RC (0308-337)78010 Main St Ste 108 110
0308-337
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
Date f` * f. Signature of Cont r
1 f 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() I am.exempt under Section B&P.C. for this reason
Date Signature of Owner
_j
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 SYrATL a1jND Policy No. 1.440125.03
(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 thelworkers' compensationprovis ions of Section 3700 of the Labor
Code; -1 shalliorthwith comply with.those provisions./
Daie:. —2—,APPlicant 7 ?r" =•.
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void r
work is not commenced within 180 days from date of issuance of suc
permit, or cessation of work for 180 days will subject permit to cancellation11
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for Inspection pur ses.
gnature (Owner/Agent)f/= /. /"Date - °
19
PERMIT PERMIT#
-BUILDING
DATE VALUATION LOT- i TRACT
JOB SITE ry6' q • ,T rtty,■+y• * 3.
ADDRESS[ 1+i. At P3J'Ei I+Ii.i.C1 l1.1i
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
OLID T OWZ .U. QlfWTA 31,C
14PAVW H(MMES
11$-080 C.'•Aill mpDo M 201
78.080 CALITCE.TfADQ MTL 2Q1
L,A.Q-LJDviA C=x 9.2"m
LA ,urls TA CA 92253
Q-60)771-2567. C 1,31A 54M
USE OF PERMIT i
C010WERClA2, REMODR,
COMMMc IAL ` ZINAN TIMY OVEIVIZNT - 12$0 3Q.?1T. BCE CREAM H01" It
TORI STORE , ON12 OCCUPANCY TYPE CONSTRUCT 10 , 2001 C:BC:,
CONTRA.0 T AMOtPAjT 24,000.00 "LS
E4'Tl lED COST OF C ONSMUCrl0I4
24,t .00 ;.
¢013 TRUCTION FEE 101-000-418-000 $144.00
PLAN ti".H?CX FEE 10 1 -00C 439--318 $1.43.9
ME 103,-000.421-000
{aMEC:HANICAL
ELIC P1t1t;AL FEF 101-.000-420-100[}
1xWMR91C3 ME P- 1011.000-419.000 $97.30
S.TRCNO MOTION FUE, • COMM 100-000-24,1-t); $2.63 '
e`MB-MTAL C O'.WTr.KI 1t{71?T AND PLAN CHECK
$4.99.53
Z w +l;E-PAS? YEW$0.00
1p I'MAL PERA l VI MPS 1)(710. NOW
AUG 2 9 2003
OF "LA fa91t%TA .
CPQ
RE C - • —
DATE
By
D E FIN
IN TOR
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
OX to Wrap
F.A.U.
Framing
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-
Heater 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
Appliances
-
Final
.
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 Notice (Perm)
COMMENTS:
t l io3 fD. 1 RrCcorr.D tnnl"5 ro+5
C } G S Bo ►3 GoKPuE[e, j '
To: Greg Butler, Building & Safety Manager To CDD: 7-18-2003
From: Oscar Orci, Planning Manager Due date: 7-24-2003
Status: 1ST review
Building Plans Approval
(This is an approval to issue a Building Permit)
The Community Development Department has reviewed the Building Plans for
the following project:
Description: Old Town TRIce Cream Shoppe)-See Attached
Address or general location: 78-010 Main St. Suites 108 & 110
Applicant Contact: Wells Marvin 771-2567
The Community Development Department finds that:
...these Building Plans do not require Community Development
Department approval.
❑ ...these Building Plans are approved by the Community Development
Department.
...these Building Plans require corrections. Please forward a copy of the
attached corrections to the applicant. When the corrections are made
please return them to the Community Development Department for
review.
`pCr , -y (-h3
Oscar Orci, Planning Manager Date
Tom Tisdale
Fire Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
Cities of:
Banning
.;.
Beaumont
Calimesa
.;.
Canyon Lake
4.
Coachella
4 -
Desert Hot Springs
Indian Wells
:•
Indio
Lake Elsinore
4.
La Quinta
Moreno Valley
4 -
Palm Desert
4.
Perris
4 -
Rancho Mirage
4.
