0403-041 (PLBG)78015 Main St Ste 107
0403-041
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
12
D to eSignature of Contracto'r, !%"` f/rte <
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.
Q); 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:
Cartier STATE FUND Policy No. 1440'12S•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 df the Labor
Code, I_shall forthwith comply with th'dse provisions,"
,Date: " ? frrG Applicant 7% ` /; ' ;•C= <, ' •,""y
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 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 propertyafor inspect>urposes.
Signature (Owner/Agent) i Date
PERMIT#
BUILDING PERMIT
DATE ,. xiMALUATIOU LOT ' d TRACT
,
JOB SITE -
APN
ADDRESS 7B-015 AAIN eS M' SUITII. 10
-
OWNER -
CONTRACTOR / DESIGNER / ENGINEER
OLD TOW LA QUDTiiG, .C.,d Z
MXR-SYN T.?OLM
78.080 CAJ LE IMAI)0. i7S/.n 2 02
78.081 C&T.. I,'E; TAPO UYU, 2011
LA QUINTA, CA 92253
LA QUINTA CA 9.",25'3
('763)771-2567 C-BIA 5407
"
USE OF PERMIT
PLUN4 LI. O
iNSO I'ALI.ATION OF 900 0A1,1,ON OIE"aE I14 T,EIRCisP TOR AT SUITZ 1 PER
AL
PLAN Wt4D HEALTH DEPT APPROVAL
VAt. UA 1014 1,500.00 IS
ESTWAIXED COWT Or OONYMUCTION
I ISM.00
ARY
PLUNIDING YET -11 101-000-419.000 S27,00
D a
fl N .ca,' 1'L3 .ixf A25 CI CK
$27.00
P- P,M 1+10.1.3
$0.00
MARUss
,, 6 2004
J O :1?; 1t F£I : '3 Y)UP, O r
CITY OF LA QUINTA
FINANCE DEPT.
«27,00
,RECEIPT
DATEBY
DATE FINALED
INSPECTOR
'/ r
ZL
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 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 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
Fodures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
SGPAARCHIRKTURE r PLANNING
TRANSMITTAL
DATE January 22, 2003
TO Mr. Brian Monroe
Marvin Investments, Inc.
78-080 Calle Estado, Suite 201
La Quinta, CA 92253
FROM Michael Cather
VIA Fax: (760) 771-5057
PROJECT Old Town La Quinta
La Quinta, California
SAN DIEGO ■ SAN FRANCISCO
PROJECT NO 20210-D-01
DESCRIPTION
Enclosed please find proposed grease interceptor schedule for buildings A, B & C
COPY TO File
F:\7002\20210\D01 \CorrXmi\Client\B,io.Monroo.vrN.dnc
1545 Hotel Circle South, Studio 200, Son Diego, Caiifomia 92108 David Reinker, AIA. President 619.297.0131 (p) 619.294.9534 (i) www.s3Pa.com
gar -30-03 09:26am From -WATER DISTRICT/COANEUA VALLEY +7603983111 T-013 P.02/03 F-428
)UN'fY OF RIVERS(GE COMMUNITY H&ALTH AGENCY
PARTAJENT OF ENVIRONNENTAL HEALTH
1 :^'-vPLICAYIOH FOR WASTE WATER DISPOSAL APPROVAL
'PLICAN-e S40nt-t this fear rho fur oaptaa or 0 SGAuto pot plan (I' w W "-w SCALEI dna-n to CeuPtY LPeGLCatlCru As ald""'d .A 'me attaCN!U
Cch 49: A non -rel. Wabl►. filin ise is reQ.:bea NAan rA apphCaton a avbnldr.d. Chec% must be maa payatle :a the CowtW of R•,versidg. ApOtGeau Of ilia
.Id'.ryti0. .nh.n rammn .old far 6 bend flit to exceed one yaw :Som 44116 'A Daymont
ds it___ -- - ■ S"J
lgenl ^C,an Amlor. Contact Ptroon AOoeeaa ----
vmar g0urass ,^rile SWtG
)04 Property AaErt= C A
(.ot Sae I WDW Agem0wal U13 of Pefmll. PIP, SUP. PUP. ate, I Legal CraCripGon
UA'alnft. MH Sae MO.. e:t. I /
' Stpnaluf4 o`ApptiC7n .- Del
FOR OFFICE U36 CNltr
CVECK BOX 1F Ftf(JU11 )
It any box is dhadwa, Ws eyphcafAA"be ooraldeKa mi"Ad wW rw O Oilaii.a Contour plot Plans R04YYed tt m S toot irnervy)
1 mlCr•'M:Wns . provided and the paid. ROs.btMW+c later thmA 90 Gays
ne
7r Ut! noleO oelOw rear mgvlt'. repayment Of 10.1 IJ Clow
rj HoiOrnp 7Jnk A9rcanta.;tt Cornpbad (]
SW specloost tat In.pechott AOGurreq
a cemaw a e"nS 9.41. %stem Ragturod T11Ontaz 13roe. Page rind
Imdats
L Q ubOCE L%lestanea tA.quilad C) DatO Lau InsD.sc4on COtrtD4tWd:—
r (Attach for 00WSAN-W7. 3anU MO Reylon Clio) .
