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RC (0402-196)78065 Main St Ste 103 0402-196 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 771883 'B I I:n012( ri Da /,l % Signature of Contractor/ ,. 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 ntaF mr) . Policy No. 1440125.03 (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' compensatiyn 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 those provisions.; Date: a.,%A! df r Applicant 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 fora 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 properrttyyfor Inspe c tiionn piurposes. Signature (Owner/Agent), Date.-+ • BUILDING PERMIT PERMIT" 4 f' 9M '#tx 9 DATE X41,UATION LOT TRACT JOB SITE I , -"ADDRESS APN OWNER CONTRACTOR / DESIGNER / EN 1NEER 01 D TOW i• LA QUi*1'.rA M AW4..W Pl0,47A 78.080 C:iLUR s,;.YTtI DO 78-030 CAUXnT ADO UTI; 201 LAS QL INTA CA 92253 LA QUM-1A CA 02253 (160)771.2567 C'K4.4 507 USE OF PERMIT . P.'U"IM fp.I.IALRMfJ]' R1, C0111WE12.Ci.A'I T.L(THTNOS ON S'PRibl'OS). OCC. LC.AD 28, VN SPRINKLERM V OCCUPANCY, 200E COC, `UWRACTMOUNY 0 PIy'.k2BW F X SUMMARY CONSTRUCTION FEE 10.1-000--418-000 PLOD 4?LAV, CHEICK M11% 101-000-439-348 '71 8 13i MKCHKI41CAL liER' 101.000-4-21.10i 0 $191" El:,1X'1'I;'ICAL T;'ZZ 101-000-4•20-000 STRONG MOTION AX COMM 100-000-24 1 -000 ' 1 !SIRUCITON ii3:f LAN CSCR $20 :.£31 ' p y.)E a,a0 FEB 2 4 2004 'OTA'T''" rT sVIM., NOW $204.81 CITY OF LA QUINTA FINANCE DEPT. RECEIPT DATE • / . r t 0 BYC„ ,_. DATE FINALED INSPECTOR 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 0. K. to Wrap F.A.U. Framing !i 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 POOLS - SPAS BLOCKWALL APPROVALS steel Set Backs Electric Bond Footings Main Drain Bond (seam 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 OX for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: 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) F LA QUINTA o S ^ BUILDIN SAFETY DEPARTMENT FEg 2 4-7012 7 INSPI= CTIN REQUEST LINE 77-7153 -' ITS •,ai....r XPi. O;aDi, D A QUINTA tor. 0402-196 DST ON tSNSPICUOUS PLACE 'ECTOR MUST SIGN ALL'APPLICABLE SPACES ►DRESS 78-065 MAIN STREET, STE. 103 ✓IERCIAL T.I.(THINGS ON STRINGS). OCC. 28, VN SPRINKLERED, M OCCUPANCY. 200 TYPE OF INSPECTION DATE INSP. IARY POWER KS MBING / WASTE .CTRICAL / GROUNDING GS / STEEL =TE SLAB )O NOT POUR CONCRETE UNTIL ABOVE SIGNED -=(COMBINATION F 1 ION -AL' COVER NO WORK UNTIL ABOVE SIGNED )R GYP. BD. DRYWALL OR LATH :ST :ABANDONMENT I CONNECTION ;/GREASEINTERCEPTOR MASONRY INSPECTIONS VGS / STEEL BEAM POOL / SPA / WATER FEATURE INSPECTIONS UNITE/ SETBACKS . .UMBING aS .ECTRICAL ASTER ALARMS / BARRIERS FINAL INSPECTIONS USE OF PERMANENT POWER D— -RICAL 31NG - ANICAL - C WORKS DEPARTMENT 1UNITY DEVELOPMENT DEPT. . / JOB COMPLETED O ABOVE APPROVALS DO NOT INCLUDE RIGHT TO TURN ON UTILITIES OR OCCUPY BUILDING X X A x Bi" #co City of La Quinta Building 1z Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quanta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet I Permit # (9 qa,-- ' + Project Address: 71-©6 54 ,-, 0 3 Owner's Name: e.' ) /-( A. P. Number: Address: 5 r 94 00 Legal Description: Contractor: /, 9,uZk( Ta UEST4V1 S j1( FTelephone: 7% Z % r- `` Address: _ p S0 (',41-4F T'4D0 Tj6 ZD Project Description: f 4 ,, r t, 4 city, : . zip rr C 4A fZ2,53 p +0 Telephone to Y = - "" ::; State Lic. # : ( 3 City Lic. #: c9 y 7 '5k-,e.,--. Cw < < 5 ® Tri Arch., Ener., Designer-. J V"tv STFML Foazo' ArG . ^TO Vl r Address: ,3 fJ 41 6L4 5XIr-1Z.-9`7 1ZO`% City. ST. Zip: eG T f,-'2449 >r :. ,,.:. .... .,..: :.,, Telephone: -7 - !6F 1(7K '- -_ -`= _ ' * State Lic. #: C Ca tx PrVX 469.D 0. Occu an Construction Type: N SQQaklL P y:AA Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: Z4 5 Sq. Ft.: 9S 1 # Stories: # Units: Telephone # of Contact Person: l Z S stimated Value of Projec . 75 00 APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted L ftp Item Amount -Structural Cales. Reviewed, ready for eorrectio Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance 0 2 Energy Cales. Plans picked up Construction 0 Flood plain plan Plans resubmitted Mechanical • Grading plan Z" Review, ready for Corr ionsfissue Ii t7g Electrical ° Subcontactor List Called Contact Person ( --tQ G Plumbing Grant Deed i Plans picked up S.AI.I. / • H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '' Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees 2c( G 4 PcAlvs C- CDD avr 2-13., 1ye-. P.O. Box 1504 BUILDING & SAFETY DEPARTMENT 78-495 CALLE TAMPICO (760) 777-7012 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 To: Greg Butler, Building & Safety Manager To CDD: 2-04-2004 From: Oscar Orci, Planning Manager Due date: 2-13-2004 Status: I ST 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 TI("Things on Strings") Address or general location: 78-015 Main St # 103 Applicant Contact: Wells Marvin 771-2567 ext 1 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. Oscar Orci, Planning Manager Date I '1• F , ti Certificate of,Occupancy - G OF9 Building & Safety Department This Certificate is issued pursuant to the requirements of Section 109of 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: 78-065 MAIN STREET, STE. 103 Use classification: COMMERCIAL Building Permit No.: 0402-196 Occupancy Group:,M DCC. Type of Construction: VN SPRINK. Land Use Zone: VC Owner of Building: OLD TOWN LA QUINTA Address: 78-080 CALLE ESTADO City, ST, ZIP: LA QUINTA, CA 92253 By: KIRK KIRKLAND b Date: SEPTEMBER 14, 2004 Building Official POST IN A CONSPICUOUS PLACE