9903-208 (RC).-. ` LICENSED CONTRACTOR DECLARATION
A.,�ereby affirm under penalty of perjury that I am.licensed under provisions of
,�hapter 9 -(commencing with Section 7000) -of Division 3 of th ' e Business and
Professionals Code, and my License, is in full force and effect.
# Lic. Class Exp Date
4,38575, t 7J 1
4,14 j.
vDate Sigr�ature of Contractor
OWNER -BUILDER DECLARATIO
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) . 1;,as owner of the property, or . my employees with wages as their Sole
66mpensation, will do the work, and the structure is not intended or offered for
sll&.(S�c. 7044, Business & Professionals Code)..
1, as owner of the property, am exclusively contracting with. licensed
pontractors to, construct the 'project (Sec. 7044, Business & Professionals
1'a�n exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION'
I 'affirm. under penalty' of'perjury one 'of the following declarations:
, (':) I have and will maintain a certificate of consent to self -insure for workers'.
66mliensation, as provided for by Section 3700 of the* Labor Code, for the
performance of the work for which this permit is issued.
have and will maintain workers' compensation insurance, as required by
S6ction MO ofthe Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
��er Policy No.
(Thii 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 i��ued,
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 J1,should b6come
Or
Warnihg: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal; penalties and civil(fihe's up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
�
POR
Application mhereby made mthe Director mBuilding and Safety
for u permit subject to the conditions and restrictions om forth on his
application.
bohaK��app�aUoni ~ made 8eoo�
�;/-"^'p=="'~r~'~'~~~ p~'~~'~'
whose request, and for whose benefit work,isperformed under mpursuant m
.'any. permit issued aaaresult of. this app|icomn agrees to, & oxan, indemnify
m hold harmless �hoChyofLaQuinxu. i�m�oom.agonmand employees.
' n.Any permit iv000daua result o,this application becomes null and void if
work io,not commenced within 180 uuvo ,m uoto o, issuance o, such
.
permit, or0000aoion.of.nm,kfnr 1oodays will subject permit to cancellation.
I certify that | have mad this application and state that the above information is
correct. | agree mcomply with all City, and State laws relating mthe building
construction, a City to enter upon
the above-mentioned hi i ,
'^
~aijnamn, V]wnom�onV ` oa�
�
PERMIT #
BUILDING PERMIT
"OX208
DATE VALUATION LOT TRACT
.3122,199 $26,000.00
JOB SITE
APN
'1706BREWPORTBOUIEVARD
72700 CALLIANDRA gr
(760)346-3962 03M
USE OF PERMIT
PE U MIT FEE, SUMMARY
NIC01ANICAL 1-1113 1, 0 1, _000-J21 41100 $21.50
_61AL CON&I'009TION ANT) PLAN CHECK
ESS rRE-PtADFIEES
TY 01
LA Q
RECEIPT
DATE
By
DATE FINALED
INSPECTOR
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 G
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 — v
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
Temp. Use of Power
Final
Utility Notice (Perm) -
COMMENTS:
James M. Wright
Fire Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
cities of:
Banning
A
Beaumont
v
Calimesa
41
Canyon Lake
O
Coachella
Z+
Desert Hot Springs
Indian Wells
4
Indio
O
Lake Elsinore
La Quinta
41
Moreno Valley
O
Palm Desert
Perris
Rancho Mirage
3
San Jacinto
. O
Temecula
Board of Supervisors
Bob Buster,.
District 1
John Tavaglione,
District 2'
Jim 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 • Perris, California 92570 • (909) 940-6900 • FAX (909) 940-6910
May 7, 1999
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 for the group
B occupancy known as Golden Spoon located at 78-742 Highway 111, Ste. E.
y
F:\PE2\WPDATA\LAQUINTAXPROJECTS\TN_IMPRV\GSPN_FNL. WPD
Respectfully,
FRANK KAWASAKI
Chief Fire Department Planner
\"-A
By
Walter Brandes
Fire Safety Specialist
EMERGENCY SERVICES DIVISION O
PLANNING SECTION
O
INDIO OFFICE
82-675 Highway 111, 2nd FI., Indio, CA 92201
0 (760) 863-8886
O
Fax (760) 863-7072
James M. Wright
Fire Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
cities of:
Banning
Beaumont
Calimesa
A. -
Canyon
Canyon Lake
A
Coachella
O
Desert Hot Springs
O,.
