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0312-039 (RC)T ,yy LICENSED CONTRACTOR DECLARATION -1 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 # Lic. Class Exp. Date r 740276 n ,Date /� Signature of Contractor OWNER -BUILDER DECLARATION 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 issued. My workers' compensation insurance carrier & policy no. are: Carrier STATE FUND _ Policy No. '229 021249-05 (This. section need not be completed if the permit valuation is for $100.00 or less). ( ) 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 tho a provisions. Date: 1 1� 0� 0 4 Applicant �: A --- Warning: Failure to secure Workers' 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. 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 state that the above information is correct. I agree to comply with all City, and State laws relating to -the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned propertyfor inspection purposes. Signature (Owner/Agent) ..!/ i/�-�^�` ^�—m- Date PERMIT# BUILDING PERMIT 0:312-039�// c- DATE /VALUATION LOT TRACT JCR'SITE=j % _ ADDRESS% Yid^ fL P(W.i!�.�i_ Y III Sil.l';M l APN OWNER- , ' CONTRACTOR / DESIGNER / ENGINEER 'IrAW1.0 DEV1,'�LOPM NT C©, JW- 1 CONTMUMON ZONE 3856 VtA DC3LCE 1.799 3'AC_X-AL 1); 31.VFJ 710_ B MA DRM RLeY CA 902-02 1?hiM DESM CA 9221 (760)772-1585 OBL4 4112 USE OF PERMIT C.'°J''M!,4XRCIAL RE11VICIDE , (SURF CITY aQUEZZE. TI) Si: IT9 .4A, TYP1E'` N SPIR Aa.E;LED, 0 OCCUPANCY, CCCtiPANT LOAD 21.2031 00 VALVA.TIM 30,000M ,LS 3' :�i:gi', A 00ST fid' CONSTti(. MON 3W"R0 V1TRMTf'PJ 109 SUMMARY PLAN MECK FEE 101.000-439.318 CONSTRUCTION F7,9 101-000-11.18-000 MECHANICAL FEE 1011000.421=000 $fis.04 ?EILECTR10i'LL MP 101-000.4.20-000 $ �. YLI,I.E BINO FEE 101-000.419.000 $88.50 a T P.0110 MOT1034 F ER - RESID 101 -000 -MI -000 $3.00 • `S CO 'S RUCMON A,kla:3PLAW CHECK $664.51 D Q Sw PRE -PAM FESS $0.00 r WrAf. YYEES DIA." Y+Tb.`W $604-51 JAN 2 0 2004 CITY OF LA QUINTA FINANCE DEPT ' RECEIPT DATEi7 �/ �' _ �. i(BY�f r.m DAT INAL5 INSP T R . .qp,!� INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts 3 Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap 4 F.A.U. Framing ij Compressor Insulation It Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath ' — 0 Final Final BLOCKWALL APPROVAL POOI-9-SkIS7 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 TestElectric Final Waste Lines Q Heater Final Water Piping Plumbing Final Plumbing Top Out 0 Equipment Enclosure Stwvier Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final ° 7 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 p i Final Utility Notice (Perm) COMMENTS: ! •f'JI/1,2/2003 WED 0:46 FAX 760..777 7112 Bldg & Saftey x x X x 91001/001 Bin Al City of La Quinta Bni drmg 8 Safety D'Mdon U P.- O. Box 1504, 78.495 Calle Tampko La 47lilnta, U 92253 - (760) 771.7012 Building Permit Applicadon and Tracking Sheet pew Project Address: -7cl.4p5 4wY 111qA A. P. Number wner'sNA;m ddress: •TC. -728 MINLegal Description: Contractor. ity. ST. Zip: PAl_m �E GA • R 221 I FTekphoae:. '740-7.00. 44-1 1 Y Address: roject Descriptlor: TENAtrf- AA PRGV t�19 T City, ST, Zip: -r . (11 MAC- .c w'A Tt /LT 1►A, O\s wrTA •, Tckphonc: State Lic. d : City Lic. C Arch, Ensr, Desiptcr•. Address Cm, ST, Zip- Telephone: > �:�G`;"tom• State Lie. N: .::: :' Via? Name of Contact PerswJ l M F RI N M V -T— -t Construction � T S cY: TVPa' t1. t'P, Occupan Project or (circie one): New Add'n Aha Repair Demo Sq. Ft.: $111 A Storia. N [hits Telephone N of Contact person: 414.1,930 ed Value of Project: 42: om APPLICANT: DO II40T WRITE BELOW *HM LINE ' M. Submittal Req,d Recd TRACKING PERNUT FEES Paso Sets Plas Check submitted �� f ld� Item Ame+aa< Structural Caies. Reviewed, ready for corrections 1-k yj Pian Check Deposit Trum Cates. Celled Contact I;,,c oo Plan Cheek Balaeee Enc YCalla. Plans cktup . Coestructioa Flood plain plan Naos mt♦bmittiA Nicehanicai Gradiog pian r Review, reads for torte as Electrical Subcoetaetor List Called Colonel Tenon Plumbing Grant Deed Plant picked up SAM. H.O.A. Approval tiara mabmitcd Grading IN HOUSE:- 7ie Review, reedy for tomtlioWessac Developer impact Fee Planning Approval Called Contact i!'ersoe A,I,p,p: Pub. Wks. Appr Date of permit ii tut School Fees jJ G SJSU� Total Permit Fees c/o moi° . 