0302-190 (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 Exp. Date
Date 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 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:
Carrier Policy No.
(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: 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 of this City to enter upon
the above -mentioned property for inspection purposes.
Signature (Owner/Agent)
Date-
BUILDING PERMIT PERMIT# NO
DATE VALUATION
��i�lr LOT TRACT
JOB SITE ADDRESS i � `'-�R f'{'�#7;��a.F FNi 1~ R +1., r
OWNER
CONTRACTOR / DESIGNER / ENGINEER
iEE+ZI.':stil-yyt��ta�:iFF4.1C�'��*6CiYfi!
ALMA
iA Q-1TD4TA CIA 92M(
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1
USE OF PERMIT
ON1.k P2, r_ L]ILL)IN
14W .,r+ TENANT Iht1 ROV eMENT. PF U Ai?PROV ED Pi AN (AR
AN E)V119(?rF). + r+V F=i'i M,T 1014 RKF. IMPo.' -D POR WO 111 K 11I?FNO ix'IN N
WC!'MOVT Pf?FtWT.
VALUATION iR,i> VA-41 11,01
EINU A'TED (`US£ OF (4)MVIMC, U0'
49,5(�7M
Pl.A)4 01 UK WIr 1 M (W-439-3)IF Q6,4.
ti3O?4S KUC9 014 Pitil• 1()1•-o("1&() )4 KJN J,
MEC RAW'41, FR 101 •DW,-4: 1-(Kg) W.(10
liLEV : RIC:t L ! It 10 l ••[tCr" 20-0nu, $3r., 0
r11LLTM1%VR(1 FFF{ 101 •[')O-41 R-000' 06. qq'.
1NVESTKIAT1014 nX
t: 1. JOR AHD Pf..Atf r-.rxVi'_'K
$1,220.210
i .�a: PR-PAM FEF,;
$V.10
p [� i'•. :, PFA0k1.1-1'1'.1!'LV8 OrUK.''NOW
FEB 2 5 2903
CITY C r �,k OUINTA
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Permit �^l
p%Jo
City of La Quinta
Building ar Safety Division I
P.O. Box 1504, 78-495 Calle Tampico
!a Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: T- . 0112.. W
%%-net's Name: �ersd rN
A. P. Number: 9 — 0 2) - 00 S
ddress:-7q-�a0�LJrrM
ite. ST. Zip:
elcphone:
Legal Descri n:
Contractor:>45r
Address: Z� - ?j� Ctrlm S 0
Project Description: 1 kkM G fc-i1ereqA
City. ST. Zip4yb f-Cvl " M
p�tGC.S
Telephone: U/ OF)
State Lic. # :B �y�2-�j City Lic. #:
Arch.. Ene .. esigner.
M �� G Irt(i►V
Address:
City. ST. Zip:
fiY
Telephone:
State Lic. :
Name of Contact Person: ("—
Construction Type: Occupancy
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: F97 k Stories: b Units:
Telephone # of Contact Person: lb0 " 5M
Estimated Value of Proiect: 50.0
APPLICANT: DO NOT WRITE BELOW THIS LINE
q
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cates.
Reviewed. readv for corrections (� }��{ I/6 �
Plan Check Deposit
Truss Coles.
Called Contact Person l�� l
Plan Check Bnlance
Title 24 Calcs.
Plans picked up b
Construction
Flood plain plan
Plans resubmitted08
Mechanical
Grading plan
2" Review. ready f correctio /issu !7
Electrical 3D
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up a
S.M.I.
H.O.A. Approval
Plans resubmitted 'Z
Gradinp
IN HOUSE:-
" Review. ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P. P.
Pub. %�'ks. Appr
Date of permit issue
School Fees
Total Permit Fees
To: Greg
From:
r, Building& Safe Manager Safety 9 To CDD:
PlanPing Due date: / 31,3
Buillding Plans Approval
(this is an. approval to issue a Building Permit)
The Comrr unity Development Department has reviewed ewed the Building Plans for
the followir g project:.
Description:
Address or general location:
APN and/o legal descriptio : �1,0Zo -C)09
The Comm inity Development Department finds that:
❑ ... these Building Plans do not require Community Development
Department approval.
