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0307-181 (CSCS)U) H (V U) W o co � Q lr7 'LU oZ� C�D0O F- ca J LLI r` F -a U) Z C0 111N ON U_ °) 'It2 Z cc O 0 J J M OU � 0) ,-t Z_ ao 5 P- (3 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� Applicant " . / of Warning: Fail �e o 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 persoA 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 property for inspection purposes. Signatdre (Owner/Agent) Date 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 692234 D SIC, , � 07r;)112( Date �� pL Si1 Vgnature of Contractor �,' S 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. Se( ) I have and will maintain workers' compensation insurance, as required by ction 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 F”, D Policy No. 04,4.02-001431.0 BUILDING PERMIT PERMIT# 7.181 DATE TRACT [yIX q / r, VALUATION «E q riAd f� LOT PRI t t A��` JOB SITE ADDRESS NA APN 770 -IM -MI OWNER I` CONTRACTOR / DESIGNER / ENGINEER LA QUIffA 43'RU.I. LW . C & G CONS <EiUM0117 78.034 CCAUX SAti.(;i:�.Ca2+ A ' 965 HORM M7:C`.CJND AM 7..AQUI14`L'A CA 92253 UPLAND (.",A 91786 (909)982.9965 M.41 3.539 USE OF PERMIT COIANM. C1A1_1 Cf M?& X700 SQ.F T. 01WICIt'SHELL'' T il'P1pVV, SPRINKI-.iERYD. BUILI?MO I5 PHYSICALLYATTA HED TO BUILDINGS W/ PERMIT 4"8 030=1K{1 � 03111•R11.. STIR .I UR 2,ifl0.Ot� SF WC -• RErSIDENVAL ; noo SIS CONTRACT AMOUNT 31S;S334.00 U E�►"RBUYED COST OF CO.Eti(S-'TicY,3MON' ��i.,t1rt14.4�i P.EMM ! RR IMMARY CONSTRUCTION FTSE 101.000.41 £-000 M1.50 KAN CHWK:14LIS 101-000-X139-318 $500.32 A+ ECRANICAL FEE 101-000-431.000 $db.08 IELZCTRICAL, FEE, 1017000420.000 $136.30 PLUMMO VE R 'I D1.0004.19.000 i4M STRO NO MOTION "0, - COMM 100-000-241-040 $3'1.51 (1RADINO FRE 101 -000 -423 -NO $15.00 01ER IMPACT FFS $0,091.70 ART IN PUBLIC E"IACES - CQM1270.000-445.OW $65102 �t S'UD-TQTAL. CONB'IdiUC:TIt Ht N) PIAN C'H1r'C $8,392.55 U33 PRE -PAW M-0 ' $0,00 '1 arAL Pmm C ITERS .3. )V.K ,Now JUL 15 2003 !CI TY OF LA QUINTA FINANCE DEPT. RECEIPT DATE BY D2FINALED INSPECTQA26 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 p Exhaust Fans O.K to Wrap — F.A.U. Framing Compressor Insulation 07 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 BLOCKWALL APPRO ALS POOLS -SPAS 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 Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans OX 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: ©` zi0 �Iu�IN� B3 07- d o � _ i8 P.O. BOX 1504 • T - APPLICA ION ONLY (f 78 6Z Building/ 78-495 CALLE TAMPICO Address CI+U.EeC&Vo QUINTA, CALIFORNIA 92253 r,1 Owner r L' BUILDING: TYPE'CONST. OCC. GRP. Mailing Address r' A.P. Number City Zip Tel. Legal Description Contractor Project Description C-4AJ sm _,,C -rk; n, o 5-400 at= G /\'S i Address �-9 e SLG 1 , ri (' "'c�N City Zip C_Tel. l 2 7 i ?- 13� State Lic. City & Classif. Lic. # Sq. Ft. No. No. Dw. Arc n Size Stories Units Desi fK h��L�� New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City IZip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby aflirm that I am licensed nder provisions of Chapter 9 (commencing with Section effec of Divigiory3 of lh� Busine rofesslons Code, and my license Is in full force and effect SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason: (Sec. 7031.5,Susiness and Professions Code: Any city or county which requires 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 five hundred dollars ($500). 11 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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, Provided that such improvements are not intended or offered for sole. If, 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.) II 1, 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 contractors) licensed pursuant 10 the Contractor's License Law.) 11 1 am exempt under Sec. B. 8 P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION Ihereby 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 11 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 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. