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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