San Jacinto
4.
Temecula
Board of Supervisors
Bob Buster,
District 1
John Tavaglione,
District 2
Jim Venable,
District 3
Roy Wilson,
District 4
Marion Ashley
District 5
RIVERSIDE COUNTY FIRE DEPARTMENT
In cooperation with the
California Department of Forestry and Fire Protection
210 Westan Jacinto Avenue . Perris, Callfomia 92570 . • Fax (909) 940 -MIO
July 23, 2003
John Stanford, Architect
73-350 EI Paseo, Ste. 207
Palm Desert, CA 92260
Re: Non -Structural Building TA Plan Review
LAQ-03-TI-052 / 78-010 Main St., Ste. B108 & 110
Fire Department personnel have reviewed and approved the plans you submitted for the above
referenced project. Please be advised the following conditions apply as a part of the conditions for the
issuance of a building permit.
1) Fire sprinkler system plans for the tenant improvement area must be submitted to the Fire
Department for review, along with a plan/inspection fee. The approved plans, with Fire Department
Job card must be at the job site for all inspections.
2) Provide either a separate Knox Key Lock box, Model 4400, 3200 or 1300, mounted per
recommended standard of the Knox Company or provide key(s) for inclusion in the general building
Knox Box. If the building/facility is protected with a fire alarm system or burglar alarm system, the
lock boxes will require "tamper" monitoring. Special forms are available from this office for the
ordering of the Knox Box, this form must be authorized and signed by this office for the correctly
coded system to be purchased.
3) All egress doors shall comply with CBC Sec. 1003.3.1.8 for proper door hardware.
4) Install portable fire extinguishers per Title 19, but not less than 2A1 OBC in rating. Contact certified
extinguisher company for proper placement of equipment.
5) Approved building address shall be placed in such a position as to be plainly visible and legible from
the street and rear access if applicable. In multi -tenant buildings, businesses shall post the
business name and suite number on back doors as well as the front. Suite numbers or letters must
be a minimum of 6" in height. All addressing must be legible and of a contrasting color with the
background.
Please contact the Fire Department Planning & Engineering staff for final inspection prior to occupancy.
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 '" 0,1,
Walter Brandes
Fire Safety Specialist
Cc: La Quinta City— Building Dept.
HVEAGENERALWORM51BOng Plan Chea.dx
EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE
82-675 Highway 111, 2nd FI., Indio, CA 92201 • (760) 863.8886 • Fax (760) 863-7072
Area.# IV COUNTY OF RIVERSIDE COMMUNITY HEALTH AGENCY
DEPARTMENT OF ENVIRONMENTAL HEALTH
PLAN CORRECTION
Plan Check # NO3-052 Date 8/13/03
DBA Big Dipper Ice Cream Shoppe Address 78010 Main St Ste., 108, La Quinta .
Plans Submitted by John Stafford Phone (760)776-8477
Owner Address Phone
The plans are now approved subject to the conditions listed below and the attached compliance sheet.
1. All floor, wall and ceiling finishes in food service areas must be smooth and easily cleanable including
waitress and self service stations such as drink dispensers. Water proof (e.g. FRP) finishes to a height of
8' must be installed behind all wet areas such as 3 compartment sinks, mop sinks. The mop sink must be
a floor basin style.
2. All food and utensil sinks must be plumbed to floor sinks through approved air gaps.
3. The trash enclosure must be finished so that the interior floor and walls are smooth and easily
cleanable. Seal these interior surfaces with an approved two part epoxy.
4. All exterior and restroom doors must be self closing. Exterior doors must also be sealed against entry
by vermin.
5. The number of lockers provided should be equal, or greater than the number of workers assigned to a
peak shift
6. Finishes approved per letter received from.John Stanford AIA. All shelving must be of the Metro style
wire or plastic racks, wooden shelving is not acceptable for use.
7. Approval of this plan does not include approval by local land use, water or sewer agencies. Prior to
commencing construction or undertaking improvements, submit these plans to the Riverside County Land
Use Agency located at 82675 Hwy 111, Room 201 Indio CA 92201, phone (760) 863-7000. A facility may
not receive an Environmental Health Permit without this approval, which will be verified prior to the final
inspection.
