11-0031 (RC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4 4 4 QuAiM
Application Number:
Property Address:
IL -0000003,1
79400 HIGHWAY 111 STE 104'
APN:
649-820-002- - .-
Application description:
REMODEL - COMMERCIAL
Property Zoning:
REGIONAL COMMERCIAL
Application valuation:
1500
Applicant -Architect or Engineer:NV
000 Ilk -
0
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: 13 License No.: 853780
late:'lI I Lh,r Contractorf ;�/�,,t(jLULCC64-5711!(/C- 4,V We
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 (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 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 7031.5 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, 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.l.
(_) I am exempt under Sec. , BAP.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
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:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
te: 1/31/11
Owner: D d ��
GOGIAN JOHN J
1' 1 2011
Cr y.OF L-A �Uit4.r
Ft►�ip�.,�ECEP
Contractor: j
ULTRA CONSTR & DEVELOPMENT INC "`�--
3065 E. VERONA ROAD
PALM SPRINGS, CA 92262
(760)320-2113
Lic. No.: 853780
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 0000195-2009
_ 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 Coo/de, I shall forthwith comply with those provisions.
f Date: I 1.1 —Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDREDTHOUSAND
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 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 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 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 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 inspection purposes.
Date:` 70.1 . Signature (Applicant or Agent):jf/J AAA
%—Za -
LQPERM[T
Application Number 11-00000031
------ Structure Information SUITE EXPANSION/VB/M-OCC/47-OL/SPRINKLED-----
Other struct info . . . . . CODE EDITION
2010
FIRE SPRINKLERS
FULLY
MIXED-USE.00CUPANCY
M
OCCUPANT LOAD
47.00
1ST FLOOR SQUARE FOOTAGE
=---------------------------------------------------------------------------
1500.00
Permit . . . BUILDING PERMIT
Additional desc .
Permit Fee . . . . ' 35.00 Plan Check Fee
22.75
Issue Date . . Valuation . . .
. 1500
Expiration Date 7/18/11
Qty Unit Charge Per
Extension
BASE FEE
15.00
10.00 2.0000 HND BLDG 501-2,000
20.00
----------------------------------------------------------------------------
Special Notes and Comments
1,500SF SUITE EXPANSION/VB/M-OCC/43-OL/
SPRINKLED [ANGEL VIEW] THIS PERMIT DOES
NOT INCLUDE MECHANICAL, ELECTRICAL OR
PLUMBING INSTALLATIONS OR BUILDING
SIGNAGE. 2010 CALIFORNIA BUILDING CODES.
January 19, 2011 4:37:31 PM AORTEGA
----------------_--_-------------------------------------------
Other Fees ACCESSIBILITY PLAN REVIEW
---------------
2.28
BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
-----------------------------------------------
Due
----------
Permit Fee Total 35.00 .00 .00
35.00
Plan Check Total 22.75 .00, .00
22.75
Other Fee Total 3.28 .00 .00
3.28
Grand Total 61.03 .00 .00
61.03
f
Bin #
City of La Quinta
�a Building 8r Safety Division
Permit # P.O. Box 1504, 78-495 Calle Tampico
�\ La Quinta, CA 92253 - (760) 777-7012
1 Building Permit Application and Tracking Sheet
Project Address: Owner's Name&0 Ttz:
A. P. Number: W CO Address: `fZ
Legal Description: City, ST, Zip: �jrb , • pSp S
Contractor:UIZ
Telephone:
e.
Address:Q .6 Project Description:
City, ST, Zip:
I t4, .3 O
Telephone:
le e
P hon
State Lic. # : 7City Lic. #;
Arch., Engr., Designer:
Address: LJ
City, ST, Zip:
Telephone:
Construction s ucti
on T
Y
P
e:
Occupancy:
c
P Y
State Lic. #:
Stories: es:Pr Ject type (circle one): New Add'
n
Repair r Dem
o
Name of Contact Person: Sq. Ft.: 1,500--T#
# Units: l
Telephone # of Contact Person: _ Estimated Value of Project: $IS SO `t�,—
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Req'd Recd TRACKING PERMIT FEES
Plan Sets Plan Check submitted / em Amount
Structural Calcs. Reviewed, ready for corrections Plan Check Deposit r'
Truss Calcs. Called Contact Person Plan Check Balances .
