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0307-294 (RC)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjurythat 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 2( Date Signature Signature of Contractor %y 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: Carver';I-�,11i:1+3f3ON Policy No. (12I.�llii�ti (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 those p;ov'isio s�-- /�� Date: X?7/ %i �, Applicant 'w ✓ .��+%' fl, Warning: Failure to secure Workers' Compersation 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 /Signature above-mentioned property fpr -iris pectioii purpo e�s.� , ✓Signature (Owner/Agent ¢"f�vr3 DateAQ d✓�� BUILDING PERMIT PERMIT# TA -294 DATE40,, VALUATION �A9.. �nn� LOT TRACT JOB SITE ADDRESSj1.�1 APN OWNER CONTRACTOR / DESIGNER / EN (NEER STMM.0 D V.EL0. ?W24T CO. ROY A. MARTMM, INC. 3856VIADOLG'J+., ;'11:G�*J ![4'Al>y UXTEB MAMA9,REY CA 90292 ]RV.iliE CA. 42618 (949)581.9075 C13I.�fi USE OF PERMIT C:C1tu�AA:is'1•ict�AT:�i? 1��'i�9:pT,�:��d t:t�1�A3�TF.C7,A,f:`f':�ti'F.AT'i' F`tM{�,s.'U'V1:,3� 'hl`P a gC3.+�.Ci�F S'rt't'3.P"'Csft.Cti3JP "tVP° '' ME'RC"•ANT:IU, TYP "VW, ."31'RTNKL.ED, 0CCLIPANT LOAD 45 VJUMATION 11,000.00 !.9 1'..NMd916C:C..Y'.C.71/ 4t�J1. ,I,' OF `M`\�.F'lfDwJ.A'A„W'1_ ITT ._ 15,M).00JVP. ? a '.rte:41t� RV ; PLAN CHECKFIR 101.000439-318- CONS`1'RUCTION1 PEE 10 1; M1?Ck•WTICA4 FEE 101-0004-21-000 11,LFXTIttG..1.,T.179K STFi0NOMOTION'_FU-COM,M.. -1OU-0000-241.000 SUB -TOTAL CONWRTYMON AND PLW CHWIC $328.31 e L1,:441S FRE- JW,1a'.K;S , $0.00 OCT 27 2003 CITY OF LA QUINTA FINANCE DEPT .. ; ' RECEIPT DATE '7 1' BN/ �, ' DATE FI LED INSPE R INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts / D Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing / p Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Q3 Final Finat POOLS - SPAS BLOCKWALL APPROV LS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final ` COMMENTS: T ?,/"s A4 6�✓ IIW41-7 / 6 / N TGv9� /Q�go`03 _ J` j �y 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 / 3 Aa •Final. Utility Notice (Perm) i 06/30/2003 14:41 7607777011 LA QUINTA PAGE 01/01 • • Bill p C o2 City of La Quinta ° Building a Safety Division ° Permit # P.O. Box 1504, 78-49S Calle Tampico 'r La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet 1f Project Address: �/�� `! f Q�� S'•� Owners Neme;��'� A. P. Number; Address: ry� Legal Description: City. ST. Zip:% TX 7,5a��� X" Contractor: ��� - �Tele hone, D? x Address: rojcct Description: — ll City, ST. Zip: Telephone: : $ 8 /• — 1915-715 7cs Stale Lic. # :Citv #: f Lic. rj�%2h �J � s�7P��✓/,�� 6 /� . / rAddress:/4j�4/. ST. Zip: J )Af- t 92/ 2& phoneConstruction Type: J Occu anew: tate Lic. #,tom . A Name of Contact Pcrson: �� Project type (circle one): Neje Add'n Alter . Repair Demo S q. Ft.:11� 8 b Stories: X Telephone # of Contact Person: #Units: Estimated Value of Project: /Sed ©p -- APPLICANT: DO NOT WHITE BELOW THIS LINE p Submittal Req�d Ret'd TRACKING Plan Seta PERMITFEES Plan Cbtck submitted j Structural Cales. Item Amount Reviewed. ready ear corrections % � Plan Cbrck Deposit Truss Ca [ca. Called Contact Person 7 Z 3 Plan Check Balance • Energy Cates. Plans picked up7//p7✓ s� Construction • Flood plain pilo Plans resubmitted g Mechanical • Grading plan 2•' Review. ready for correetio :asst 9 S Electrical Subeontaetor )rift • Called Contact Person a t fit Plumbing • Grant Deed Plans picked up H.O.A. Approval Plans resubmitted HOUSE!- Grading ''Review, ready for corrections/issueDeveloper Impact Fee Planning Approval Called Contact PersoM A.I.P.P. Pub. Wks. Appr Date of permit issue bN,1N ebool Fees d ._ Total Permit Fees 0 004n$ L 5428 14q- 58a -373.5 DEC -19-03 FRI 2:54 PM RIV. CO. FIRE P&E INDIO FAX H. 1 760 863 7072 P. 1 Tom Tisdale Fie Chief Proudly serving the Unincorporated Arens of Ri vcrside County and the Cities of.