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LICENSED CONTRACTOR DECLARATION
1,1 hAby affirm under penalty of perjury that I am licensed under provisions of
Ctitpter 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 -
74216 012C
ool a Signature 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:
( ) 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 -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
perfqmance of the work for which this permit is issued.
�a I have and will maintain workers' compensation insurance, as required by
S6ction 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 STiNTE pUND cPolicy No. -d .01
142,907,
(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
x-, r 1, -
Code, I shall forthwith compfw-i ;-�t ose , rovisions.
0 -ate: __1 Annfinnnt" M
i UE
Warning: Failur'p tn' Lim 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 compensatiori, 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 ab6ve-mentioned property-for.iispelction,purposes.
I `
nt —'KKIJ�N�\, Dat
Pgn-ature (Owner/Age
'K
PERMIT #
BUILDING PERMIT
DATE VALUATION LOT TRACT
T29736
JOB SIfE/
APN
ADDRESS 78- 4 74 B XAMAY 111. (01 J) 2)
W 4 - W - 0,11
OWNER
CONTRACTOR DESIGNER EN61NEER
MADSS'O�T rJJVW'UX)Y4dWT
I
7109 THFART CX)MY, 11 R1K.,11OU
94390 MA)IRTMN AVONVE
3 001 F- Iquuz o I o
(ATILAWO CA, 91762
PA11M, ISIMIMS CA -02262
(760)322-1553 MILO 11961
USE OF PERMIT
CO'MNIRRVAL
AX - COMMMMAL 4,M.0 SF
CONTRACT AMOUNT
P11Kr.[MXrEYY COST (01 MNIST-RIJ01111014,
Yrd,MAXII
111MMIT PRE SCAMARY
C(NOMIU0,1014 ME lol-000-efis-600
PLAX C19MC VEY 101 -000,439-31 S
FEE D0001T 101-000-459-M .$1,000.00
E LIECTRWAL VER 101. -000-42W-000 $107100
PLUMB NIO YZE 101 4XI0419-000 $ITZ-50
STAO "I M"OTIOV-4 FIR COMM I OC -0004A 1-000 4elr.. S 3
101-000-423-000
DEV81,0PER IMPACTRE37,
ART 114 PUBLIC P'LNCES COM
—8, -T-OT, 16 coRl"I P, � 111LAN
ND CEM711K
a-011113 PR1'1?_:PAW lirl. Mi
",62,2.35
41.0moo
T IM".. DIVE NOW
--0F:LAoLnW-A
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FIN
RECEIPT
DATE
DATE FINALED
INSPECTOR
14);J
irIff or
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 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 PIN. 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
c<,Her Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
ti
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)
YOUNG ENGINEERING SERVICES
Engineering Architecture -Surveying- Building & Safety Services
Letter of Transmittal
To: City of La Quinta Date: 1/29/01
Project: PC #0110-179 (1" check)
Point Happy Bldg. 2
Attn: Greg Butler W.O.:
Tel No.: Tract No.:
We are forwarding: By Messenger By Mail X Your Pickup
No. of Copies Description:
1 Plans (1" submittal)
1 Plans (2°d submittal)
1 Structural calculations
1 Structural calculations addendum #1
1 Soils Report
1 Testing and Observation during grading report
1 Truss calculations
Comments: Structural content is approvable = with the exception of the solid
grouting requirement of the 9'-8" garden wall. See attached comment list.
Engineer of Record to stamp and wetsign structural plans.
This Material Sent for:
Your Files X Per Your Request
Your Review Approval
Checking At the request of:
Other
By: John W. Thompson
Phone # 760-342-9214
.47-159 Youngs Lane, Indio, CA 92201 (760) 342-9214
Bronz Young
Tom Tisdale
Fire Chief
Proudly serving the
unincorporated
areae of Riverside
County and the
Cities of:
Banning
0
Beaumont
4
Calimesa
Canyon Lake
0
Coachella
O
Desert Hot Springs
4
Indian Wells
0
Indio
a
Lake Elsinore
m
La Quirda
Q
Moreno Valley
P
Palm Desert
0
Perris
0
Rancho Mirage
4
San Jacinto
0
Temecula
Board of Supervisor
Bob Buster,
Dimer t
John Tavaglione,
Diads 2
Sun Vmable,
DirAa 3
Roy Wilwn,
Distid 4
Tom Mullen,
bia ria 5
l02 4:45PM MADISON DEVELOPMENT 100 111-0202 No -3525 P. 2
RIVERSIDE COUNTY FIRE DEPARTMENT
In cooperation with the
California Department of Forestry and Fire Protection
216 eat Son minto Avenue • Perris. California 92570 • ) • Fax (909) 9413 -WO
January 9, 2002
To: Prest Vuksic Architects
74-020 Alessandro, Ste. C
Palm Desert, CA 92260
Re: Non -Structural Building Plan Review
SDP 2000-688 / Point Happy — Bldg. #2
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) 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) 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 the 1998 CFC. A fire flow of 2,000 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.
