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04-6800 (RC)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T4'!t 4 4a QuAlm BUILDING & SAFETY DEPARTMENT BUILDING PERMIT LICENSED CONTRACTOR'S 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 Lic s i n II force and effect. License CI s: Li en a No.: B��� Date: �� ontractor: .. - .V- cAf, OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500): (_) 1, 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 ISec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the ' improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractorls) licensed pursuant to the Contractors' State License Law.). (_) I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: LQPERAIIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7/20/05 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 and policy number are: Carrier 1640856-2005 0 1 / 0 1 / 0 6olicy Number 699640 _ 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 700 of the Lab Code, 1 shall forthwith ca pl with those provisions. aD te: plicant: GJ WARNING: FAILURE TO SECURE ORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($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. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this 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 application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 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. 1 certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of thisi�� upon t ove-mentioned property f spectio urposes. f�te:.gnature (Applicant or Agent): Ci Owner: Application Number: 4-00006800 _ %� Property Address: APN: 78370 HIGHWAY 604-050-048- 111 STE 150� - - LrU D MADISON PTM LA QUINTA 71361 SAN GORGONIO RD Application description: REMODEL - COMMERCIAL RANCHO MIRAGE, CA 92270 Property Zoning: Application COMMUNITY COMMERCIAL 600000 JUL 2 ���� valuation: CITY OF LA SdUIN-M Contractor: Applicant: Architect or Engineer FINANCF- arPT. JOHNSTON CONSTR INC., D.W. 1445 N. SUNRISE WAY, #203 PALM SPRINGS, CA 92262 t WCC: STATE FUND Lic . No.: B LICENSED CONTRACTOR'S 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 Lic s i n II force and effect. License CI s: Li en a No.: B��� Date: �� ontractor: .. - .V- cAf, OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500): (_) 1, 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 ISec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the ' improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractorls) licensed pursuant to the Contractors' State License Law.). (_) I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: LQPERAIIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7/20/05 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 and policy number are: Carrier 1640856-2005 0 1 / 0 1 / 0 6olicy Number 699640 _ 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 700 of the Lab Code, 1 shall forthwith ca pl with those provisions. aD te: plicant: GJ WARNING: FAILURE TO SECURE ORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($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. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this 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 application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 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. 1 certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of thisi�� upon t ove-mentioned property f spectio urposes. f�te:.gnature (Applicant or Agent): Application Number . . . . 04-00006800 ------ Structure Information COMMERCIAL REMODEL "OKURA" TI ----- Occupancy Type . . . . . ASSY BLDG <300 NO STAGE Other struct info . . . . . CODE EDITION 2001 FIRE SPRINKLERS YES MIXED-USE OCCUPANCY A-3 OCCUPANT LOAD 155.00• ---------------------------------------------------------------------------- 1ST FLOOR SQUARE FOOTAGE 4430.00 Permit . . . .BUILDING PERMIT Additional desc . Permit Fee . . 2339.50 Plan Check Fee 1520.68 Issue Date . . . Valuation . . . . 600000 Expiration Date 1/14/06 Qty Unit Charge Per Extension BASE FEE 2039.50 100.00 3.0000 ---------------------------------------------------------------------------- THOU BLDG 500,001-1,000,000 300.00 Permit . . . ELECT - ADD/ALT/REM Additional desc . . Permit Fee . . . . 103:60 Plan Check Fee 25.90 Issue Date . . . . Valuation . . . . 0 Expiration Date 1/14/06 Qty Unit Charge Per Extension BASE FEE 15.00 4430.00 .0200 -------------------------------------------------- EL$C GARAGE OR NON-RESIDENTIAL 88.60 -------------------------- Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 137.50 Plan Check Fee 34.38 Issue Date . . . . Valuation 0 Expiration Date 1/14/06 Qty Unit Charge Per Extension BASE FEE 15.00 5.00 9.0000 EA MECH FURNACE <=100K ( 45.00 5.00- 9.0000 EA MECH B/C <=3HP/100K BTU 45.00 3.00 6.5000 EA MECH VENT FAN 19.50 2.00 6.5000 ----------------------------------------------------------------------- EA MECH EXHAUST HOOD 13.00 Permit . . . PLUMBING Additional desc - LQPERMIT LQPERMIT Application Number . . . . . 04-00006800 Permit . . . . . . PLUMBING Permit Fee . . . . 262.50 Plan Check Fee 65.63 Issue Date . . . . Valuation 0 Expiration Date 1/14/06 Qty Unit Charge Per Extension BASE FEE 15.00 30.00 6.0000 EA PLB FIXTURE 180.00' 1.00 15.0000 EA PLB BUILDING SEWER 15.00 1.00 7.5000 EA PLB WATER HEATER/VENT 7.50 1.00 12.0000 EA PLB INTERCEPTOR 12.00 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 1.00 9.0000 EA PLB LAWN SPRINKLER SYSTEM 9.00 8.00 .7500 EA PLB GAS PIPE >=5 6.00 1.00 15.0000 EA PLB GAS METER 15.00 ---------------------------------------------------------------------------- Special Notes and Comments Commercial Remodel."Okura" Restaurant TI. "A-3" Occupancy, Type V One Hour Sprinkled, Maximum Occupant Load 155 with no out door dining approved. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STRONG MOTION (SMI) - COM 126.00 Fee summary Charged Paid Credited ------------------------------------------------------ Due Permit Fee Fee Total 2843.10 .00 .00 2843.10 Plan Check Total 1646.59 .00 .00 1646.59 Other Fee Total 126.00 .00 .00 126.00 Grand Total 4615.69' .00 .00 4615.69 Temporary Certificate of Occupancy o� .moo 9w5 Building & Safety Department OF 'T1 This Certificate is issued pursuant to the requirements of Section 109 of the California Building x 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: 78-370 Highway 111 Suite 150 Use classification: Commercial "Okura Restaurant" TI Building Permit No.: 04-6800 Occupancy Group: A-3 Type of Construction: V-1 hr Sprinkled Land Use Zone: CR 30 day Certificate of Occupancy, correction list attached. Owner of Building: Madison PTM La Quitna Address: 71361 San Gorgonio Rd. City, ST, ZIP: Rancho Mirage, CA 92270 By: Daniel P. Crawford Jr. Date: Expires 12/10/05 Building Official POST IN A CONSPICUOUS PLACE n Certificate of Occupancy -_ %df ot Irrtpeoaxo-a� . avec s G OFT9� 9► Y p Building & 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. 4 BUILDING ADDRESS: 78-370 Highway 111 Suite 150 Use classification: Commercial "Okura" Restaurant TI Building Permit No.: 04-6800 w Occupancy Group:-A-3 Type of Construction: V-1 hr Sprinkled Land Use Zone: CR Owner of Building: Madison PTM La Quinta Address: 71361 San Gorgonio Rd City, ST, ZIP: Rancho Mirage, CA 92270 �d By: Daniel P. Crawford Jr. Date: 12/21/05 Building Official . w POST IN A CONSPICUOUS PLACE