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become subject to theWorkers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Ihereby 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 slate that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the above- mentioned property for inspection purposes. Signature of a0plicant Date Mailing Address City, State, Zip WHITE = BUILDING DEPARTMENT PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure APR 2 1 2003 A 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: YELLOW = APPLICANT PINK = FINANCE L'. Date 7/15/03 No. 24709 Owner LQ Grill, LLC Address City Zip Tract # Type Commercial CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road La Quinta, CA 92253 (760) 771-8515 Lot # No. Street Unit 1 78026 Calle Barcelona Unit 2 Unit 3 Unit 4 Unit 5 APN # Jurisdiction Permit # Study Area No. of Units S.F. Lot # No. 6070 Unit 6 Unit 7 Unit 8 Unit 9 Unit 10 �N�1FIFps0�0 � O Q BERMUDA DUNES GO RANCHO MIRAGE �_, INDIAN WELLS PALM DESERT t� LA QUINTA 4RINDIO v 0 Y 769-103-007 Street Comments 78030 Calle Barcelona included. Two commercial shell buildings joined by common restroom facilities. S.F. At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $0.34 X 6,070 S.F. or $2,063.80 have been paid for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued. Fees Paid By CC/Bank of America - Ken West Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by S Signature Check No. 2014852436 Telephone Funding Commercial Payment Recd $2,063.80 Over/Under NOTICE: Pursuant to Government Code Section 66020(d)(1), this wilTsepfe to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE: This Document NOT VALID if Duplicated Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy = Accounting Tom Tisdale Fire Chief Proudly serving the unincorporated areas of Riverside County and the Cities of. •Banning Beaumont , .C• Calimesa e• Canyon Lake .;. Coachella e• Desert Hot Springs Indian Wells Indio Lake Elsinore e. La Quints Moreno Valley Palm Desert Perris Rancho Mirage 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 March 16, 2004 Interior Dimension Number 2 Saturn Circle Rancho Mirage, CA 92270 Re: Non -Structural Building TA Plan Review LAQ-04-TI-039 / 78-026 B Calle Barcelona 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. Special forms are available from this office for the ordering of the Knox Box. 3) All egress doors shall comply with CBC Sec. 1003.3.1.8 for proper door hardware. 4) Install portable fire extinguishers per Title 19, but not less than 2A10BC in rating. Contact certified .extinguisher company for proper placement of equipment. 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. Building addressnumbers shall be a minimum of 12" for building(s) up to 25' in height. 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. 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. By ,CCc:-City-of-La-Quinta = Building -Dept H:IPEiNiD&-MV-0RM----1 W1 -�a — Sincerely, FRANK KAWASAKI Chief Fire Department Planner Walter Brandes Fire Safety Specialist EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE 82-675 Highway 111, 2'a FI., Indio, CA 92201 • (760) 863-8886 • Fax (760) 863-7072 TWY1 4 4 a" 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 Building Plans Approval To CDD: Z-26-2.004 Due date: 3-4-2004 Status: I st Review The Community Development Department has reviewed the Building Plans for the following project: Description: Office Space Address or general location: 78-026 Calle Barcelona Applicant Contact: Ken West 218-5559 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. ,w ❑ ... 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. 4 Oscar Orci, Planning Manager '�'r �►,� al�lc l�hl� i 0 N CaP�� V _Op, �� M T n 0 N sbonwa3a MA