0205-073 (RC)LI('yEINSED.CONaRACTOR DECLARATION
I{fi eby afflrm,under penalty of perjury that I am licensed under provisions of
Cha'ter 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
BUM
Date ��"�_/f'Ma 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
perfo�rmance of the work for which this permit is issued.
' (, T,O l 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
Carver ,,,TATE )+iFP1 Policy No. Q1.10TE #51,01 1DO
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I *shall not employ any person in any manner so as -Eo become subject to the
workers' compensation laws of California, and agree that if,l should become;
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith complyeith those,provisions.
�/Date:`> a,r.,Ae, - Applicant""=r..;'�``,'a
Warning Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal$enalties 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.
/Slgnature (Owner/Agent)., +' - ;,vim *t t _A Date��"'+f
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
JOB SITE
ADDRESS "-14 .BY" 1. 1(Gsi7"M& 73)
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
91.48 21CSR'l`H 14 TOMPr IN
PO DOX &SA 3
CA 9176.,E
MILWO NAWTAP . CA 92061
USE O(FtPERMIT
MMIC i'N"Pit.E 'f UXED0 STOR , (1495 SP TK.NANT 94PR.UVENt-".,'W
OCCUPANO "M CONTOT UX41f ire d J' V1&11 1CWi0W FEE MVESSED Pr t
1997 ii, X §304.5 FOOLWORK, R Elf GUN ''x+%11 Fi01JT BU-11,DfrACY PP-R.Mi'm "•
CONTAC'T AMOi314 T Aimwgo J
'i+ 1YMWM COSY' OF COg"iFIR174:' 1011T
u
MR ? WVER PAW '
CONS RUC i IOM 101-000:4181-000 r/2.00
FCiT Zii °tli, FEZ I01-(V(If OI X000 - $19.:50
'�f,,,�'�i;"E`3k'1�G:.'�L, .� t:f*: i i)i-�'t3fJ�u1 �)•iJCx' .' _ X45. �t4
11 V&-;T1MTyC7T4
CITY01F QU N'TA
FINANCEDEPT;_
SUB -T d%AT.. Q0146 -1 -RU .t3Nb -'-0 C iF'CK
rI
O�Y
TOTAL S?X= 7lit"�=M 9�) y�0
q 292...Osota
.
t
RECEIPT
DATE
BY
DATEL
IN TOR
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 Wall Firewall
Exterior Lath
Drywall - Int. Lath _ t?
Final
Final
POOLS - SPAS
BLOCKWALL APPROV LS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
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:
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)
Ow
�y
Bin tr/
City of La Quinta MADI Som fj.��'a
of Building. 8r Safety Division
^ 3 P.O. Box 1504, 78-495 Calle Tampico p •
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
ProjgctAddress *-.�iw78=474 Hwy
1 11. Suite B
0,Amer'sName: Desert For als Inc
A. P. Number:
Address: j3 2_475 Date Palm Dr .
Legal Description: ;, , f -
Contractor: -,4(- ASARO Builders
City, ST. Zip: -jE-Cathedral C-ity,.,CA-9=2234
Telephone: L-�—_7_6.03.2 _: 7_1_71--
Address: jr; R�
�
ProjectDescription: �- q'
City. ST, Zip:-
Construction
h
Telephone-
one: .i:
........ <.;
State Lic. #_:--* 588920
Cite Lic. #:.
,.Arch.. Engr., Designer: —IN—HOUSE
Address:
F City, ST, Zip:
Telephone:^;
jState Lic. #: —
m::>;
Construction T� e:
. P Occupancy:
Project type (circle one New Add'n Alter Repair Demo
N.am of Contact Person: --"1
�'1("Larry Spurloek
Sq. Ft.:.
#Stories:
# Units:
Telephone # of Contact -Person -- _
P
_ 20�Es_titnated Value_of_Proiect___rj_
APPLICANT: DO NOT WRITE BELOW THIS LINE
l Req'd Rec'd
TRACKING PERMIT FEES
/ nidG�'r
VStu
AW p(
Plan Check submitted 7 ae7 Q Item
Amount
l Calcs.
Reviewed. ready for corrections �b/Plan Check Deposit
cs.
Called Contact Person i1 Plan Check Balance
alcs.
Plans picked up /OL Construction
Flood plain plan
Plans resubmittedIV Yzo
�. i' D2 Mechanical
Grading plan -
2°" Review, ready for corrections/issue %/�j p Electrical
Subcontactor List
Called Contact Person �)b) Plumbing
Grant Deed
Plans picked up
H.O.A. Approval
1%"air fitted LL ?
/u'--
/D.L Grading
IN HOUSE:-
'^' Review, ready for correctio`t e ' Developer Impact Fee
Planning Ap al 1905Called
Contact Person Ll/r_ R,t/ JVP. P.
Pub. Wks. Appr
Date of permit issue Gy w
o 7P�ft
School Fees
E 410
U% ,
0 �N � Total Permit Fees
I M4J
y ,tea. v — A / - • '—J,1 ;0 CR-. Wr-,Awl — S O,✓ (AT 6146 4Ap' _544x'
'V4 �1111ZA 77
—did
Tom Tisdale
Fire Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
Cities of:
Banning ..
