9604-040 (CSCS)LICENSED CONTRACTOR DECLARATION
I hereby affirm 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.
gq
Licenser# j y1l pLic. Class Exp. Date
D
'Date ` l— / li�'Signature of Contractor
OWNER-BUILDEFLOCLARATION
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 Issue My workers' compensation insurance. carrier &.policy no. are:
Carrier Policy No.
(This ction need not be completed if the permit valuation is. for•$100.00 or. less).
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 to the
workers' compensation laws of Californialand agree thato,if I� should become
subject to the workers' compensation provisions of See6 3700 of the Labor
Code, I S all forthwith comply with thoseprovisions
Date: r �•- E ,licant" f
Warning: Failure to secure �Worke'rs' 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..
I
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
correct. I agree to comply with all City, and
construction, and hereby authorize repres�e
the above-mentioned DroDertvxfor insDecti9n
Signature (Owner/Agent)
---f
that the above information is
laws relating to the.building
fes of this City to enter upon
oses.
Date A14W
w
. BUILDING PERMIT
BUILDING
PERMIT# : CONTROL#
3114
DATE%: VALUATIONLOT
TRACT
JOB ADDRESS 8-�T721'It >f�-if'kB� 3rl��iC�H�V.Fi�;. .111 1
APN 1110-004.
OWNER
CONTRACTOR / DESIGNER / ENGINEER
t,# `F #('1 WIJ-117E1S
. 1-tF-RIZ13" CONS RUff;ON
P.O. 13OX 1949
COSTA #UFjr:S.A C A 9 6
P.ALNI 1)fi;S#,AT CA 9271:1.
(714)6504 111
(619)7 064330 f, RIA 4?29
in' A1,1,RICK .[.riaN'G,
USE OF PERMIT
3199 A.3 A1#21VR`F I.001P
C'0STA'A4F%SA. fA 92�, 4"2';?67
SHEI,a BIJR.61NO AND 011EY AUTO PARTS `i -1.4 1U TAIPfRADVE1b#316l'GR0AJP M
,ae aa+5yt-, a ^v^+ s rr.•, :x rrr• - z:; ,c
nc r - :x .
ESiEii?tte`fW CMT OF CON'S`F•:CBdJC'l•101%
310,475.60
CONSTR[,iO••A`YtJN :t"'ER i0i-m-4i g-Ut)i}
!S f. `ns,00
SiI CHAMICAL FFE 101--(10{#-4'21-000
S104.50
1Af x7nf #zap 161-000.419,000
5iw�f.2s .
Vf.AN("fifC3y,.FEE .101AM-439-318
�1 r3G5.�f
:j' fZ lO Ri,-q.1 i. # ,. (�C tt�. l ' i (X.-OW.2,41-000
E ifit0tt`r'(S f'}•sl:: e' (1.1=i'iQ()-t12 i-fiilG
$7a°3.t7tt
101.000455-000
1-70i.01-113051111.1
-$f3iT0.Cffi
CESS PRE-PAIDM— S
-20( OO
IAt PERA41TWES
DUE NOW
S3.603.04a
SPR 1 � .�� 6 •.
..
.
RECEIPT
DATE
BYDATE
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
—Ir
Compressor '
Insulation6.
Vents
Fireplace P.L.
Grills ,.
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
-
Drywall - Int. Lath
ras -
Final
Final
BLOCKWALL APPROVALS
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
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:
P��.i F -f5
CJw�!��, G1.2�/-Gj� A(GL
Building
Address
Owner
Mailing
Address
City
Com,)
Contractor
Address
•
001V T
�! VP.O. BOX 1504 A CATI N ONLY /Sr Tine
78-105 , C LE ESTADORNIA 9
LA OUINTA, CALIFOrRNIA 92253
BUTYPE CONST.— OCC. GRP. �; `j� O U 1
JI(\a_T '�,L_V6 S-kt
Number
17?ITe' fI 6C� - f,41Legal Descript
ty IZip I Tel.
State Lic. I City
i£ Classif. Lic. #
Arch., Engr.,
Designer 1,
Address u_ Tel.
CityZip ry State t�
,161�
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 anc 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 Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, 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 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
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
F] 1, as owner of the property, or my enployees 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 no: 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 1 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 contrac(or(s) licensed pursuant to the Contractor's License Law.)
it I 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
n Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it 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
I hereby affirm that there is a construction lending agency for the performance of the
work for which this p{U�,Iit is issued (Sec. 3097, Civil Code.) ,p
Lender's Name �u-"1�hq�C��CXfiJC r 1–
Lender's Address R -.USA III
g permit when pfilled—out,
This is a building emsroperly idled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I certify that I have read this application and state thatdhe above information is correct.
I agree to comply with all city,"and ceunty ordinancesOnd state laws relating to building
construction, and hereby authod-ze representatives of this city to enter the above-
mentioned property for inspecfiorjpurposes. I,
Signature of applicant a + (/ Date r 7'Ci
Mailing Address t -t
City, State, Zip -A VVI
BUILDING DIVISION
Project Description
Sq. Ft.
Size
New ❑
No.
Stories
No. Dw.
Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimate0 Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
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`Setbaek r' o Property Line
FINAL DATE I
Issued by: ' '!
