0309-164 (RC)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 ! 1 Exp. Date
4616572 BTil;—, � � 12/31/2£
{ Signature of-CoRtreeter r. f
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
�"r I hereby affirm under penalty of perjury one of the following declarations:
p ( ) I have and will maintain a certificate of consent to self -insure for workers'
Y= compensation, as provided for by Section 3700 of the Labor Code, for the
J performance of the work for which this permit is issued.
Q
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
Zpermit is issued. My workers' compensation insurance carrier & policy no. are:
� Carrier STATE COMk'BAISATI Policy No. . 0083740-2403
d `.
J
(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.
Date: 1- Ap 1p Ip "sht ..
-11 -,
./ Warning: Failure to secure Workers'Co pensation,.coverage is unlawful and
shall subject an employer to criminal penalties an'd 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
I 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 t.
any permit issued as a result of this applicaton agrees to, & shall, indemni D
o & hold harmless the City of La Quinta, its officers, agents and employee
2. Any permit issued as a result of this application becomes null and void
work is not commenced within 180 days from date of issuance of su
e permit, or cessation of work for 180 days will subject permit to cancellatio .
I certify that I have read this application and state that the above information i
correct. I agree to comply with all City, anti State laws relating to the buildin
construction, and hereby authorize representatives of this City to' enter upc
the above-mentioned property for inspection purposes.
'(Signature (Owner/Agent) Date L2
'`.
PERMIT #
-- - BUILDING -PERMIT
t '
03019,-164DATE
i vALUATION LOT TRACT
01
JOB SITEl
ADDRESS '9-40 MdHWAY 1.11 5MVE. #16
APN
,
OWNER
CONTRACTOR/DESIGNER/EN (NEER
7131~:i3G MI, RS)
'cdWAT.)FL I^ EY CA 90292
P +.T. SPRINGS CA 92264
(760)3273974 CM4 TBD ;
USE OF PERMIT
COA04UZCIALREMODEL
CCIQ�MF.J CIAL tEMODE.I.;(SAM Lf I SAM'S To 'a" OCCUP. N;lJ , f VPty, 14
SPRINKLED. OCCUPANT LOAD 46 r
V Al U.0,, 3".I OH 24U,iliru, 0;7 Ls
.i1,917.lb'..£VVlV COW OF C0HS13<1'9C°nom
PFTWT FEZ g'iJ'bMARY !d
PLAN CHECK PH1, 101;U�(5�39«31�
GO�d3'i'I i3C'i Ia" l N" I; 101-f�bQ X413'-t1C�C9
MECHANICAL FER 101 -000 -421 -WO ' �3:�►,i��
ELECTRICAL Flli 10) --000-420-4003 j. *0.'D.00
PLLIMBI140 FEE „ 101 -000419 -WO
S'I'ROW MOTION VES - COMM 1,00-0,00-241-000 142.00
4 3,
ST ,-TEi'1" :i 1(::1TC�R AA3'1� PLAIT T -JE TZ
$1,899€x.18
.I.Xa��p�'r PREr.PAID ,M, Z
T10100
rrr 10 2003 ,
CITY OF LA C UINTA
FINANCE DEPT . j
RECEIPT'
DATE
BY.-, �r
DA IN D
INSPE OR
INSPECTION RECORD
OPERATION j
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 p/V
/
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
Final
Final
a
POOLS-- SPAS
BLOCKWALL
APPROVAL6
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 Test
Electric Final
Waste Lines
/ D
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
3 D
Final
COMMENTS:/ -sell -
tip�'t7 d
%hz 0'6�t��
-
Final
'Utility
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
r
Final D
4tility Notice (Perm)
19
A
X
Bm,City of La Quinta
Building aL Safety Division atm
P.O. Box 1504, 78-495 Call mpico
Permit La Quinta, CA 92253 - Q ) 777-7012
030i- ��I Building Permit ' avon an cking et
Project Address: Owner -s Name:/J
A��'e .Number Address: S S 3gs6 (Apt
l.eeal Description: City. ST. Zip:
Contractor. ; FTelephone: 2
Address: pro 3 0-woL/' 4/
City. ST. Zip:
' C
J
Telephone:
lCiry
State Lic. #:
Lic. #:
Arch.. Engr., Designer.
