0202-132 (CSCS)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
G hlpter 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
8 R92
bate i t of U C" 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:
( ) 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).
( ) 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
performance of the work for which this permit is issued.
2 1 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:.
Policy No.
Carrier �°t'.A t'p 7Tkv
(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
Code, I shall forthwith comply with those provisions.
Date: rem• 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. c is
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.
Y / j '� f
Signature (Owner/Agent) � #�""�'"7” u ;z - Date– ( �
BUILDING PERMIT PERMIT#
DATE VALUATION LOT�'�� TRACT
JOB SITE
APN
ADDRESS 18-474 ITIGHW Y III 1,81M ) ..
604^Q:MMA
OWNER
CONTRACTOR/DESIGNER/ENGINEER
A/CdO,{3 ON ]YEWIH..Ciy.''1 >`j'.�
PS TZ0 BUM31,T48
911,1 .t'Y ].7AOU"011144I.`1 AM ,= la',1.•
PONJ+!"L'8i543
WTMIG CPA 911162
CA 92067
(859)755,4678 M1 1 4
USE OF PERMIT
IMM: LPATEXAM
_ €Up ?l f � Trytd f'�R,� ' �)'U�llGbi ig(CH� N, 0Z 01? C.C3�?T.R,,11C 0k). COMMERCIAL
SHELL jii i./L,DlHO 405 *�I.JARE I ZiTFrNTEVN-i. PRJkW.kV c.99
OCCUPANCY,
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7
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yiJP1�t �f ,'i°t'I41 i�srT�Af11` ^3 101-00042.3.000 91,10
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$0.00
®d
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- TOTAL MM;4 TERS X9C7:1+; wC3w
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ATE
(BY
DATE F ALED
INSPEC
....,w,,/
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
_G
F.A.U.,
Framing
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
Final
Final _�.Z�U2 _C
BLOCKWALL APPROVALS
POOLS - SPAS
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
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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
Te p. Use of Power
s Det/
Final
Utility Notice (Perm)
COMMENTS:
Q./ �/) GGA JP7-e-`l/ G4lv— S
ex
ljhlv-1, G�—ri C*I—
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"O�aQUIN�TAP F LA QUINTA
AFETY DEPARTMENT
77-7012
NREQUEST LINE
77-7153
Contractor AISARO BIJELDERS
Permit Number __ _ 11202-132
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 78-474 Ilwy. 111 Id 2
COMM. SHELL 4975 SQ.FT/
TYPE VN-SPRINK/"B" OCCUP.
SUPP.T 110-179 change contr. l I
rd
TYPE OF INSPECTION DATE INSP.
TEMPORARY POWER
SETBACKS G
U/G PLUMBING/ WASTE
U/G ELECTRICAL / GROUNDING
FOOTINGS / STEEL
CONCRETE SLAB
DO NOT POUR CONCRETE UNTIL ABOVE SIGNED
ROOF NAIL / PRE -ROOF
OKAY TO WRAP - /� • v2 L
FRAMING COMBINATION S
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH MECHANICAL -
INSULATION
COVER NO WORK UNTIL ABOVE SIGNED
INTERIOR GYP. BD. DRYWALL
EXTERIOR LATH "7_
GAS TEST
SEPTIC ABANDONMENT
SEWER CONNECTION
SEPTIC / GREASE INTERCEPTOR
MASONRY INSPECTIONS
FOOTINGS / STEEL
BOND BEAM
POOL / SPA / WATER FEATURE INSPECTIONS
PRE-GUNITE / SETBACKS
U/G PLUMBING `
U/G GAS
U/G ELECTRICAL
PRE -PLASTER ALARMS / BARRIERS
FINAL INSPECTIONS
TEMP. USE OF PERMANENT POWER
PLUMBING
MECHANICAL
PUBLIC WORKS DEPARTMENT
COMMUNITY DEVELOPMENT DEPT.
FINAL / JOB COMPLETED
WEAPPROVALS DO NOT INCCU—DE-RI G(iT TO
TURN ON UTILITIES OR OCCUPY BUILDING
s 08/22/2002 13:35 FAX
e}
jMW TRUSS
JIM HUFFMAN
August 22, 2002
JIM HUFFMAN
ASARO BUILDERS ,
74-607 GARY AVENUE
PALM DESERT, CALIFORNIA 92260
RE: POINT HAPPY
g RETAIL PROPERTIES
HWY 111 & WASHINGTON
, . PALM DESERT, CALIFORNIA
TO WHOM IT MAY CONCERN,
THIS LETTER CONFIRMS ON 8-22-021 PHYSICALLY INSPECTED THE TRUSSES WITH
TOP CORD SCARF CUTS. THES TRUSSES HAVE BEEN REPAIRED AND HAVE THE SAME
STRUCTURAL INTEGRITY AS ORIGIONALLY DESIGNED.