Beaumont
Calimesa
Canyon Lake
Coachella
Dessert Hot Springs
Indian Wells
Indio
Lake Elsinoree.
La Qainta
Moreno Valley
Palm Desert
s.
Perris
Rancho Mirage
San Jacinto
Temecula
Board of Supervisors
Bob Buster,
District 1
John Tavaglione,
District 2
Jim Veaable,
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 West San Jacinto Avenue • Perris, Ca I omia 92570 • (909) 940-6900• • Fax 9(9) 10
October 31, 2002
City of La Quinta
Building Department
Re: Fire and Life Safety Clearance
The Riverside County Fire Department is granting a fire and life safety clearance
foi the Tuxedo.Exchange loc`ated'at 79-'474 Hwyl l Lsuite B, La Quinta.
Respectfully
FRANK KAWASAKI
Chief Fire Department
By �S
Terry DeSoucy
Fire Safety Inspector
EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE
P.O. Boa 1504
78-495 CALLL TAMPICO
tihinuig ungnier Ina" Ever LA Q U I N TA , CALIFORNIA 92253
July 22, 2002
Mr. Ed Alderson, Construction Manager
Madison Development
71-361 San Gorgonio Road
Rancho Mirage, CA 92270
Re: Roof access for 78-474 Highway 111 (Building #2)
Dear Mr. Alderson,
(760) 777-7000
FAX (760) 777-7101
In your letter dated July 17; 2002 (attached), you asked permission to allow the
roof access hatch located in the largest suite in the above-mentioned building to
serve as roof access for all suites.
Additionally, your undated letter (attached) which was submitted during plan
check for the shell building, indicates that you, as the landlord, will make a key
available to all for access to the roof.
The Building Department finds this to be an acceptable arrangement for all
tenant improvements for this building. Please submit a copy of this
correspondence and its attachments with all future tenant improvement
submittals for this building to remind us of this arrangement. We reserve the right
to review and. revise this position in the event that future, unforeseen conditions
arise: In that event, we will work with you to seek the best solution available.
A copy of this correspondence has been placed in the file for the tenant
improvement currently in plan check (Suite B, Tuxedo Shop).
Sincerely,
reg Butler
Building & Safety Manager
Attachments (2)
Ju1-11. 2002 11:54AM MADISON DEVELOPMENT 76U 771-0202 No.5541 P. 1
July 17, 2002
City Of La Quinta DEVELOPMENT
PO Box 1504
78-495 Calle Tampico
La Quinta, California
92253
Re: Point Happy Building #2 roof. access
Attn: Greg Butler
Dear Gregg:
In our remit conversation$ regarding roof access to the HVAC equipment of the subject building, Please
consider the following.
You have made it a requirement that we provide access to the roof from each of the 3 tenants spaces in the
building. This is not possible given the following conditions we have encountered as we physically
examine the building.
The suggestion has been made that we provide an exterior ladder to the roof accessing the HVAC well.
There is no way this can be accomplished given that the enclosure is surrounded by the roof that we are
reluctant to have workmen walking on for safety reasons as well as ongoing damage to the roof with the
carryi.ag of tools and equipment by maintenance personnel.
Secondly it has been suggested that we provide access panels for each tenant space. This to is impossible
due to the construction of the roof framing in each suite. This can be verified iso the held. Also Consider
that the building is, at this time, a multi tenant building but the future may, be that it will 'become a single
or rivo tenant building as time and leases expire etc. This would create ceiling access panels all over the
space and again, I feel it an unrealistic approach even if there was mom to do it. We have installed a roof
access panel, per the original plan, that is located is the largest of the current suites. Also consider that
One of the. suites is not located under the HVAC well at all. An access panel would do not good what so
ever.
Gregg, given the above, I once again request that the letter you required at the time of the shell permit
apply in this situation. A Copy is in the shell permit file. The letter states that we as the landlord, will
Provide assurances to each tenant and the city that access to the HVAC equipment WW be guaranteed to
each of the 2 otlier tenants at all times. As the building owner we have the right to enforce this condition.
Also I do not believe your concerns regarding after hours access to the roof is valid in as much as any
maintenance work would be done during working hours in any event This is not a situation were it
would be considered an emergency. I believe this letter should suMce in safe guarding the respective
tenants.
A
�gajnl
thank you for your consideration.
n
Madison Development / Construction Manger
71361 San Gorgonio Road . Rancho Mirage, Calllornla 92270 . 760.771.1755 . Fax 760.771.0202 . 760.776.1728 . Fax 760,773.0738
�. 2001 3:25PM MADISON DEVELOPMENT 160 111-0202
mi,
-- --
DEVELOPMENT
N0.3321 P. 1/1
City Of La Quinta
PO Box 1504
'78-495 Calle Tampico
La Quinta, California
92253-1504
Re: Building #2 access ladders
Ann: 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 access ladder. Should
you have any further questions, please do not hesitate to call.
Regards: 1
Ed Alderson
Madison Development / Construction Manager
938 North Mountain Avenue
. Ontario. California 91762
909.933.91 18 .
