12-0058 (AC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: / 12-00000058.
Property Address:
78073 CALLE BARCELONA
APN:
770-182-002-9999-0000OD-
Application description:
ADDITION - COMMERCIAL
Property Zoning:
VILLAGE COMMERCIAL
Application valuation:
27007
Applicant:
Td4t 4 4 Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
.BUILDING PERMIT
Owner:
DESPRAS MICHEL
Contractor:
FINISHLINE
PO BOX 391125
ANZA, CA 92539
VOICE (760)
FAX (760) 0
INSPECTIONS (760) 77 -
Date: 11/05/12
°FNOV 05 2012 ID
/
PIPFINANCE
.. (951)972-9962 1 I
Lic. No.: 860897 CITY OF LA QUINTA
.
DEPT.------------------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: 13-C6 License No.: 860897
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
•
issued.
t Nate: �eontractor:
_ 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
• OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier EXEMPT Policy Number EXEMPT
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor Code, I shall forthwith comply ', ose provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
�1 ^ , ,( .• r
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
✓✓ v pl
ate: �O` �+pplicant: / V l./t/ \ ,
( I 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
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.).
I—) I am exempt under Sec. B.&P.C. for this reason
Date her
CONSTRUCTION LENDING AGENCY
I 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: \1 IL!
LQPERMIT
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, indemnity 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 a plication and state that the above information is correct. I agree to comply with all
city and county ordinances d state laws relating to building construction, and hereby aut 'ze representatives
of th�isco my o enter u n the above-mentioned property for inspection'pur,p/oses.
DatC7fr ignature (Applicant or Agent): V v
Application Number . . . . . 12-00000058
------ Structure Information 372SF WALKIN COOLER ADDITION
[CONY]
-----
Construction Type . .
. . . TYPE V, UNPROTECTED
Occupancy Type . .
. . . ASSEMBLY BLDG <1000
Other struct info . .
. . . CODE EDITION
2010
FIRE SPRINKLERS
NO
MIXED-USE OCCUPANCY
NA
OCCUPANT LOAD
12.00
----------------------------------------------------------------------------
1ST FLOOR SQUARE FOOTAGE
372.00
Permit . . . BUILDING PERMIT - ADA INV FEE
Additional desc .
Permit Fee . . . .
543.00 Plan Check Fee
176.48
Issue Date . . . .
Valuation . .
. .
27007
Expiration Date . .
5/04/13
Qty Unit Charge
Per
Extension
BASE FEE
504.00
3.00 13.0000
----------------------------------------------------------------------------
THOU BLDG 25,001-50,000
39.00
Permit MECHANICAL
Additional desc . .
Permit Fee . . . .
24.00 Plan Check Fee
6.00
Issue Date . . .
Valuation . .
. .
0
,Expiration Date
5/04/13
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 9.0000
--------------------=-------------------------------------------------------
EA MECH APPL REP/ALT/ADD
9.00
Permit
ELECT - ADD/ALT/REM
Additional desc .
Permit Fee . . . .
22.44 Plan Check Fee
5.61
Issue Date
Valuation . .
. .
0
Expiration Date
5/04/13
Qty Unit Charge
Per
Extension
BASE FEE
15.00
372.00 .0200
--------------------------------------
ELEC GARAGE OR NON-RESIDENTIAL
a
7.44
PLUMBING
Additional desc .
Permit Fee . . . .
24.00 Plan Check Fee
6.00
Issue Date . . . .
Valuation . .
. .
0
LQPERMIT
_
Application Number . . . . . 12-00000058
Permit . . . . . PLUMBING
Expiration Date . . 5/04/13
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 6.0000 EA PLB FIXTURE 6.00
1.00 3.0000 EA PLB FIXTURE DRAIN/VENT REP/ALT 3.00
----------------------------------------------------------------------------
Permit . . . GRADING PERMIT
Additional desc .
