PLBG (0403-046)78065 Main St Ste 200
0403-046
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
1113 010.
Date 4 ' • 'x!"gnature 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.
(` t)' 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 .sutn.1 uND Policy No. 144012,5.0t
(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 om I with those'provisions.
1) ate 1Z/Z2 rAPPlicant
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.
16, 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.`A-ny 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•insp ection purposesy o
Signature (Owner/Agent) Date • - 'f:-*.
""yrX_,FB ILDING PERMIT PERMIT#
DATE` it- VALUATION, LOT TRACT
JOB SITE '"' ` - --
APN
ADDRESS r
OWNER ' 1
t,L1
CONTRACTOR / DESIGNER / EN (NEER
OLD 7 fi1F1`N A Qfs:Lwrp, MC
izv','N 1:iOMM .
%8-03 CPJ.J.,.0 ESNYWO, 201
18.080 C;AUX V.5'tiADid VE 201
1J, QUNTA CA 92253
LA Qu °.k CA 9225:3
(760)'771.25G7 CR14 54357
USE OF PERMIT
INSTA.LLA.T'IUN OF 6000 CALLON CIREASP; I;NTIaRCERP"'ORAT $UNZ 200
(HODS L'•REATH Rr,—TA,URA. H T), PLIi PLAM AND EIA..ALTH DEPT
. fty t lf i iL.
:s ;; :t: AT.L D fw 9& f OF COMMUCTIC3N
9, i3.%1Y3
PLUMBING FEE 101.000-419.000
l.1"f-0i7lSYK.A yy' SyyyyPl((gd N 5;. 1y3':.(C"K,,
/2111. 0
t0
yam) y
ry
MAR 1 6 1004 . .PRV
$27.00
FEES DUE HOW
CITY OF LA QUINTA ,
FINANCE DEPT.
RECEIPT
DAT
,E
BY
{
DATE FINALED
INSPECTOR
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 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 Pibg. 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:
r'r'fl—LAST. rr'miti1:Ts rrii:. rtiz.yr i f—ih - -i im.,
lot
999
fit
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1
Vd 'ONI 'IHSVIS 'H'Q EZZO-b9S-09L Eb:Si E00Z AIO,
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Area.# ry s' r , t COUNTY RNERSIDE,COMMUNITYrHEAL .'AGENCY
xtiDEPARTMENT OF ENVIRONMENTAL HEALTH °3 =
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rt.t4',3,,,Yr 4-- i:, it,t ; a PLAN CORRECTION
s r w nn - S , _ i res t i a k yF 'kms r ';,c s • ,k
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Plan Check # . NO3-069p r r n
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DBA -t Hogs' Breath A dresses 78-065 $1111ain St °C200" Le Quints CA /1/03 - L'
d ,
Plans Submitted by "
am brown r i y. x rsw i c3 0 5"1 akv i
toJ r
ne ,200-3553 ,F'`r J,'
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Owner Kaiser Marcus §5t41, ,Address I
tt
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The plans are now.approved"subject to the condition`s listed below and the attached oornpliance sheets s.
1. An additional 10 feet of kitchen storage shelving forA total of 59' will be required for,this kitchen based upon
the size of the working flood service area (approximately 739 sq,. °This etm must Winstalled prior to ficial. , f
2. All powered equipment specified in the plan as not In contract must conform to NSSFF or equivalent
._ ay 4 3 ".i"tiva AZ T. a
:. _ 1 a Y 5 ie a y 1 ? " r5 4 1 xs k r
standarcfs (e.g. cappuccino`machines) r ; R ti . K; r
3. Provide a minimum storage capacity for the hot water heater of 80-100 gallons The specfied Btu rating of, .
213,000 is adequate.'` s "
4. The hood must be installed -as shown -on hood plan sheets FS9, FS10, FS11. You --'may not substitute hood
brands or models without formally notifying `this office and resubmitting hood plans Addrbonalyhood plan ,
., r t.
check will tie performed at,a rate of $466.00 and will require at least 20 working days to complete No final will
be performed until all outstanding plan check issues have been resolved.
