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0109-175 (RC)C'4 W O =) M d r OZf CZD 0.0�� H ( J0VD LU LU U) Z t_. LICENSED CONTRACTOR DECLARATION I hereby 0irm 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 Date `�'`"� 1 Sof,--�: Signature of Contractor w 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. 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 j I„MPT Policy No. (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 E Code, I shall forthwith comply with�those proves, ons. Date �e� ;fir �y%� APPlicant !.•'«, s ; ... W . Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the.City of La Quinta, its officers, agents and employees. 5 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and•state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection qurposes. ' Signature (Owner/Agent) Date �2• z+/`y'� t' PERMIT # BUILDING PERMIT 01109-17: DATE�* VALUATION �A�� LOT TRACT j- )�+r.r JOB ADDRESS '18.4 ..A y-w-� way A I I, t�i`�Yrl't ** APN _ - OWNER CONTRACTOR / DESIGNER / ENGINEER a'1,ANG nIINGI 0,"LP 'I`IN, C:.,C)MM'I+'a3C"I'.fON `113-58.1 HWY 1 J 1 12.651 'E'€ :I?%iRALANE P:faIM. DI SWT CA 92260 .I?dtaiLM DR.1 s 1U CA 92'260 0,60,-T779-0790 CTIA(f 6448 USE PERMIT �MOF {��♦p qs�� / �� jq A. O cKC'rbV 1:.LL�...I i...1' ikPtJfl�lrrfWl`L 1 d${t :�Ir ;'Is.�iack�' I+e+?2,Pf-'t£��En'ti'T' 83iK�ei. A.e",'�R.C)�''€y'•Z;3 Ft.�3+o..a%4,41..$9: D�5�".t' . CI,ZA,.RBWMS) `16"0Lc.9AtJUI VA -1 Abi TICY24 BRIM TED C IT UP r':ONIT:RipCTION, 10100 0100 PER'Mr`L F FlUM EBY �'LA `3 41,M NX FZr 101.000 439-3119 $3 _I S. 7161 CLgMMME(C'B°LON FIZZ, 101-000-4113-000 $111.00 AhKt'.HAN€C°AL,K!9 $19,30 ° 3.1.l.i AliP��A. k�tw' 10f-000-420,000 $M.3.3 I's�a 19IkI1IC9 Z tsE ' 1CIT-000.41:9.000 CU. 00 II.A�e3]+Ia MOTION FBE a COMM t100 -000 -24.1 -akin ®� f 2 9 tool C17YOFLAOUINT/4 i13FTOTAI , C�CSwiflf:I:Ti"``Y1,10:3 Al;twl MAW CI:WE LE1119's PRE -PAID FRITS Saw 11M k0wV':k:.laA IM flow '$5.4 7:xi'1 RECEIPT DATE ' BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE I 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 �_� - __ C`! ( Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wail Firewall Exterior Lath ' Drywall - Int. Lath // Final (�`Z"�• �- BLOCKWALL APPROVALS Final 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 Waste Lines (:ZC 1010< Gas Test Electric Final 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 Temp. Use of Power Final /- Utility Notice (Perm) COMMENTS: . 09/07/-2001 09:08 7607777011 Bin Permit Project ddress: g4w %4 A. P. Amber: t LA tUINTA 144 R PAGE 02/021 R- bf La QUinta ruild��g &r Safetybj*jon P.O. 8 ' 15P4, 78-495 Calle Tampico La QuIntal - (760) 777-7012 PerMij C' 92253 B 111jPe A0plication and Tracking Sheet 0 Nme- Addicss: 7-3 V�t D IF 1:1city, ST Zip: -O'ev 2 o I Telephone: MINN.— Description. City, ST Zip: Tele by le: a State tate L# i( Lim City Lic. #: ItApp &a4e Arch., E 19r., Designer- M C4�,t Address Qfi_Xa0AA AVr,, -Mtip i City, ST Zip: ASA 4., (?A C1 1 -7 Telephoi �Ondtruction Type: Occupancy, State Lt #' Proj t type (circle one): Ncw Add'n Alter Repair Demo Name of Contact Person: CA -M JGt A a, --G S-M\)F- #St Telephol c# Of Contact Person: Esti ated Value of Ksect; '.t APPLICANT: DO NOT WRITE $ELOW THIS ILINE ------ # Su ""itta, Req'd Recd TRAdwm; PERMIT FEES PIE a Sets Plan Check submitted Item I 7 Amount Sty ictural Cates. Reviewed. ready for correlti0QI aJ Plan Check Deposit TV Cales. Called Contact Person Plan Check Balance ,72 Tille 24 Calc3. Plans picked up Construction 00 FICA plain plan V I Plans resubmitted Mechanical Or ding plan 2"' Review, ready ro correctio ssue f •-35- Electrical Sul contactor List Called Contact Person Plumbing i Or, nt Deed Plans picked up .0 'A. Approval Plans resubmitted Grading IN IOUSE.