Address:
City. ST. Zip:
Telephone:
State Lic. #:
'f • ; _ ,. _�: ': , =
;,,... •-;:..•�.:: •
Construction Type: Occupancy:
Project type (circle one)• New Add'n Alter Repair
Dano
Name of Contact Person:
V 2--7i0-�
q. Ft.:
kstimated
# Stories:
N Units:
Telephone # of Contact Person:
Value of Project• 2
q APPLICANT: DO NOT WRITE BELOW THIS LINE "
M
Submittal
Req'd
Rec'd
TRACKMG
PERMIT FEES
Sets
I�
2. Wa
Plan Check submitted
�yPlan
Item
Amount
Structural Cala.
Reviewed. ready for corrections -
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance •
Energy Calcs
Plans picked up / -- 7
to - .Ztt
9
Construction *011
Flood plain plan
Plans resubmitted
r)*�
�9 i73
Mechanical �'a •
2a
%"19'D
Grading plan
2" Review. ready for correction�(issue,
Electrical 0.or�meo •
7.
Subcontactor List
Called Contact Person
Plumbing •
13'f ,gp
Grant Deed
Plans picked up
S.t►1.1. (; , •
¢2, o a
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Review. ready for correctionslssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. APpr
Date of permit issue
r Q
School Fees
D LTti
a
OVM_./i � Nro co,✓r"%Ln. Bl7f LiT
Total Permit Fees
25
Val >44,e -,t
�j 3 �/�� SQA' �Le,T'•��/cel —
-�' L/U 6C44'r- 7/5
'Doc ('0
#-
�D�7L
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) 777-7$1A
f
To CDD: 8-29-2003
Building Plans Approval
(This is an approval to issue a Building Permit)
Due date: 9-8-2003
Status: 1ST Review
The Community Development Department has reviewed the Building Plans for the
following project:
Description: Restaurant — Samurai Sam's (TI)
Address or general location: 79-405 Highway 111, Ste. 10
Applicant Contact: Sam Wang 702-228-6890
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.., i
d
� It
❑ ...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.
Os Orci, Planning Manager Da e
Imo.. d
Tom Tlsdale
Fire Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
Cities of:
Banning
.,
Beaumont
0
Calimesa
4*
Canyon bake
.g
Coachella
0
Desert Hot Springs
w
Indian Wells
Indio
•1
Lake Elsinore
4.
La Qumta
0
Moreno Valley
Palm Desert
•3
Perris
.,
Rancho Mirage
0
San Jacinto
.;.
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
82-675 Highway 111, 2nd FI., Indio, CA 92201 . (760) 863-8886 . Fax (760) 863-7072
September 8, 2003
David A. Udkow, Architect
9750 North 96th Street; Ste. 219 �
Scottsdale, AZ 8525.8
Re: Non -Structural Building TA Plan Review
LAQ-03-TI-064 /Samurai Sam's
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) 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
Job card must be at the job site for all inspections.
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
'Knox Box. If the building/facility is protected with a fire alarm system or burglar alarm system, the
lock boxes will require "tamper" monitoring.
3) Install portable fire extinguishers per Title 19,. but not less than 2A10BC in rating. Contact certified
extinguisher company for proper placement of equipment.
4) Install a Hood/Duct automatic fire extinguishing system.. System plans must be submitted, along
with a plan checkrnspection fee, to the Fire Department for review.
5) 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.
6) Room capacity shall be posted in a conspicuous place on an approved sign near the main exit from
the room.
Please contact the Fire Department Planning & Engineering staff for final inspection prior to occupancy.
All.questions regarding the meaning of these conditions should be referred to the Fire Department
Planning & Engineering staff at (760) 863-8886.
K%PEZWP Doaw Qmia%PR0JecrsrnLA(W3.T oee.doo
Sincerely,
FRANK KAWASAKI
Chief Fire Department Planner
By �F
Walter Brandes
Fire Safety Specialist
EMERGENCY SERVICES DIVISION • PLANNING SECTION . INDIO OFFICE
82-675 Highway 111, 2nd FI., Indio, CA 92201 • (760)'863-8888 • Fax (760) 863-7072
A FAI
COUNTY OF RIVERSIDE COMMUNITY HEALTH AGENCY AssessoR'S PARCEL NUMBER
DEPARTMENT OF ENVIRONMENTAL HEALTH — —
APPLICATION FOR WASTE WATER DISPOSAL APPROVAL
APPLICANT: Submit, this form with four copies of a SCALED plot plan (1"=20' to 1"=40' SCALE) drawn to County specifications as indicated on the attached
check list. A non-refundable filing fee is required when the application is submitted. Check must be made payable to the County of Riverside. Approval of this
application shall remain valid for a period not to exceed one year from date of payment.
