05-0983 (RC)(t
TW!t 4 4 Q"
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 - (760) 777-7012
78-495 CALLS TAMPICO w FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number
Property Address . . . .
APN:
Application description
Property Zoning . . . . .
Application valuation . .
Owner
KLEINE NEIL WAYNE
41910 BOARDWALK A-10
PALM DESERT
PALM DESERT CA 92211
r0�5*1-00000983 y Date 3/17/05
79400 HIGHWAY 111 #102
649-820-00.2- -
REMODEL - COMMERC
REGIONAL COMMERCI
1000
MAR 3 0 2005
Contractor L CITY OF LAQUINTA J
---------------FFRANCE1 EPT.
KLEINE BUIL
41910 BOARDWALK, SUITE A-10
PALM DESERT CA 92211
(760) 776-4840
Qty Unit Charge Per Extension
WCC: STATE FUND
WC: 1769113
12/01/05
CSLB: 390365
03/31/07
CCC: B -C27
-----------=--------------
Structure Information -------------------------
Construction Type . .
. . . TYPE V - NON RATED
Occupancy Type ...
. . . MERCANTILE
Other struct info . .
CODE EDITION 2001
FIRE SPRINKLERS YES
MIXED-USE OCCUPANCY M
------------------------------------------------------------------1----------
Permit . . . . . .
BUILDING PERMIT
Additional desc
Permit Fee . . . .
25.00 Plan Check Fee
16.25
Issue Date
Valuation
1000
Qty Unit Charge
Per
Extension
BASE FEE
15.00
5.00 2.0000
-----------------------------------------------------------------------------
HND BLDG 501-2,000
10.00
Permit . . . . ...
ELECT - ADD/ALT/REM
Additional desc
Permit Fee . . . .
15.75 Plan Check Fee
3.94
Issue Date . . . .
Valuation . . . .
0
Qty Unit Charge.
Per
Extension
BASE FEE
15.00
1.00 .7500
----------------------------------------------------------------------------
PER ELEC DEVICE/FIXTURE 1ST 20
.75
Permit .. . . .
MECHANICAL
Additional desc
Permit Fee . . . .
21.50 Plan Check Fee
5.38
Issue Date . . . .
Valuation
0
Qty Unit Charge Per Extension
P.O. Box 1504•
VOICE (7601 7 7-70121
78-495 CALLS TAMPICO
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-701 I
INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number:
off— pc
Applicant:
Applicant's Mailing Address:
Date: 3 -
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
rsuII-uiNU rtKMIT DECLARATIONS
- 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. �D 2 �S
License Class %j La -7 License No. J
Date Contractor 'UC." K-"�j.�•�c� r� '3� ����. V
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 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 Contractors' 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 7031.5 by any applicant fora permit subjects
the applicant to a civil penalty of not more than five hundred dollars (5500).):
U 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 jmproves thereon, and who does the work
himself or herself or 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.).
U 1, 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.).
U I am exempt under Sec. . BA P.C. for this reason
Date Owner
WORKERS' 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. W workers' compensation insurance carrier and policy number are:
Carrier Policy Number 11 bG \ 1 3
_ 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 3' . 6 A ,plicant
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 (S100,000), IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION
I hereby affirm under penalty of perjury that there is a construction lending age cyorJthe peAGENCY
performance of he work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
ACKNOWLEDGEMENTAPPLICANT
IMPORTANT Application is hereby made to the Director of Building and Safety for apemit ubohe 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 benefit 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 Ouinta, 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 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 anis state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building
construction.and hereby authorize representat"v s of this countyW enter upon the above-mentioned property for inspection purposes.
nt or
Date_ � '30 -y� Signature (Applica
Cl
Page
2
Page
2
Application Number . . . 05-00000983
Date
3/17/05
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 6.5000 EA MECH VENT
-------------------------------------------------------------------------
FAN
6.50
Permit . . . . PLUMBING
Additional desc
Permit Fee . . . . 30.00
Plan Check
Fee
7.50
Issue Date . . . .
Valuation
. . . .
0
t Qty Unit Charge Per
Extension
BASE FEE
15.00
2.00 6.0000 EA PLB FIXTURE
12.00
1.00 3.0000 EA PLB WATER
----------------------------------------------------------------------------
INST/ALT/REP
3.00
Special Notes and Comments
Single ac.comodation toilet
facility. Shell improvement in
preparation for tenant improvement.
---------------------------------------------
Other Fees STRONG
--------------------------------
MOTION (SMI)
- COM
.50
Fee summary Charged Paid
-----------------
Credited
Due
--------------------
Permit Fee Total 92.25
----------
.00
----------
.00
92.25
Plan Check Total 33.07
.00
.00
33.07
Other Fee Total 50
.00
.00
.50
Grand Total 125.82
.00
.00.
125.82
Craig E. Anthony
Fre Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
Cities of:
Banning
Beaumont
00
Calimesa
y�
Canyon Lake
o••
Coachella
Desert Hot Springs
E•
Indian Wells
Indio
.C•
Lake Elsinore
La Qainta
s•
Moreno Valley
40 -
Palm Desert
d•
Perris
d•
Rancho Mirage
00
San Jacinto
.g
Temecula
Board of Supervisors
Bob Buster,
District 1
John Tavaglione,
District 2
Jeff Stone,
District 3
Roy Wilson,
District 4
Marion Ashley,
District 5
RIVERSIDE COUNTY
FIRE DEPARTMENT
Ig ay., n Io, . . Fax (160) 863-7012
March 29, 2005
Robert Pitchford Architect
74-835 Fox Hils Ct.
Palm Desert, CA 92260
Re: Non -Structural Building TA Plan Review
LAQ-05-TI-032 / Premier Billiards & Design
79-400 Hwy 111, Ste. 102
Fire Department personnel have reviewed and approved 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) As may be necessary to maintain proper fire sprinkler protection due to constructions changes, fire
sprinkler system plans for the tenant improvement area may be required to be submitted to the Fire
Department for review,^along with a plan/inspection fee. The approved plans, with Fire Department
Job card must be at the job site for all inspections.
2) Provide keys to the tenant space for inclusion in the main building Knox Box. Key(s) shall have a
durable and legible tag affixed for identification of the correlating tenant space.
3) Install portable fire extinguishers per Title 19, but not less than 2A1 OBC in rating. Contact certified
extinguisher company for proper placement of equipment.
4) Approved building address shall be placed in such a position as to be plainly visible and legible from
the street and rear access if applicable. In multi -tenant buildings, businesses shall post the -
business name and suite number on back doors as well as the front. Suite numbers or letters must
be a minimum of 6° in height. All addressing must be legible and of a contrasting color with the
background.
Please contact the Fire Department Planning & Engineering staff for final inspection prior to occupancy.
Requests for inspections are to be made at least 72 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.
Cc: City of La Quinta — Building Dept
K'JIMWP Ra%Ua QuftWR0JEc=7MAQ M1VMdx
Sincerely,
FRANK KAWASAKI
Chief Fire Department Planner
By �
Walter Brandes
Fire Safety Specialist
EMERGENCY SERVICES DIVISION . PLANNING SECTION . INDIO OFFICE
82-675 MKgh%W 111, 2te FL, Indio, CA 92201 . (760) 863-8886 • Fax (760) 863-7072