8. A compliance guide is attached to this plan correction sheet. All construction not otherwise addressed
on this plan correction must be performed in accordance with the guidelines set forth therein.
CONSTRUCTION INSPECTIONS: Contact the Plan Checker for a Preliminary Inspection when construction
is approximately 80% complete, with plumbing, rough ventilation, and rough equipment installed. Request for'
inspection should be made at least five (5) working days in advance.
A FINAL INSPECTION MUST be made upon completion of ALL work including finished details. APPROVAL to
operate shall not be granted, or remodeled areas approved to operate, until the facility has passed the FINAL
INSPECTION, and "APPLICATION TO OPERATE" has been completed and PERMIT FEES have been paid.
Request for inspection should be made at least five (5) working days in advance.
PLANS CHECKED BY David E. Day Phone (760) 320-1048
I acknowledge the corrections noted herein and as indicated on the plans and agree to incorporate
them during construction:
Signatur
Comp' ny
Date g /
COUNTY OF RIVERSIDE COMMUNITY HEALTH AGENCY Decal # _
DEPARTMENT OF ENVIRONMENTAL HEALTH
District Environmental Services Division District #
P.O. Box 7600
Riverside, California 92513-7600 Facility #
Phone: (909) 358-5172
AN APPLICATION TO OPERATE A FOOD FACILITY
Riverside County Ordinance No. 4.52 and the California Health and Safety Code
THIS APPLICATION IS FOR: [ ) A NEW OPERATION [ ) RE -OPENING A CLOSED FACILITY
[ ] ANNUAL RENEWAL [ ] CHANGE OF OWNERSHIP
NAME OF. OWNER: SARA y1iA_U._1 DBA: W S11 r
ADDRESS OF DBA: CITY: LA C c ZIP 3
BILLING ADDRESS: `, ` O 10 ma CITY:_ LA (3 yt ,r1 c , e'o _ ZIPCI?-:
PREVIOUS NAME OF ESTABLISHMENT AT THIS LOCATION (IF ANY):
DATE YOU PLAN TO OPEN? %T" Feb 1% dV DID YOU OPERATE THIS BUSINESS LAST YEAR? I_
PLEASE BE ADVISED THAT FOOD WORKER CERTIFICATES ARE REQUIRED FOR EMPLOYEES OF FOOD ESTABLISHMENTS LOCATED IN
THE UNINCORPORATED AS WELL AS THE INCORPORATED (CRY) AREAS EXCEPT IN. THE CITY OF BLYTHE.
FOOD ESTABLISHMENTS
FOOD ESTABLISHMENT
LESS THAN 2,000 SQUARE FEET IN SIZE ..................................................
[vf$405.00
FOOD ESTABLISHMENT
BETWEEN 2,001 AND 5,999 SQUARE FEET IN SIZE .................................
[ ] $612.00
FOOD ESTABLISHMENT
6,000 SQUARE FEET OR MORE IN SIZE ....................................................
[ l $850.00
# if additional food operations
Each Additional Food Operation wfin Food Establishments ...........................
[ ] $112.00
FOOD ESTABLISHMENT
LESS THAN 200 SQ. FT_ IN SIZE, PREPACKAGED FOOD ONLY ..............
[ l $147.00
PRODUCESTAND
CATERER............................................................................
.........................................................................................................................
[ l $384.00
COMMISSARY..............................................................................
[ 1$267.00
CERTIFIEDFARMERS MARKET
........
[ .j $307.00
CHRISTMAS OPERATION
.........................................................................................................................
FROM NOVEMBER 26TH TO DECEMBER 31ST
[ l $277.00
NON-PROFIT SEASONAL SNACK
.........................................
BAR (OPEN LESS THAN 6 MONTHS PER YEAR) ......................................
[ j $ 71.00
[ 1$91.00
VENDING MACHINE .
P,.......
[ I NUMBER OF MACHINES: EACH
$ 46.00
..............