1�1 P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 To: Greg Butler, Building & Safety Manager From: Oscar Orci, Planning Manager BUILDING & SAFETY DEPARTMENT (760) 777-7012 FAX (760) 777-7011 To CDD: 11-12-2003 Due date: 11-25-03 Status: l st Review Building Plans Approval (This is an approval to issue a Building Permit) The Community Development Department has reviewed the Building Plans for the following project: Description: Surf City Squeeze Address or general location: 79-405 Highway 111, Ste. 2 Applicant Contact: James Reinmuth 760-416-3930 The Community Development Department finds that: ❑ ...these Building Plans do not require Community Development Department approval. ...these Building Plans are approved by the Community Development Department. ,r� ❑ ...these Building Plans require corrections. Please forward a copy of the attached corrections to the applicant. When the corrections are made please return them to the Community Development Department for review. Orci, Planning Manager Date COUNTY OF RIVERSIDE COMMUNITY HEALTH AGENCY DEPARTMENT OF ENVIRONMENTAL HEALTH ENVIRONMENTAL HEALTH SERVICES SUPPLEMENTAL REPORT TO SAN. FORM # DATE SUBJECT PERMIT NO. ADDRESS INSPECTOR---.--,- - - -- - -------------- 7---------- REMARKS: 13 r//) Alnl a, --7 7w. - rDA A." A-4 0 A DEH -SAN- 'Rev 8/02), PINK—, ,Office Area.# IV COUNTY OF RIVERSIDE COMMUNITY HEALTH AGENCY DEPARTMENT OF ENVIRONMENTAL HEALTH PLAN CORRECTION an Check # NO3-087 Date 11/24/03 DBA Surf City Squeeze Address 79-405 #2, Hwy 111, La Quinta Plans Submitted by J. Reinmuth Phone (760)416-3940 Owner D. Pool Address Phone The plans are now approved subject to onditions listed below and the attachedcompliance sheet. 1 The hot water heater rrfust-miryimally have a heating capacity of 50,000 Btu's. —(see red line correction sheet A4-1). 2. All food and utensil sinks must be plumbed to floor sinks through approved air gaps. The mop sink must be of the floor basin style of a sufficient size to contain the contents of a mop bucket. Behind all three sinks in the splash zone the finish must be water proof to a height of 8' (e.g. FRP/tile) 3. All floor, wall and ceiling finishes in food service areas must be smooth and easily cleanable including waitress and self service stations such as drink dispensers. 4. The trash enclosure must be finished so that the interior floor and walls are smooth and easily cleanable. Seal these interior surfaces with an approved two part epoxy. 5. All exterior and restroom doors must be self closing. Exterior doors must also be sealed against entry by vermin. The delivery door air curtain must deliver air at a velocity of 1600 fps at a height of 3above the floor. 6. The number of lockers provided shall be equal, or greater than the number of workers assigned to a peak shift 7. Approval of this plan does not include approval by local land use, water or sewer agencies. Prior to commencing construction or undertaking improvements, submit these plans to the Riverside County Land Use Agency located at 82675 Hwy 111, Room 201 Indio CA 92201, phone (760) 863-7000. A facility may not receive an Environmental Health Permit without this approval, which will be verified prior to the final inspection. CONSTRUCTION INSPECTIONS: Contact the Plan Checker for a Preliminary Inspection when construction is approximately 80% complete, with plumbing, rough ventilation, and rough equipment installed. Request for inspection should be made at least five (5) working days in advance. A compliance guide is attached to this plan correction sheet. All construction not otherwise addressed on the plan correction must be performed in accordance with the guidelines set forth therein. A FINAL INSPECTION MUST be made upon completion of ALL work including finished details. APPROVAL to operate shall not be granted, or remodeled areas approved to operate, until the facility has passed the FINAL INSPECTION, and "APPLICATION TO OPERATE" has been completed and PERMIT FEES have been paid. Request for inspection should be made at least five (5) working days in advance. PLANS CHECKED BY David E. Day Phone (760) 320-1048 1 acknowledge the corrections noted herein and as indicated on the plans and agree to incorporate them during construction: Signatu Compan ,l Date ri e2- CAUfOANIq - , Q,�IMEHIa,�Afsgr RIVERSIDE COUNTY FIRE DEPARTMENT andF1�E PPOifCf/py In cooperation with the �F� California Department of Forestry and Fire Protection Silt CQ" _4 82-675 Highway 111, 2nd Fl., Indio, CA 92201 . (760) 863-8886 • Fax (760) 863-7072 + m December 12, 2003 Tom Tisdale Fire Chief James C. Reinmuth 2121 E. Tahquitz Canyon Way