Fax 909.933.0066
71361 San Gorgonio Road .
Rancho Mirage, Calllornia 92270
760.776.' 728
Fax 760.773.0738
Tom Tisdale
Fire Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
Cities of:
Banning
Beaumont
Cahmesa
Canyon Lake
r.
Coachella
Desert Hot Springs
4.
Indian Wells
Indio
.;.
Lake Elsinore
La Quinta
.;.
Moreno Valley
Palm Desert
Perris
4.
Rancho Mirage
San Jacinto
Temec}ila„
Board of Supervisors
Bob Buace ,"
District 1
John Tavaglione,
District 2
Jim Venable,
District 3
Roy Wilson,
District 4
Tom Mullen,
District 5
I
RIVERSIDE COUNTY FIRE DEPARTMENT
In cooperation with the
California Department of Forestry and Fire Protection
210 st San Jacinto Avenue • Perris, California 92570 • 909 9 Fax (909) 940-6910
July 29, 2002
To- City of La Quinta
Building Department
Re: Release'for Building T/I Permits
Tuxedo Exchange
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,
n
B
FRANK KAWASAKI
Chief Fire Department Planner
By
Walter Brandes
Fire Safety Specialist
H;%PE2IWPDATABAQUINTAXPROJECTSBLDG PC1D2•BLDG-135 BP Release.dw -
EMERGENCY SERVICES DIVISION • PLANNING:SECTION •'IhDIO OFFICE
82-675 Highway 111, 2.d FI.; Indio, CA 92201. • (760)'8&3-8886 • Fax (760) 863-7072
Tom Tisdale
Fire Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
Cities of.
Banning
Beaumont
Calimesa
Canyon Lake
Coachella
Desert Hot Springs
Indian Wells
Indio
Lake Elsinore
La Quinta
Moreno Valley
Palm Desert
Perris
Rancho Mirage
4.
San Jacinto
4.
Temecula
Board of Supervisors
Bob Buster,
District 1
John Tavaglione,
District 2
Tun 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 West San Jacinto Avenue a Perris, California 92570 • 909 9 • Fax 940-6910
June 11, 2002
Tuxedo Exchange
32-475 Date Palm Dr.
Cathedral City, CA 92234
Re: Non -Structural Building T/I Plan Review
02 -BLDG -135 / Tuxedo Exchange — La Quinta
Fire Department personnel have completed a review of the plans you submitted for the above
referenced project. Please be advised the following conditions or corrections must be completed and
approved by the Riverside County Fire Department before a building permit can be issued.
1) Fire sprinkler system plans for the tenant improvement area 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.
2) The building sprinkler monitoring system must be extended to provide an interior notification device
within the tenant space. Plans must be submitted to the Fire Department for review, along with a
plan check/inspection fee.
3) Provide either a separate Knox Key Lock box, Model 4400, 3200 or 1300, mounted per
recommended standard of the Knox Company or provide key(s) for inclusion in the general building
Knox Box. 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
Knox Box. This form must be authorized and signed by this office for the correctly coded system to
be purchased.
4) Install portable fire extinguishers per NFPA, Pamphlet #10, 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. 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.
Please contact the Fire Department Planning & Engineering staff for final inspection prior to occupancy.
Should there be need for further information and/or clarification, please contact the undersigned at (760)
863-8886.
Sincerely,
FRANK KAWASAKI,
Battalion Chief/County Fire Marshal
By
Walter Brandes
Fire Safety Specialist
H V E21WPDATAM AOUINTA%PROJ ECTVM_INPRV102-8LDG•115.doc
EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE
82-675 Highway 111, 2^d FI., Indio, CA 92201 • (760) 863-8886 • Fax (760) 863-7072
RIVERSIDE COUNTY FIRE DEPARTMENT
FIRE PROTECTION
JOB ' CARD j
I THIS INSPECTIONI
,RECORD MUST BE _ !
AT JOB SITE WITH AN APPROVED
SET OF PLANS
t
Owner '� C{�;ro .�; Date 8 02
Location
Case No. Ll�Q-oz « •!�3
Sprinkler Company
Underground Static Date
Inspector
(200 PSI For, 2 Hrs. Prior to Inspection': Tme)
(Center Load Pipe Only, Joints and -Thrust Blocks Must -Be Exposed).._..
LA
Underground Flush Date Inspector
_5•U(i
Ov hea Static' Date
(209
Inspector
Overhead Final I
"IQat
Fire Main Installer
Underground Static
(200 PSI For 2 Hrs. Prior to
(Center Load Pipe Only, Jg,
Date
and Thrust
Date
Inspector,.
cks Must Be Exposed).
Inspector
0
410
-d)
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 78-474 Highway 1 1 1 Suite "B"
Use Classification: Commercial "TI" Mercantile Tuxedo Store
Occupancy Group: M Type of Construction:
Owner of Building: Madison Development
�CZ%" t
Building Official
Bldg. Permit No.: 0205-073
Land Use Zone: CR
Address:
938 North Mountain
City:
Ontario, CA 91762
By:
Daniel P. Crawford Jr.
Date:
11/8/02
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