Validated b r
Validation: gY
CONSTRUCTION ESTIMATE
NO, ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. _, SO. F.T. @ $
2ND FL SQ. FT. @
POR.. SQ. FT. @
GAR. SQ. FT. @
CAR P. I SO. FT. @
WALL SO. FT. @ `
SO. FT. @
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
-
YARD SPKLR SYSTEM,
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
I
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ c
BATH TUB
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 1Y. c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/ec
HOUSE SEWER -
REMARKS:
VENTILATION
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
r
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
GARDEN WALL FINAL
FOR'S 51UNA7 URESIINITIALS
W.
Notice:
Document Cannot Be Duplicated
Date 4/10/96
No. 14320
Owner Name Desert Equities
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
'619-775-3500
CERTIFICATE OF COMPLIANCE
No. 78792 Street Hwy III
City a uinta
Tract # Lot #
Type of Development Commercial
Comments
APN # 009-000-154-9
Jurisdiction La Quinta
Permit #
Log #
Zip 92253 Study Area 232
Square Footage. 7121
No. of Units 1
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports,
covered patios/walkway's, 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 .28 X 7,121 or $1,993.88
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 Desert Equities _ Telephone- 714=646-9000
Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received ' ' $1,993.88
f
nn L'
Check No. 1006
Signature. �� q1► x a y.P nn o A A &,Y"—
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
�Z C0U1'TY
RIVERSIDE w.Y
�-> J. M. HARRIS
'—� FIRE CHIEF
Mr. Gene Scarcello
Stonington Properties
1706 B Newport Bled.
Costa Mesa, CA 92627
Re: Plot Plan 95-559
RIVERSIDE COUNTY
FIRE DEPARTMENT
210 WEST SAN JACINTO AVENUE • PERRIS, CALIFORNIA 92570 • (909) 657-3183
PLAN CHECK
March 5, 1996
Fire Department personnel have completed a review of the plans you submitted for the above referenced
project and have no conditions or corrections to be met prior to issuance of building permit.
Fire Department approval is based upon the 1994 Uniform Building Code requirements for Group B
occupancies. It is prohibited to use; process or store any materials
In the occupanc}% that would classifi it as
an H occupancy per Chapter 9 of the 1994 Uniform Building Code.
The Fire Department is required to set a minimum fire flow for the remodel or construction of all commercial
buildings using the procedure established in Ordinance 546. A fire flow of 1250 gpm for a 2 hour duration
at 20 psi residual operating pressure must be available before any combustible material is placed on the job
site.
The required fire flow shall be available from a (Super) hydrant(s) (6x4" x 2-1/2" x 2-1/2") located not less
than 25' or more than 165' from any portion of the building(s) as measured along approved vehicular travel
ways.
THE FOLLOWING CONDITIONS MUST BE MET PRIOR TO OCCUPANCY:
1. Install a complete fire sprinkler system per NFPA 13 Ordinary Hazard Occupancy, Group II. The post
indicator valve and fire department connection shall be located to the front within 50' of a hydrant, and a
minimum of 25' from the building. System plans must be submitted to the Fire Department for review;
along with a plan/inspection fee.
2. The approved plans, with Fire Department Job card must beat the job site for all ilnspections.
❑ RIVERSIDE OFFICE
3760 121h Sireet, Riverside, CA 92501
(909) 275-4777 • FAX (909) 369-7451
Subject J1�TT A PERIOD f4OT TQ EXC vpD FOR
YEAR FROM TfiE Si�E ED'ONE ." ,
S. ,
Tom` rtd� d1F1ED:-
Oil TH
Date—!,,(
S 6 P P tiSss 5 E APPROVAL DATE- LINE;
F_
FIRE PREVENTION DIVISION �
PLANNING SECTION -2I IND1O OFFICE
999 8
(619) 863-8886 •FAX (A ION 863-7072 t
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I
June 7, 1996
Mr. R. Kirk Kirkland
City of La Quinta
Building Department
P.O. Box 1504
La Quinta CA 92253
RE: Pad F-3 One -Eleven La Quinta Center
La Quinta, CA 92253
HASSAN ZARENEJAD, P.E.
P.O. Box 491509
.(-.,.,Redding CA 96049
x,7_916-246-7200
CITY OF LA QUINTA
JUN 13 RECD
BUILDING AND SAFETY
Gentlemen:
With help from Mr. Dennis Wish, P.E., I performed structural
—
observation on t e subject-`p`roject-and'-found all the structural""_,
aspects o e pro'ect per plan to be satisfactory:;t.r:,E
Respec fully mitted, rr+,
Hassan Zarene'
Project's Structural Engineer
HZ/a
cc Mr. Dennis Wish
11
,VT a
r�
fit�r of 14a I�uint�
�itil�in� r�n� �Sr�fet�r �tbt�si�n
This Certificate issued pursuant to the requirements of Section 306 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 ADDRESS78-792&78-802 HWY 111
Use Classification COMMERCIAL —Bldg. permit No. 9604-040
Group B2 Type Construction VN Fire Zone Use Zone CPS
Owner of Building Address
DESERT EQUTTIES 78-792 78-802 HWY 111
City LA QUINTA By. KIRK KIRKLAND
Dote: 6-28-96
Building Official
POST IN A CONSPICUOUS /LAC[