07-0485 (PLBG)P.O. BOX 1504
78-495 CALLE TAM PICO
LA QUINTA, CALIFORNIA 92253
Application Number: 07.-00000485
Property Address: 79255 HIGHWAY 111
APN: 649-030-999-8 -30420.
Application description: PLUMBING
Property Zoning: REGIONAL COMMERCIAL
Application valuation: 20000
Tit!t 4 4 Q"
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------------------------------
LICENSED CONTRACTOR'S 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.
.License Class: A -B License No.: 650389
+ Date: 2_14V-07 Contractor: •a^Gi- ^
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason ISec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 703.1.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(_ 1 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 and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, _
and who does the work himself or herself through his or her own employees, provided that the
_ 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 or she did not build or
improve for the purpose of sale.).
(_ I I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_) I am exempt under Sec. B.&P.C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under -penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMLT ,
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/14/07
Owner:
STAMKO DEV CO
C/O PROVIDENT FINANCIAL MGMT PFF
10345 W OLYMPIC BLVD 2 FL
LOS ANGELES, CA 90064
iB � 2007
Contractor:
JACOBSSON ENGINEERING CONSTR CITYQF QUJNTA
P.O. BOX 14430
FINANCE DEPT.
PALM DESERT, CA 92255
(760)340-0194
Lic. No.: 650389
-----------------------------------------------
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 and policy number are:
Carrier STATE FUND Policy Number 765310106
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 Code, I shall forthwith comply with those provisions.
Date: 2'Iy-O Applicant:00�-0,.-✓i
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($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.
APPLICANT ACKNOWLEDGEMENT "
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to -the
conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose request and.for
whose be work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes nulj 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 county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for insp tion p poses.
/� es. _ (w
Date: %-1-/-M Signature (Applicant or Agent): -
Application Number . . . . . 07-00000485
Permit . . . PLUMBING
Additional desc .
Permit Fee 27.00 Plan Check
Fee
6.75
Issue Date. . . . . Valuation
. . .
. 0
Expiration Date 8/13/07
Qty Unit Charge Per
Extension ,
BASE FEE
15.00..
1.00 12.0000 EA PLB INTERCEPTOR
12.00
----------------------------------------------------------------------------
Special Notes and Comments
3000 GALLON,GREASE INTERCEPTOR FOR
"TORTILLA EXPRESS" PER PLAN APPROVED BY
PUBLIC WORKS/CVWD.APPROVAL.
Fee.summary Charged Paid Credited
.---------------------------------------------------------
Due
Permit Fee Total 27.00 .00
.00
27.00 `
Plan Check Total 6.75 .00
.00
6.75
Grand Total 33.75 .00
.00
33.75
Bin #
City of La Quinta
Building 81 Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: '79 2-55' µWY 1 1 1 < -rfi (o
Owner's Name: S iA 0 K 0 fJ i�✓ f- L o P M s N
A. P. Number: LA. Q %A 10 T /� � G /}
Address: P o 6 0)( _14430
Legal Description:
City, ST, Zip: PA, LM f)S S 2T 6.4 C1 ZZ, �S
Contractor: J A co (s o 1J >✓ Q b w 6 E K., , N b
Address: Lt 1 6 2 I: G �.fs G 1' L L- 1
Telephone: (-79,0) 717- -7& � 6
Project Description: -r0 Q 7' t /.h Ir A P rte, r. S S
City, ST, Zip: P A. 1_ tA b 6 S t: tL- ( (,A 2,2-` 0
(4 e- t=. A- 5 c-, I lJ i,& A_& e t r 0
Telephon&.- 16 a). 3140 01 9 L(
1CWityLiC-#: Z
State Lic. #: 6 450 4 9'.
Arch., Engr., Designer: -rA N -r 6 e-
Address:
City, ST, Zip: .PA- 1. ra p1; '(-C- 2, 1 G/Z'
Telephone: 7 6 0 3 IP6 C6 4
State Lic. #:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: b a A) f q C.z7 g S S p
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact PcrsonO 6 O ?,-7<' `f 0 6
Estimated Value of Project:
M/ E (760) 27S -SS'7 1 APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Reed
TRACKING .
