0003-017 (CSCS)LICENSED CONTRACTOR DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of
'k, hapter 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
521238 3
oDate Signature.of Contractor
OWNER-BUILDERDECLARATION
I hereby affirm under. penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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 (Sec. 7044, Business & Professionals Code).
1, 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-ins.ure for workers'.
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which ihis permitis issued.
) I I have and will maintain workers' compensation insurance, as required by
S
ecton 3700 of the Labor Code, for the performance of the work for whick'this
permit is issued. My workers' compensation insurance carrier 8, policy no. are-:
Camer Policy No.
CLARDIDONNATIU-
(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 peFrson in any manner so. as to become subject to the
workers' compensation laws of California, and agree that if I should_become
subj�pt to the workers' compensation provisions of' Sectiorr'9356 of the�Lab&
Code, I shall forthwit comp y wi t X se pr- sill fs��
Aate: -2A?,ZnI5 Applic
Warning: Failure to secure Workers' Compensapon coverage is unlawful and.
shall subject an employee to criminal penalties and civil lines 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.
I MPORTANT Application is hereby made to the Director of Building and Safety
for *zF`p`e"rmit 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 pe.rformed under'o.r pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless t6 City of La Quinta, its officers, agents and employees.
2. Any oe.rmit,issued as a result of this applicatior� becomes null and void if
work.is not commenced within' 180 days frorn date of issuance of'suc'h
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 fpr inspectionsilirposes. 7
Date
V,Signature (Owner/Agent)/ee1_71/ - Ze
ERMIT#
BUILDING PERMIT P
DATE VALUATION LOT TRACT
PAR5 P11 '190,018
JOB SITE
ADDRESS
APN
CONTRACTOR DESIGNER ENGINEER
MOHREAM PARIMMS-
T
12TINSMY CON SIRICNOR COI&AN Y
12 5,55 HIGH BLXAer- DRWR
22642LANIBERTST-, SM 409
SAW DITMO CA 921.1.
LAIMFORM C. A " 6.4 0
(94V)UR-e983 4574
USE OF PERMIT
COMMERCIAL
6300 SF RETAIL SUILDINO OT'01J, VIJAIL01,
P090WATIO 3F
SPRINKUR sp
AIC -- COMMERMAL 6,300.00 OF
Ca14T'P_kCT AMOUNT LS
LEIS, rMAIInD COTXOF C*X9MV(7,no.K
3M,710.20
C ON 3 T RV CT I ON FE R 101-000-416-000 $1,465,30
PLAN CHECK FEE 101-000-439-318 $1,10.02
FEE DEPOSIT 101-:000-439-318 411000-100
M-ECHAMICAL.FFM 101-000-421 4M
ELECTRACAL PEE - 101 -000-4.20-000 $112.10
PlIumarNa FEE" 101 �000-419000- $10.25
STRONG MOTION ME, - POMM .100-000-241 -0.00 10
DEVEWPEIR IMPACT, PEE.
ART N PUDO.C. PLACKS - COMt 7011-000�q�55-000 $1,618.53
M =A10HAN )LAN'al K
$12,210.32
IYOU PRE-PAU) H: M,
41.000.00
e I ME ow
RECEIPT
BY
I LEP_-/
INSPECTOR
JDATE
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
Framin4 ,,6Aog±!% C4
-F.A..U.
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
4 oc
Exterior I ath
Drywall - Int. Lath
Final
Final
ezz
POOLS -SPAS
BLOCKWALL
APPROVALf
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
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
ina
COMMENTS:'
7
/A�
owzs— ,(�F
-:s ('210 1
�0 ,
Final
Utility Notice (Gas).
ELE CTRICAL APPROVAL
1 !4
Temp. Power Pole 0(/
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) of ->7
000 0 1
BOX 1504 APPLICATION ONLY
Building 78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253
Owner
0 + �-k r r- 4 1--, %f PAC—, 190 i� BUILDING: TYPE'CONST. OCC. GRP.
Mailing
Address 124 57 5 Q I i-, F� LU r- r- Q Z I'%/ E A.P. Number 6 L9 0/f,
City Zip' Tel.
1177-1,30 P 52 - Z5 1 - Legal Description Me FL 9F i3men-
Contractor 41AI-D -1� t iff)l Project Description(w) P-LO-174IL- P,&T'� ALr)�'.
Address 0rf L I T I I: % -;I u m 9. e 0 '7%, 1- M
2;24,+2- L-Amaegr sTeee-r. 4-0 1� AHO
City Zip Tel.
