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0103-049 (CSCS)O 5 M �pLr) W oZr` Zo 0- ~o H(0 LU r- F- 0- Z`. 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 742569 .tom Signature of Contractor 41J30i2C OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 I contracting with licensed c6ntractors to construct the project (Sec. 7044'; Business-& Professionals Code). ( )' I am xempt,under Section B&j�C f_or,this reason Date�V 4 f t. I Signature of '0wner� e�, t vl\' ' - 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 Policy No. ` �'Y•'�►.1',11? M;E'ND 1424997 (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, Ihs"hall 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 hall forthwith complyCifl e,provlslons. %Date: 4 Applicant Y.--Aa /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 foriin ;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. 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(n� & hold harmless the City of La Quinta, its officers, agents and employees. YY►► 2. Any permit issued as a result of this application becomes null anQ.'Oid if work is not commenced within 180 days from date of; issuance gf�scly 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 abovetinformation. 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 ithe above-mentioned proerty for inspection purposes. Signature (Owner.. gen ' l� f�/ ^S 1 -NN Date`k) BUILDING PERMIT PERMIT# DATE VALUATION:„ LOT �1�{a°�jJ]� TRACT JOB SITE — APN ADDRESS pt��sgl •��pp� rqqq��y� W� gqp�yy�j�'q,p ��yyyy��`� ryry�� OWNER CONTRACTOR / DESIGNER / EN (NEER MINT XVIN :YTEAM AVENUE E 3001 R T1I`.4x9D}.M1, 01 M GWAR10 r -A 91762 PALM.119WHOIS CA 5.,r2262 (160)322-1553 CITU 3967 USE OF PERMIT f,OM ERCI.R,'I, F3UILDI:SSdG (.�,r104 3Q?:11fi,R9 ALT. SPRINKLER. 6,4tSff.fJQ SI*` VC �4 COMMERCIAL 6,40.00 3V QutwlN'P.N�CT t.MI.,DiT 281,08R.f10 ws .. �yq� /y�q �Y jfQ y��'T��Q %�}�x ��++��j�+�' qq7��' �� 77++�� {p'�� con • EffrR.I�Y.CQ�MA.N' SroA7.Y m, lr'Vv�1�.Gd�1JL•-0.$4dI.'7 a7��+gA SAYVA7 ? OINISF'IIAXIT «A ME 101-M0418.000 $A, 34,00 Iy�9l:..ftt„,��3?d))i:11•alf1A'�'"EEF:��Eyy�E,Z 2,0yy;E••iJ(C��3y��-439�-f�111y,l9 $1,iYe*•S.:Ahs32� ” .M �C.Ar��.N�•3I,�It�sJ Li'EE 101-011t� 4Gn1P°000 5105,00 �ry.°••��Jt0 i100-:000-241-000 0iy96.Ode ''�/� #a (yj��,0ryI7i1••4j ,1q (;y?'tI11JIISNIsL�t/l�ra�0.FLI, JP, FEE I�f% x?J�tla, 101-000-423-000 $20.01 DW9W�'.KR L'.t' IQT tx E $7,148.00 •1'.xr Iii �'>ItJ�:Isitw k�I.AC. Y C Ifs �f �-iIJ� :�5 4 eJ $6l,tS91.i�J 101-000-439-318 -sisnou 2001 tum."rarm, CoNsmueno ewm_) PLA& I:: yv 1., '+i .'Y •_;. 1 LEVU PRE PAD TFM 41'.4;00.00 'L`an- f, 1'II.Vam FEE'sl .°{1` w wow SlOoI 78. iii RECEIPT.--. ; -- DATE BY DATE FINALED INSPECTOR J 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 Fireplace P.L. / ( �( Vents - Grills Fireplace T.O. Fans & Controls Party Wall Insulation z Condensate Lines Party Wali Firewall Exterior Lath Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS 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 COMMENTS: ` T Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduft 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) I Building _ Address 9-17b P. hAov Jj7 City I Zip C40 Tlt Z I Contractor Tw Address City lZip ;...•,r,y�. "'.�. './`.+Gi`i/.�':.<.%v",.1..r.��f,.-:ter-+4.:. •. i:.k�h -.-• i, TAM BOX 1504 78-495 CALLE TAMPICO �+ LA QUINTA, CALIFORNIA 92253 BUILDING: TYPE'CONST. t i %IAA Ag:7 . A.P. Number Tel. b - Legal Description r State Lic. I City & Classif. Lic. q Arch., Engr., Designer" .�/U�G6j�G-G�I 1a7 Address I Tel. CityZip State �fN1 IiC�12T `JZZb� Lic. a C_ Iy�1 0 LICENSED'CONTRACTOR'S DECLARATION I hereby affirm that lam If under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION Ihereby 'affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,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 the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he 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 (5500). EJ 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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees. provided that such 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 did not build or improve for the purpose of sale.) , IA 1, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) I'7 I am exempt under Sec. B. & P.C. for this reason Date Owner r WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a Certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company t7 Copy is filed with the city: ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thg 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. Date Owner NOTICE TO APPLICANT: 11, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 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.