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for correctionslissue
Electrical
Subeontaetor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''' Review, ready for correctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
CITY OF LA QUINTA - PUBLIC WORKS DEPARTMENT GREEN SHEET
PUBLIC WORKS CLEARANCE FOR RELEASE OF BUILDING PERMIT
Form updated & effective 11/17/2006
Green Sheet approvals are forwarded to the Building & Safety Department directly by Public Works.
Please DO NOT submit the Green Sheet (Public Works Clearance) Packet to the Public Works Department
until ALL requirements listed below are. complete. Incomplete applications or applications which cannot
be processed will be returned to applicant.
Date: Z' (7 Developer: �j� A-ewt
Tract No.: Tract Name:n. Z . fj Lot Nq (s) L
Address(s).: /�- - — - - - r- -
The following are the requirements for Public Works Clearance to authorize issuance of a building permit
from the Building & Safety Department:
CUSTOM HOMES: PROVIDE ITEMS #2 #3 #4 AND #5 BELOW
❖ TRACT HOMES:. PROVIDE ITEMS #1 #2 #3 #4 (AS APPLICABLE) AND #6 BELOW
❖ COMMERCIAL BUILDINGS/OTHER: PROVIDE ITEMS .#1 #2 #3 AND #5 BELOW
WALLS: PROVIDE ITEMS #7 BELOW
J
•:• SIGNS: PROVIDE ITEMS #8 BELOW
TeAJ �(
P�SP'``)VN
1-2 ?�f-Fl 31TAtfac PadElevation Certificates in compliance w tea prodesigevation for building
pad (maximum allowable deviation of .+/- 0.1 foot). Pad Elevation Certificates must be current
(within 6 months -of current date). If a precise grading plan creates the pad for approval, please
withhold green sheet submittal until a Pad Elevation Certificate can be provided.
2. Attach, geotechnical certification of grading plan compliance.
3. Attach recorded final map showing proposed building locations are legal lots.
4. Attach a completed < 1 acre per lot or infill project Fugitive Dust Control project information form,
PM 10 plan & agreement or provide alternative & valid City approved PM 10 plan set reference
number or hard copy plan. PM10 plans for commercial & residential developments (beyond 1 lot)
are submitted separately with grading plans & are sub1ect to additional requirements.
5. Attach an approved precise grading plan for the building location(s). AO flood zone. developments
will require an approved flood plain development plan.
6. Attach an approved rough grading plan for the building location(s).
7. Attach wall plan & related approved grading plan.
8. Attach sign layout/plan & related precise grading/landscape plan.
I have reviewed and confirmed the requirements 1'sted above as presented and find the improvements to
be sufficiently complete for con truction of t proposed buildings/structures/walls/signs on the subject
lot(s). Pursuant to m din It ab ve p sect may be released for building permit issuance.
Recommended by: Dated: I p
77
Public Works Distribution: ( k'Green Sheet to Building & Safety counter
(_) Green Sheet to Community Development
Declined for approval for reason(s) as follow(s), please correct and resubmit:
City of La Quints - PM 10 Project Information (< 1 acre per Lot or Infill Project) Page 1 of 3
Form updated & effective 8/25/2005
Project Information
Project Phase
Project Contractor:
Project Phase
(Check One):
EI.Construction
❑ Demolition
Project Name:
Project Tract
Number:
Lot Number(s):
Anticipated Start Date:
Project Street
Address:
Anticipated
Completion:
Total acres in active
construction (< 1 acre
per Lot):
Project Contact
Information
Please Note: Dust control is required 24 hours a day, 7 days a week,
regardless of construction status. Person listed below is responsible
for dust control during business and non- business hours.
Name:
Title:
Company Name:
Mailing Address:
City.
State:
Zip Code:
Primary Telephone
Number:
Fax:
24 Hour
Access/Emergency
Phone:'
Cell Phone:
PM 10 Certificate
Number:
❖ Expanded PM 10 plans for commercial and residential developments > 1 acre are required by
the City of La Quinta.