LMS #
Agent, Contractor, Contact Person
. I �! "" t �1 V ► 01",a
Address City State Zip
"°`� I Y2c • R1 i VVI
Telephone
�-; z�
Owner
Address*,; City State + "� Zip
Telephone
OJob
Property 'Address
0 1/1A�� O -� - L, .0 1:4_1 h
City
Zip
Lot Size
Water Agency/Well
Use of Permit P/P SUP, PUP, etc.
G
Legal Description
DBA
cn
�j j
veU5t +��c�►t.�.�"��u
dl�� I Jr��j
v+� vo,
Dwelling, MH Site Prep., e c.
t,, t�
j
LA Qtill iJ 41.1
Signature of Applicant
Date
FOR OFFICE
USE ONLY
CHECK BOX IF REQUIRED
If any box is checked, `this application shall be considered rejected until the
information is lKe
❑ Detailed Contour Plot Plans Required (1 to 5 foot interval)
provided arL Jee paid. Resubmittals later than 90 days
after date noted below mayrequire repayment of fees.
❑ Other x.
Z❑
Holding Tank Agreements Completed
C]Staff Specialist Lot Inspection Required
0
❑ Certification of Existing S.D. System Required
Thomas Bros. Page Grid
W
❑ WQCB Clearance Required
❑ Date Lot Inspection Completed: Initials
(Attach for DOH -SAN -007, Santa Ana Region Only)
Remarks:
❑ Soils Percolation Report Required
❑ Maintenance Booklet Provided
❑ Special Feasibility Boring Report Required
❑ Final Inspection by Department of Environmental Health is required.
❑ Rereview Required Initials ; Date
Please call 24 hours PRIOR to inspection.
C/42 / Soils Percolation Boring Report By " Lic/Project # Date
Soils Map Page Soil Type Approved By Date
No. of Systems
Type of System(s)
No. Dwelling Units
(1) Septic Tank
Soil Rate
Grease/Sand
❑ Holding Tank ❑ Replacement
Bedrooms, Fixture Units
Grease Intcp int Trap
New ❑ Addition
❑ Existing ❑ Connect to Sewer
Gal.
/DD 0 Gal.
Sq. Ft.
Total Linear
Sidewall Allowance
Leach Bed sq. ft.
Bottom Area
Ft.
ft. rock/ sq. ft. running ft.
Install Lines) ft. long ft. wide
of Bottom Area
Inlet Tested Depth ❑ N/A
with min, inches rock below drainlines
U
Proposed Bottom Tested Depth
or
Z
0
Leach lines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below Inlet (61)
Seepage Pit
Maximum
Other:
Applicable:
Total Depth
Allowable
W'
N/A Overburden Factor
C35' El 6'
TD
Depth
U
Well Review Approved: Date: Well Drilling Permit#
SIGNATURE
Pqv ,yak
Grading Plan Approved: Date: ,I ww�A�'�
SIGNATURE 1000
Plan Check Only Approved: Date:
f� (� `
REMARKS: A LL r?'��' &sx (&r �,�1/ i h 4i ~4 �L 4 U1K'. t I i
i ^-& v 1
cLo%s +Iat c A&M dt_
This application s APPROVED/DENIED for :the category checked in
SECTION B aboveNrega dngsthe design of a disposal system as indicated
on the accompanied plot plan, using the requirements set forth in SECTION
C above. A building permit is necessary for the installation the
p�
of above-
Revenue Code Fee $ ilS
designed system. No construction is permitted in the reauired reserved
-.111.
100%'expansion area.
!
Check l� 2.1-6
(1) Septic Tank must be 100' minimum from any wells.
#
Z(2)
Leach lines must be 100' minimum from any wells, including expansion
�~
Date 6 1 1 13 1 0:3
Initial
:O
area.
"O
(3) Sewer -lines must be 50' minimum from any wells.
W
U)
(4) Seepage pits must be 150' minimum from any wells, including expansion
RIVERSIDE: 909-955-8980
r
area.
l•�
INDIO: 760-863-7000
SOUTHWEST: 909-600-6180
,
Signature i,
t O
Date
n r W.gAAI_t99
_..._. -
vISLF—Lwr-
1 i. vvrn i vmce HE; YELLOW—Hppi cant; PINK—Bldg. Dept.; GOLDENROD—Plans/Records
A ea.#' iv COUNTY OF RIVERSIDE COMMUNITY HEALTH AGENCY
DEPARTMENT OF ENVIRONMENTAL HEALTH
PLAN CORRECTION
Plan Check # NO3-081 Date 11/10/03
DBA Samurai Sam's Address 79-405 Hwy 111 Ste. 110, La Quinta
Plans Submitted by Tom Wang Phone (702)228-6890
Owner Address Phone
1
The plans are now approved subject to the. conditions listed below and the attached compliance sheet.
