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13911 (CSCS)Budding 78-•702 Hwy 111 rs Owner Tom NClan 4 -< P.O. BOX 1504 No. 139.11 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Mailing ]BUILDING: TYPE CONST. VN. OCC: GRP. s•-2 Address 1775 R. palm Capt' n OJ City Zip Tel. Palm Springs CA 92254 (519)'779--5904 Contractor oranco`Development Address 333 Poppy Ave. %trona � Del Haj ;1p CA 92525 Tell .10 660-1199 State Lic. D 359596 (City & Classif. Lie. # Arch.,.-Engr., _ _ - - Designer Areid Johnson, Assoc. Ltd.. Address Tel. ( 602 ) 8024 N 24th Ave. Suite 0� QQC_AA C 9hoeniX' • AZ ZIp 85021 Lic.t# 04081 LICENSED CONTRACTOR'S DECLARATION I hereby affirmthatI am licensed under provisions of Chapter 9 (commencing with Section x'1000) of Division 3 of,the Businesi�and Professions C de, and my license is in full force and OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or,counly which requires a permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also requires the applicant forsuch permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, 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 subjecta the applicant to a civil penalty of not more than five hundred dollars ($500). as O I;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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds -or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or 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.) ❑ I, as owner of 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.) - - ❑ 1 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 Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Polic-py �No. Company iV pt' is filed with the city. ❑Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed 9 the permit is for one hundred dollars ($100) valuation or less.) - I certify that in the performance of thg 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. Date Owner NOTICE TO APPLICANT: If, 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.: c; I hereby affirm that there is a construction lending agencyfor the performance of the work for which this permit is issued. (Sec. 3097, 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 if 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 applicant Date Mailing Address City, State, Zip A.P. Number Legal Description Parcel 15 Parcel, chap 27784 T.I. Domino's Pizza Project Description i Sq. Ft.2i�© No. No. Dw. Size Stories' Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition'❑ r . Estimated Valuation ���� Ui►S� « V PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. _ Const. 4 it • Vo Mech. 44 f .s V v Electrical 83.00 Plumbing 69 • i0o .S.M.I. i3 a S;D Grading �� • Driveway Enc. Infrastructure TOTAL "�"''� •�� REMARKS 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 DA' Issued by: Validated Validation CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES J '� 1ST FL. f SQ. FT. ® $ UNITS SLAB GRADE r BONDING YARD SPKLR SYSTEM 2ND FL. SQ. FT. @ FORMS SEWER OR SEPTIC TANK POR. SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CARP. SQ. FT. OTHER APPJEQUIP. DRAINAGE PIPING WALL SQ. FT. TEMP. POLE DRINKING FOUNTAIN. SQ FT ® GROUT URINAL ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation WATER SYSTEM FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT. WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. ® c BATH TUB SPARK ARRESTOR SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL LATHING SQ.FT.GAR ® 3/ac HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ -Plus-X$-=$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL L\- - ca:l; •, M ! COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY DEPARTMENT OF ENVIRONMENTAL HEALTH ENVIRONMENTAL HEALTH SERVICES SUPPLEMENTAL REPORT TO SAN. FORM # /0 DATE SUBJECT l[ oln x/I O 5 PERMIT NO. ADDRESS % INSPECTOR r REMARKS:'' / a 2. C Cir -t-� e l I C'1.S l� Qa C� Vv� i C a C �� ;To• I mo! dv�� C. s r I l' C' In �' e 0. C c+� A 1 lr9 k n ' n r Gt Go k 4K. S ' a S lam\ 4 C Aga k -t c /k 3 Seo. ( a f I/� S( � :c 6 l 0,oVt Y D UEH-SAN-119 (Rev 5/93) --I -�l a ' s CITY OF LA OUINTA Or DEPARTMENT OF PLANNING & DEVELOPMENT BUILDING DIVISION 24-HOUR NOTICE FOR INSPECTIONS 777-7153 CIYY Uh LA UUINTA Owner Tom Nolan *-AI Contractor Oranco Development Permit Number 13 911 POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES JOB ADDRESS 78-702 Hwy 111 Domino's T.I. TYPE OF INSPECTION DATE INSP. FOUNDATION & SETBACK FOOTING STEEL MAIN GROUND SYSTEM GROUND PLUMBING 197 PRE-GUNITE DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED CONCRETE SLAB JOISTS & GIRDERS ELECTRICAL GROUND WORK DO 14bT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED ROUGH ELECTRIC ROUGH PLUMBING ROUGH GAS & GAS TEST HEATING & VENT- A/C FIREPLACE ROOF BOND BEAM O.K. TO WRAP GROUT ❑ 4' ❑ 8' FRAMING ,!'12 INSULATION PRE -ROOF COVER NO WORK UNTIL AB VE HAS BEEN SIGNED DRYWALL INTERIOR EXTERIOR LATH POOL PRE PLASTER POOL FENCE & GATE SEWER SEPTIC TANK/,, FI ELECTRICAL PLUMBING L� FINAL GAS TEST HEATING -A/C _ 67C-161 lee„ HOUSE NUMBERS JOB COMPLETED CJ c TEMP POWER ABOVE APPROVALS DO NOT INCLUDE RIGHT TO TURN ON UT's "^ ni,yr, L: ��"'� �..._...�+– ,..�...�.w...u.-..+iww.w...�.. •wwww..............ms...............^._.._....µ .�.. w.....+w�w.�w��.�r __�...:....... . ...... MIM Ml�M� u0I1lvj�d � � ' 1:jbtidd 6141 X'Vd 99ki t1S ldiV) 1041641 (OIL) xyd lttrm 010 I CRR6 10 *fm 14 "I"s 4,00 im) wu*b� ctaet 1044 VD vm + tv `n" 4111 09et got"o d1cm 9 201"0 IMMAN d 1071088 JNTI`1 and OMAN 9011ls'81>,8?td 'rtld Z6/01 Z 672,9 .� . 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For the following: BUILDING ADDRESS 78-702 Highway 111 Use Classification Restaurant Bldg. Permit No. 13911 Group B2 Type Construction N7W Fre Zone Use Zone CPS Owner of Building Tom Nolan Address 1775 E. Palm Canyon #J City Palm S rin s, CA 92264 By Richard Kirkland ,yam Date; October 21, 1994 Building Official �. POST IN A CONSPICUOUS PLACE