6637 TC +�6\ 658 TP 6556
A R.E-INSPECTIO:N EE OF $3c,(?6-6,U 11 S i S ytf o f i 3a t °rt 1 y
> 1� fi t
1 ry e' � s,� � +n. �+.. },PS _ -a� q .. „�5 � � .r�e'z-} � b� ��, � �r"i� i`' +J. Is l i �` X)
WILL BE CHARGED IF rIE APPRO _ T> Grpx'`+' ' k r7r� �' �r3 �`n�t r f`
f
662U TP c,8,..-rxii' •« u
)(1rf+�
PLANS AND JOB CA ARE NOTE �f m ,
PA +� s i b G tr,+'� n '� r„x e, 3.1 +.n /n } r;[. ..'h� r ♦ �+. Y 9G
THE SITE FOR. SCHEDU
1 66 $DT ?• I T: l�f N,1;SyK zt{ 'a +�4Y A� I C -fir ii. �1f
6640�TP 2711yp( =�ra4r h'' ��ti '(F
(65.81 TC) I 66-04 1NV 1 x 4 "fib 0 4C r {'L 1 D cN tF T - ' < z�• u �" ry r a
INSPECTION. �I (65.31�1a7 i'rsiP�iN�ry d`II �t ik yj „tlffie��i7 s
NO EXCE IONS! Z
�ia6 sr #I k " ItF rte'
of 27 66.7 F 8 J d G ° 1;.,. fY t al. 't 2 )�) 1 yt wti= �!••r�'. 4 w x._.'27 66<
' 66.57 INV' n t?.`TC d fi64
' I 67.16 FS4 . +• zl', fiBa
I:
1 aS' a
CITY OF LA QUINT ; 2-R0x
BUILDING. & SAFETY DEPNW
.I 67.
6.
APPROVE[) �� 2, 6
w FF=.67.20
FOR CONSTRUCTION h .�
PAD ' -7 66.:7
29'
.i41f1 66.7 FG. - .. ..
.66.2 TG
31
64.70 INV 64.20 0A! 66.J, FG .
1 1 NP 31 66.2 TG
`64.22 1NV . '66.3 FC 31 66.2 TC .. .. .
I
4..�_
�:74 IN677C loll. 66.3 FGl 4
296J66667FP6..12 TG
2
.56TP
INV
>
t. I I i -_---_ .6R \` tea... _____' ._ •.��_._ 66.92 FS CO PROP. IAiENK � - _
- 1 - - - - -`� BS` X202. 3•�Ng2.34'127Y 122. R5: u �7 - �EXKi1NG.SElV[p 1.
_ __ _ __ -_' 'EX157MG WATER -- 59.1 1 -
67.2
_ _ _ 67.7 TC
GRkMC SCALE
�• > g :' h FUTURE DEVELOPMENT • ' -�=-- (67 Se.
PARCEL. 9. (6715
CITY .OF LA UINTA
GREASE TIUP EXMrr' _:'PARCEL e OF ,
PARCEL MAP 90420 -& LLA. NO. 02---- _
1LG1FD w 11¢'YL 1/4 K = a Par, R7[ f M
wm 1a
THE -.CENTRE AT 4A. QUINTA
SEE NOTE NO. 2
SEE NOTE N0. 3
A
INLET—
DOWN WATER RES7STANT
IRON FRAME AND Cpyd2
ri
i
ew
111A+�
MODEL A
ALL DIMENSI.11 ONS IN
INCHES
2r -o"
PC G-2000 gp
8 C
0
48
E
F G
H
PC G_2500 gg
65 74
57 74
74
24 3/4 4 1/2
41 1/2
PC G-3000 6211/2
74
60 1/2 771/2
74
29 3/4 4 1/2
50 1/2 .
—{
85
86
303/4 5
53 1/2
1 1�30*
1 1
s • 1 ARE
c.... -w , S
M
u�y ayl l• A SCHEDULED
L�p�, � .i :NSD •'y i%^'�
r=.s 1
A Q 1, RE0 SPECIFICATION
2- REFER TO SPECIFICATION SHEET NO
EET .. S-218
3• REFER TO SPECIFICATION SHEET N0. S-251
LOCK '
E
1
VARIABLE To
6. GRADE IN
I"CREW1
EN75
OUTLET 6`
ET7U k �p ICAL
WALLS .
