0308-125 (CSCS)LICENSED CONTRACTOR 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 # Lic. Class Exp. Date
Datelel
• ,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 wagesas 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 exclusivelycontracting 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 ?�3dlTH ?Acs, Co Policy No. ZO11011108
(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 provisions. r
fate: /67- -Applicant
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`Pf this City to enter upon
the above-mentioned property for inspection purposes.
,/ w
.Signature (Owner/Agent) `f, `, -`� ' > �r' • • Date
BUILDING PERMIT PERMITN
0".8-`A,2115
DATE `VALUATION LOT TRACT
' �� 1'8.i�i►
ADDRESS J33•�i}JF fives. .�'a�C a, SI%�.CE JOB SITE
•
APN
A
OWNER
CONTRACTOR / DESIGNER / EN (NEER
38561 VIADODI; GE I
3IS 9 REXYM.L NVERI'M
MARWAaO�1�.'�11" CA 90292
Cr,13TiikWi,SA (14A 9262
(114)434..4887 t1HYLA
USE OF PERMIT
7
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COMMUMICATIOat>;SIP M - OMI TY[11 4M OP111W.KIARED
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IiI,+L�;i'ltICA'1:, F}�;c., ? 211-'i1Q11-•�i Ci-di0"�; $'At.;:�'
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STRONG 0TIO N:RE COMbfi 1ODA)'00-241-000 �IG:01f
CC IT"I `TT-we-no?� f 1 d t'""rl f:FF:
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OCT 2 2 1003 1° ���?.RMU'.L'EID',,DUE' NOW
�i�±%s,�T.1^'.tl
C17Y OF ; i2CIiP1TA
DEPT. -
RECEIPT
DATE
BY
DATE FI LED
'
INSP TOR
zvvzo.may
o
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
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
�O
Final
4
Final 44M 31;POOLS
BLOCKWALL APPROVALS
steel
- SPAS
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
Q SJ,
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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
Final
Utility ,Notice (Perm)
COMMENTS:
;
-
-
9q,
`
A
X
Bin #
City of La Quinta
Building ex Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
C
Project Addrcss:71557- &LV—k:z-Z
Owner's Name:
A. P. Number:
gAddress:
Legal Description:
Contractor
OrCity. ST, Zip:
11Tclephon .749
Address: jlk;tz�
XProject Description:
r ;,i
City, ST, Zip:
7/-, '7'�- ,0 z
Telephone:
State Lic. #
City Lic. #:
Arch., Engr., Designer.
Address:
'City, ST, Zip:
Telephone:
7
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
I # Stories:
# Units:
Telephone # of Contact Person: (-VO) /5�/
rEsti..ted Value of Project:
APPLICANT: DOAOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
21
Plan Sets
Plan Check submitted
Amount
Structural C21CS.
Reviewed, ready for corrections
F712jIvItem
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan
Plan Check Balance
Energy Calcs OA/
Plans picked up
Construction
Flood plain plan
Plans resubmittedMechanical
plan
2" Review, ready for correction sue
�-sGrading
r TElectrical
Subcont2ctor List
Called Contact Peon
rs
Plumbing
Grant Deed
P12US picked up a
SAI.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, readv for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
7 > RIA.V 4C -A- A
Total Permit Fees
. I --- — r. I " %--,w s, 0/ /1 6/c,- fety Jim& J,1zelis
61q C D alep
o�
IF
T 'Q
it�t 4 4 "
To: Greg Butler, Building & Safety Manager To CDD: 7-22-2003
From: Oscar Orci, Planning Manager Due date: 7-29-2003
Status: 1ST 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: Tenant Improvement -Nextel
Address or general location: 79-405 Hwy 111 Suite 7
Applicant Contact: JakeWebster310-328-6300 ext 114
The Community Development Department finds that:
1❑ ... ...these Building Plans do not require Community Development
Department approval.
these Building Plans are Approved by the Community D velopment
Department.
❑ ...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. _ • .
21
car Sbrci, Planning Manager Date
r e
ARCHITECTURAL DESIGN BULLETIN NO. 001 (ADB -001)
The following is issued as supplemental instruction to the construction documents. It shall
immediately be implemented on ALL Destination, In -Line and Kiosk locations currently in either
the bidding, permitting or construction phase, if previous condition is not already implemented
the day of this issuance. No change in Contract Sum or Time is assumed. If change in
Contract Sum or Time is warranted, contractor shall immediately issue a Change Order Request
in writing to the assigned Nextel Project Manager.
Description:
Item #1 All rear doors with hardware "E" shall have a door sweep installed if necessary. Type to be
field determined.
Item #2 The four plex outlet under the phone board in the workroom shall be installed at 42" A.F.F.
Item #3 There should be an 18"x18" access panel installed in the gyp. board ceiling at the entrance of
all In -Line stores. It shall only be installed at destination stores if sign is below roof line. If
signage junction box is above the roof line then access panel is not required. The location
shall be determined by the Rolling grille requirements and/or the requirements of the signage
contractor for electrical connections for the signage.
Item #4 . The workroom, toilet rooms and mop room shall have 2x4x5/8" Armstrong Ceiling #1729A
white fine fissured square lay -in for interface with prelude XL 15/16" exposed tee grid white
track. All exposed cut edges shall be painted white to match the ceiling tiles.
Item #5 All shelving hardware for the desk in the workroom will be white epoxy finish. The desk
millwork and the shelving and hardware will be supplied by Nextel through the millwork
contractor and installed by the contractor.
Item #6 The shelving and shelving hardware in the toilet room shall be supplied and installed by the
contractor. The shelving hardware for the toilet room should be white epoxy finish.
