0309-024 (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
349001 13 MIC
Date ignature 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:
( ) 1, 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 "� �`i Signature of Owner f%�.. Pr .2
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 STATEFUND Policy No. 1631633-01
(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, and3agree that if I should become
„subject to the workers' compensation provisions of Section 3700 of the Labor.
Code, I shall forthwith comply with those.pfovis6ss
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 purpos s.
r
Signature (Owner/Age � —^f _ -_t -' Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0"0� TRACT
JOB SITE
ADDRESS 79_,M0 Cc.Rp�Oix C1i:1Y C�� �x�.Ii
APN
- -
-OWNER
CONTRACTOR / DESIGNER / EN (NEER
PRAT OF LA Qt JN rA
EMLD CONT1213G°TING
79-440 CORPORATE CT.t3"tRE MVE
1,021 'F ANSYWAY
LAQUINTA. C.A. 512253
&ICAJON CA 92019
(619)590.2202 1':F3,T.O 2864
USE OF PERMIT
CO2t4, AERC;` L R1::dS&OD1a L
f;t7WAFACW. RMMODI€ L CH) 116A S.F. (13DDIX i'ION TO &X1.39'H10
SUITE 112) 2()01 CDC "6° OCCUPANCY, TYPEW, 3PRI KLIRD
VALUATION 311,000.00 w
Rl,! 1t I TED COST OF CONS'1„Cti7CH:ION
30111)000)
P�`fff MIT ME S'C1TtIlkAlE'c.`Y
PLAN CHM PTE 101.000.439.3111 &181,93
CONSTAUC CION FEE 101--000-418-000 $191.50
MECHA1;i1CAL FEE 101.000421-0100 $36,00
ELECTRICAL PER 101.000-420-0100 138.18
FF..L • COMIA 100.000.2.41-000 $6.30
fSTlON40'MOTION
MM -TOTAL C."ON9T'L2.CrMON AND PLAN �.`1"-tT.IMMG
$5,50.01
T 13 PRE-PATD P M
$0,00
". ( P.W.2:1txY'1'.1' LIFS DITL NOW
x530.01
,
D ..
NOV 12 2003
CITY OF LA QUINTA
DEPT.
RECEIPT
BY
DATEFI LE
INSPECTOR
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
Final
Final
BLOCKWALL APPROVALS
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
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
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS::
�llJill l 14,4944A
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City. of La Quinta
Building al: Safety Division
P.O. Box 1504, 78-495 cane Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #;�
Project Address: -
/� �T�. Z
Owner's Name:
A. P. Number:
Address: - 7 7
Leeal Description:
GtaGK - G'O,e2F.GTlOA) 5 \I
City. ST. Zip:�! r
!,� //v ��
Contractor. -C M e-/2- -
CDA) TIZ
FTelephone-
Address: t D Z
W
Project Description:
City, ST. Zip: /
! 1) �pQ
Telephone: i _
-'� -
iCitvLic.#:
%1!`iC(
State Lic. # : Q
RAI LA 1A27A
Arch., Engr.. Designer:
Address: -7930 L4
M�9_16L —1) r__7 4
City. ST. Zip:
Telephone: �j 2 -
•.-;._ . ..•_�,s .. .
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: prT 1 L
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
—
stimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal Req'd
Rec'd
TRACKI'.,%G PERMIT FEES
Plan Sets
3
Plan Check submitted 91//9 Item Amount
Structural Calcs.
Reviewed. ready for corrections / Plan Check Deposit
Truss Calcs
Called Contact Person It Plan Check Balance
Energy Cales.
p�
Plans picked up Construction ' t
Flood plain plan
Plans resubmitted q'(�j Mechanical •
Grading plea
2" Review, readyor correctio issue 9/3d Electrical 11104(g,ol- 0
Subeontaetor List
Called Contact Person -*t-- g Plumbing
Grant Deed
Plans picked up OWN •
H.O.A. Approval
Plans resubmittedN' Grading
00
IN HOUSE:-
'"' Review, re • • for eorrecti issue 11,'-' Developer 1 pact Fee
Planning Approval
Called Co ct Person �' �/ �'� A.l.P.P.