5. All floor, wall and ceiling finishes in food service areas must be smooth and easily cleanable including
waitress and self service stations such as drink dispensers' ' vsx
4 t } .
6. All food and utensil sinks must be plumbed to floor sinks through: approved air gaps The mop sink must be
of the floorbasin -style 8ehmd all three sinks in the splash zone the finish must be water pnnof to a height of 8'
(e. FRP/file
9• ) ... . t.x ..s .,,.vu.- 'w• T.. r S" r -s F ' { E'. -a a -
7. The trash enclosure must be finished so that the interior floor and walls are smooth`and easilycleanable
Seal these interior surfacesiivith an approved two part epozy t, ' = ,.-
..
8. All exterior and restroom doors must be self dosing.,,'. Exterior doors must also be sealed against entry by
vermin. The delive door air curtain must deliver air ata velocity of 1600 fps`at a height of 3' above the floor.
9. The number of lockers provided shall be equal, or greater than the number of workers assigned to a peak
r a'.' ♦ 9 *' w yy r "r a„- , . ✓ wzar - .c ' ; 7 < 2" •`'a` y„"•"', .
, y v t.: t. . iyr`,...lr s . 'fl ` ' of $ F Pl':n "` > , cr's'A.
shift 2 , 'rY3c S'X `*¢ .k"'a,t a...t is S:: :a. 3 , ` ` °3ys v t t .+ a._, a v+y-. 3- - 4 Ac s
b x --_ . t 3 =.- " " ravw. C. n'_ _ -t ' v'' 'i ,' .... , `
a zLT
10. An air balance"report will be required prior to completion of the final inspection ,'
11. Approval of this plan does not include approval by local land use, water, or sey*e agendes. Prior to
commencing construction or undertaking improvements, submit these plans to the Riverside County Land Use
Agency located at 82675 Hwji`'111, Room 201 Indio CA 92201, phone (760) 863-7000. A facility may not
receive an Environmental Health Permit without this approval, which will be verified prior to the final inspection
CONSTRUMON INSPECTIONS: Contact the Plan Checker for a Preliminary Inspection when construction is approximately
80% complete, with plumbing,' rough ventilation, and rough equipment installed. Request for inspection should be made at least five (5)
working days in advance. - A compliance guide is attached to this plan correction sheet All oanstruction sot athea%ise addressed on the
plan correction must be performed in accordance with the guidelines set forth therein. A FINAL INSPECTION MUST be made upon
completion of ALL work including finished details. APPROVAL;`to,operate shall not be granted, or rt modeled areas approved to '
operate, until the facility has; passed the FINAL INSPECTION, and "APPLICATION TO OPERATE" has been `completed and,
PERmrr FEES have been pard
Request for inspection should be made at least five (5) working days in advance.
PLANS CHECKED BY David E. Day Phone
_(760) 320-1048
I acknowledge the corrections noted herein and as indicated on the plans and agree to incorporate
them during construction
Signature
Company
Date /o 40 Z 0
"OUNTY OF, RIVER8IDECOMMUNITY HEALTH AGENCY
DFPASRTMENT, 0FtENVIR,nO.NMENTAL HEALTH `,`4, st
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81PPLIiCA ION'F,QRiVIIASTEyWaATER DISPOSAL`APPROVAL ' ' ' t* '+
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in, c.V4,1•' ";liar, , , 1, ,i, Opp ; r.'* ;: r , n t ;3 „k .* ! ► ...±
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gPPLIGAtV Submlls form with four copies of;a.SCALED plot plan (1"=20'.to 1"=40' SCALE) drawn 'to County apeGBcations as indicated on the attached
Check-list A'10 ' »' Y ..• `
+refundable filing feeftls 6guired6wheri the application is submitted. Check must be ade payable to the County.of Riverside. Approval of this
appllca7ry4ion shall .rematp valid for a period not to exceed.one year from date of payment.'
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AddressCity 4 y , Stat Zip
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Telephone
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Address 'a l ", yCity° 'State ; .' Zip
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Use of;Permitj:P/P, SUP, PUP, etc.:4(,
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Legel acid}i
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Dwelling, MH Site Pep., etc.'