1. The minimum acceptable water heater heating capacity is 12kW based upon the number of sinks and their
projected usage. The 50 gallon storage capacity is appropriate. (See redline sheet P2)
2. Splash guards must be installed at the hand, utensil and prep sinks, where they are located next to storage
racks or tables. Hand sinks require 12" splash guards and all others require 18". (See redlines pages EQ and
P2).
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. 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. Behind all three sinks in the splash zone the finish must be water proof to a height of
8' (e.g. FRP/tile)
5. 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.
6. All exterior and restroom doors must be self closing. Exterior doors must also be sealed against entry by
vermin. Service windows such as.drive through windows must likewise be self closing and if greater than 216
square inches have dedicated air curtains. The delivery door air curtain must deliver air at a velocity of 1600
fps at a height of 3' above the floor.
7. All equipment must meet NSF or equivalent standards.
8. The number of lockers provided shall be equal, or greater than the number of workers assigned to a peak
shift ,
9. An air balance report will be required prior to completion of the final inspection
10. 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:
Signature
Company
Date
4
e
' COUNTY OF RIVERSIDE COMMUNITY HEALTH AGENCI
DEPARTMENT OF ENVIRONMENTAL.HEALTH
ENVIRONMENTAL .HEALTH SERVICES
DATE
SUPPLEMENTAL REPORT TO SAN. FORM # `
r PERMIT NO. !/?%
SUBJECT J " I ..'. ° . kr..i r'L•� .
ADDRESS
INSPECTOR • DLe
l :'r i — I �-
REMARKS:
dz
c i'. sz �; Lc �' r D (72")
S1 d.P_e ', tJ('72.D
•l
-01 F C
'�,- D -1-+- 4lSAi„-7Q2 ,
kvos
i
i
Distribution: WHITE—Office;, CANARY—Owner; PINK -Office
i5-4777 (760) 863-88811
Q) 955-4886. FAX (760) 863-7072
JOB CARD
FHIS.INSPECTION RECORD MUST BE AT JOB SITE
WITH THE APPROVED SET OF PLANS
wILlTCl1. Sow, S Date z z!o
on �Q-�►oS .�. CJI S SID
No. LAQ-03-7T-o6�
;ler Company
Underground Visual
and Thrust Blocks Must Be
Underground Static
'SI For2 Hrs. Prior to Inspection
Underground Flush
Overhead Static
'SI For 2 Hrs. Prior to 1r
Overhead Final
lain Installer
Inspector
Inspector
nspector
Inspector
Time)
Date Inspector
Underground Visual Date
3 and Thrust Blocksust Be Exposed)4
.
Underground Static Date
'SI For 2 His. Prior to Ins ction Time)
Inspector
Inspector
Underground Flush r Date Inspector
]wishing System InstallerA1114 14rt C �„au3sher
1044
Final Uati 1nspector
klarm Installer
.Final .
Installer
Final
_ MODIFICATION
Final
Date
Date
Inspector
RIVERSIDE COUNTY FIRE DEPARTMENT
IN COOPERATION WITH
CALIFORNIA DEPARTMENT• OF FORESTRY
Amn FIRE PPnTPrT1nK1
C UNTYgF -
R/VE; SrDL�
4080 LEMON STREET, 2ND FLOOR i
P.O. BOX 1549
RIVERSIDE, CA 92502-1549
(909) 955-4777 FAX (909) 955-4886
JOB CARD
THIS INSPECTION RECORD MUST BE AT JOB SITE
WITH THE APPROVED SET OF PLANS
Owner ��„,u,�;"s Date AgLI
Location '?9415
Case No. Mj�,i
Sprinkler Company
/ P,4 ri,
Undergrou d Visual
Date
Inspector
(Joints and Thrust Blocks Must Be Exposed)
Undergro��Static
Date
Inspector
(200 PSI For 2 Hrs. Prior
to Inspection Time)
--
AIM
-
Underground Flush
Date
Inspector
y
verhead
,,� Date
Inspector
Date
Overhead Final
i
Inspector
Inspector I
.i
Inspector,,
Fire Main Installer C .