RESTRICTED FOOD SERVICES (SUCH AS "BED AND BREAKFAST OPERATIONS) WITH 20 ROOMS OR LESS
--
[ ] NUMBER OF ROOMS:
. $220.00
PLEASE SUBMIT A CHECK OR MONEY ORDER PAYABLE TO RIVERSIDE COUNTY
L DEPARTMENT OF ENVIRONMENTAL HEALTH WITH YOUR APPLICATION
AN ENVIRONMENTAL HEALTH PERMIT APPROVED BY A REPRESENTATIVE OF THIS DEPARTMENT IS REQUIRED BEFORE OPENING A NEW OR CLOSED FOOD
FAC(LRY_ 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 PERMfr. AN ADDITIONAL
PENALTY FEE OF 20% WILL BE REQUIRED. IF THE PERMIT IS NOT APPLIED FOR OR NOT RENEWED WITHIN SIXTY (60) DAYS OF THE DATE OF OPENING OR
THE OWIRATION DATE OF THE CURRENT PERMIT, AN ADDITIONAL PENALTY OF 100% WILL BE REQUIRED PERMITS ARE NOT REFUNDABLE OR TRANSFERABLE.
I HEREBY APPLY FOR A RECEIPT/PERMIT WITH APPROPRIATE FEES ATTACHED, TO OPERATE THE ABOVE FOOD ESTABLISHMENT, SNACK BAR BED &BREAKFAST
VENDING MACHINE COMMISSARY, CATERING OPERATION. PRODUCE STAND OR CHRISTMAS OPERATION IN THE COUNTY OF RIVERSIDE.
IDAATE. 2— i0' d1 OWNERIMANAGE2 7TH 0-14VSIGNATURE DRIVERS LICENSE
TELEPHONE(S): BtJs1NM-- ( ,Q
COUNTY USE ONLY
NOTES:
x
COUNTY OF RIVERSIDE COMMUNITY HEALTH AGENCY
DEPARTMENT OF ENVIRONMENTAL HEALTH
ENVIRONMENTAL HEALTH SERVICES
SUPPLEMENTAL REPORT TO SAN. FORM # hq DATE
SUBJECT
PERMIT NO.
ADDRESS . 1.;4
INSPECTOR /c
REMARKS: r ;; , !LO'i
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DEH -SAN -118 (Rev 8/02)
Distribution: WHITE—Office; CANARY ,Owner; PINK—Office
i
- COUNTY OF RIVERSIDE A 1586781
+ UNTP"M OFFICIAL RECEIPT
-/VERS D
Department 6d:5 Date Z /0 20
Received from 7 E,2 ta
L, 2Jl /,1/w,y DOLLARS
100
Description e.41ZA IACQ - /t (oZ %
4 7 op
Division
$ 7 OK`PAYOR COPY By
CHECK
`J
P
Certificate of Occupancy
Til !t oF 4 a".
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: 78-010 MAIN STREET SUITE 108
Use classification: COMMERCIAL
Occupancy Group: B
Owner of Building: MARVIN HOMES
Building Official
Building Permit No.: 0308-337
Type of Construction: VN Land Use Zone: VC
Address: 78-080 CALLE ESTADO STE 201
City, ST, ZIP: LA QUINTA CA 92253
By: KIRK KIRKLAND
Date: 2-11-04
POST IN A CONSPICUOUS PLACE
iENEI?AL CONTRAIL; I vrto m1mLol••. .
UBMIT A vONTRACTOR'S.LIST STFOROFINAL INSPECTION PER CITY
'OMPLIANCE PRIOR TO REQUE
)RDINANCE.
SANITARY FACILITIES (I.E. CHEMICAL TOIINSP CTION
PPROVED TEMPORARY SANIT TE PRIOR TO REQUEST FOR FIRST
.E ON THE CONSTRUCTION>- ODE, SECTION 5416.
TER -HEALTH AND
SHALL PROVIDE A TRASH BIN TO INSURE PROPS
;ONTRACTOR ADBOR DING MATERIALS .