3) The required fire (low shell be available from a (Standard/Super) hydrant(s) (6'x 4"x 2'/2"x 2'/2")
located not less than 25' or more than 165' from any portion of the bullding(s) as measured along
approved vehicular travel ways.
The following conditions must be met prior to occupancy:
4) Install Knox Key Lock box, Model 3200, mounted per recommended standard of the Knox
Company. If the building/facility is protected with a fire alarm or burglar alarm system, the lock box
will require "tamper" monitoring. Special forms are available from this office for the ordering of the
Key Box. This form must be authorized and signed by this office for the correctly coded system to
be purchased_
5) Install portable fire extinguishers per NFPA, Pamphlet #10, but not less than 2A10BC In rating.
Contact certified extinguisher company for proper placement of equipment.
6) 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 budding(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. i
7) Electrical room door shall be posted 'ELECTRICAL ROOM' on the outside of door.
8) Room capacity shall be posted in a conspicuous place on an approved sign near the main exit from
the room.
EMERGENCY SERVICES DIVISION - PLANNING SECTION - INDIO OFFICE
82675 Highway 111.2-1 FI.. Indio, CA 82201 - (760) 863-8886 • Fax (760) 863-7072
Jan.15. 2002 4:45PM MADISON DEVELOPMENT 100 771-0202 No -3525 P. 3
Please contact the Fire Department Planning & Engineering staff for final inspection prior to occupancy.
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 6
Engineering staff at (760) 863-8886.
Sincerely,
FRANK KAWASAKI
Chief Fre Department Planner
By
` Walter Brandes
Fire Safety Specialist
H:we7wrwTAXL*4U*ffA% ro,E=ee.m vCeMWAD a. OWI Z.dw
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Building
Address 7JI
I Owner
NCA V� 4
- Mailing
f'Address
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Zvp ITel.
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Contractor
L in N 1, 4, t C1,
Address
—,City Zip Tel. -
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—State Lic. City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City Zip State
I I Lic. #
P.O. BOX 1504 APPLICATION ONLY
LA 78-495 CALLE TAMPICO
QUINTA, CALIFORNIA 92253
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70DO) of Division 3 of the Business and Professions Code, and my license is in full force and
effect .
SIGNATURE DATE
OWNER-BUILOER DECLARATION
I he reby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 703 I.S.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 La., 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 ($500).
I] I as o net of the property, or my employees with wages as their sole compensation, will
�do ihe wowrk, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
k Professions Code: The Contractor's License Law does not apply to an owner of property who
I builds orl.improves thereon arfd who does such work himself or through his own employees,
tprovided that such improvements are not intended or offered for sale. If, however, the building
0, 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.)
1*1 1, as owner (Zf 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'! I am exempt under Sec. -B. & P.C. for this reason
Date -Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worke r's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
In Copy is filed with the city. 0 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thp work for which this permit is issued, I shall not
empi by any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date_Owner
NOTICE TO APPLICANT., ff. 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. 309 7, 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 it work thereunder is suspended for 180 days.
I 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
YN-50wvr,
LDING: TYPE'CONST. OCC. GRP
.Number 6v�_ OY/
al Description ter 7& V 234
Sq. Ft.
Size
New 0
Description
LX S
No. No. Dw.
Stories Units
A dd 0 Alter 0 Repair 0 Demolition 0
— �4 ; -% '—# I —
�stimated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Eric. 4 �11
Inf rastructure
TOTAL
REMARKS
AMOUNT
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:
Validation:
WHITE = FINANCE YELLOW = APPLICANT
PINK = BUILDING DIVISION
Notice:
Document Cannot Be Duplicated
Date 2/14/02
No. 22944
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
APN # 604-050-041
Jurisdiction La Ouinta
Owner NameMadison Development
No. 78-474
city La Quinta
Street Highway 111 (BLD 2)
Zip 92253
Permit # 0 110- 179
Log #
Study Area
Tract # T29736 Lot # 2 Square Footage 4975
Type of Development Commercial
Comments
Shell Building 4975 s.f.
No. of Units 1
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:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 - in the amount of
.33 X 4,975 or $ 1,641.75 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 Tele bone
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Nicola Wong
Signature
P
µ
Payment Received $1.,641 75
Check No. 104882
INOTICE: Pursuant to Assembly Bill 3081 (CHAP 549, VATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified I
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
collect 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
YOUNG ENGINEERING SERVICES
Engineering Architecture•Surveying• Building & Safety Services
Letter of Transmittal
To: City of La Quinta
Date:
Project:
Attn: Greg Butler W.O.:
Tel No.: Tract No.:
4/2/02
78-474 Highway 111
Bld'g 2 — revision
We are forwarding: By Messenger By Mail X Your Pickup
No. of Copies
1
1
Description:
Plans
Structural calculations
Comments: Structural content is approvable.
This Material Sent for:
Your Files X Per Your Request
Your Review Approval
Checking At the request of:
Other
By: John W. Thompson
Phone # 760-342-9214
47-159 Youngs Lane, Indio, CA 92201 (760) 342-9214
Bronz Young