M, --"...these Building Plans are approved by the CommunityDevelopment
opment
Department.
Plane
-1-7-
Tom Tisdale
Fire Chief
Proudly serving the
Unincorporated
Areas of Riverside
County and the
Cities of -
Banning
.;
Beaumont
4.
Calimesa
4.
Canyon Lake
Coachella
Desert Hot Springs
Indian Wells
Indio
Lake Elsinore
4.
La Quinta
4.
Moreno Valley
4. -
Palm Desert
Perris
4.
Rancho Mirage
San Jacinto
Temecula
Board of Supervisors
Bob Buster,
District 1
John Tavaglione,
District 2
Jim Venable,
District 3
Roy W ilson,
District 4
Marion Ashley,
District 5
RIVERSIDE COUNTY FIRE DEPARTMENT
In cooperation with the
California Department of Forestry and Fire Protection
0 West San Jacinto Avenue • Perris, California 92570 • 09 00 • Fax 0
April 24, 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
Dr. Albert Anderson located at79"=440-Corporate CentreDrivesuite-111, La Quinta.
Please call if you have any questions: - --
FRANK KAWASAKI
Chief Fire Department Planner
By
Terry DeSoucy
Fire Safety Inspector
EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE
82-675 Highway 111, 2n° FI., Indio, CA 92201 • (760) 863-8886 • Fax (760) 863-7072
Tom Tisdale
Fire Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
Cities of:
Banning
4.
Beaumont
Cahmesa
Canyon Lake
Coachella
Desert Hot Springs
Indian Wells
Indio
Lake Elsinore
La Quinta
Moreno Valley
Palm Desert
Perris
Rancho Mirage
4.
San Jacinto
Temecula
Board of Supervisors
Bob Buster,
District 1
John Tavaglione,
District 2
Jim Venable,
District 3
Roy Wilson,
District 4
Tom Mullen,
District 5
RIVERSIDE COUNTY FIRE DEPARTMENT
In cooperation with the
California Department of Forestry and Fire Protection
210 West San Jacinto Avenue • Perris, Ca i omia 92570 • (909) 940-69M • Fax 909 940-6910
February 6, 2003
Sundance
50827 29 Palms
Morongo Valley, CA
Re: Non -Structural Building TA Plan Review
LAQ-03-BP-009 / Dr. Anderson
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 by the installing C16
contractor to the Fire Department for review, along with a planfinspection fee. The approved plans,
with Fire Department Job card must be at the job site for all inspections.
2) The building sprinkler monitoring system must be extended to provide an interior notification device
within the tenant space. Plans must be submitted to the Fire Department for review, along with a
plan check/inspection fee.
3) 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 or burglar alarm system, the lock box
will require "tamper" monitoring. Special forms are available from this office for the ordering of the
Knox Box. This form must be authorized and signed by this office for the correctly coded system to
be purchased.
4) Install portable fire extinguishers in accordance with Title 19. 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. In strip centers, businesses shall post the business name
and 6" suite number(s) on back doors as well as the front. 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.
Sincerely,
FRANK KAWASAKI
Chief Fire Department Planner
By
Walter Brandes
Fire Safety Specialist
H.XPE2IWPDATAUAOUINTAIPROJECTS\TH IMPRW.AO.013BP-M.doe
EMERGENCY SERVICES DIVISION . PLANNING SECTION • INDIO OFFICE
82-675 Highway 111, 2nd FI., Indio, CA 92201 • (760) 863-8886 • Fax (760) 863-7072
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 79-440 CORPORATE CENTER DR. SUITE 111
Use Classification: COMMERCIAL TI "DR. ANDERSON" Bldg. Permit No.: 0302-190
Occupancy Group: B Type of Construction: VN Spklr Land Use Zone: CR
Owner of Building: J. PAUL
Building Official
Address: 79-440 CORPORATE CENTER DRIVE
City: LA QUINTA, CA 92253
By: DANIEL P. CRAWFORD JR.
Date: 4/22/03
POST IN A CONSPICUOUS PLACE