74-�;f
State Lic City
& Classif Lic. # Sq. Ft. No. No. Dw.
�-A Size 0 0 9, t�- stories Units
Arch., Engr.,
Designer NewX. Add 0 Alter 0 Repair 0 Demolition 0
1 A PA IZ I KI F iZ ';H) -P
Addr6ss Tel.
P.X, I M. v 5 0 I?J;�q - 2 5 q 4
city , :4 lZip Lic_#C_Z,+TZq (=:'. Clao Is I r
1;4 ki n\ '77-190- 29 State
LICENSED CONTRACTOR'S DECLARATION -CaLzmO
I hereby affirT that I am licensed under provisions of Chapter 9 (commencing with Section
7000) 0 r.
effect. f Division 3 of the Business and Professions Code, and my license is in full force and
SIGNATURE V OWNER�-BUILDER DECLARATION ZA T::E:' Z;oo C;)) 7 -7
I hereby affirm'Ihat I am exempt from the Contractor's License Law for the following lEstimhW Valufition
reason: (Sec. 7031.�,Business and Professions Code: Any city or county. which requires a
permit to construct, alter. improve, demolish, or repair any structure, prior to *its, issuance also
requires !he applicant f6( such permit to file a signed statement that he is licensed pursuant to PERMIT AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Businessond Professions, Code or that. he is exempt therefrom, and the basis
for the alleged exemption, Any violation of S6clion 7031.5 by Any applicant for a permit Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
I] I as owner of the propehy, y employees with wages as their sole compensation, will Plan Chk. Bal.
do ihe work, and the structureois"not intended or offered for sale. (Sec. 7044, Buisness and t
Professions Code: The Contra'qtor's License Law does not apply to an owner of property who Const.
builds Or improves thereon and --who does such work himself or through his own employees, -Mech.
Provided that such improvements'—
are not intended or offered for sale. If, however, the building
or improvementais sold within one year of completion, the owner -builder will have the burden Electrical
ofpr.ovingthath did not build or improve for the purpose of sale.)
;J��I,.as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
'to I the project. (Sec. 7044, flusiness and Professions Code: The Contractor's License Law
does not apply to an owner 'of properly no builds or improvqs thereon, and who contracts for S. M. 1.
such Prot . acts with a contractor(s) licensed pursuant to the C ntractor's License Law.)
Grading
1-1 1 am, exempt under Sec.— B. & P.C. for,this reason
Driveway Enc.
Date Owner HIH MtALTV Infrastructure
WORKERV. COMPENSATION DECLARATION
I hereby affirm that I have a 6ertificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, of a certified cop thereof. (Sec. 3800, Labor Code.)
I y
Policy No.—: company
n Copy is filed with the city. 0 Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if �the permit is for ;no hundred dollars ($100) valuation
or less.)
I certify that in. the performance of thp work. for which this permit is issued, I shall not
ernpl oy any person in any manner so as -to become subject to the Workers' Compensation
Law s of California.
late _'Owner
NOTICE TO -APPLICANT, If after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be*deemed revoked. Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDI�G AGENCY Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
work for which.this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line
Lender's Name—
Lender's Address '
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE —INSPECTOR
expiration it work thereunder is suspended for 180 days. 4� " 4� — . ,
I certify that I have read this application and state that the above information is correct. Issued by: Date— Permit
I agree to comply with all city and county ordinances and state laws relating to building
con s truction, and hereby authorize representatives �of this city to enter the above-
mentioned property for inspection purposes. Validated b;f�,
Signature of aOplicant Date—
Mailing Address Validation:
City, State, Zip
WHITE FINANCE YELLOW APPLICANT PINK BUILDING DIVISION
City of La - Quinta
Developers Project Approval Form
Prior to the' issuance of Building Permits for the project listed below, the following Departmental
clearances must be obtained. Please return this form to the Building and Safqty DepartmenLomid-y-
after—appxay-al. Contact applicantfor resolution of conditions preventing or delaying approval.
Project: (1) 6 600 S.F. RETAIL PAD BUILDING
� V HIGHWAY 111
Applicant Contact: M & H REALTY PARTNERS 858 259 9909
Application / Circulation Date:
Date
Community Development Department
I I 1 5 4",
Christine Di lorio, Planning Manager Date
Public Works Department
Steve Speer, Senior Engineer Date
Building and Safety Department
Greg Butler, Buildingand Safety Department Manager
Health De—pAftnent
Date
Fire D epartment
Date
Schools Fees Paid
Date
Date
*1&
Caw. LC&�
City of La Quinta
Developers Project Approval Form
Prior to the issuance of Building Permits for the pr oject listed below, the following Departmental
clearances must be obtained. Please return this form to the Building and Safety Department "nl
qfter ap
j2ro�a . Contact applicant for resolution of conditions preventing or delaying approval.
