9709-003 (CONR)LICENSED CONTRACTOR DECLARATION
kl',�
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 #rr Lic. Class Exp. Date t
1d'.lji!1k! 14, 4#/47
• '97 -�"• Date(? --I 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 Policy No.
CA". r�i. '�1i1'{i* v4:?) 711 J 197, f4 C'r'1 j
(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
workdrs' 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. aIL ort .i comply th t"ose`provls ons.
Date: { Applicant-'` "�-•
n -
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.
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. A
1. Each person upon whose behalf this application is made & each person at t
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 pro erty for insp .ction purposes. ^y
V ,�
VSignature (Owner/Agent) �+-- Date � 1�7
PERMIT # CONTROL #
BUILDING PERMIT ji7il.�iH�.t 5843
DATE VALUATION LOT LOT TRACT
4/1-7/9-7JOB
�.
SITE
ADDRESS 78-:541: 000tS i i �E 52
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
'iRl',t:►IT11 14 (_'i.kffi ASSt:K"IA'1,17rS i,I,C
3 T I'I AV] 10C, INC
r8505 AV E 57
41.1415 *11101RD ALK 1}2ii-4
17()()).'40 0,19'io C ?I,0 02 f
r
USE OF PERMIT
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ART tN 111+41.)+. ` M. A€'!i 4 - t '0N A 70 t -4100.1.5540) %6** t 40
ANO )l1,i1 N ( iizil'• ,
$5,741 A!
LIESS, PR E-11AID
1130
1� 199 T0I'AL 11E.14MIT +F.E. s 9aJ Ji, 4(la�Y
A.743_�tt
SEp -
I IIII II IIID III VIII IIII 06
Fu w�,�'���{-
IE
.��
RECEIPk
DATE
BY Ra.
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts.
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
—
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
- 2 -
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
O
Exterior Lath
- U �i
Drywall - Int. Lath
-_Y-
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
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
G
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
i.e c-
-C,Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Nbtice (Perm)
,S
t �
OF
/ Qu/ ,
Q
eve Rev
COUNTY OF RIVE SIDE A 114 8 0 8 3
`aUNt_Yih-
YEASIICTAL RECEIPT
l AI6��
Dep artment Date
Received from
DOLLARS
100
Des —
$ CASH
CHECK PAYOR COPY
s
Y OF RIVERSI6EITALTH SERVICES .YaENCY
DEPARTMENT OF ENVIRONMENTAL HEALTH
District Environmental Services Division
P.O. Box 7600
Riverside, CA 92513.7600
PHONE: (909) 358-5172
Decal #
District#
Computer#
Facility #
AN APPLICATION TO OPERATE A RETAIL FOOD, FACILITY
Riverside County Ordinance No. 640.3 and the Cailfornia Health and Safety Code
THIS APPLICATION IS FOR: >41 A NEW OPERATION
[ ) ANNUAL RENEWAL
( J RE -OPENING A CLOSED FACILITY
(' J CHANGE OF OWNERSHIP
NAME OF OWNER: S I E/VAI A \^J CS 7- NAME OF BUSINESS: p
ADDRESS OF .BUSINESS:_] 9-505 o.6 AVS � CITY: L.g aLtIA17� ZIP: /,1a.53
NAME AND LOCATION OF TEMPORARY OR OCCASIONAL EVENT: M
BILLING ADDRESS: SAH CITY: ZIP:
PREVIOUS NAME OF ESTABLISHMENT AT THIS LOCATION (IF ANY): /UO �JE-
DATE YOU PLAN TO OPEN? iI - q �$DID YOU OPERATE THIS BUSINESS LAST YEAR? 'VO*
* PLEASE BE ADVISED THAT FOOD HANDLER CARDS ARE REQUIRED FOR EMPLOYEES' OF. FOOD ESTABLISHMENTS LOCATED IN THE
-UNINCORPORATED AS WELL AS THE INCORPORATED (CITY) AREAS.
