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0402-188 (RC)i LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of t� Chapter 9 (commencing with Section 7000) of Division 3 of the Business and C� W Professionals Code, and my.License is in full force and effect. O1� M License # Lic. Class Exp. Date Z ,Date, Signature of Contractor O CD �:_W,I J U C:) OWNER -BUILDER DECLARAT1 N W UJ r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's I) License Law for the following reason: Z_ ( ) 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). - C•`) () I am exempt under Section , B&P.C. for this reason LO N Date Signature of Owner O C\I CL Q WORKER'S COMPENSATION DECLARATION D < cc I hereby affirm under penalty of perjury one of the following declarations: n Fa- p () 1 have and will maintain a certificate of consent to self -insure for workers' < W compensation, as provided for by Section 3700 of the Labor Code, for the D - Q performance of the work for which this permit is issued. n Q U ( ) I have and will maintain workers' compensation insurance, as required by L Q Section 3700 of the Labor Code, for the performance of the work for which this L 0)permit is issued. My workers' compensation insurance carrier & policy no. are: ? Z Carrier II9i1�..�1PT Policy No. cb Z) J (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 3 subject to the workers' compensation provisions of Section 3700 of the Labor Code hal forthwith comply with thos pro visions.✓ Applicant— Warning: pplicant 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. 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 property for inspection purposes. Signature (Owner/Agent) y Date _/ " F,. BUILDING PERMITPERMIT /JtKE VALUATION LOT TRACT f ), 'i CI$501000.00 /� o'la. s JOB SITE q APN ADDRESS 7i"C ,� OMWAa;�L %II OWNER CONTRACTOR / DESIGNER / EN 1NEER y,' M i�R.OPOEMY ��.�iM�`9�i7`.�MENT LLC �ai..EVI A.W.�JER T)E-V .�_0PM WT 12-15155 81:.01-I aiLTl:rF DR S11:7> 71 35 ' 3699 ANDrtEM 11MLS ROAD SAN D111010 CA -121..10 SPRWiS CA 91262 (Mop10W3631. CSI:,# TBD USE OF PERMIT rB}?3.`2Q..}tyx"1,f'.y�Ttd'�i'yii�{R.�1•VOR. 3tt�;R,ltr7c'�DEL • :f:�EN`i'.e"�1L i�TPICL. 8S �Cx€�NIVI-T.I. Y.NWA ION lio,005100 fats PFRh d'1'" `"FF.. S'CJIVIMMY PLAN C:}•lilMFEES 101-000-439.318 $2,69.43 COWSTPIU(." f lION PFE 101-000-418-000 $414.50 MECHANICAL FM 101#000-421-000 VIM :X tX ,TR,1CAf..1 fiF, $60.50 PLUMB1140 101.OW-419.000 587160 D � D MAR 2 9 2004 CITY OF LA QUINTA FINANCE DEPT . SIM-TIOTAL CONSTRUC 710H MID PL" CHM, Z_ LEE PRE -PAID TIRES TOTAL ]PERNIH]FRES IYUr NOW 14', 8143 I RECEIPT DATE,, .r c BV DATE FI ALE INSPECT .. G � - � f,. �_ io13ia! - 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 S / 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 (o Final / Final D POOLS - SPAS BLOCKWALL APPROVA S 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 JjzHeater Final Water Piping Plumbing Final Plumbing Top Out UEquipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Qfi Final COMMENTS: a /% 0wo- /���iUGN/l/ / Te `1eAwo � Rst�nacr awm to%n LTc uut 4 z8 c ��•'J/ / Ge�t� L°' FS Sl Final 0 Utility Notice (Gas) F ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit /ill.4s1�fl,IL Rough Wiring / Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power " Flnal ' Utility Notice (Perm)44 Craig Anthony Fire Chief Proudly serving the Unincorporated Areas of Riverside County and the Cities of: Banning Beaumont Calimesa 4. Canyon Lake Coachella Desert Hot. Springs .;. Indian Wells 4. Indio Lake Elsinore 4. La Quinta 4. Moreno Valley Palm Desert Perris Rancho Mirage San Jacinto Temecula Board of Supervisors Bob Buster, RIVERSIDE COUNTY FIRE DEPARTMENT In cooperation with the California Department of Forestry and Fire Protection 210 West San Jacinto Avenue • Perris, California 92570 • 940.69 • Fax ( 9413-69110 October 12, 2004 City Of La Quinta Building Department Re: DR. Long LAQ-04-TI-019 The Riverside County Fire Department is granting a fire and life safety clearance with the following address 78-461 Hwy 111, La Quinta. Please call if you should have any questions. District 1 John Tavagh6rie, , District 2 Jim Venable, TD/j1 trict 3 Roy Wilson, IS�fie6.4= Marion Ashley; t , District 5 FRANK KAWASAKI Chief Fire Department Planner By Terry eS ucy Fire S ste s Inspector EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE 82-675 Highway 111, 2nd Fl., Indio, CA 92201 • (760) 863-8886 • Fax (760) 863-7072 Tom Tisdale Fire Chief Proudly serving the unincorporated areas of Riverside County and the Cities of: Bannin Beaumont e• Calimesa 4 Canyon Lake Coachella Desert Hot Springs 4• Indian Wells 4• Indio 4� Lake Elsinore . 