Permit Fee .1 . . . 15.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 5/04/13
Qty Unit Charge Per Extension
BASE FEE 15.00
----------------------------------------------------------------------------
Special Notes,and Comments
372SF WALK-IN COOLER ADDITION AT
EXISTING RESTAURANT KITCHEN
(CONVENTIONAL] THIS PERMIT DOES NOT
INCLUDE REMODEL TO EXISTING KITCHEN.
***INVESTIGATION FEE ASSESSED PER 2010
CALIFORNIA BUILDING CODE CHAPTER 1
§109.4 FOR WORK COMMENCING BEFORE PERMIT
ISSUANCE***
2010 CALIFORNIA BUILDING CODES.
October 10, 2012 1:13:15 PM AORTEGA
-------------------7--------------------------------------------------------
Other Fees . . . . . . ACCESSIBILITY PLAN REVIEW 17.65
BLDG STDS ADMIN (SB1473) 2.00
STRONG MOTION (SMI) - COM 5.67•
Fee summary Charged Paid Credited Due
Permit Fee Total 628.44 .00 .00 628.44
Plan Check Total 194.09 .00 .00 194.09
Other Fee Total 25.•32 .00 .00 25.32
Grand Total 847.85 .00 .00 847.85
LQPERN11T
t
J
Bin.# t1q
8
City. of La QWho
Building a Safety Division
P.O. Box 1504;78-495 Calle Tampico
la.Quinta, CA 92253 - (760) 777-7012 '
Building Permit Applicatlon and Tracking Sheet
Permit #
Project Address: 78073 CALLE BARCELONA.
Owner's Name:. MICHEL DESPRAS
A.P.Number. .770-182-002-3
Address: 78073 CALLE BARCELONA
) T9 1 5 �L % -JA � TA CLUB TRACT- # 1
Legal Description:
�, p LA QUINTA GA 9 2 2 5 3
Ci ST Zi : r
Contractor TBD760- s�:
telephone: r
Address:
Project Description: CONSTRUCT A SHELL
City, ST, Zip:
STRUCTURE TO HOUSE A NEW COOLER
Telephone:`
FOR AN EXISTING RESTAURANT.
State Lic.#:
Lie. #--
THIS NEW STRUCTURE WILL ATTACH TO
Arch, Engr., Designer. MICHAEL
SWARTZ
THE EXTERIOR` REAR WALL OF THE
Address: 81730 HIGHWAY
111 STE. 4
RESTAURANT KITCHEN.
City.,ST,Zip: INDIO, CA 92201
Telephone: 7 6 0— 4 85— 9 2 9 9Construction
'�";�
Type V—N Occupancy A3
State Lie. #: C11682
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: STAN POLLAKUSKY
Sq. Ft„ 3 7 3 # Stories: 1
# Units: 1
Telephone # of Contact Person: 7 6 0— 3 3 3—
Estimated Value of ProjecC_$25, 000
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal Req'd
Recd
TRACMG PERMIT FEES'
Plan Sets
3
Plan Cheek submitted. �2Amount
Structural Calcs.
Reviewed, ready for corrections Plan?Check Deposit. .
Truss Calcs.
Called Contact Person Plan Check Balance
Title 24 Calcs.
Plans picked up Construction
Flood plain plan
Plans resubmitted.. Mechatilcal
Grading plan
2'! Review, ready for correction a Electrical
Subcontactor List
Called Contact Person:V/81 Plumbing
Grant Deed
Plans picked up S.M.I.
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
'"` Review; ready for correetionsfissue Developer Impact Fee
Planning Approval •
Called Contact Person P.
Pub. Wks. Appr -
Date of permit issue
School Fees
Total Permit Fees
cry rho - M +'c•►u.