- Banning C Banning fi l3caulnont Calimesa Canyon Lake t Coachella Desert Hot firings f Indian Welts } Indio 4. - Lake Elsinore La Quinta r:. M(weno Val Icy . Palm Desert Perris Rancho Mirage San Jucinto T'emccula Board of Supervisors Bob Buslcr, District 1 John Tavagtione, Whilst 2 Jim Venable, Dimeict 3 Roy Wilson. District 4 Marion Ashley, District 3 RIVERSIDE COUNTY FIRE DEPARTMENT In cooperatiotr with the California Department of F'on utry and Fire Protection 0 est San acinto venue . erns, Calr ornia 9;. 0. 90 ) 9.0W900:Fax 09) —MWo—=7: -' December 10, 2003 City of La Quinta Building Department Re: Fire and Lite Safety Clearance The Riverside County Fire Department is granting, a fire and life safety clearance for the following project�Game Stop located at 79105 HWy 11I 1 Q Yf7-440 S . Please call if you should have-and'Quesfions. ` Respectfully FRANK KAWASAKI Chief Fire Department By Terry DeSoucy Fire Safety Inspector EMERGENCY SERVICES DIVISION . PLANNI IG SECTION • INDIO OFFICE 82-675 Highway 111, 2- FI., Indio, CA 92201 • ( 160) 863-8886 • Fax (760) 863.7072 Tom Tisdale Fire Chief Proudly serving the unincorporated areas of Riverside County and the Cities of: Banning Beaumont Calimesa Canyon Lake Coachella Desert Hot Springs Indian Wells .o Indio ;. Lake Elsinore 4.1 - IA Quinta Moreno Valley 0. - Palm Desert .r Perris Rancho Mirage 4 - San Jacinto 00 Temecula Board of Supervisors Bob Buster, District 1 John Tavaglione, District 2 Jun Venable, District 3 Roy Wilson, District 4 Marion Ashley District 5 RIVERSIDE COUNTY FIRE DEPARTME1 In cooperation with the California Department of Forestry and Fire Protection an acm PC ax o venue • Pe , a �� • July 14, 2003 DRV Design 16466 Bemardo Ctr. Dr. #136 San Diego, CA 92128 Re: Non -Structural Building T/l Plan Review L'AQ:0a7l-050 / Game Stop Store - r? Fire Department personnel have reviewed and approved the plans you submitted f referenced project. Please be advised the following conditions apply as a part of tt issuance of a building permit. 1) If the building has an existing fire sprinkler system, plans for the tenant improve submitted to the Fire Department for review, along with a plan/inspection fee. with Fire Department Job cans must be at the job site for all inspections. 2) Provide either a separate Knox Key Lock box, Model 4400, 3200 or 1300, mou recommended standard of the Knox Company or provide key(s) for inclusion u Knox Box. If the building/facility is protected with a fire alarm system or burglar lock boxes will require "tamper" monitoring. Special forms are available from - ordering of the Knox Box, this form must be authorized and signed by this offic coded system to be purchased. 3) Install portable fire extinguishers per Title 19, but not less than 2A10BC in ratio extinguisher company for proper placement of equipment. 4) Approved building address shall be placed in such a position as to be plainly 1 the street and rear access if applicable. In multi -tenant buildings, businesses business name and suite number on back doors as well as the front. Suite nl be a minimum of 6° in height. All addressing must be legible and of a contra: . background. Please contact the Fire Department Planning & Engineering staff for final inspecli Requests for inspections are to be made at least 24 hours in advance and may tr (760) 863-8886. All questions regarding the meaning of these conditions should be referred to the Planning & Engineering staff at (760) 863-8886. Sincerely, FRANK KAWJ Chief Fire Del By ( Walter Brand Fire Safety Si EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE �-A" r -e am►1 .176018634M • Fax (760)1163 NW { -S `ate �•� Certificate of Occupancy u 19ei G 9�5 f p rtment_ OF � Building & Sa a ty 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 3 Use classification: MERCANTILE Building Permit" No.: 0307-294 Occupancy Group: M Type of Construction: VN - SPRINKLED Land Use Zone: CR P' Owner of Building:: STAMKO DEVELOPMENT Address 3856 VIA DOLCE t City, ST, ZIP: MARINA DEL REY CA e By: DANIEL P. CRAWFORD, JR. Date: December 19, 2003 Building Official POST IN A CONSPICUOUS PLACE _. ng