Project: Rubio's Restaurant - TI in Pad 5 Building
78-437 HIGHWAY 111
Applicant Contact- Lorenzo Reyes (714) 516-1010
Application / Circulation Date:
Community Development Department
Christine Di Iorio, Planning Manager
Public 3yorks Department
,tILA 45��
'Steve Speer, Q114r Engineer\-"
Building and Safety Department
Greg Butler, Building and Safety Department Manager
Health Department
Fire Department
Schools Fees Paid
i
Date
Date
Date
Date
1)
E�ate
Date
M EM 0 RAN D U M
TO: Gre' Butler, Building* Man4ager�
9
FROM: Steve. Speer, Senior Engi e
UATE: November 28, 2000
RE: Rubio's Restaurant
This memo is offered in concert with the "green" sheet for the subject project.
The developer has not completed the plan check process in the Engineering Department
with respect to the Precise Grading Plan which also includes other site improvements.
The developer is under intens6 pressure to kart construction by December 1, 2000, to
comply with an agreement it has with the restaurant operator. Therefore, the Engineering
Department is releasing a portion of the grading plan for building construction purposes
to allow the developer to obtain the building permit. The Engineering Department release
is subject to the following stipulations:
1 The grading plan is sufficient with respect to constructing the building pad
only.
2.- The grading plan must be signed by the design engineer, soils engineer, and
geologist, prior to obtaining the building permit.
3. The developer must continue, and complete, the plan check process with
respect to other improvements on the plan not related to the building pad,
and pull a -permit from the Engineering Department prior to commencing
other improvements shown on the plan, excepting of course the building pad
which has.been released for construction via this memo.
4. All revisions to the plan that occur as a result of the continuing plan check
process will be acknowledged as revisions to plan.
Please be advised:
0 The approved Building Pad Elevation for the restaurant is 74.85
* The approved Finished Floor Elevation for the restaurant is 75.60
6: Plenn-Goodman, M&H,-Properties 858.259.8886
Gene Woods, Lindsley , Construction 449.768.7394
Hector Guzman, Assistant Engineer ll'*
TAPWDEMSTAFRSPEEMEMOSA001 128a.wpd
YOUNG ENGINEERING SERVICES
Engineering e Architecture -Surveying- Building & Safety Services
Letter of Transmittal
To: City of La Quinta Date: 8/23/2000
-017
Project. PC # 0003
Pad 5 -Plaza La Quinta
Attn: Greg Butler W.O.:
Tel No.: Tract No.:
We areforwarding: By Messenger _'By Mail X Your Pickup
No. of Copies Description:
2 Plans (Issubmittal)
2 Plans (2 "d submittal)
I Revised structural calculations
1 Title 24 calculations
1 Non-structural 2 "d check comment list
1 Soils report -
Comments: Greg — Structural portion is acceptable, see comment list for non-struct.
This Material Sentfor:
Your Files X Per Your Request
Your Review Approval
Checking At the request of.,
Other
By: John W. Thompson
Phone # 760-342-9214
4 7-159 Youngs Lane &Indio, CA 92201 (760) 342-9214
*Bronz Young
LarTy Benson
Fire Chief
10:35 AM RIV, CO. FIRE P&E INDIO FAX NO. 1 760 863 7072 P. I
1,'EkSIDE COUNTY FIRE 1[,.,1ARTMENT--,
'
In cooperation with the 19 L-7
California Department of Forestry and T'Ire Protection
21OWest San JacintoWy-enUe * Perris, C-aril`om—ia 92570 # (9W) 94043!= s Fax 10
vt W3 �D
March 7, 2000
To: M&H Prop" Management. Inc.
Pmudly scn* the
Re:
Architectural Building Plan Review
unincorWrated
SDP 2000-6671 Plaza La Quinta, Pad 5
areas ofRiverside
County and the
Fire Department personnel have completed a review of the plans you submitted for the above
Ciqcs of
referenced project- Please be advised the following conditions apply as a part of the conditions for
the
issuance of a building permit.
1) .
T!learance
Those N"n Heceive --of on—ly. No fire and life safety
Beaumont
will be Issued for a tenant space until e specific occupancy classification has been
.0.