- a.a Review, ready (or correction 'is" sue Developer impact Fee Pla oing Approval Called Contact Person Pul. Wks. Appr Date of permit Issue Sc 01 Fees f1 Total PermitFees 7—w i &A ar& J fl�5 r O.J. 7`c) 0.0 7/(,7 Wo T �'M -41 Mehl" pl, Aeono t/4 344,,0.9 _F:�95 -SAO CITY OF LA QUINTA SUB -CONTRACTOR LIST , e_57'a '. JOB ADDRESS �� C I PERMIT NUMBER OWNER S,�i�� i -r � BUILDER S, 6- kA-10� This form shall be i2osted on the 'ob kith the Building Inspection Card at all times in a cons icuous lace. Only persons appearing'on this list or their employees are authorized to -work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to -comply will result in a stoppage of work and/or the voidance of building permit. For each applicable trade, all information requested below must be completed by applicant. "Un File" is not an acceptadie response. Ttade::L;Class�f�cation:::>;; Contractor:..:.:.:.; ......:.. .. .....;State.>Contractor.. s.;ucense:::.: Workecs::Com ensation:rinsurance Cit Business Incense.. E xP . Date Lice e Nu mbe rClassifi Classification License Exp. Date Carrier Name Policy Number an Name -81 1xxxxxx1 xx xx/xx1 1x1e. .StateFund, CalComP1 1Format Vari s1 1xxxx1(e.g.A B C1E xxx P I xxD /a xtxe 1 I W /1 P1"g— C ity 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: Tenant Improvement (Palm Desert Cleaners) 78-525 Highway 111 Applicant Contact: Patricia Gee/Steve Prince (626) 793-9119 Application / Circulation Date: Community Development Department Christine di Iorio, Planning Manager Public Works Department '/V //I— Steve Speer, Senior Engi eer Building and Safety Department Greg Butler, Building & Safety Manager Date Date ate Date C ity 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: Tenant Improvement (Palm Desert Cleaners) 78-525 Highway 111 Applicant Contact: Patricia Gee/Steve Prince (626) 793-9119 Application / Circulation Date: Community Development Department Christine di Iorio, Planning Manager Public Works Department Steve Speer, Senior Engineer Building and Safety Department Greg Butler, Building & Safety Manager Date Date Date Date EXHIBIT A Permit # C16 p -- X75 NOTICE: THIS IS ONLY A TEMPORARY PERMIT. THIS PERMIT WILL EXPIRE IN 30 DAYS. IN ORDER TO CONTINUE OCCUPANCY BEYOND THAT DATE, OWNER IS REQUIRED TO OBTAIN A FURTHER OCCUPANCY PERMIT. BE ADVISED THAT NO PERMANENT OCCUPANCY PERMIT WILL BE ISSUED UNLESS AND UNTIL OWNER HAS COMPLIED WITH ALL. REQUIREMENTS NECESSARY TO RECORD THE FINAL PARCEL MAP NO. 29791 AND THE MAP HAS BEEN RECORDED, AND ALL OTHER CONDITIONS OF APPROVAL HAVE BEEN MET. WHEN THIS PERMIT EXPIRES, THE OCCUPATION OF THE BUILDING SHALL CEASE AND ALL OCCUPANTS SHALL VACATE THE BUILDING UNTIL AND UNLESS A FURTHER OCCUPATION PERMIT IS OBTAINED. OWNER AND OCCUPANTS AGREE TO AND ACCEPT THIS RESTRICTION IN ORDER TO OBTAIN THIS TEMPORARY PERMIT. Agreed to and Accepted bz-iol Date /Z 2 V o/ 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: 78-525 HIGHWAY 111, SUITE 300 Use Classification: COMMERCIAL Bldg. Permit No.: 0109-175 Occupancy Group: B Type of Construction: VN Land Use Zone: CR Owner of Building: SANG KAHNG i Building Official Address: 73-583 HIGHWAY 111 City: PALM DESERT, CA 92260 By: KIRK KIRKLAND Date: APRIL 4, 2002 POST IN A CONSPICUOUS PLACE 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: 78-525 HIGHWAY 111, STE. 300 Use Classification: COMMERCIAL - DRY CLEANER Bldg. Permit No.: 0109-175 Occupancy Group: B Type of Construction: VN Land Use Zone: CR Owner of Building: SANG KAHNG, TEMPORARY CERTIFICATE OF OCCUPANCY SEE EXHIBIT A, ATTACHED Building Official Address: 73-583 HIGHWAY 111 City: PALM DESERT, CA 92260 By: RICHARD KIRKLAND Date: 12/21/2001 EXP. 03/15/2002 POST IN A CONSPICUOUS PLACE 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: 79-525 HIGHWAY 111 SUITE 300 Use Classification: COMMERCIAL - DRY CLEANERS Bldg. Permit No.: 0109-175 Occupancy Group: B Type of Construction: V-1 Land Use Zone: CC TEMPORARY CERTIFICATE OF OCCUPANCY/SEE EXHIBIT A - ATTACHED Owner of Building: SANG KAHNG . Address: 73-583 HWY 111 City: PALM DESERT CA 92260 Building Official By: KIRK KIRKLAND Date: DECEMBER 21, 2001 /EXPIRES 1-21-2002 POST IN A CONSPICUOUS PLACE