R...
:3 SOtb PMcOIstiOn Report R.gla0d 0 ltlainterwice GOOnlcq Pfovlfltd
(7 SPde d F4aa10,0V Boring n.pdA Raavded I , Final Insp$Gum by Depa asst el erwommmial Noah i0 laavifea,
J iBrswrw Redvhed hitial0 _Da:e I + Plasa ra ll Za hours FRIOR to mWeewB.
'-wI r Sas percMaaon alm" Roper. ey lic/PropM a nes
Soto Map Pap. - -- - —.Svi SYS - dprOVCd BY taw —
c i No. of Systems 96 of 9ystarNS) No. owe'Dlg Unna HZZ
an Rate GroeaNfend
Cuoole IntepiLnl Tqp
O Netdmp Tank O lt+pl0.aateM BectCOrr;. FixWfO tJnib
U now D AaetdoS — t 'cat.C) iE"Unp ConnaCt Co Sewer59. ft. 'teal Llnear 9WwarNltwrfrtoe oath Bed 10 hracw eq. A. ronNB .IL lonex tt of 60ltlMtAr1m1µ Tooted Depm -_L7 achesrockbelowor*r&ws
prw*ed 1"WA Tvstsd Depth
17_ I Laacn t{necrbad cvecif dtselgn Iar.Inpol (9) Pit 0tom iter Not Pols Pit Oaav IMet (Bt) ftepa90 Ptl Mffflf "Intl
Tate' Depth AOovraow .. .... .. .. ...... ... _.. ..._ ... ... .
FADOaicOb.a I DOOM
Ll wP't _Cvofburden F&C W O d'
t Deb: 'Woo ani" Parinits
Well Rc!LwwA0PM8G:
Gr&M9 Plan ADp:wed. gets; — ;✓'
Plan Gn.cr. poly pppr. ca: Data:
REMMKS:
A Q , S.. ✓ 1.y ai .`
t Q o U !
1 Tnis agcncat;on b APPROVE 1DERI60 tOr tate calopory ateckod in
516CT'ION 0 9.zAaAP&Ma tsosl9n nl a dtp su:.yarOm as L:eleatsd ---'~
411 Me accanvAniad Ola par.. velry rhe re<.tuu"n"'M ;et 'CM en SECTION Fant ti ) RI =
C abdve. A b'-AIA09 perrNt K aet`atlary for the iMtaAaven of Inc ab Ova- Revenue COCK - -
easSSfea .rnartl. fls? sa Rtai . o tut d I we a gVkcj.3jjOWA
%of ' a■ .t+ten Check i1 _
(t) Sepw tank roust be 100' min mum Oam eny wags.
Q t;) taactt tinitC muni to 100' mlFlmum tr01 any wana. 'nawsnnp atpanblon Dab
—Initial
17, bewar Hoes m"m to 50' moll"Urn AOT on %"06.
'WI' muton RIVERVOL: 909-2was0C
(e) Saepe90 Pas rrarel to t!0' rrminwm ttJm ani vWtO. vrtuitnS ap
Otto'INtJ10: 76o-863-7000 I
sotfTHWEST: 909.600.8180
d
142,
(S
P+.'A
OLD TOWN LA QUINTA
GREASE INTERCEPTOR SCHEDULE
BUILDING A
January 22, 2003
Suite
Square
Number
I Waste
Waste
(Interceptor
No.
Footage
Interceptor
No.
Footage
of meal
X
Flow
X
Retention
X
Storage
= size
I (Liquid I
per
peak
Ratio
Time
capacity)
Factor
: (Liquid
hour
2,162
1,189
1,458
3,026
peak
X
X
X
X
6
b
6
6
B-100
1,899
30
1 X 1 6
acity)
X 2
= 900
hour
905
1 50
1 X 16
X 1 2.5
X 1
= 750
411'02
A-100
3,089
40
X
6
X
2.5
X
2
=0
A-109
1,199
60
X
6
X
2.5
X
1
= 900
A-111
1,225
40
X
6
X
2.5
X
2
= 1200
BUILDING B
Suite
Square
Number
I Waste
Waste
(Interceptor
No.
Footage
of meal
X Flow
X Retention
X Storage I
= size
Flow
Ratio
X
per
RatioTime
Storage
Factor(Liquid
L
Factor i
I (Liquid I
hour
peak
capacity)
hour
2,162
1,189
1,458
3,026
35
60
40
100
X
X
X
X
6
b
6
6
B-100
1,899
30
1 X 1 6
X 2.5
X 2
= 900
B-102
905
1 50
1 X 16
X 1 2.5
X 1
= 750
BUILDING C
Suite
Square
Number
Waste
i
i
InterceptorNo.