4• La Quinta Moreno Valley Palm Desert 4• Perris Rancho Mirage 4• San Jacinto 4• Temecula Board of Supervisors Bob Buster, District 1 John Tavaglione, District 2 Jim Venable, District 3 Roy Wilson, District 4 Marion Ashley District 5 RIVERSIDE COUNTY FIRE DEPARTMENT In cooperation with the California Department of Forestry and Fire Protection 82-675 Highway 111, 2nd Fl., Indio, CA 92201 • (760) 863-8886 . Fax (760) 863-7072 February 17, 2004 Patterson Dental Supply, Inc. 9380 Waples Street, Ste.105 San Diego, CA 92121 Rem Nonstructural Building TA Pian Review �_LAQ-04-TI-019 / Dr. Long De —Dental Office "7 78-461 Hwy 1_11—�—`" Fire Department personnel have reviewed and approved 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) Fire Department approval is based upon the 2001 CBC requirements -for Group B occupancies. it is prohibited to use this facility in a manner that would classify the use as a Group 11.2 Occupancy per Sec. 307 of the 2001 CBC. 2) ' If existing in the building, fire sprinkler system plans for the tenant improvement area must be submitted to the Fire Department for review, along with a planAnspection fee. The approved plans, with Fire Department Job card must be at the job site for all inspections. 3) . All egress doors shall comply with CBC Sec.1003.3.1.8 for proper door hardware. 4) Install portable fire extinguishers per Title 19, but not less than 2A10BC in rating. Contact certified extinguisher company for proper placement of equipment. 5) 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. In mufti -tenant buildings, businesses shall post the business name and suite number on back doors as well as the front. Suite numbers or letters must be a minimum of 6" in height. All addressing must be legible and of a contrasting color with the background. Please contact the Fire Department Planning & Engineering'staff for final inspection prior to occupancy. 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 Watter Brandes Fire Safety Specialist of La Qulnta—13uilding Dept. Ky'EMP oa u, o%&aft0JWr TP4AQ- M1@.da EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE 82-675 Highway 111, 2nd Fl., Indio, CA 92201 • (760) 86348886 • Fax (760) 861-7072 �1 .....,C Vi. Tenent Improvement For Dr. Michael W Long owner., Dr. long address 78-461 hwy 111 La Quinta CA, 92253 �m chanical�room� 72s =74r.�. 8 employees . 2 handycapped bathrooms contact person: Dennis Alexander phone # (760) 910-3631 fax# (760) 564-3874 CONTENTS FLOOR PLAN FOUNDATION FRAMING LEASE AGREEMENTS el ' Ica t � 'NT BUILDING & SAFETY DEPT. APPROVE FOR CO STR CTI0 DATE 3 Z(p S Y B 27 a40 :7 2'- uS iok — I� \) � ipt. 9 0 0 v A8 — 31b0 NOuon8-LSN00 80_j •'1d3Q ld33V5 -V ONIQlins P ViNino v-, q® Ailo 0 0 m o o rouncaatlon plan O>� 0 G)0 co90 c®„� �m�. z�M 2 . --a mecnanlcal room i m o o rouncaatlon plan O>� 0 G)0 co90 c®„� �m�. z�M 2 . --a mecnanlcal room 2X6 ra 4x8 beams 5/8 anchor bolts 32" oc 2x6 plat framing plan mechanical room D M T : DO 0 G) ��� ®T� MC: 0002 LE TER AGREE NT June 4, 2003 Michael W. Long DDS 78-461 Highway 111 La Quinta, California 92253 RE: Extension of Lease Term and Expansion of .Premises MICHAEL W. LONG, DDS PLAZA LA QUINI'A, LA QUINTA, CALIFORNIA UNIT#32-23 . Dear Dr. Ur1g; By a document entitled "Lease" dated June 16, 1995, as amended (hereafter the "Lease' I Landlord's predecessor in interest leased to Michael W. Long; DDS (hereafter. "Tenant") certain premises or approximately 1,300 square feet, located in the Plaza La Quinta (the "Shopping Center") with an address of 78-461 Highway 111, La Quinta, California (hereafter the "ExistingPremises"). Landlord and Tenant acknowledge that the term of the Lease expired by its terms on March 3 i, 2002 and that Tenant has subsequently been in possession of the Existing Premises as Tenant or a month-to-month. tenancy. Landlord and Tenant now desire to amend and modify the Lease in certain respects as hereafter set forth. Therefore, in consideration of the mutual covenants contained herein, Landlord and Tenant agree as set forth below. Except as expressly set forth below all of the terms and provisions of the Lease shall remain in full force and effect: 1. Expansion of Premises• A." -Effective June 1, 2003 (the "Effective Date'), Landlord shall deliver to Tenant the space located adjacent to the Existing Premises known as 78-451 Highway 111, La Quinta. California (hereafter the "Additional Premises") . The Leased Premises shall now be defined as the Existing Premises plus the Additional Premises plus the Compressor Area (defined below) and may be hereafter referred to as the "New Premises" or the "Leased Premises". The Additional Premises consists of approximately 1,950 square feet. The New Premises thus contains approximately 3,250 square feet plus the Compressor Area. The New Premises is . outlined ion the F Z -bb -i -t-22 site plan attached hereto, From and after the Effective Date, any reference to Exhibit "B" in the Lease shall mean the attached Exhibit 'B". 