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. 1 certify that I 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 this city to enter the above- mentioned property for inspection purposes. Signature of a0plicant Date Mailing Address City, State, Zip / WHITE = FINANCE YELLO J > QU��VT APPLUAWN O 60 200 N '4 OCC. GRP. ?9 Z' VZ' It Description N w c_--*_wvzU or- I+Vj4 111 .4 WMSN n-xv`M C..o4—o So— C3S Sq. Ft. w� Size I4c` No. ( No. Dw. Stories I Units New Add ❑ Alter O Repair ❑ Demolition ❑ s jrl 1, 4 Estimated Valuation PERMIT J I ((� b AMOUNT Plan Chk. Dep. A 5 Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: W Validation: 11� (p)Irc�ea e h►CL- , ?-�- T4 -r,.. ter+n�• -7tI = APPLICANT PINK = BUILDING DIVISION Notice: Document Cannot Be Duplicated Date 3/15/01 No. 21764 Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE Owner NameMadison Development No. 78-450 Street Highway 111 City La Quinta Tract # T29736 Lot # 4 APN # 604-050-043 Jurisdiction La Quinta Permit # 0103-049 Log # Zip 92253 Study Area Square Footage 6400 Type of Development Commercial No. of Units 1 Comments Building At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes. It has been determined the above-named owner is exempt from paying school fees at this time due to the following reason: Commercial Building EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of .33 X 6,400 or $ 2,112.00 the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may. now be issued Fees Paid By CC / First Community Bank - Ed Alderson Telephone 2760--322-1553 Name on the check �� Z By Dr. Doris Wilson Superintendent Fee collected /exemp ed by Annette Barlow Payment Received $2,112.00 Check No. 098973 r Signature 40TICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) this will serve to noGty you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to .ollect them on the District('s)(s') behalf, whichever is earlier. Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting Tom Tisdale Fire Chief Proudly serving the. unincorporated areas of Riverside County and the Cities of: Banning ❖ Beaumont Cahmesa ❖ Canyon Lake Coachella - 4. Desert Hot Springs Indian.Wells Indio Lake Elsinore 4. La Quinta 4. Moreno Valley 4� PalmDesert Perris Rancho Mirage_ _ San Jacinto ... V* Temecula ' Board.o€Supervisors Bob Buster, - District 1 John Tavaglione, . . . District 2 Tim Venable, ' District 3 Roy Wilson, District 4 . Tom Mullen, District 5 RIVERSIDE COUNTY FIRE DEPARTMENT In cooperation with the California Department of Forestry and Fire Protection 210 est San acinto Avenue • Perris, Ca i omia 925TO • (909 • Fax (909) 940-6910 February 27, 2001 To: Prest Vuksic Architecture 74-020 Alessandro, Ste C Palm Desert, CA 92260 Re: Building Plan Review- Non -Structural Point Happy / SDP 2000-688 - Bldg. 5 Fire Department personnel have completed a review of 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) These conditions are for a shell building and will receive a shell final only. No fire and life safety clearance will be issued for a tenant space until the specific occupancy classification has been established and tenant improvement plans have been reviewed and conditioned by the Riverside County Fire Department. 