Footage
of meal
peak
X
Flow
Ratio
X
Retention
Time
X
Storage
Factor(Liquid
L
sizeper
capacity)
hour
C-100
C-102
C-104
C-200
2,162
1,189
1,458
3,026
35
60
40
100
X
X
X
X
6
b
6
6
X
X
X
X
2.5
2.5 i
1 2.5
1 2.5
X
X
X
X
2 1=
1
2 1=_I
2 j=
j 1050
= 900,
1200
3000
SEE ,07E 3
I ---E
FlTTW SEAL
SEE SPEC SHEET-
UO- S -25D
NLf T —
C
A
INLET
SEE NOTE 2
ALru
001 DOM WATER RESISIAIT
E AND COVER
NOTES-.
I. REFER TO SPECIFICAnONS SHEET NO S-242
2. REFER TO SPECIFICATIONS SHEET NO S-257
ourtE A 3. REFER TO SPECIFICAPONS'SHEET NO. 5-251
OUTLET
B
1I VAFL48LE TO
1 I QWE B4
6" QICREHO415
I
1 I
3 1/4- TYPICAL
n END h SIDE
WALLS
RECESS
4 3/4' TYPICAL
TND h S OE
WALLS I
OUTLET sl-
SECTION - q- A END VI II
GREASE IN7ERCEPTOR ' Ih11H SAMPLE` BOX
TWO MANHOLES EXTENLED TO GRADE
DESIGNED FOR DIRECT H-20 LOADING:
OF MANHOLE EXTENSIONS
750 THRU 1500 GALLONS
EXCAVATION SPECIFICATIONS
ALL
OHMENSIONS IN
INCHES
G-1500
I.FF4CT14 12'-0"
12'-O"
WODEL
A B
C
0
E
F
G
H
PC C-750
40 38
55
74
74
19 3/4
4 1/2
31 1/2
PC G -MD
50 418
63
74
74
24 3/4
4 1/2
41 1/2
PC G-1200
59 57
74
74
74
29 1/4
4 1/2
50 1/2
PC G-IJL)D
Lit 1/2 60 I/2 77 1/2
85
1 85
30 3/4
5
53 1/2
NOTES-.
I. REFER TO SPECIFICAnONS SHEET NO S-242
2. REFER TO SPECIFICATIONS SHEET NO S-257
ourtE A 3. REFER TO SPECIFICAPONS'SHEET NO. 5-251
OUTLET
B
1I VAFL48LE TO
1 I QWE B4
6" QICREHO415
I
1 I
3 1/4- TYPICAL
n END h SIDE
WALLS
RECESS
4 3/4' TYPICAL
TND h S OE
WALLS I
OUTLET sl-
SECTION - q- A END VI II
GREASE IN7ERCEPTOR ' Ih11H SAMPLE` BOX
TWO MANHOLES EXTENLED TO GRADE
DESIGNED FOR DIRECT H-20 LOADING:
OF MANHOLE EXTENSIONS
750 THRU 1500 GALLONS
EXCAVATION SPECIFICATIONS
MODEL C-750
G-1001)
G--1200
G-1500
I.FF4CT14 12'-0"
12'-O"
12'-0"
12'-O"
WIDTH 8'-0"
BELOW INLET 3'-4"
4'-2"
4'-1t"
5'-2 1/2"
TANK HEIGHT 4'-7"
5'-5'
6'-2"
6'-5 1/2-
P.O. BOX 6D2
HIGHLAND. CA 92346
909 793-7602 800 945-8265
Fox: 909 793-1283 _
1-01 I IS. BRAKE t I t' = 1' 1 8044
1 i.v', i vivnL
r-1Nk,AJLMLN I t -r -m UVWU UWG S-46
10 -FEET EACH
WAY
OF PROP. WATER MAIN
-ONSTR XT
V'
SDR
35 VENT LINE
-ONSTRUCT
8"
SDR
35 SEWER MAIN
-ONSTRUCT
48" SEWER
MANHOLE PER CVWD DWG S-5
CONSTRUCT
8"
X 6"
PVC WYE
--ONSTRUCT
8"
X 6"
PVC REDUCER
;ONSTRUCT
6"
X 90'
PVC BEND
IMPROVEMENTS PLANS.
v -
° r /mac%
PROP. 6 -
LATERAL .. _.._.......,_.. .. _
/ FUTURE \
BLDG. ®D°
FF -42.50 2 TCO 41.90
PE -42.00 CO INV 34.01 \
C
PROP. BLDG. •C
FF -42.80
PE -42.30
5 5=
i
I
o
.
1
IMPROVEMENTS PLANS.
v -
° r /mac%
PROP. 6 -
LATERAL .. _.._.......,_.. .. _
/ FUTURE \
BLDG. ®D°
FF -42.50 2 TCO 41.90
PE -42.00 CO INV 34.01 \
C
PROP. BLDG. •C
FF -42.80
PE -42.30
5 5=