14 Mbar c,
! 8 J%L{` 101- AAP. *yAff k+C0 .3&0 —f
Building
Address
Owner
Mailing
Address j
City 1 rr 7
Contractor
Address
City
»�
;7,:P- 7 P.O. BOX 1504 APPLICATION ONLY
n 78-105 CALLE ESTADO
LA QUINTA. CALIFORNIA 92253
�25S
Zip
r^_r
State Lic. City
& Classif. Lic. #
Arch., Engr.,
Designer i; aEu- e' "-It �--
Address 5,5 Tel Z3 ' 7-Z (G
City f f Zip _ State
1 i�3 �zli�o7 Lic. # c
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of ❑ivision 3 of the Business and Ptofesslons Code, and my license is in full force and
of fecr-
SIGNATURE _ DATE
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt Iron the COnIfaClOf s License Law for the loilowing
reason: (Sec. 7031.5,8usinms and Profes .ions Gale: Any city or county which rogwms a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that he 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 Trve hundred dollars ($500).
❑ I, as owner or 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, Bussness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds orrrnproves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. lf, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec—B. & P.C. for this reason —
Date Owner
WORKERS' COMPENSATION DECLARATION
hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800. Labor Code.)
Policy No. Company
r] Copy is filed with the city. Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify That in the performance of thr. work for which this permit is issued, I shall not
employ any ppeerrsson in any manner so as to become subject to the Workers' Compensation
Laws of CaliTOmia.
Date —Owner
NOTICE TO APPLICANT. ft, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or Ihfs parmif shad) be deemed rwmked,
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all elty and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above -
mentioned properly for inspec[lon purposes.
Signature of applicant. Date
Mailing Address
City, State, Zip
BUILDING: TYPE CONST. 17 t t= UKOCC. GRP. -�'
A.P. Number. -765, - sa- nus _ oo(;; •fi01
r
Legal Description 4r �. �� 3 1s02-r �{LJ
Project Description np� up
Sq. Ft. No.
Size 4�1 ] `$ Stories
No. Dw.
Units
New El Add,& Alter Elr Repair El�Demolition El1�4.,1a'
I lD f sE . tQt,1CI
S� 7JZ✓✓ '; I�
Estimated Valuation /
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Z.
Const.
m�Q
Mech.
Electrical
Q
Plumbing
7
S.M.I.
Grading
Driveway Enc.
Infrastructure
D
TOTAL
REMARKS
ZONE:
BY:
Minimum Setback
Distances:
Front Setback from Center line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date Permit
Validated by:
Validation:
BUILDING DIVISION
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL
FEES
NO.
PLUMBING
FEES
$
UNITS
1ST FL. SO. FT, Cii
YARD SPK iYSTFM
'
2ND FL SO. FT. Ca
MOBILEHOME SVC.
BAR SINK
4/1
POR, SO. FT. @
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT, Cap
DRAINAGE PIPING
CAR P. SQ. FT_ a
DRINKING FOUNTAIN
- WALL SO. FL 0
URINAL
SQ. FT.
WATER PIPING
ESTIMATED CONSTRUCTION VALUATION $
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
_
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
TEMP USE PERMIT SVC
WATER CLOSET
l
ABSORPTION SYSTEM B.T.U.
COMPRESSOR HP
-
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
S
SHOWER
BOILER B.T U
SQ. FT. ® c
BATH TUB
SO. FT. ® c
0
WATER HEATER
MAX. HEATER OUTPUT, B.T.U. �i .
��
SO. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
452
/
SQ,FT.GAR ® 3/4c
HOUSE SEWER
r-
t —
GAS PIPING
S
PERMIT FEE
T
PERMIT FEE
— —
PERMIT FEE
DBL TOTAL FEES MICRO FEE
MECH.FEE
PL.CK.FEE CONST. FEE
ELECT. FEE
SMI FEE
PLUMB. FEE
/y/ s o
1
-5-Cl
/ 73• GO
STRUCTURE
SETBACK
SLAB GRADE
FORMS
FOUND. REINF.
REINF. STEEL
GROUT
BOND BEAM
LUMBER GR.
FRAMING
ROOFING
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
PLUMBING
GROUND PLUMBING
ROUGH PLUMB.
SEWER OR SEPTIC TANK
GAS (ROUGH)
GAS (FINAL)
WATER HEATER
WATER SYSTEM
FINAL INSP
INSPECTOR'S
ELECTRICAL
UNDERGROUND
BONDING
ROUGH WIRING
METER LOOP
TEMP. POLE
SERVICE
HEATING & AIR COND.