* FOOD ESTABLISHMENTS
FOOD ESTABLISHMENT ( J LESS THAN 2,000 SQUARE FEET IN SIZE ........................................................... :.............. ..
.........
$326 •
FOOD ESTABLISHMENT ( J BETWEEN 2,001 AND 5,999 SQUARE FEET IN SIZE ..... :.............. .....:
$492.00
FOOD ESTABLISHMENT ( J 6,000 SQUARE FEET OR MORE IN SIZE......:...:..............................:................................................$642.00
FOOD ESTABLISHMENT (.:) LESS THAN 200 SQ FT 1N SIZE, PREPACKAGED FOOD ONLYr..................................................
$118.00
PRODUCESTAND( 1 ................................ .................................................................................................._.............
....... ......
$309.00
CATERER( j ........................................................... ........................... ................... ........................................................ ..:
$215.00
COMMISSARY[ )................................ .............................................................................................................................
$247.00
CERTIFIEDFARMERS MARKET [ J.............................................................................................:..............................................................
$223.00
CHRISTMAS OPERATION ( j FROM NOVEMBER 26th TO DECEMBER 31st .................... ,$
..........................................................
57,00
TEMPORARY FOOD FACILITY (VALID FOR ONE EVENT OF LESS THAN 25 DAYS) ' [ )........................ ............................. ................ a......................
$ 99.00
OCCASIO AAL EVENT (VALID FOR ONE EVENT OF 3 DAYS OR LESS) ( ).................................. I ......... ,............. ......... ............. ... .............................
$.49.00'
STATIONARY MOBILE FOOD PREPARATION LINIT (VALID ONE EVENT LESS THAN 25 DAYS) [ )....:.................................................................
$124.00
NON-PROFIT SEASONAL SNACK BAR (OPEN LESS THAN 6 MONTHS PER YEAR) [ J
$ 65,00
VENDINGI MA CHIN [ 1. NUMBER OF MACHINES: .........................................................................................:.................... EACH
$ 37.00
FOOD VEHICLE ICE CREAM ( J CATERING [ J BAKERY ( J CART I ).................................................................:.........................
$186.00
LICENSE NO. YEAR: MAKE:
PROD 1 .E VEHICLE ( ).....................................:........................................................................................ ............... .......................................................
$112.00
LICENSE NO. YEAR: MAKE:
UNPA . A D FOOD •ART ( j LICENSE NO. YEAR: TYPE: ..............
$262.00
PLEASE SUBMIT A CHECK OR MONEY ORDER PAYABLE TO RIVERSIDE COUNTY
DEPARTMENT OF ENVIRONMENTAL. HEALTH WITH YOUR APPLICATION
*AN ENVIRONMENTAL HEALTH PERMIT SIGNED BY A REPRESENTATIVE OF THIS DEPARTMENT IS REQUIRED BEFORE OPENING A NEW OR CLOSED FOOD
FACILITY. YOU ARE NOT AUTHORIZED TO OPERATE UNTIL ALL APPROVALS HAVE BEEN OBTAINED. IN THE EVENT THE PERMIT IS NOT APPLIED FOR OR
NOT RENEWED WITHIN THIRTY (30) DAYS OF THE DATE OF THE OPENING OF THE FOOD FACILITY OR THE EXPIRATION DATE OF THE PERMIT, AN ADDITIONAL
PENALTY FEE OF 20% WILL BE REQUIRED. IF THE PERMIT IS NOT APPLIED FOR OR NOT RENEWED WITHIN NINETY (90) DAYS OF THE DATE OF OPENING
OR THE EXPIRATION DATE OF THE CURRENT PERMIT, AN ADDITIONAL PENALTY OF 100% WILL BE REQUIRED.
I HEREBY APPLY FOR A RECEIPT/PERMIT, WITH APPROPRIATE FEES ATTACHED, TO OPERATE THE ABOVE FOOD ESTABLISHMENT, TEMPORARY FOOD.