Underground Visual Date Inspector
(Joints and Thrust Blocks Must Be xposed)
Underground Static
(200 PSI For 2 Hrs. Prior to Inspection
Underground .Flush
Inspector
Inspector
-CITY J,� QUINTA,-OFi�
MARUItIJlNi. & SA�E'TY DEPARTMENT
CF'yOF �1 .Z77-%012
` �•- _io £;I(N.SPE`gTION REQUEST LINE
STAMKO DEVELOPMENT CO
Owner
Contractor JERRIS CONSTRUCTION
Permit Number 0309-164
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
79-405 HIGHWAY 111 SUITE #10
JOB ADDRESS
COMMERCIAL REMODEL (SAMURAI SAM'S TI)
"B" OCCUPANCY, TYPE YN SPRINKLED,
OCCUPANT LOAD b/REPLACEME
TYPE OF INSPECTION---DArTE-- INSP.
TEMPORARY POWER
SETBACKS /
U/G PLUMBING / WASTE D
U/G ELECTRICAL/ GROUNDING I
FOOTINGS / STEEL
CONCRETE SLAB I
DO NOT POUR CONCRETE UNTIL ABOVE SIGNED
ROOF NAIL / PRE -ROOF
OKAY TO WRAP
FRAMING COMBINATION ;
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH MECHANICAL
COVER NO ORK UNTIL BOYE SIGNED
INTERIOR GYP. BD. DRYWALL /
EXTERIOR LATH
GAS TEST
SEPTIC ABANDONMENT.
SEWER CON ECT-1QN::
SEPTIC / (3MEASE INTERCEPTOR, 1/ :1/+4:/
MASONRY INSPECTIONS
FOOTINGS / STEEL
BOND BEAM
POOL / SPA / WATER FEATURE INSPECTIONS
PRE-GUNITE / SETBACKS
U/G PLUMBING
U/G GAS
U/G ELECTRICAL
PRE -PLASTER (ALARMS/ BARRIERS
FINAL INSPECTIONS
TEMP. USE OF PERMANENT POWER V
ELECTRICAL
PLUMBING
MECHANICAL
PUBLIC WORKS DEPARTMENT
COMMUNITY DEVELOPMENT DEPT.
FINAL / JOB COMPLETED / 0 /
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
i
APR -14-04 WED 4:45 PM R'IV, CO,- FIRE P&E INDIO FAX VO, 1 760 863 7072 P, 1
RIVERSIDE COUNTY FIRE DEPARTMENT
In cooperation with the
California Department ofForesiry and Fire Protection
D 0 West San Jacinto Avenue • vert s, California 9251'0 • 909 • Fax ( )940-6910
Tom Tisdale
Fire Chief
Proudly serving the
Uni ncorporaUxl
Areas of Riverside
County raid die
Cities of.,
Banning
Beaumont
Calimcsa
Canyon Lake
Coachella
4
Desert I•lot Springs
0
Indian Wells
Indio
Lake Elsinore
o.
La Quinta
4
Moreno Valley
Palm Desert
E'
Perris
•3
Rancho Mirage
4
San Jactlrto
Temecula
Roard ul'Supervisors
- I;ob 1laster,
District l
John Tavaglionc,
Dista ict 2
Jinn Venable,
f );strict 3
Roy wibon.
Nstfid 4
Aiarion Ashley.
District 5
April 14, 2004
City Of La Quinta
Building Department
Re: Fire and Life Safety Clearance
Samurai Sams
The Riverside County Fire Department is granting a fire and life safety clearance for the
Following address located at 79-405 hwy 111 STE #10, La Quinta. Please call if you
should have any questions.
TDrI
FRANK KAWASAKI
Chief Fire Department Planner
By
Terry DeScy
Fire Systems Inspector
EMERGENCY SERVICES DIVISION • PL" NTNG SECTION • INDIO OFFICE
82-675 Highway 111, Zan FI., Indio, CA 92201 . (760) 863.8886 . Fax (760) 863-7072
Certificate of Occupancy
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,#10
Use classification: Commercial Restaurant (Samurai Sam's) Building Permit No.: 0309-164
Occupancy Group: B Type of Construction: VN Sprinkled Land Use Zone: CR
Owner of Building: Stamko Development Co. Address: 3856 Via Dolce
I City, ST, ZIP: Marina Del Rev. CA 90292
LI By: Daniel P. Crawford Jr.
Date: 4/14/04
Building Official.
I POST IN A CONSPICUOUS PLACE
•