2) Fire Department approval is based upon the 1997 UBC requirements for Group B occupancies. It is prohibited to use, process or store any materials in the occupancy that would classify it as a Group H occupancy per Sec. 307 of the 1997 UBC. 3) The Fire Department is required to set a minimum fire flow for the remodel or construction of all commercial buildings using the procedure established in California Fire Code. A fire flow of 1,500 gpm for a 2 -hour duration at 20 -psi residual operating pressure must be available before any combustible material is placed on the job site. 4) The required fire flow shall be available from a (Standard/Super) hydrant(s) (6" x 4" x 2'/2" x 21/2") located not less than 25' or more than 165' from any portion of the building(s) as measured along approved vehicular travel ways. 5) Prior to the issuance of a building permit, applicant/developer shall furnish one blueline copy of the water system plans to the Fire Department for review. Plans shall conform to the fire hydrant types, location and spacing, and the system shall meet the fire flow requirements. Plans must be signed by a registered Civil Engineer and/or the local water company with the following certification: "l certify that the design of the water system is in accordance with the requirements prescribed by the Riverside County Fire Department' 6) Install a complete fire sprinkler system per NFPA 13. The post indicator valve and fire 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 Department Job card must be at the job site for all inspections. 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 Department for review, along with a plan check/inspection fee. 8) Install Knox Key Lock boxes, Models 4400, 3200 or 1300, mounted per recommended standard of the Knox Company. Plans must be submitted to the Fire Department for approval of mounting location/position and operating standards. 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 be purchased. EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE 82-675 Highway 111, 2°d Fl., Indio, CA 92201 • (760) 863-8886 • Fax (760) 863-7072 9) If the building/facility is protected with a fire alarm system or burglar alarm system, the lock boxes will . require "tamper' monitoring. 10) Install portable fire extinguisher's per NFPA, Pamphlet #10, but not less than 2A1 OBC in rating. Contact certified extinguisher company for proper placement of equipment. 11) 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. 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' in height. Minimum of 6" lettering is required for suite identification. 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. 12) Electrical room door shall be posted "ELECTRICAL ROOM" on the outside of door. 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) 863-8886. 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 By Walter Brandes Fire Safety Specialist H:\PE2XWPDATAU.AOUINTA\PROJECTMLDG PC%SDP2000-688 Bldg 5(b).doc k RIVERSIDE COUNTY FIRE DEPARTMENT FIRE PROTECTION JOB CARD THIS INSPECTION RECORD MUST BE AT JOB SITE WITH AN APPROVED SET OF PLANS Owner-cL Date a e Location. F(.t�G�- owl.?.�t,�L �d�t� — 78-q3o Awy w . 1 ' Case No. Sprinkler Company ��..,;i rn�I D tonspectord) (200 PSI For 2 Hrs. Prior to Inspection Time) (Center Load Pipe Only, Joints and Thrust Blocks Must Be Expos Underground Flush Date Inspector zooh psi y Z lr r3 p_ O erhead Static Date Inspector (200 PSI For 2 Hrs. Prior to Inspection Time) Overhead Final Date Inspector Fire Main Installer Underground Static Date Inspector (200 PSI For 2 Hrs. Prior to Inspection Time) (Center Load Pipe Only, Joints and Thrust Blocks Must Be Exposed). Underground Flush Date Inspector Extinguishing System Installer Final Date Inspector Fire Alarm Installer Final Tank Installer Date Inspector m 0 fI" REGISTERED INSPECTOR'S WEEKLY REPORT JON TANDY 37630 Medjool Ave. Palm Desert, CA 92211 Office (760) 772-7192 Fax (760) 772-7193 Pager (760) 776-3338 TYPE OF INSPECTION PERFORMED ❑ REINFORCED CONCRETE TRUCT. STEEL ASSEMBLY ❑ ❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER r - ❑ REINFORCED MASONRY ❑ FIRE PROOFING�(�SZ,✓��f,4(. JOB LOCATION � LAb Go REPORT SEQUENCE N0. TYPE 0 RUCTURE � � � PERMIT NO. � � s O OA � � DAY OF WEEK MATERIAL DESCRIPTION (� ,^ p -� ! 1!- 1t V //,►s `/G_7 APC' E-S)t--/ 7 INS ECTOR NRS. CHARGED -- o t 4,S - ENNGG{,ININEER e -7 ASS�SIISSTTANTY HRS. CHARGED INSPECTION GENERAL SUB DATE' ' CONTRACTOR '�'IiLm CONTRACTOR-` -S�.�``Lw1I1 C Szzl— i COPY SENT TO CLIENT ❑ CONTINUED ON NEXT PAGE ❑ PAGE OF CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF ,THE GOVERNING BUILDING LAWS. SIGN TURE OF REGISTERS INSPECTOR DATE O REPORT REGISTER NUMRFR