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Signature .App Ica44
Date
)69 ; ;' 4 < t FOR OFFICE
CHECK BO1f IF REQUIRED`:* {$ r ° k `f i . ':^(.
(i j, n } ,.. tiT+,, r > I h
USE ONLY, r` zit
t t .: a
p•, ! i ya• ; 5 • y
quited
If eny bok is ichectied; this'appllcatlon`shall bo, considered rejected until the
❑M Detailed Contour Plot Plans (1 to 5 foot Interval) •; ,
infomtafion;is provided and the fee. paid Resubmittals later than 90 days
{
' •; y '-'3 ; ' 1.
' 6ftef date noted below may require repayment.of fees; ;: 1 :'
❑ Other
,t.
❑ Staff Specialist Lot Inspection Required
❑,'Holding•TankAgreements,.Completed EI)
-
Ce
J `❑,-rtification of Existing S.D..-System Required
Thomas Bros. Page .,'. Grid
U ❑ zWQCB'Clearance Required
❑ Date Lot Inspection Completed: • Initials
n ,(Attach forDOH-SAN-007; Santa Ana Region Only)
..
Remarks:
< ❑, Sotls Percolation Report Required'
'
❑ Maintenance Booklet Provided -
❑',Special•Feastbility.Boring, Report Required,,;°
'
` ". `_' `.
❑ Final Inspection by Department of Environmental Health is required.
❑ Rerevlew Required `' ' Initials Date
Please call 24 hours PRIOR to inspection.
C/47/ Soils Percolation Boring Report. By Lic/Project # Date
✓ Soils Map Page Soil Type Approved By Date
No. of Systems
Type of System(s) - ,
'
No. Dwelling Units
(1) Septic Tank
Soil Rate GmmmLSand
❑olding Tank ❑ Replacement
New 'LlAddition
Bedrooms, Fixture Units
I
Grease Intc nt Trap
'
xisting Connect to Sewer
Gal.
Gal.
Sq. Ft. ,
Total Linear
Sidewall Allowance
Leach Bed sq. ft.
Bottom Area
Ft.
ft. rock/ sq. ft. running ft.
Install Line(s) ft. long ft. wide
of Bottom Area
Inlet Tested Depth ❑ N/A
with min. inches rock below drainlines
Proposed Bottom Tested Depth
or
Z Leach lines/bed. special design-for slope:
(3) Pit Diameter
No. Pits
Pit Below Inlet (61)
Seepage Pit
Maximum
Other:
Applicable
Total Depth
Allowable
•
•Depth
N/A ' Overburden Factor •
Ll5' ❑ 6'
TD
Well Review Approved: Date: Well Drilling Permit#
SIGNATURE / C -
G '1
Grading Plan Approved: Date: boo—) oo—) (L l'0_&.e
`5,
'. SIGNATURE D ✓ m.
Plan Check Only Approved: Date:
+
REMARKS: r LV
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17,1.kimF S•., r%/\ tV6. ,+ c
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, 11 /
VA
This application isPPROI E ENIED for the category checked in
SECTION B above, ard. , design of a disposal system as indicated
on the accompanied plot plan, using the requirements set forth in SECTION
C above. A building permit is necessary for the installation of the above-
Revenue Code 13 Fee
designed system. No construction Is permitted In the reauired reserved
100% expansion area,
.
Check #
(1) Septic Tank must be 100' minimum from any wells.
(2) Leach lines must be 100' minimum from any wells, including expansion
Date Initial
O area.
(~j (3) Sewer lines must be 50' minimum from any wells.
W
(4) Seepage pits must be 150' minimum from any wells, including expansion
RIVERSIDE: 909-955-8980
area.
INDIO: 760-863-7000
SOUTHWEST: 909-600.6480
Signature
0
Date
XHSAW122 (Rev 6/01) UistnoUUOn: WH I I t—orrice rue; rtt_LUW—Applicant; FINK—U10g. wept.; UUt MINIKUu—vians/Kecoras
FUTURE I !
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120 WTR INV. 36.67
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2 10 CO INV 35.95 2 2 CO INV 34.88
--41.50 /(27+02)
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41.29 O INV 36:44
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PROP. BLDG. 'C'
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BOUNDARY=JIM_,
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