BLDG (0403-252)78015 Main St Ste 202, 204
0403-252
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
ChapQer 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
x . "1883
Date E' -Signature of Contract, ✓- r,
OWNER-BUILDERDECL RATION
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 STATA FUND Policy No. . 1940123-03
(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, andagree that if I should become
subject to the workers' compensation provisions of Section 3700,of the Labor
Code, I shall'forthwith cdmply with those p provisions.
ti/
Date: oApplicant a-c ° `. ''
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.
t
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 o (this City to enter upon
the above-mentioned propertyy ,fiyo-r Ins ectio n purposes✓
Signature Owner/A enti" i Z' ` r Dates'..
-" B_ UILDING-PERMIT ' PERMIT #
DATE ^> EVALUATION- ' C LOT ' TRACT
7
,S
f
'!
JOB SITE - ±' -
APN
ADDRESS 7&.01. AT"1
OWNER
CONTRACTOR / DESIGNER / ENGINEER
OLDTOWN LA. Q1iIA+1 .A.
KkT?'VNT tRUNTES
7.8.080 C.t4.l..S.E. ,a '.LADO VE 201
78N080 t-101.7.Ei.:M.'A''DO STE 201
1-4 QLTnrrA CA. 9225:
j -k QiYT T, -A CA 92253
(76PY171-2567 CBUi 54V/
USE OF PERMIT
REVISION WHILE UNDP -0. CONST'13UC`I101.i - ADDITIONAL rj0OR REs:'3'1Ri-W44
lli1 202%'301
VALUATION to
XISIr 1"IED C01+5" (AT C: 9O1'dIM`CI'CT1014
1160040
PER A T&' FJJTT ,.99AAWARY
PLAN CNRCY. FFY, 101-000,4311-318 $24,05
COIaWRILICTI aN FEE 1+01-000-10..8-000 $r/.00
S TItt7Ni3MCi 1014 MF 100.00044 t -000 $150
S(M-1`O AL COMIiTJC`.'T OX AND P1." CINC'K
$61.55
LESS I RZ,;PAU) FEF-
Q D
$0100
D IMALPKIMSE]rIME,SDUE.NOW
_
MAR 19 2004
CITY OF LA QUINTA
w
FINANCE DEPT. p f
RECEIPT
DATE
BY (",
DATE FINALED
INSPECTOR
l/++ //
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
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
PSewer 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:
-
Tom Tisdale
Fire Chief
Proudly serving the
unincorporated
area of Riverside
County and the
Cities of:
Banning
4•
Beaumont
.C•
Cahmesa
e•
Canyon Lake
d•
Coachella
Desert Hot Springs
r
Indian Wells
Indio
Lake Elsinore
La Quinta
Moreno Valley
4.
Palm Desert
Perris
❖
Rancho Mirage
4 -
San
San Jacinto
e•
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 FI., Indio, CA 92201 . (760) 863-8886 . Fax (760) 863-7072
June 8, 2004
Trans Pay USA
78-015 Main St., Ste. 204
La Quinta, Ca, 92253
Re: Non -Structural rlig FA-WaA-Ravi
LAQ-04-TI-0 / 78-015 Main St., Ste. 204
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 3200, 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.
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
Walter Brandes
Fire Safety Specialist
C.c:_Cily of La Quinta = Building -Dept
H1PEMENE X ORMSIBiidiq P ClbdCdx
EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE
82-675 Highway 111, 2nd FI., Indio, CA 82201 • (760) 8634MM • Fax (760) 863-7072
COrtificate of Occopac n•Y
TA
OF _ = l Building & Safety; Department
This Certificate is issued pursuant'to the requirements.' of Section ,109 of the California 'Building G ,
Code; certifying that, .:at. the : time - of , issuance, -this; structure was fin ',.compliance With ;the
provisions -,of `the Building Code _ and the va' nous. ordinances -of the Xit_y regulating.. building,
construction and/or use.
tj
BUILDING:ADDRESS: 78-015 MAIN STREET 202/204
Use classification: COMM ,. ' ' Building Permit No.: 0403-252
"Occupancy Group: M - , - Type of Consttuction' VN Land Use Zone: VC
Owner of Building: OLD TOWN LA QUINTA :. Address: 78-080 CALLE ESTADO STE. 201
City, -ST, ZIP: LA QUINTA CA 92253
By: KIRK KIRKLAND"
-'Date:. 3-23-2004
Building -Official f - ,
POST IN A CONSPICUOUS PLACE
a � L—J `
y
SUITE A202 ADDENDUM A
78-015 MAIN STREET • LA QUINTA, CA.
❑ ❑ john stanford architect
❑ ❑ 73-350 el paseo suite 207 palm desert, ca.
tel. (760) 776-8478 fax (760) 776-8477
fli
3/15/04
1/8" = 1'-0"