Calimesa
established and tenant Improvement plans have been reviewed and conditioned by the Riverside
County Fire Department.
Canyon Lake
4-
2)
Fire Department approval is based upon the 1994 UBC requirements for Group B occupancies. It
Coachella
is prohibited to use. process or store any materials in the occupancy that would classify it as a H
occupancy per Sec- 307 of the 1994 U5C.
Desert Hot Springs
4:0
3)
The Fire Department is required to set a minimum fire flow for the remodel or construction of all
IndLan Wells
commercial buildings using the procedure established in the Uniform Fire Code. A fire flow of
411
Indio
1.500 Upm for a 2 -hour duration at 20 psi residual operating pressure must be available before
1C.
any combustible material is placed on the job site.
Lake Elsinore
4)
The required fire flow shall be available from a (Standard/Super) hydrant(s) (6" x 41' x 21/20 x 21/21)
La Quinta
located not less than 25'or more than 165'from any portion of the building(s) as measured along
Q
approved vehicular travel ways.
Moreno Valley
%%
5)
Prior to the Issuance of a building permit, applicant1developer shall furnish one blueline copy of
palm Iks=
the water system plans to the Fire Department for review. Plans shall conform to the fire hydrant
0
penis
types, location and spacing, and the system shall meet the fire How requirements. Plans must be
.C. -
signed by a registered Civil Engineer and/or the local water company with the following
Rancho Mirage
cartification: "I certify that the design of the water system is In accordance with the
1%
%
requirements prescribed by the Riverside County Fire Department".
San JAcinto
0
6)
Install a complete fire sprinkler system per NFPA 13. The post indicator valve and fire
Temecula
department connection shall be located to the front within 50'of a hydrant, and a minimum of 25!
from the building. System plans must be submitted to the Fire Department for review, along with
a plan/inspection fee. The approved plans, with Fire Depart ment Job card must be at the job site
Board ofSupervisom
for all inspections -.
B00 Hudcr,
District 1
7)
Install a monitoring system as per NFPA 72, which must include a water flow monitor, control
valve tamper and continuous monitoring service. System plans must be submitted to the Fire
John Tavaglime.
Department for review, along with a plan checklinspection fee.
Disuid 2
.ran Vcnablt;
8)
Install Knox Key Lack boxes, Models 4400. 3200 or 1300, mounted per recommended standard
Mstrid 3
of the Knox Company. Special forms are available from this office for the ordering of the Key
Switch, this form must be authorized and signed by this office for the correctly coded system to
Roy Wilvxu
DiArid 4
be purchased.
Tom mullm,
Dixtrict 5
MEMMY 3ERVIM DIV ISION - 11ANNING swnoN - INDIO 0MCE
G-073 friahway 111. 2" FL. ladig, CA M01 o (760) 8634186 - Fax (760) 863-7073
-.M�Y,-17-00 WED, 10:36.AM RIV. CO, FIRE P&E INDIO FAX NO. 1 760 863 7072 P. 2
4
9) Electrical room door shal* posted 'ELECTRICAL R00M9 on the out2de of door.
10) Install portable fire extinguishees per NFPA. Pamphlet #10, but not less than 2A1 08C in rating. Contact
certified extinguisher company for proper placement of equipment.
I i) Ail fire sprinIder systems, fixed fire suppression systems and alarm plans must be submitted separately for
approval prior to construction. Subcontractors should contaict the Planning & Engineering office for
submittal requirements.
12) . Approved building address shall be placed in such a position as to he plainly visible and legible from the
street and rear access if applicable. Building address numbers shall be a minimum of 12" for building(s) up
to 25'in height, and 24' in height for building(s) exceeding 25'ln height. Minimum of 6" lettering is required
for suite Identlification. In strip centers, businesses shall post the business name and suite number on back
doors as well as the front. All addressing must be legible and of a contrasting color with the background.
13) A durable sign stating "This door to remain unlocked during business hours" shall be placed on or
adjacent to the front exit doors. The sign shall be in letters not less than one Inch high on a contrasting
background.
Please contact the Fire Department Planning & Engineering staff for final inspection prior to occupancy..
Applicant/installer shall be responsible to contact the Fire Department to schedule inspections.
Requests for Inspections are to be made at least 24 hours In advance and may be arranged by calling* (760)
All questions regarding the meaning of these conditions should be referred to tho Fire Department Planning &
Engineering staff at (760) 863-8886.
Sincerely,
FRANK KAWASAKJ
chief Fire Department Planner
By
Walter Brandes
Fire Safety Specialist