13- The New Premises also includes an area immediately at the rear of the j Existing Premises as shown on Exhibit "B" (the "Compressor Area"). 'The Compressor Area consists of unimproved land upon w "ch the Tcna�ats sole cost and ex ens a c nstruct a fCjl ructure compatible with the existing exterior na Pe Willding of which the L d Premises area part to house Tenants Compressor and related dental equipment and the feed and 1 i LE TER AGREE NT June 4, 2003 Michael W. Long DDS 78-461 Highway 111 La Quinta, California 92253 RE: Extension of Lease Term and Expansion of .Premises MICHAEL W. LONG, DDS PLAZA LA QUINI'A, LA QUINTA, CALIFORNIA UNIT#32-23 . Dear Dr. Ur1g; By a document entitled "Lease" dated June 16, 1995, as amended (hereafter the "Lease' I Landlord's predecessor in interest leased to Michael W. Long; DDS (hereafter. "Tenant") certain premises or approximately 1,300 square feet, located in the Plaza La Quinta (the "Shopping Center") with an address of 78-461 Highway 111, La Quinta, California (hereafter the "ExistingPremises"). Landlord and Tenant acknowledge that the term of the Lease expired by its terms on March 3 i, 2002 and that Tenant has subsequently been in possession of the Existing Premises as Tenant or a month-to-month. tenancy. Landlord and Tenant now desire to amend and modify the Lease in certain respects as hereafter set forth. Therefore, in consideration of the mutual covenants contained herein, Landlord and Tenant agree as set forth below. Except as expressly set forth below all of the terms and provisions of the Lease shall remain in full force and effect: 1. Expansion of Premises• A." -Effective June 1, 2003 (the "Effective Date'), Landlord shall deliver to Tenant the space located adjacent to the Existing Premises known as 78-451 Highway 111, La Quinta. California (hereafter the "Additional Premises") . The Leased Premises shall now be defined as the Existing Premises plus the Additional Premises plus the Compressor Area (defined below) and may be hereafter referred to as the "New Premises" or the "Leased Premises". The Additional Premises consists of approximately 1,950 square feet. The New Premises thus contains approximately 3,250 square feet plus the Compressor Area. The New Premises is . outlined ion the F Z -bb -i -t-22 site plan attached hereto, From and after the Effective Date, any reference to Exhibit "B" in the Lease shall mean the attached Exhibit 'B". 13- The New Premises also includes an area immediately at the rear of the j Existing Premises as shown on Exhibit "B" (the "Compressor Area"). 'The Compressor Area consists of unimproved land upon w "ch the Tcna�ats sole cost and ex ens a c nstruct a fCjl ructure compatible with the existing exterior na Pe Willding of which the L d Premises area part to house Tenants Compressor and related dental equipment and the feed and 1 utility lint..srelated to the operation of the Compressot: Dr Long DDS 78-461' Hwy 111 La Quinta, Ca Compressor & Storage Room. 3'-0" x 6'-8" - 2'-� - I �'-s 7'5" Wa1111-f�igth on back wall �r ---o .L ... _ X-4 3'-0" x 6'-8" t 1 v ,,�" v\\` 4" Concrete Slab ° ' sem,, Footing Lf = 39 j Wall SF = 273 Trash Bin Area o /� 5 / Slab SF = 72 2'-9„ / -2' x 61- .. .... '-...... Cl) ,! 7' Wall Heigth on front wall 6x8xl6 Block Building �� Certificate of Occupancy ,- copy. 19et O 1 Building & Safety Department r 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 f construction and/or use.IX y BUILDING ADDRESS: 47-461 Highway 111 Use classification: Commercial Rerv>lodel (Dental Office) Building Permit No.: 0402-188 t Occupancy Group: B Type of Construction: VN Land Use Zone: CR r Owner of Building: M&H Property Management LLC Address: 12555 High Bluff Dr Ste 285 CA 92130 City, ST, ZIP: San Diego �z ^�t�..t ' By: Daniel P. Crawford Jr. v i Date: 10/13/04 , Building Official r POST IN A CONSPICUOUS PLACE : '