--BUILDING
OF LA QUINTA
GILDING & SAFETY DEPT: b(
APPROVED.
AOR C014STRUCTIaNi
mvucl_ G-2000 C-2500 _--
G-3000
LENGTH
WD-TH
2r
2r -o"
10'-0.
10'-0"
11'-0..
BELOW INLET
4'-2"
.4'-11"
5'-2 1/2'
TANK He
5.-5.
6'-2"
6'-51/2'
ENff'ST E CAL
THREE MANHOLEStrIOR WITH SAMPLE BC
O GRAD
DESIGNED FOR DIR C I EXTENDED-2TLOADING
OF MANEXTENSIONS
'l 000 TTHRU 3 00 GALLONS
o
P•0• 8OX 602
909 793E 7602 CA 92346
Fax: 800 945-8265
909 793-1283
DRAM"
M" Dr.
BRAKE
8056
COACHELLA VALLEY WATER DISTRICT ASSESSOR'S PARCEL NUMBER
85-995 Avenue 52
Coachella, California 92236
(760) 398-2651
APPLICATION FOR WASTEWATER INTERCEPTOR/SEPARATOR APPROVAL
APPLICANT: Submit this fora with a copy of a SCALED plot plan (1"= 20' to V= 40' SCALE) drawn to District specifications. A nonrefundable filing fee is required
when the application is submitted. Check must be made payable to the Coachella Valley Water District. Approval of this application shall remain valid fora period
not to exceed one (1) year from date of payment.
Plan Check No.
Agent, Contractor, Contact Person
tA1c:,tk/>e✓\. N
City State tip
82-_576 GAb)e- pt?;k- :r/40,a CA qZ2?o
Telephone
C7u3a x Te-_5?.8
Owner
qe f�ICy i?—
Address City State , zip
370 Gab le ' p�,'l1c -:Zr4 Ab C A ,' i zz a
Telephone
76 0 �s�s-sze a
Job Property Address -�s� x�fivy i�/, Su//e city zip
Ccwkc.fR -4 L-k4wi-J-v3 .}ten IN AR<_e_i iE!_� eA413,41d
Legal Description
DBA
PLEASE COMPLETE THIS SECTION FORREVIEW OF FOOD ESTABLISHMENTS'
NOTE: PLANS WI[;Ii NOT BE ACCEPTED UNLESS THIS APPLICATION IS COMPLETE AND THE PLAN CHECK FEE IS PAID.
GENERAL CONSTRUCTION:
Type of Construction:
New Food Facility { ` Remodel of Existing Food Establishment Hours of Operation Seating Capacity: internal 90 External
External Seating with Misters or Heaters �� Bar with Food Service Bar Nonfood Service Water Softener
Servta:
Multiservice (reusable) Single Service (disposable)
OWNER/REPRESENTATIVE DECLARATION: I certify that I have read the entire application and state that all information is conva I understand that the amount of fee
paid is based on my declaration of information on this form and that incorrect information is grounds for denial of the submitted plans. I also understand that plans writ be
discarded if not picked up within sixty (60) days of approval or denial and that no inspection of my establisbment will be'conducted, or approval ed to until all
8 operate,
proper mformaeion requested has been received and plans have been
. p approved a� returned. .
Signature Date
•'
No: of Systems Type of System(s)
No. Dwelling Units OR ❑ Grease Interceptor Waived ,
Fixture Unita
Interceptor❑Replacement
ew 13Existing
[3Lim Trap
❑ Addition
❑ Clarifier
❑ Connect to Sewer
�)
04U crag.
R 111L'llllla7: .
`+
—1141M, 14
'application is:
�o
Approved . 11 Denied. ❑ Conditional Approval*
Fee $
Cheek No.
*See Remarks
Date /2 pip
Initial
Signa
Date d
CV WD -921