Proudly serving the Palm Springs, CA 92262 unincorporated areas of Riverside Re: Non -Structural Building TA Plan Review County and the LAQ-03-TI-101 / Surf City Squeeze =Cities of: Fire Department personnel have reviewed and approved the plans you submitted for the above Banning referenced project. Please be advised the following conditions apply as a part of the conditions for the issuance of a building permit. Beaumont Cali. 1) Fire sprinkler system plans for the tenant improvement area must be submitted to the Fire Department for review, along with a plan/inspection fee. The approved plans, with Fire Department Canyon Lake Job card must be at the job site for all inspections. .3 Coachella 2) Provide either a separate Knox Key Lock box, Model 4400, 3200 or 1300, mounted per ❖ recommended standard of the Knox Company or provide key(s) for inclusion in the general building Desert Hot Springs Knox Box. If the building/facility is protected with a fire alarm system or burglar alarm system, the 4. lock boxes will require 'tamper" monitoring. Special forms are available from this office for the Indian Wells ordering of the Knox Box, this form must be authorized and signed by this office for the correctly Indio coded system to be purchased. 4. Lake Elsinore 3) Install portable fire extinguishers per Title 19, but not less than 2A10BC in rating. Contact certified 4. extinguisher company for proper placement of equipment. La Quinta ❖ 4) Approved building address shall be placed in such a position as to be plainly visible and legible from Moreno Valley the street and rear access if applicable. In multi -tenant buildings, businesses shall post the 4. business name and suite number on back doors as well as the front. Suite numbers or letters must Palm Desert be a minimum of 6" in height. All addressing must be legible and of a contrasting color with the Perris background. 4. Rancho Mirage Please contact the Fire Department Planning & Engineering staff for final inspection prior to occupancy. San Jacinto All questions regarding the meaning of these conditions should be referred to the Fire Department ❖ Planning & Engineering staff at (760) 863-8886. Temecula Sincerely, Board of Supervisors Bob Buster FRANK KAWASAKI District t Chief Fire Department Planner John Tavaglione, District 2 Jim Venable, ' 0 By District Walter Brandes Roy Wilson, Fire Safety Specialist District 4 Cc: City of La Quinta — Bldg. Dept. MIPEMP Data%La QNnta%PROJECTMTRA043.71-101.doc Marion Ashley District 5 - EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE 82-675 Highway 111, 2nd FI., Indio, CA 92201 9(760)863-M6 • Fax (760) 863-7072 �S Tel: (626) 448-8182 Fax: (626) 449-8092 Suite 118, El Monte. CA 91731 0 v. AO U Tyt e- z4vTz-4 A T LA 19 U/11Ti9 LVL 00,V0 � 33,6 336K J Na � Z�c Br DATE 51-L''//t J'i O OF CITY OF IN' 4 X , BUILDING & SAFETY DEPS - Z- CI,SrV-9 r.� FOR CONSTRUCTION U U .1 �o ao M �. Jo t. CITY OF IN' 4 X , BUILDING & SAFETY DEPS - Z- CI,SrV-9 FOR CONSTRUCTION DATE _� BY -79l1/l�j Tel: (626) 448-8182 Y Fax: (626) 449-8092 118. EI Monte, CA 91731 G /,V KK Joe No. I O By DATE S. OF s- ) X, vo 2, lTDk �76 . /-JDMr117- AA1,g GySij �c�� = 3 �� 7, ) CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTION I DATE BY. 0 � r ....♦. f..........♦...... ♦.......,...�......... I f...♦1....f..f.f........♦1'..♦ ...... ..uaa.Aaaa.aaaaaaauaaauaaaa.auu66s4a•u.�a.P�'�'?�,isfy;r4au.a►.auua.aaaaa�aau�uuaauuuaaa�auaaaaa IWO --. HlDdl� TOILET MEN ■■■1■�Nis •s■�. p ■■■■■■�1■1■�fCi = ' NNNIIN INNIIIIIIIIIIIIIIIII�■■`t'umnunnnutuurnm:nrnttunutuum�nmrreuuttnn�narrrutrtnun�= ONE ■mime l�!!!�J■■� i.'.2�,j54 srnumunarwimmtu�nrifruwwumrrntmlTurwuumrom[nnuratreimnatmnmuueumrwunumnirtor•�� � ::-Roro - .•y q �o �-a� Co Certificate of Occupancy oF�9 Building &Safety Department This Certificate is issued pursuant to the requirements of Section 109 of the'California Building Code, certifying that, at the time of issuance, this structure was in compliance with the provisions of the Building Code and the various ordinances of the City regulating building construction and/or use. BUILDING ADDRESS: 79-405 Highway 111 Suite #1 Use classification: Commercial (Surf City Squeeze TO ! Building Permit No.: 0312-039 Occupancy Group: B Type of Construction: VN Land Use Zone: CR Owner of Building: Stamko Development Co. Building Official CONSPICUOWS PLACE i Address: 3856 Via Dolce Cir; ST, ZIP: Marina Del Rev. CA 90292 By: Daniel P. Crawford Jr. Date: 4/26/04