FACILITY, VEHICLE, VENDING MACHINE, COMMISSARY, CATERER, AND PRODUCE VEHICLE IN THE COUNTY OF RIVERSIDE.
DATE: .OWNER:
SIGNATURE DRIVER LICENSE
DATE: OWNER:
SIGNATURE DRIVER LICENSE
TELEPHONE(S): BUSINESS... -16 0 - %y -$ -7 L�3 HOME
q
DEH -SAN -008B (Rev 8/95)
NOV- 9-98 MON 4:42 PM RIV. CO. FIRE P&E INDIO FAX NO. 1 760 863 7072 P I
James M. Wright
Fire Chief
Proudly serving the
unkoorpWaW
areas of Rhw side
County and the
Cities of.,
Banning
4
Beaumont
Catimesa
4
C rayon Lake
O
Coachella
O
Desert Hot Spring6
O
Indian Wells
O
Indio
0
Lake Elsinore
O
La Oulyda
s
Moreno Valley
O
Palm Desert
4
Perris
O
Rancho Wrap
•
San Jacinto
O
Temecula
awrd of supsrvrsors
Sop Buster,
bistrid 1
John Tavaggom,
DhMd 2
Jim van"le,
DIs1rld 3
Roy Wdwn,
District 4
Tom VAftn,
Oistrid 5
RIVERSIDE COUNTY FIRE DEPARTMENT
In cooperation with the
California Department of Forestry and Fire Protection
210 West San Jadrto Avenue • Perris, Catlfamla 9270 • (MD) 9406900 & FAX (909) 940`8910
November 5, 1998
City of La Quinta
Building Department
Re: Fire and Life Safety Clearance
The Riverside County Fire Department is granting a fire and life safety clearance for the group
B occupancy known as the Traditions Half Way House located at Traditions Country Club.
release ktwpd
Respectfully,
RAY REGIS
Chief Fire Department Planner
Walter Brandes
Fire Safety Specialist
Post -it" brand fax transmittal memo 7671
9 of pages ►
From `
Co. _
Co.
Dept.
Phone #
Fax u -7-)7 _
EMERGENCY SERVIM DIVISION ♦ PLANNING SECTION O INDIO OFFICE
82-675 f%hway 111, 2n4 FI., rndb, CA 92201 O (7fi0) a69 -SM 4 F= (700) 863.7072
James M. Wright
Fire Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
cities of:
Beaumont
0
Calimesa
0
Canyon Lake
0
Coachella
0
Desert Hot Springs
O
Indian Wells
Indio
0
Lake Elsinore
O
La Quinta
4
Moreno Valley
0
Palm Desert
0
Perris
O
Rancho Mirage
0
San Jacinto
0
Temecula
Board of Supervisors'.
Bob Buster,
District 1
John Tavaglione,
District 2
Jim Venable,
District 3
Roy Wilson,
District 4
Tom Mullen,
District 5
RIVERSIDE COUNTY FIRE DEPARTMENT
In cooperation with the
California Department of Forestry and Fire Protection
210 West San Jacinto Avenue • Perris, California 92570 *(909)940-6900 * FAX (909) 940-6910
October 15, 1998
To: Fireline
37-921 Porter Dr
Cathedral City, Ca 92234
Re: Hood/Duct Suppression System
Traditions Halfway House - SDP 96-599
The hood/duct plans you submitted for the above referenced project have been reviewed by Riverside
County Fire Department and are approved with the following conditions:
1) Operation instructions must be posted in a visible location.
2) A 4013C extinguisher must be mounted in the kitchen area.
The following inspections/tests are required to be witnessed by the Fire Department:
1. Final
a. System operation check-out and final to be performed by the installer.
The Fire Department Job Card, approved plans and conditions letter must be at the job site or NO
inspection will be performed.