Indian Wells
Indio
A
Lake Elsinore
A
La Quinta
Moreno Valley
A
Palm Desert
O
Perris
A
Rancho Mirage
A
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
RIVERSIDE COUNTY FIRE DEPARTMENT
In cooperation with the
California Department of Forestry and Fire Protection
210 West San Jacinto Avenue • Perris, California 92570 • (909) 940-6900 • FAX (909) 940-6510
March 22, 1999
To: GLS Associates
74-854 Velie Way, Suite #5
Palm Desert, CA 92260
Re: Building T/I Plan Review
78-742 Highway 111, Suite E
SDP 98-626
Fire Department personnel have completed a review of the plans you submitted for the above referenced
project. Please be advised the following conditions apply as a part of the conditions for the issuance of a
building permit.
1. Provide either a separate Knox Key Lock box, Models 4400, 3200 or 1300, mounted per
recommended standard of the Knox Company or provide key(s) for inclusion in the general building
Knox Box. 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.
2. Install portable fire extinguisher's per NFPA, Pamphlet #10, but not less than 2A1 OBC in rating.
Contact certified extinguisher company for proper placement of equipment.
3. Approved building address or suite/unit number shall be placed in such a position as to be plainly
visible. Said numbers shall contrast with their background.
4. A durable sign stating "This door to remain,u n locked,during business .hours"•shal[ be placed
on or adjacent to the front exit doors. The sign shall be in letters not less than one inch high on a
contrasting background.
Please contact the Fire Department Planning & Engineering staff for final inspection prior to occupancy.
Applicantlnstaller shall be responsible to contact the Fire Department to schedule inspections. A
reinspection fee will be required to be paid if more than one (1) inspection is necessary. Requests for
inspections are to be made at least 24 hours in advance and may be arranged by calling (760) 863-8886.,
All questions regarding the meaning of these conditions should be referred to the Fire Department Planning
& Engineering staff at (760) 863-8886.
Sincerely, .
FRANK KAWASAKI
Chief Fire Department Planner
By
Walter Brandes
Fire Safety Specialist
c: La Quinta Building Dept.
F:%PE2\WPDATA\ AOUINTA\MISCITN -IMPRVAG SPOON.WPD
EMERGENCY SERVICES DIVISION O PLANNING SECTION O INDIO OFFICE
82-675 Highway 111, 2nd FI., Indio, CA 92201 A (760) 863-8886 A Fax (760) 863-7072
COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY
DEPARTMENT OF ENVIRONMENTAL HEALTH
ENVIRONMENTAL HEALTH SERVICES
SUPPLEMENTAL REPORT TO SAN. FORM # DATE
SUBJECT rl� co IN PERMIT NO.
ADDRESS 7,p
REMARKS:
INSPECTOR
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DEH -SAN -116 (Rev 2/96) Distribution: WHITE—Office; CANARY—Owner; •PINK—Office
2
Certificate -of Occupancy
City of -LaQuinta
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
ollowing.
BUILDING
ADDRESS: 78-742
HWY 111 SUITE E
Use Classification:
COMMERCIAL - GOLDEN SPOON
Bldg. Permit No.: 9903-208
Occupancy Group:
B Type of Construction:
VN
Land Use Zone: COMMERCIAL
Owner of Building:
REAL PROPERTY ASSOCIATES Address:
1706 B NEW PORT BLVD
City:
COSTA MESA, CA., 92627
By:
DANIEL P. CRAWFORD JR.
Date:
5/10/99
Building Official
POST IN A CONSPICUOUS PLACE