A.C. UNIT
HEATING (ROUGH)
DUCT WORK
HEATING (FINAL)
FINAL INSP
GRADING
FINAL INSP. cu. yd.
$ piu• xS
REMARKS:
SOLAR
COLL. AREA
STORAGETANK
ROCKSTORAGE
OTHER APP.IEQUIP.
GARDEN WALL FINAL
Bin # ,.
.
City of La Quinta
Building8t Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Gjg
�� ✓
Project Address:
Owner's Name:
A. P. Number:
Address:
Legal Description:
City; ST, Zip-.
Contractor.
Telephone:
Address:
Project Description:
City, ST, Zip:
.
Telephone:
} vfi?'y�sc%)i.^N
c a::: >::. •.;.;:...r:
;:,.. .
State Lic. # : City Lie. M
Arch., Engr., Designer:�� A 0
Address: L ( 2
City, ST, Zip:
Telephone: 0 .,.. : .
."kN^h��� Cil!�:!�::f �: SIo:C%= W:y-.yy:��v:{k.f
State Lic. #: :. -e. -:<;><:°•>,>. -
Name of Contact P V
Construction ion Type: _�Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. FL: 9 ® # Stories:
# Units:
Telephone # of Contact Person: p I 1/01
Estimated Value of Project: d ®Q
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACKING PERMIT FEES
Plan Sets
3
Plan Check submitted I' I q it,. Amount
Structural Cafes.
Reviewed, ready for corrections `- Plan Check Deposit
Truss Cafes.
Caned Contact Person ~ Pian Check Balance
Title 24 Cates.
Plans picked up Construction
Flood plain plan
Plans resubmittedi% %Q i Mechanical
Grading plan
2"Review, ready f rrectiea ue Electrical
Subcontactor List
Called Contact Person Plumbing
Grant Deed
I Plans picked up S.M.I.
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
'`' Review, ready for corrections/issue Developer Impact Fee
Planning Approval
Called Contact Person A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
z '126 112-
PROUDLY SERVING THE
UNINCORPORATED AREAS
OF RIVERSIDE COUNTY
AND THE CITIES OF:
BANNING
BEAUMONT
CALIMESA
CANYON LAKE
COACHELLA
DESERT HOT SPRINGS
EASTVALE
INDIAN WELLS
INDIO
JURUPA VALLEY
LAKE ELSINORE
LA QUINTA
MENIFEE
MORENO VALLEY
PALM DESERT
PERRIS
RANCHO MIRAGE
RUBIDOUX CSD
SAN JACINTO
TEMECULA
WILDOMAR
BOARD OF
SUPERVISORS:
BOB BUSTER
DISTRICT 1
JOHN TAVAGLIONE
DISTRICT 2
JEFF STONE
DISTRICT 3
JOHN BENOIT
DISTRICT 4
MARION ASHLEY
DISTRICT 5
0 RN ,DE 9 ® te r
IN COOPERATION TH
THE CALIFORNIA DEPARTMENT OF FORESTRY AND FIRE PROTECTION
John R. Hawkins - Fire Chief
210 West San Jacinto Avenue — Perris, CA 92570
(951) 940-6900 — www.rvcfire.org
September 10, 2012
RE: TENANT IMPROVEMENT PLAN CHECK -Non Structural
LAQ- I 2 -BP -048 Lavender Bistro Cooler 78-073 Calle Barcelona La Quinta, CA
You have been issued a release for a tenant improvement on an existing building. THIS IS NOT
AN OCCUPANCY PERMIT.
An automatic fire sprinkler system is not required.
It is prohibited to use/process or store any materials in this occupancy that would classify it as an
"H" occupancy per Sec. 307 of the 2010 CBC.
All breakers must be, labeled and a clearance of 36 inches must be maintained around the panel
at all times.
Applicant/installer shall be responsible to contact the Fire Department to schedule a final
inspection. A re -inspection fee will be required if more than one (1) inspection is necessary.