Applicantrinstaller shall be responsible to contact the Fire Department to schedule. inspections. A
reinspection fee will be required to be paid if additional inspections are necessary.
Requests for inspections are to be made at least 24 hours in advance and may be arranged by calling
(760) 863-8886.
All questions regarding the meaning of these conditions should be referred to the Fire Department
Planning & Engineering staff at (760) 863-8886.
Sincerely,
FRANK KAWASAKI
Chief Fire Department Planner
By
Walter Brandes
Fire Safety Specialist
EMERGENCY SERVICES DIVISION o PLANNING SECTION o INDIO OFFICE
46-209 Oasis St., 2nd FI., Indio, CA 92201 ® (760) 863-8886 & Fax (760) 863-7072
FIRE PROTECTION
JOB CARD
THIS INSPECTION RECORD MUST BE
AT JOB SITE WITH AN APPROVED
2 SET OF PLANS
0
Owner
No.
Sprinkler Company
Date
(Issued)
Underground Static Date Inspector
Overhead Static Date Inspector
Flush Date Inspector
' Final Date Inspector
Fire Main Installer
Underground Static Date Inspector
Final Date Inspector
Hood/Duct Installer �4� —
Final Date Inspector
Alarm Installer
Final
Tank Installer
Final
Z.--� — — — - - — - 7��
Date Inspector
Date Inspector
Tank Installer
Final Date Inspector
INAL for OCCUPANCY
Inspector
Date
DO NOT OCCUPY THIS STRUCTURE UNTIL
264.159(4=) AFTER FINAL INSPECTION.
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
pos r ///V, G
DO NOT POUR CCFNCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE .
SEWER SEPTIC TANK
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
Piping ; Block Iron 3/8 Inch.
Schedule 40
Link e 450 Deg.
Hood 12'x4"
Plenum 12' Single Bank
Salamander
Range
36'x24'
Radiant
Charbroiler
32'x22'
Griddle
36'x24'
Fryer
14'xl4'
Duct Nozzles #ADP -2
Plenum Nozzles #ADP -2
Salamander Nozzle #ADP -1
Range Nozzles #Rl-2
Charbroiler Nozzles #GRW-1-2
Griddle Nozzle #ADP -1
Fryer Nozzle #F-2-1
The above system to be
System Type ; Range Guard
4 Gallon.
Installation address
installed in accordance
Total Flow Points Possible -----------12
with NEPA pamphlet 96
Total Flow Points Used --------------12
Traditlon Half way House
and 17A 2-5.24.
Duct --------------------------------2
78505 Ave. 52
IF building is alarmed
Plenum ------------------------------2
La Quinta, CA.
extinguishing system shall
Appliances ---------------------------8
be connected to alarm,
Total -------------------------------12
Bottle Site
Remote Pull
Gos Valve \ 5 High
` O n
Kitchen Areo
COUNTvi. ,� UP IVES'S'ODE
N ENT 0i
Subject cond"Uoris SEE ATTACHED LETTER
Ede Tive, f 5 s
Wireline
37921 Porter Dr. -
CathIedral. City, CA
.
Phone :.324-36'43
C-16� 611628
I
Certificate of Occupancy
City of La Quinta.
Building and Safety Department
This Certificate issued pursuant to the requirements of Section. 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS:
Use Classification: COMMERCIAL
Occupancy Group:
78 -505 -AVENUE 52 (HALFWAY HOUSE).
B Type of Construction: VN
Owner of Building:. TRADITION CLUB ASSOC LLC
.. --7;;;,
Building Official
Bldg. Permit No.: 9709-003
Land Use Zone: COMMERCIAL
Address: 78-505 AVE 52
City: LA QUINTA, CA., 92253
By: DANIEL P. CRAWFORD JR.
Date: 11/9/9 8 (30 DAY TEMPORARY USE)
POST IN A CONSPICUOUS PLACE