Title 24 Calcs. Plans picked up Construction
Flood plain plan Plans resubmitted Mechanical r.
Grading plan 2nd Review, ready for corrections/issue Electrical
Subcontactor 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 correction /isue Developer Impact Fee
Planning Approval Called Contact Person
�y A.I.P.P.
Pub. Wks. Appr Date of permit issue
School Fees EJ I ka"MAMA-e `n
l 1 I I 1 Total Permit Fees (� v
13
J%4A6 Gsr%-t} dire l tt
Craig E. Anthony
Fre Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
Cities of:
Banning
Beaumont
4•
Calimesa
Canyon Lake
Coachella
Desert Hot Springs
4
Indian Wells
Indio
Lake Elsinore
La Quinta
oa
Moreno Valley
Palm Desert
ee
Perris
4.
Rancho Mirage
ee
San Jacinto
4 -
Temecula
Board of Supervisors
Bob Buster,
District 1
John Tavaglione,
District 2
JeftStone,
District 3
Roy Wilson,
District 4
Marion Ashley,
District 5
RIVERSIDE COUNTY
FIRE DEPARTMENT
82-675 y o, Fax V60) 863-7072
January 24, 2005
Robert Pitchford Architect
74-835 Fox Hils Ct
Palm Desert, CA 92260
Re: Non -Structural Building TA Plan Review
LAO -05 -TI -001 / Pitstop
79-400 Hwy 111, Ste 104
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 Fir
Department for review, along with a planfinspection fee. The approved plans, with Fire Departmel
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
durable and legible tags affixed for identification of the correlating tenant space.
3) Install portable fire extinguishers,per Title 19, but not less than 2A10BC in rating. Contact certifier
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 fr
the street and rear access if applicable. In muWtenant buildings, businesses shall post the
business name and suite number on back doors as well as the front Suite numbers or letters m
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 occupar
Requests for inspections are to be made at least 72 hours in advance and may be arranged by callii
(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
Waiter Brandes
Fire Safety Specialist
Cc: City of La Quints — Building Dept
MPEZMP Daaua ouoaaTRaEcrsmwoosnam.mo
EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE
62-675 Highway 111, god FI., Indio, CA 92201 . (760) 863.8886 • Fax (760) 863-7072
rauFOANIp
RIVERSIDE COUNTY
D p EAPROIfCIpNy
FIRE DEPARTMENT
c , .
In cooperation With the
oF
• E tt.
California Department of Forestry and Fire Protection
r ``�tpS1lf .
210 West San Jacinto Avenue • Perris, California 92570 • (909) 940-6900 Fax (909) 940-6910
FIRE
BEt TMEMT
Tom Tisdale
Fire Chief
,
April 7, 2005
Proudly serving the
unincorporated
areas of Riverside
To: La Quinta Building Department
County and the
Cities of.
Banning .
Beaumont '
Re: Final fire Clearance
Calimesa
Canvon Lake
The Riverside County Fire Department is granting a fire life safety clearance for Pitstop
Coachella
L 0O.Hi Way`11°lsui_tej#j4_LA-OSTI0010
Desert Hot Springs
Indian Wells
Indio
If you have any questions contact me at 760-345-6954
Lake Elsinore
"
La Quinta
Respectfully,
Moreno Valley
Palm Desert
Pew
Neal Stephenson
4*01
Rancho Mirage
Fire Systems Inspector
San Jacinto
Temecula
Board of Supervisors
Bob Buster,
District 1
John Tavaglione,
District 2
Jim Venable,
District 3
Roy Wilson,
T%.-"- n
t
ow -,
goo
jgcvj*cjD Z��l � -Is -Solk
57.il
do
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