Requests for inspections are to be made at least 72 hours in advance and may be arranged by
calling (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.
Fire
Specialist
COUNTY OF RIVERSIDE • COMMUNITY HEALTH AGENCY
DEPARTMENT OF ENVIRONMENTAL HEALTH
FOOD ESTABLISHMENT INSPECTION FORM
FACILITYDBA
r
RECORD ID AI EXP DATE
0U' D
PH NE ,
4 i6 d:713
DATE
/2 (o
ADDRESS CiTY ZI CODE
7901-5
NAitFr 6V OF PERSON IN CHARGE PE I��IOLD�R D
/1/ !
DISTRICT
3-3
P.E.I SERR18CE
REINSP. DATE
TINE IN i air
I
THE CONDITIONS LISTED BELOW CORRESPOND TO VIOLATIONS OF THE CALIFORNIA HEATH AND SAFETY CODE AND/ OR RIVERSIDE COUNTY ORDINANCES LISTED AND MUST BE CORRECTED
AS INDICATED BY THE ENFORCEMENT OFFICER. THE DEPARTMENT OF ENVIRONMENTAL HEALTH APPRECIATES YOUR COOPERATION. PUBLIC HEALTH IS EVERYONE'S RESPONSIBILITY.
In - In Compliance / NIO - Not Observed I NIA = Not Applicable i COS o Corrected on Site I MAJ m Major Violation I Out m Out of compliance / PTS - Points
DEMONSTRATION OF KNOWLEDGE cos W our vrs
In NO 1. Food safety certification I 1 ❑ 1 2
Food Safety Cerflfled Employee/Cert Agency: Exp Date:
EMPLOYEE HEALTH AND HYGIENIC PRACTICES
in 2. Communicable disease; reporting, restrictions and exclusions ❑ ❑ ❑ 4
in NO 3. No persistent discharge from eyes, nose, mouth ❑ ❑ 2
In N/O 4. Proper eating, tasting, drinking or tobacco use ❑ ❑ 2
PREVENTING CONTAMINATION BY HANDS
In WO 5. Hands clean and properly washed; gloves used properly ❑ U ❑ 412
Adequate handwashing facilities supplied & accessible ❑ 1 ❑ 2
TIME AND TEMPERATURE RELATIONSHIPS
In N/0
N/A._
7. proper hot and cold holding temperatures
❑
❑
O
412
In�
NtAin
a. Time as a public health control; procedures and records
n
❑
❑
412
NIO
NA__
9. Proper cooling methods
❑ '
❑
❑
4/2
InN/O
10. Proper cooking time and temperature
❑
❑
❑
4/2
i" 21. Hot and cold water available - Water Temp:
❑ ❑ ❑ 4 / 2
LIQUID WASTE DISPOSAL
I" 22. Sewage property disposed
In N10
11. Proper reheating procedures for hot holding
❑
❑
❑
412
NIA -
PROTECTION FROM CONTAMINATION
In WO
12. Returned and reservice of food U ❑ 2
NIA -
15. Food obtained from approved sources
In
13. Food: unadulterated, no spoilage, no contamination ❑ ❑ ❑ 4 / 2
In N/O
NIA
14. Food contact surfaces; dean and sanitized ❑ 1 ❑ I ❑ 14/2
Uxer Mothod: O CNodne ❑ Quaternary Ammonia
arewash Sink Wash Basin Temperature:
U Iodine❑ Hot Water ❑ 00M r
i
CONFORMANCE WITH APPROVED PROCEDURES
Senitizer Concentratlon (ppm):
In WA 18. Compliance with variance, specialized process & HACCP Plan
FOOD FROM APPROVED SOURCES
ENV6tONMENTAL ALTH SPECIALIST (PRINT)
In
15. Food obtained from approved sources
❑ 1 ❑ p 1 4
in NO
MIA -
16. Compliance with shall stock tags, condition, display
I D 021 1
In N/O
17 Compliance with Gulf Oyster RegulationsWA-
0 ❑ 1
CONFORMANCE WITH APPROVED PROCEDURES
38. Adequate ventilation and 6ghgng; designated areas; use
In WA 18. Compliance with variance, specialized process & HACCP Plan
❑ ❑ 2
CONSUMER ADVISORY
❑
Ili'. N10 19. Consumer advisory provided for raw or undercooked foods
p ❑ 1
SCHOOL AND HEALTH CARE PROHIBITED FOODS
1
in NIA20. Licensed heailh care facllifles/public & private schools; prohibited
❑ ❑ 2
WATER / HOT WATER
i" 21. Hot and cold water available - Water Temp:
❑ ❑ ❑ 4 / 2
LIQUID WASTE DISPOSAL
I" 22. Sewage property disposed
❑ ❑ ❑ 41 2
VERMIN
No rodents, Insects, birds or animals 1 ❑ 1 ❑ 1 ❑
RECEIVED BY ._.
