
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October 23, 2003
Via hand delivery
Mr. Greg Butler
CITY OF LA QUINTA- Building Department
78-495 Calle Tampico
La Quinta, CA 92253
Re: Arnold Palmer's Restaurant
Dear Greg,
.41
Upon issuance of the Final Certificate of. Occupancy, please correct name of building owner to
La Quinta Restaurant Group, LLC at Post Office Box 780, La Quinta, CA 92253. If you have
any questions or need additional information, please do not hesitate to call.
Sincerely,
Christina J. Capetz
for La Quinta Restaurant Group, LLC
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cc: Caroline. Schermer
POST OFFICE BOX 780 0 LA QUINTA, CALIFORNIA 92253 • (760) 771 -GOLF
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Certificate of Occupanqy
�oF9, _ Building'A 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: 78-164 AVENUE 52
Use classification: RESTAURANT Building Permit No.: 0106-408
Occupancy Group: A-3 Type of Construction: V-1 H Land Use Zone: VC
Owner of Building: CHAPMAN GOLF DEVELOPMENT Address: 78-505 OLD AVE 52
City, ST, ZIP: LA QUINTA CA 92253
By: KIRK KIRKLAND
" Date: 11-7-2003
-Building Official =
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POST IN A CONSPICUOUS PLACE
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