COMMITTED TO EXCELLENCE,
RICH WILSON
PRESIDENT
SOUTHWEST'S LEADING TRUSS MANUFACTURER
Q. O. T. S.
Quality On -Time Service
35-325 DATE PALM DRIVE SUITE. 225 CATHEDRAL CITY, CA 92234
760-202-3699 (0)760-202-4399 (I')
RICH WILSON
U001
40 * Earth S stems Consultants 79-811B Country Club Drive
y Bermuda Dunes, CA 92201
.•`� Southwest (760) 345-1588 • (800) 924-7015
DAILY. REPORT OF INSPECTION OF CONCRETE
SB/R.S CO. GOV. UBC TITLE 21/24 OTHER //
Building Permit No.: DSA Application No.: Date of Inspection: C4 !./to Z
Project Name: 'Po INf Naypy 8,0 i H J 4#Z Job No.: a 761
Project Address: 7$ - -4 74 Hio y ZZl . La. ovix"fa
Architect: Structural Engineer:
General Contractor: Sub Contractor:
TYPE OF INSPECTION: �SReinforcing Placement Other, 9DaXv A m" Ars
Description of Work Inspected: rrA S Dea- ted i n s+p.Ittd- i d m d 4— 9-A "' A ll hhyeo-d
-- J,les e= /evrt" by en, P*1Dvess br4-1sA
FpoXy tape; 6impsam SGT- PAC rd/3o 5`Z71
Ame,kcrs ,we.re- irisfyOW mer Martij-6cArws re4uirc�rre'I�f"s.
Unresolved Items:
, Descriptive Location of Samples:
Slump: Cone Temp:
Water Added: Air Temp:
Air Content, %:
Time in Mixer:
Specified Strength:
Unit Wt.: Sample Time:
Supplier:
Mix Design -
Admixture:
Truck #:
# of Samples:
Field I.D. Marking:
I hereby certify that I, have inspected all of the above reported work, unless otherwise noted, and to the best of my ability I have found this work to comply with the approved
plans, specifications & applicable building laws. Final report issued at project completion.
Inspector's Name/No. IV14-),k w Qrf Inspector's Signature -
3"1080
All inspections based on a minimum of 4 hours; over 4 hours will be an 8 hour minimum.
In addition, any inspection extending past 12 pm will be an 8 hour minimum.
Contractor's Representative
BD -M-402 (10/98) Copy 1 ESC Lab Copy 2 Project Superintendent Copy 3 Governing Agency
Tom Tisdale
Fire Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
Cities of-.
Banning
Beaumont -
Calimesa
Canyon Lake
.;.
Coachella
e. -
Desert Hot Springs
Indian Wells
4.
Indio
Lake Elsinore
.y
La Quinta
Moreno Valley
Palm Desert
4.
Perris
Rancho Mirage
San Jacinto
Temecula
Board of Supervisors
Bob Buster,
District 1
John Tavaglione,
District 2
Jim Venable,
District 3
Roy Wilson,
District 4
Tom Mullen,
District 5
� 4
RIVERSIDE COUNTY FIRE DEPARTMENT
In cooperation with the
California Department of Forestry and Fire Protection
2 0 est San Jacinto Avenue • Perris, California 92570 • (909) 940 • Fax ( 940-6910
January 9, 2002
To: City of La Quinta
Building Department
Re: Release for Building Permits
SDP 2000-688 / Point Happy — Bldg. #2
The Riverside County Fire Department hereby releases the above referenced project for issuance of a
building permit at the discretion of the Building Department.
Respectfully,
FRANK KAWASAKI
Chief Fire Department Planner
By
Walter Brandes
Fire Safety Specialist
H:VPE2lWPDATALLAQU1MAXPRQIECTS%BLDG PMDP200D-M Bldg 2 BP RUease.da
EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE
82-675 Highway 111, 22.d FI., Indio, CA 92201 • (760) 863-8886 • Fax (760) 863-7072
WWI
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 Safety Department only
after approval. Contact applicant for resolution of conditions preventing or delaying approval.
Project: Commercial Shell Building, 4975 s.f.
78-474;'Highway 111, Building 2
Applicant Contact: Ed Alderson (760) 561-9541
Application / Circulation Date:
Community Development Department
N
lam'
Christine di Iorio, Plan ng Manager
Public Works Department
Steve Speer, Senior Engineer
Building and Safety Department
Greg Butler, Building '& Safety Manager
l o iiI /
Date
/() / /&/C)/
Date
Date
Date
S
Dec -18. 2001 3:25PM MADISON.DEVELOPMENT 160 111-0202
No.3321 P. 1/1
DEVELOPMENT
City Of La Quinta
PO Box 1504
78-495 Calle Tampico
La Quinta, California
92253-1504
Re: Building #2 access ladders
Attn: Building Department
Gentlemen.