ENV6tONMENTAL ALTH SPECIALIST (PRINT)
SIGNATURE IALS
VERMIN our Pre
24. Vermin proofing, air curtains, self closing doors ❑ 1
SUPERVISION / PERSONAL CLEANLINESS
25. Person In charge present and performs duties, demonstration of
knovARdna
❑
2
26. Personal cieaNlness and hair restraints
❑
1
GENERAL FOOD SAFETY REQUIREMENTS
27. Approved thawing methods used, frozen food storage ❑ 2
28. Food separated and protected from contamination ❑ 2
29. Washing fruits and vegetables ❑ 1
30. Toxic Substances property Identified, stored, used ❑ 1
FOOD STORAGE i DISPLAY / SERVICE
31. Self service: utensils, food types, maintained ❑ 1
32. Consumer self-eervice ❑ 1
33. Food properly labeled & honestly presented. adequate storage ❑ 1
EQUIPMENT i UTENSILS 1 LINENS
34. Utensils and equipment approved, good repair
u
2
35. Warewashing: Installed, maintained, proper use, test materials
❑
1
36. Equipment / Utensils: Installed, clean, adequate capacity
❑
2
37. Equipment and utensils: storage and use
❑
1
38. Adequate ventilation and 6ghgng; designated areas; use
❑
1
39. Thermometers provided and accurate
❑
1
40. Linens and wiping cloths: property used and stored
❑
1
PHYSICAL FACILITIES
41. Plumbing, properly installed, good repair, wastewater disposal t.1 2
42. Refuse properly disposed; facilities maintained ❑ 1
43. Toilet facilities: properly constructed, supplied, cleaned ❑ 1
44. Personal Item storage and cleaning items storm ❑ 1
PERMANENT FOOD FACILITIES
45. Floors, walls and callings: good repair / fully enclosed
❑ 1
46. Floors, walls and callings: dean
❑ 1
47. No unapproved private homes / living or sleeping quarters
❑ 1
SIGNS 1 REQUIREMENTS
48. Last Inspection report available
O
49. Foodworker cards available, current, complete
❑ 1
50. Grade card and slgns posted, visible
❑
COMPLIANCE AND ENFORCEMENT
51. Plana approved I submitted ❑
62. Permit available and current 0
' 53. Permit suspended / revoked
INSPECTION TOTAL NUMBER OF
SUMMARY I MAJOR VIOLATIONS=
TOTAL POINTS TOTAL NUMBER OF
POSSIBLE -100 POINTS DEDUCTED= .,/ vs.
A B C_
SCORE
ZI-f 1 of
14 � 11l
COUNTY OF RIVERSIDE • COMMUNITY HEALTH AGENCY
DEPARTMENT OF ENVIRONMENTAL HEALTH
FACILITY N E J ADDR SS f r RECORD ID #
V ar r , r 2l rn (y
Major / Minor Violatlons: Major Violations are those that pose an Imminent risk to public health and warrant immediate closure of the food facility or Immediate correction. Minor
Violations are those violations that do not pose an Imminent public health risk, but do warrant correction.
