12199 (PC)U 4
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 7 8 - 7 2 2 . Hwy 111 LA QUINTA, CALIFORNIA 92253
Robin Ventures
Mailing
Address 2835 Townsgate Road
City Zip Tel.
Westlake, CA 91361 1(805)375-8700
Contractor
Deforest Construction
Address
17498 Santa Rosa Road
Perris, CA 92370 (909)943-5227
State Lic. City
& Classif. Lic. #
Arch., Engr.,
Designer Archnet Inc. - Chris Cooper
Address I Tel.
010 / 17—V V't0
Cityip State
West Hills, Cr 91307 Lic.#
LICENSED CONTRACTOR'S DECLARATION'
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,8usiness and Professions Code: Any city or county which requires a
permit to construct, atter, 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 Law, Chapter 9 (commencing with Section 7000) of
Division 3 or 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, 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner or 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.)
O 1, 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.)
O 1 am exempt under Sec. B. 8 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.)
Policy No. Company
O Copy is filed with the city. Q Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed i1 the permit is for one hundred dollars ($100) valuation
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.
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. 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 1 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
No. 12199
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
Legal Description
Project Description Restaurant
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 DATE
INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
FINANCE
Sq. Ft.
Size 7200
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Permit includes trellis
and trash
enclosure
screen wall.
Estimated Valuation
$474,532.00
PERMIT
AMOUNT
Plan Chk. Dep.
1,000.00
Plan Chk. Bal.
607.56
Const.
1.952.00
Mech.
187.50
Electrical
3 3.00
Plumbing
327.00
S.M.I.
99.54
Grading
.00
Driveway Enc.
.00
Infrastructure
.00
TOTAL
5,442.93
4.442.93
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 DATE
INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
FINANCE
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
Date 10/8/93 1 Type of Permit La Quinta
No. 112473 Permit #
Log
Owner Name Red Robin/Top Robin Ventures
No. 78722 Street Hwv 111
City La Quinta Zip 92253 Study Area 232
APN # Tract #I I Lot # 0 Square Footage 17200
Type of Development lCommercial No. of units
Comments
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 .27 x 7 200 or $ 1,944.00 have been paid to D.S.U.S.D. for
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 DeForest Construction, Inc. Telephone 909-943-5227
Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Vickie J. Durrett
r
{� Payment Received
Signature /`�d U_t�
Check N.0.014538
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