;-LLEAN-UP OF A
S OR DEBRIS SHALL BE CONFINED ES MAY NOT BE
;TORAGE OF BUILDING MATERIAL CANT ON OF THE OWNER IS ON
=0R WHICH THE PERMIT IS ISSUED. ADJACENT VECANT PROPS
1LIZED FOR THIS PURPOSE PUBLIC RIGHT-OF-WAY SHALL BE MAINTAINED IN A
FILE WITH THIS OFFICE. ALL TIMES BL
CLEAR CONDITION
ADDRESS NUMERALS SHALL BE ILLUMINATED AS PER CITY ORDINANCE.
TOR TO THE ISSUANCE OF A BUILDING PERMIT.
SCHOOL TAX FEES MUST .BE PAID PR ST BE PAID PRIOR TO THE
TRAFFIC UNIFORM MITIGATION FHECIC WITUMFi T E DEPARTMENT OF PUBLIC
SSUANCE OF A BUILDROPRIATEIFEES.
WORKS FOR THE APP
PERMIT DOES. NOT AUTHORIZE THE ORALLATION
0. THE ISSUANCE OF A BUILDING PE ELECTRICAL, HEATING
OF MECHANICAL WORK, SUCH IRES A SEPIARATE PLUMBING, ELECTRICAL,
HEATING, OR REF WHICH REQUIRES
PERMIT.
HEATING, OR
"Approval of these plans by the County of Riverside Q ShffT A —
Department H£ aith, does not relieve thePI
Engineer or Architect of the responsibility for the Engineering
or Architectural design."
UCTURAL k-
1L
lNG, MIECHANICAL, AND..TR ELECTRICAL, PLUMB r f
tEPAIRS AND INSTALLATIONS SHALL BE DONE UNDER PERMIT ,
0
=ROM
G AND SAFETY
DEPT OF BUILDIN-NOTICE-
FOR PRELIMINARY AND FINAL INSPECTIONS
NOTIFY DEPARTMENT OF ENVIRONMENTAL
HEALTH
-
ro0) 320- roy S
A PERMIT t' ''1.'?TA.INFD FROM THE .
COUNTY OF RIVER:.::..
1:N',1iRCP MENTAL HE/
PRIOR -i,v ;Cvr'HNCY OR USE
THIS APPROVAL 0041ES NOT INCLUDE THE
SUBSURFACE SEPTI': SYSTEM, GREASE INTERCEPTOR,
OR OTHER WASTE DISPOSA !_ SYSTEM. OBTAIN
CLEARANCE FROM APPROPRIATE AGENCY
FOR YOUR WASTE DISPOSAL SYSTEM.
Permanent ar%rMn,c d soap and't"
dispensers a installed at
8.11 hand washing sinks.
CHEC 9R FOR A PRELIMINARY
CONTACT THE PLAN
INSPECTION WHEN CONSTRUC`I-ION IS AI'?iC;:iMATELY
80% COMPLETE. (BEFORE EQUIPMENT IS INSTALLED.)
W and cold running water through
a mixing faucet staall be provided
at all sinks.
-------- consult=
TENANT:
ROBERT SEDWARDS
50949 WASHING TON
LA QUINTA, CA.
- __ A r-nAC
ELECTRICAL ENGINEERING:
HEGG GELECTRIC
42240 RE N WAY
PALM DESERT, CA.
(760) 776-5560
v %0,,,1rr
s
H4' H5
FLOOR PLAN NOTED
COUNTY OF RIVERSIDE
COMMUNITY HEALTH AGENCY
DEPARTMENT OF ENVIRONMENTAL HEALTH
The propose,; construction/equipment
instillat;c-in is approved.
See attached correction she
Approved _ By
This approval does not authorize the v9
law, erdlnance, or other regulation, bfny
T
Al
I I HIS APPgo—g
COUNTY
DEPARTMENT OF
IS VALID FOR ONE (1) YEAR FFt
oma
NOTIFY THE PLAN CHECKER IN
OF. ANY CHANGES OR RLT.ERAR,
PL-"-N"S AS ORIG,7,
ALLY APPROVI,
(ie: flooring, wails, ceilings or equ
Call for iris e
P cfio,ns.. I
scheduled five ,' esocil; r' 3 s
(5) viork!ng days ir,