0312-178 (RC)78015 Main St Ste 103
0312-178
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
7718 8$ i13#2t
Date✓ Signature of
f 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 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 FU,611) Policy No. S44013S-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 the workers' compensation provisions of Section 3700 of the Labor
Code, I sh II torthwith comply with tho"se provisions.
dD'ate: ,Applicant7.,1,e
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 employe
2. Any permit issued as a result of this application becomes null and voi i
work is not commenced within 180 days from date of issuance of su
permit, or cessation of work for 180 days will subject permit to cancellati
I certify that I have read this application and state that the above information I
correct. I agree to comply with all City, and State laws relating to the buildi g
construction, and hereby authorize representatives of this City to enter up n
the above-mentioned propertyd or inspection pt rposes.
Signature (Owner/Agent'), v Date l
BUILDING PERMIT PERMIT# . .
0312478
DATE VALUATION LOT TRACT
121184,010,
JOB SITE
ADDRESS SLMR 103
APN
OWNER
CONTRACTOR/ DESIGNER/ ENGINEER
OLD TOWN LA QU1ANTA LLC
a MAS VIN HOMES
78-080 C A' LE F..STAI>0 V`E 201
LA Q1M. IA CA 92253
LA QTJ'S1+TLA CA 92253
-
(760)7-11-256-7 C x 0, 5407
USE OF PERMIT
C 01%4_MKRC'7AI,l t i G tSI?3
::C7ARMERCIA1, RFMODKI, (OLD TJ'WN JXW7,LRY" STORE TI) 476 S.F. 'M'
OCCUPANCY, T'YPEVN SP'RINKi.,M OCCUPANT WAD 15, 2001 CDC ;
TA1;Ci.A'I'IQTd US0,00 LS
ES-1`1R'iA 1%.Y) COST OF CONS TRUCM011T
EMUfff YIE K(TbVdARY
PLAN CFIIs'CK FEE 101.000.439•318 040,95
CONSTRUCTION FUrf: 101-000-418-000 $63.00 '
MECHANICALFEE 1010000.421.000 $19.50 .
EI,W.TR1C:A1., FFE 101 -WO -420-000
StTRONO ?MOTION YEE - COMM 100.000-241.000 flat
SUB-701PAL COX T 1111 *'°TIOIJ AbM PI_AT7 r_JXCK
$124.26
LMS PRE -PATO FHEI
$0,00
a DUK
w .119FA'l:.f i'E:RPi .T 1}F.ES .NCbw
DEC 18 2003.
CITY OF LA GiUiFA TA
FINANCE DEPT.
PT
DATE
BY t
DATE FINALLP
INSPE R
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
0 D
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 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 Nonce (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:
Tom Tisdale
Fire Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
Cities of:
Banning
Beaumont
Calimesa
Canyon Lake
Coachella
Desert Hot Springs
Indian Wells
.;
Indio
4.
Lake Elsinore
4.
La Quinta
4 -
Moreno Valley
4.
Palm Desert
-*e
Perris
.;
Rancho Mirage
San Jacinto
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
82-675 Highway 111, 2nd Fl., Indio, CA 92201 . (760) 863-8886 . Fax (760) 863-7072
February 12, 2004
John Stanford Architect
73-350 EI Paseo, Ste. 207
Palm Desert, CA 92260
Re: Non -Structural Building TA Plan Review
LAQ-04-TI-017 / Strings on Things
__78-065 Main St., Ste. 103
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 planAnspection 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) Install portable fire extinguishers per Title 19, but not less than 2A1 OBC in rating. Contact certified
extinguisher company for proper placement of equipment.
4) 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.
c City-of-La-Quinta = Bldg -Dept
R%PEZ%W7 DatsUA-o ihwe0.lEcrsmrA044-nAr7—da
Sincerely,
FRANK KAWASAKI
Chief Fire Department Planner
By ,
Walter Brandes
Fire Safety Specialist
EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE
82-675 Highway 111, 2nd FI., Indio, CA 92201 • (760) 863-8886 • Fax (760) 863-7072
uwt, ,,
a
Certificate of Occupancy
a
ot xP
INCO,PORATED
c of 9 Building y p & 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: 78-015 MAIN STREET, SUITE 103
Use classification: COMMERCIAL-MERCANTILE Building Permit No.: 0312-178
Occupancy Group: M Type of Construction: VN, SPRINKLED Land Use Zone: VC
Owner of Building: OLD TOWN LA QUINTA, LLC Address: 78-080 CALLE ESTADO, STE. 201
City, ST, ZIP: LA QUINTA, CA 92253
By: KIRK KIRKLAND
Date: March 11, 2004
Building Official
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