Item #7 The track light fixtures which indicate four fixtures shall have two flood lamps installed in the
two outside fixtures and shall be directed at the wall graphics. The two inside fixtures shall
have spot lamps and should be directed at the table displays. The track light fixtures which are
indicated as having only two light fixtures shall have flood lamps installed and should be
directed at the wall graphics.
Item #8 The alarm and security system should be coordinated with the requirements of the landlord.
Item #9 All lighting products will be supplied by Nextel through Valley lighting to the site. Installation will
be by the contractor.
Item #10 If the junction box for the signage on destination sites will be required to be installed above the
roof, the roof penetration will be the responsibility of the contractor. The roof work should be
coordinated with the landlord and done by an approved roofing contractor.
Item #11
Tom Tisdale
Fire Chief
Proudly serving the
Unincorporated
Areas of Riverside
County and the
Cities of: }
Banning ,
Beaumont
Calimesa
Canyon Lake
.y
Coachella
Desert Hot Springs
4.
Indian Wells
40-
Indio
oIndio
Lake Elsinore
La Quinta
Moreno Valley
00
Palm Desert
Perris
Rancho Mirage
4 -
San Jacinto.
•r
Temecula
Board of Supervisors
Bob Buster,
District 1
John Tavaglione,
District 2
Jim Venable,
District 3
Roy Wilson,
. District 4
Marion Ashley,
District 5
RIVERSIDE COUNTY FIRE DEPARTMENT '
In cooperation with the
California Department of Forestry and Fire Protection
210 West San Jacinto venue • Perris, California 92570 • (909)940-6900 • Fax (909) 940-6910
December 23, 2003
City of La Quinta
Building Department
Re: Fire and Life Safety Clearance
The Riverside County Fire Department is granting a fire and life safety clearance
for the following project located at 7905 Hwy�11=1-Ste #_�7LasQuinta `
Please call if you should have and Questions.
" Respectfully
FRANK KAWASAKI
Chief Fire Department
By
Terry DeSo y
Fire Safety Inspector
EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE'
82-675 Highway 111, 2"O FI., Indio, CA 92201 . (760) 863-8886 • Fax (760) 863-7072
w. :7
r f
j a RIVERSIDE COUNTY FIRE DEPARTMENT
IN COOPERATION WITH
CALIFORNIA DEPARTMENT OF FORESTRY
AND FIRE PROTECTION
RIVERSIDE OFFICE INDIO OFFICE
4080 LEMON STREET, 2ND FLOOR 82-675 HIGHWAY 111
P.O. BOX 1549 2ND FLOOR
RIVERSIDE, CA 92502-1549 INDIO, CA 92201
(909) 955-4777 (760) 863-8886
FAX (909) 955-4886 FAX (760) 863-7072
JOB CARD
THIS INSPECTION RECORD MUST..BE AT JOB SITE
WITH THE APPROVED SET OF
PLANS
Own Date lallvL
Location_.i
Inspector
Case No. _4M -03 -Ti -o55 -
os
Sprinkler Company doari s
Dat
Inspector
Ail
Underground Visual Date
Inspector
(Joints and Thrust Blocks Must Be Exposed)
Inspector
Underground Static Date
Inspector
(200 PSI For 2 Hrs. Prior to Inspection Time)
Date
Underground Flush Date
Fire Alarm Installer
�51 ector
"�6(4
Final
Over ea 9>t Date
Inspector
( e)
Overhead Final Date •
Inspector
Fire Main Installer
Underground Visual
Date
Inspector
(Joints and Thrust Blocks Must Be E
os
Underground Static
Dat
Inspector
(200 PSI For 2 Hrs. Prior to Inspection Tim
Underground Flush
Date
Inspector
Extinguishing System Installer
. Final
Date
Inspector
Fire Alarm Installer
j
Final
Date
I
Inspector {
Tank Installer
I
Final
FUEL MODIFICATION
Final
Date Inspector
Date Inspector
DO NOTOCC Y THIS STRUCTURE UNTIL
AFTER INAL INSPECTION BY
BUILDING AND SAFETY
264.159 (Rev 11/02)
0
Go T, ments:
Date Intls.
Date Intls.
Date Intls.
Date Intls.
Date Intls.
Proudly serving the
unincorporated
areas of Riverside
County and the
Cities of-
Banning
f
Banning
Beaumont
Calimesa
Canyon Lake
Coachella
Desert Hot Springs
Indian Wells
Indio
Lake Elsinore
4.
La Quints
d•
Moreno Valley
A.
Palm Desert
V
Perris
Rancho Mirage
San Jacinto
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
210 West San Jacinto Avenue • Perris, California 92570 . (951) 940-6900 . Fax (951) 940-6910
Date is A /
City of La Quinta
Building Department
The Riverside.ount _ Fire Department is ting the Fire clearance for the following
location
Please call if kou should have questions 760-863-8886
Respectfully
By
D
Terry DeSouc
Fire Systems spector
Certificate'of Occupancy
T4&f 4 4a�rw
Building & Safety Department
i 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 buildin
g
construction and/or use.
BUILDING ADDRESS: 79-405 Highway 111 Suite #7
Use classification: Commercial (Nextel TO Building Permit No.: 0308-125
Occupancy Group: M Type of Construction: VN Sprinkled Land Use Zone: CR
Owner of Building: Stamko Development Co. Address: 3856 Via Dolce
City, ST, ZIP: Marina Del Rev. CA 90292
f.� By: Daniel P. Crawford Jr.
Date: 12/23/03
Building Official
POST IN A CONSPICUOUS PLACE