Pub. Wks. Appr
Date ofit issue
Scbool Fees
C2hk—
- w✓
Total Permit Fees
4 -&
VX,4% & �a
q -1-7 -r-
GtaGK - G'O,e2F.GTlOA) 5 \I
'AT
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v
CF's OF Tt
To: Greg Butler, Building & Safety Manager To CDD: 9-03-2003
From: Oscar Orci, Planning Manager Due date: 9-09-2003
Status: 1 st 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: ADDITION TO EXISTING SPACE (PRN LA QUINTA)
Address or general location: 79-440 CORPORATE CENTRE DRIVE #112
Applicant Contact: PHIL (619) 997-7445
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.
❑ ...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.
Oscar Orci, Planning Manager Date
Tom Tisdale
Fre Chief
roudly serving the
nincorporated
teas of Riverside
:ounty and the
: lies of
Wmning
letmont
0
alimesa
ee
'anyon Lake
p
;oachella
lesert Hot Springs
ee
idian. Wells
o,,
ake Elsinore
a Quinta
loreuo Valley
o. -
atm Desert
ems
41
rancho hfirage
0
an Jacinto
42%
emecula
Board of Supervisors
ob Buster,
District I
An Tavagiione,
District2
M Venable,
District 3
oy Wilson,
District 4
larion Ashley
District 5
RIVERSIDE COUNTY FIRE DEPARTMENT
In cooperation with the
California Department of Forestry and Fire Protection
82-675 Highway 1.11, 2nd Fl., Indio, CA 92201 • (760) 863-8886 . Fax (760) 863-7072
.i
September 16, 2003
Roy Johnson
7830 La Mesa Blvd., Ste. A
La Mesa, CA 91941
Re: Non -Structural Building TA Plan Review
LAQ-03-TI-065 / PRN La Quinta
79.440 Corporate Centre Dr., #112
Fire Department personnef.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 sprinlder system plans for the tenant improvement area must be submitted to the Fire
Department for review, along with a planlnspection fee. The approved plans, with Fire Department
,job card must be at the job site for all inspections.
2) All egress doors shall comply with CBC Sec. 1003.3.1.8 for proper door hardware.
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) 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 Supe 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) 863-0886.
Sincerely,
FRANK KAWASAKI.
Chief Fire Department Planner
By \&& �0,1,
Walter Brandes
Fire Safety Specialist
Cc: La Quints City — Budding Dept
KWEMP DoW o *taW0JECrsmuoosnoWdw
EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE
8275 Highway 111, 2nd Fl., Indio, CA 92201 • (760) 863.8888 • Fax (160) 863.7072
Tom Tisdale
Fire Chief
Proudly serving the
Unincorporated
Areas of Riverside
County and the
Cities of:
Banning
Beaumont
.;.
Calimesa
'J
Canyon Lake
Coachella
.;.
Desert Hot Springs
Indian Wells
•a
Indio
Lake Elsinore
La Quinta
Moreno Valley
Palm Desert
Perris
Rancho Mirage
San Jacinto
.y
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
10est San Mac -into Avenue • Perris, California 92570 • () 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 A09 44OCorporate Center-Ste=1..12 ,_LaQuinta
Please call if you should have and'Questions.
Respectfully
FRANK KAWASAKI
Chief Fire Department
BY �- 0 'So
Terry DeSoucy
Fire Safety Inspector
EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE
82-675 Highway 111, 2"0 FI., Indio, CA 92201 • (760) 863-8886 • Fax (760) 863-7072
• '3139;1E
M P SO"Ek;; ^
.,Gtx T
PFGE G17
� � V
AtDa'Ra a�
aravcr+l�fac
;No 1NaaNI17
January 23, 20U3
To: OrY Builders
Re" James Paul Building Addition
La Guit:ta, CA
Attn: Orel and Mark
Foh
" w
11
ORR BUILIDERg
The ex terfor 5. I llu-Ittm bew
1 8" x I s•• t, n for
was inrital led �� ith "top" �tan� Patio at the south/west comer of the buildi: ig
P down. n. since the can, her for this Glu -lam hew„ i's L)" It
can he installed with top or hottoni dr,.y„•
9 fVi in`i,
Jr.s
f 9 �9rt 41U 0; I2ao. S��i
�a 1 laVuna UwS to 91FSj
%a[(S4Q)#fc 737.4