GRADES REPRESENT THE FOLLOWING RANGES: A = 100-90 Passed Inspection / meals minimum health standards; B = 89-80 Did not pass Inspection I does not meet n*drnum health
standards; C = 79-0 Failed inspection / condition exist which may pose a potential or actual threat to public health and safety. This factfity, Is required to display a grade card in a conspicuous place
selected by the Enforcement Officer. The grade card shall not be concealed and can only be removed by the Enforcement Officer. Per County Ordinance 492 / County Code Section 8.40.020
Vrr,l:CS IN: KIVCKSIUC, C3LTTR4, GVKVNA, nCmCI, INUIV, IVIVKKICIA AP,{! FKL1VI 0rR11M%7Q
For more Information call (888) 722-4234 or visit the Department Web Site — www.riveoeh.org
OBSERVATIONS AND CORRECTIVE ACTIONS
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RECEIVED BY
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For more Information call (888) 722-4234 or visit the Department Web Site — www.riveoeh.org
ADJACENT LOT
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- —L (E) PATIO COVE13 DEMO (E) LOW BLOCK WALL
1
PHASE ' ` ;—' - -- T-- -. -- --- _ ___.. w�. _.. ---- -- • -- ---.: �- -
E
PROPOSED
. MI STOfi�WG1 � �
��- NEW COOLER
T - - PIIAS! t
EXISTING PAAAKING
29 SPACES CARS
V
(E) PATIO �
- EXISTING PAAKlkG
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-- (E) STORAGE C C —
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Lavender Bistro Restaurant — Storage Addition
STORAGE BLDG. STATISTICS
(E) STORAGE 275 SE
(N! STORAGE 896 SE
TOTAL STORAGE 1171 SF
Scope of fork for New Storage Shed
This work to be perforined uxider separate permit.
Cooler addition is also under separate permit,
Construct a new storage shed adjacent to the existing smail storage
shed. New shed to be un-conditioned space with only 6 ceiling
fluorescents. Metal roof and stucco are to match existing existing, All 4
exterior walls will be sheathed with 3/8" Struc.t 11 plywood. Interior
walls and ceiling to be sheathed with 5/8" type X gyp. board,
New electrical circuits; to be connected to an existing 12SAm•p sub panel
serving the existing storage shed.
CITY OF 1A QUINTA
SUMNG & WIE Y DEPT.
APPROVED
Fw ti ilHuCl"
17esigner
Scan Poilakusky
760-775-0707
40-320 La Spezia court
Indio, CA 92203
Project Addrttas:
78-073 Barcelona
760-564-5353
La Quin#a, CA 92253
Owner:
Michel Despras
760-564-5353
do Lavender Bistro
U-093 Cabe Bucelona
La Quin#a, CA 92253
PN :
770-182-011
Legal Uescriptinnt
Lots 1-5, Block 3, Desert Club -tract 01, TSB lei, P& 75,
La Quints. Riverside County
Zoning
VC
Building Use:
Restaurant Occupaut toad - 192
Applicable Codes.,
2010 C13C, CEC, CPC, CMC•,
La Quinta MuoJcipul Code
Building nal o.
Lot Area.
1.6 Ae,
6%% SF
Exiseing Restaurant:
Restaurant
3747 SF
Kitchen
1550 SIR
IE1 Storage
2,Z5 SF
Total Existing
5672 SF
Proposed Storage
$96 5F
Tutial Sq. Building Foutrge
6468 SF
F31dg_ C'ovcrage;
6469 SF 9.3 %
Parking i Paving
32315 SF 46.4 %
Landscaping
322094 SF 44.3 %
Parking rcquircd:
$tt spaces Provided
89 shares
RC; Parking Required-.
A Provided
4 spaces
Singte Story
Occupancy Group
A-3
Construction Type
V-N
Index of Drawings
t C over.sheet i Site plan
2 Floor Pian - Frsaming Plan - Elevations
3 I-andsCNpe hla"
4 Full ndgsion Plan
- Elec. Plan - DetaiIs
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6.
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cot
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75
F•6f
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NOL
REVISIONS
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