0308-111 (RC)78015 Main St Ste 105
0308-111
LICENSED CONTRACTOR DECLARATION
U) s 1 hereby affirm under penalty of perjury that I am licensed under provisions of
/F /- 1
.[;Chapter
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
v/- • i `
u , Professionals Code, and my License is in full force and effect.
O—= cO License # Lic. Class Exp. Date
LU t lits 11 /30l2C
tZ
j ,-
Z ate > Signature of Contractor' • K f - '
O
J U C:) OWNER -BUILDER DECLARATION
LU w rl- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ U) License Law for the following reason:
Z_ ( ) 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
LO
N Date Signature of Owner
p N
01
a Q WORKER'S.COMPENSATION DECLARATION
p cc I hereby affirm under penalty of perjury one of the following declarations:
0 () 1 have and will maintain a certificate of consent to self -insure for workers'
X W .LL compensation, as provided for by Section 3700 of the Labor Code, for the
m Q performance of the work for which this permit is issued.
Q U (yc), I have and will maintain workers' compensation insurance, as required by
p U Q Section.3700 of the Labor Code, for the performance of the work for which this
11 rn permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Carrier sTATE FUND Policy No. 1.440125-03
ao 5
CY
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
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 t o`se provisions.. r
ate: Applicant-
Warning: Failure to secure WorkersCompensation 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 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 inspe9tion purposes.
v ig (Owner/Qgent)l 1%s- wro Date -4, f
BUILDING PERMIT PERMIT#
-11
DATE VALUATION LOT'TRACT
G 8, `. $14,450.00
JOB SIE
APN
ADDRESS 7g_015 MAW .9 ' SCIT." If
OWNER
CONTRACTOR / DESIGNER / EN (NEER
OLD TCiW.1,1' .L A Qt31?J A, UX.
MARVW 110,WM
78.080 CALi2, R A1: O
73.080 CAUR:I` ..CAI. O SIT 201
LA C,1[311< IA CA 92253
T..!'1(UIN A CA. 9225.3
(760)-171.2567 C13L# 5407
USE OF PERMIT
COM7KM(:'WA RI<MO '7'. -L
COMMERCIAL f*J.ANTIMP.RCIVL►firll?!>4T:1DAYSPA, ''H'OC'CUPkNCYTYPE
STN CONSTRUCTIM 2001CBQ
VALUATION 14,450,00 LS
c
3±Et II1urrm COST 0T.I''CO NSTRUC110N
14,450.00
PERWf 7I TE S%1N[' AR Y
PLAN CF1b K FEE 101.000.439x518 $93.60
CONSTRUCTION FEE 1.01-000-418-000 $144.00
1'4Ef H"ICAL FEE 101.000.421 -OW $18.00 '
ELECTRICAL FER , 101-000-420-000 $38.00
PLUM111NO RE 101.000.419.000 $46,00
ST RONO MOTION FEE - COMM 100-000-241-000 $2.64
-TC9TAi.CC31 S'I iJO':i'ION.! PI..P 't:HECT
p q p LE33 I-R-pAID FEES
$342°29
koo
AUG 0 8 1003 PE_TM1r ' 6 DIS NONNY
04229
CITY OF LA QUINTA
FINANCE DEPT..
✓
RECEIPT
DATE
BY
INALE
INSPE R
I
-
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
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali 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 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:
.CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT_,
777-7012 -''-
INSPECTION REQUEST LINE
i 777-7153
AW613 IN CONSPICUOUS PLACE
)R MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS ° 78-015 MAIN ST. STE.405
COMMERCIAL TENANT IMPROVEMENT - DAY SPA, "E
OCCUPANCY TYPE VN CONSTRUCTION, 2001 CBC.
TYPE OF INSPECTION DATE INSPP,
TEMPORARY POWER
SETBACKS
U/G PLUMBING /WASTE -
U/G ELECTRICAL / GROUNDING
FOOTINGS / STEEL
CONCRETE SLAB
DO NOT POUR CONCRETE UNTIL ABOVE SIGNED
ROOF NAIL / PRE -ROOF
OKAY TO WRAP
T"MING COMBINATION
-JGH ELECTRIC
ROUGH PLUMBING
ROUGH MECHANICAL
INSULATION -d
COVER NO WORK UNTIL ABOVE SIGNED
EXTERIOR LATH
GAS TEST
SEWER CONNECTION
SEPTIC / GREASE INTERCEPTOR
MASONRY INSPECTIONS
FOOTINGS / STEEL
BOND BEAM
POOL / SPA / WATER FEATURE INSPECTIONS
PRE-GUNITE / SETBACKS
U/G PLUMBING
U/G dAS
U/G ELECTRICAL
PRE -PLASTER ALARMS / BARRIERS
FINAL INSPECTIONS
TEMP USE OF PERMANENT POWER - Ol
PLUMBING
M-'4ANICAL
R._ _ iC WORKS DEPARTMENT
COMMUNITY DEVELOPMENT DEPT.
FINAL / JOB COMPLETED
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
Tom Tisdale
Fire Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
Cities of:
Banning
c•
Beaumont
Calimesa
ee
Canyon Lake
d•
Coachella
g.
Desert Hot Springs
Indian Wells
ee
Indio
Lake Elsinore
c•
La Quinta
Moreno Valley
Palm Desert
c•
Perris
c•
Rancho Mirage
c•
San Jacinto
Temecula
Board of Supervisors
Bob Buster,
District 1
John Tavaglione,
District 2
Tim 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) 86348886 . Fax (760) 863-7072
March 29, 2004
John Stanford
73-350 EI Paseo, Ste. 207
Palm Desert, CA 92260
Re: Non -Structural Building TA Plan Review
LAQ-04-TI-050 / 78-065 Main St., #105
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.
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 mufti -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.
Cc:_City of La Quints — Bldg._D.ept
MPERYW DahLLa Q*ftWR0JECTSWAL4C &11-=.ddd
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
:0j,( U,wtfQ,cCertificate of Occupancyo
W
4
RA=
OBuilding & 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 105
Use classification: COMMERCIAL Building Permit No.: 0308-111
Occupancy Group: B Type of Construction: VN 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 dr
POST IN A CONSPICUOUS PLACE