10918 (RER)a if
P.O. BOX 1504
Building78_00 Ave Ld •t�12S a 7&105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
Virginia Bauer
Mailing
Address P. 0. Box 35
City
Zip
Tel.
La Quint~
92253
Contractor
GaMe.tte CG2lartruction 1
Address f• ` {
55888,VY%fcca Trail'
City .-! l
Zip ••
Tel.:
Yucca Vly . i
92284
365--0889
State Lic.
& Classif. 280103
City
Lic. #
t2288
- - Arch., Engr., -• s:
Designer
-c
Address =�
Tel.
City Zip!, State
Y Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section.
7000) of Division 3 of the Business and Professions 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,Business and Professions Code: Any city or county which requires a
permit to construct, atter, 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
Me 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 l applicant for a permit
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).
❑ 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 sale. 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 Lnprove for the purpose of sale.) -
Vi' as owner of the property, am exclusively contracting with licensed contractors to con-
Jstruct 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.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date "! d O / 0Owner ! .ti li I^I r -,�t ,.r .,c f J..�l /► .i /! .t .tel
`
WORKERS' COMPENSATION DECLARATION
I 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.)
Poligy No. Company
TCopy 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 th0 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 the Workers' Compensation. provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
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.)
Lenders 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 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 applicant— Date
Mailing Address
City, State, Zip
LDING: TYPE CONST
P. Number
Description
(Project Description
No. 1.0918
OCC: GRP.
of Coffee Shop
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
tstlmatea valuation 10,000
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal. °,' 76.05
Const.
Mech.
Electrical
Plumbing 27.00
S.M.I. 1.00
Grading
Driveway Enc.
Infrastructure-----
"`._ �.%w r nr.f x (5 rr s •el :"sr _tt'. ,O:r 11 A
+ F13ft
TOTAL 221.05
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Cen`ier Lind i= Ci
Rear Setback from Rear Prop. Line ,r
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date �,,er�mit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. 'SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. I SQ. FT.
WALL SQ. FT.
SQ. FT.
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
`
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL •
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS O�
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/sc
HOUSE SEWER
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEEPLUMB. FEE
STRUCTURE / PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK 1191
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMBS ycj
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS O�
SEWER OR SEPTIC TANK
ROUGH WIRINGS' GJ
`
L DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
---,FINAL INSP. l �2
GRADING
cu. yd.
$ plus x$
c$
LUMBER GR.
FRAMING c
FINAL INSP. )
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTIO
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
l
Titit .4
78-105 CALLE ESTADO — LA QUINTA, CALIFORNIA 92253 - 16191 564-2246
FAX (619) 564-5617
March 31, 1993
Mike Garcia
RIVERSIDE COUNTY HEALTH DEPARTMENT
79-733 Country Club, Suite E -
Bermuda'Dunes, CA 92201
Dear Mr. Garcia:
Please be advised that Ginny Bauer's Coffee and Collectibles,
located at 78-040 Avenida La Fonda is currently closed due.to, a
fire on Monday, March 29, 1993.
We will not issue another Certificate of Occupancy until we receive
approval -from the County of Riverside Health Department.
Please feel free to contact our office if you have any questions.
Sincerely,
BUILDING AND SAFETY DEPARTMENT
Tom Hartung
Director of' Building and Safety
kt
cc: Ginny Bauer, Coffee and Collectibles
MAILING ADDRESS - P.O. BOX .1504 - LA QUINTA, CALIFORNIA 92253
:JUT..IFICATION OF FIRE
CITY OF :L -IA V 1N da DATE MV -CH 7-17I_
TYPE OF FIRE STRcI C- 7-Ok olnlno2cth L- TIME, / 6 JC .5 HR_S
CAUSE ___C/(�/6p(--/TF ASHE5 AN !RA5Hc>ouT191eVE1?-
DOLLAR DAMAGE PROPERTY 11000 ? CONTENTS '3000
TYPE OF OCCUPANCY COFFEE- SHOP
PHYSICAL DAMAGE S(`oKC1H p/� j�2� ��} (� �'J�LTE f�L�45T I
c.
Li�ffi t-1 xTuB _ sh-90KE DA1117Ag
PROPERTY %g Q c O, A V 1) I A, -0,Aj DA
coFFc� sholo
TENANT Glnl7v- �A EOZ
H�vl•
bos ' -
BUILDING INSPECTION NEEDED ,yy.
NOTIFICATION SENT TO
DATE R)gl2-Cg 3 0 M�3 TIME O 80
F/2�F - )PE2 S0r, E' L
cHEckl6q Foe i �10- E