Reference the plan check and permit issuance on the subject building, please consider the following.
The plan before you is for the construction of a shell building. The concern for the location of the roof
access ladder is indicated on the building plans. Should the building be eventually divided into more than
one tenant, we as the landlord will make a key available to all for access to the roof acoess ladder. Should
you have any further questions, please do not hesitate to call.
Regards:
Ed Alderson
Madison Development / Construction Manager.
938 North Mountain Avenue . Ontario. California 91762 . 909.933.9118 . Fax 909.933.0066
71361 San Gorgonio Road . Rancho Mirage, Call torn la 92270 . 760.776.1728 . Fax 760.773.0738
Tom Tisdale
Fire Chief
Proudly serving the
Unincorporated
Areas of Riverside
County and the
Cities of:
Banning
•:*
Beaumont
Calimesa
.a
Canyon Lake
Coachella
Desert Hot Springs
E•
Indian Wells
4.
Indio
` Lake Elsinore
La Quinta
0. -
Moreno Valley
Palm Desert
r,
Perris
01
Rancho Mirage
4 -
San Jacinto
Temecula
Board of Supervisors
Bob Buster,
District I'
John Tavaglione,
District 2
Jim Venable, s
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
210 West San Jacinto Avenue • Perris, California 92570 • (9 09) 940-6900 • Fax (909) 94"94"910
April 21, 2004' f�f
City Of La Quinta
Building Department
Re: Fire and Life Safety Clearance
LAQ-03-TI-041
Point Happy
The Riverside County Firea fire and life safety clearance for the
Following address located �78474 hwy 111 La uinta. Please call if you should have
any questions.—'`-�`~--
M
DSI
FRANK KAWASAKI
Chief Fire Department Planner
By
Terry D oucy
Fire Safety Specialist
EMERGENCY SERVICES DMSION • PLANNING SECTION • INDIO OFFICE
82-675 Highway 111, 2nd Fl., Indio, CA 92201 . (760) 863-8886 • Fax (760) 863-7072
From BG To: Ed Alderson Date: 7/2/2002 Time: 3:20:54 PM Page 2 of 3
B.C... STRUCTURAL ENGINEERING
BRIAN GOTTL_IEB - CIVIL ENGINEER - Lic. No. C33047
J 45-535 Via Corona
�j Indian Wclls, CA 92210
(760) 568-3553 (760) 568-5681 Fax
July 2, 2002
Mr. Ed Alderson
Madison Development
71-361 San Gorgonio Road
Rancho Mirage, CA 92270
'78- 474 MOY /r I
r
RE: Point Happy Building 2 — La Quinta, CA
The purpose of the site observation work undertaken by B.G Structural
Engineering for the above named project was to confirm that this project has been
constructed in general conformance with the structural. drawings and as required
by the 1997 UBC Section 1702.
Observation of the construction of this project was conducted or supervised by
Brian Gottlieb of this office. These observations were to establish the
conformance of several items including, but not limited to: conformance of
framing to framing plans, the assembly of shear walls, wall sheathing, drag straps,
holdowns, and detailed connections. Corrections were provided after each
observation to communicate the items of concern to the builder. Subsequent re-
checks of the structure for compliance were performed until all outstanding
correction items were resolved.
In conclusion it is the opinion of this office that the construction of this project, is
in general conformance with the requirements of the structural drawings.
The conclusions reached above are based solely on a visual review of the
structure. Due to the visual nature of these observations, and limited access to
structural elements, not all of the structural elements or connections have been
observed. No tests have been conducted on any materials or soils and no
warranties are expressed or implied. The opinion above is based upon widely
held engineering principles and judgment, and it follows a standard of care which
defines a level of . skill and competence ordinarily and contemporaneously
demonstrated by professionals of the same discipline practicing in the same locale
and faced with the same or similar facts and circumstances.
t
From: BG To: Ed Alderson Date: 7/2/2002 Time: 3:20:54 PM
Point Happy — Building 2
July 2, 2002
Please call me at (760) 568=3553 if you have any questions or would like to
discuss this matter.
�oQROFESS/p�
Sincerely, , ���- a GOTT
Ca
R a 6- i4
Brian Gottlieb, P.E. 'Pr'9Ts F ca LF°��P
cc. file VALID ONLY IF SIGNED
INRED
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