BCOM2015-0044Applicant: U.27
I I Contractor:
GABRIEL LUJAN C U TENANT :DAVID HENDERSON
36947 COOK ST STE 104 Z 15 46520 WASHINGTON STE 3
PALM DESERT, CA 92211 LA QUINTA, CA 92253
LAOUw7AOPME9T DEPARTMENT (760)333-4535
Llc. No.:
LICENSED CONTRACTOR'S 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 Professions Code,
and my License is in full force and effect.
License Class: _ License No.:
Date:
Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair
any structure, prior to its issuance, also requires the applicant for the permit to file a
signed statement that he or she is licensed pursuant to the provisions of the
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Divisio 3
of the Business and Professions Code) or that he or she is exempt therefrom and the
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for
permit subjects the applicant to a civil penalty of not more than five 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, Business and Professions Code: The Contractors' State License Law does not
apply to an owner of property who builds or improves thereon, and who does the work
himself or herself through his or her own employees, provided that the 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 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 am exempt under Sec. P.C. for this r ason
rDa�o� I Owne
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 Na
Lender's
. 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 and policy number are:
Carrier: _ Policy Number: _
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 agreeth if I should beco ne subject to the
workers' compensation provisions of Se ion 37 0 of th ab r ode, ha
mll forthwith
comply with those provisions.
1
r �( 1—I
Date: l) Q f Applicant.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($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.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official 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, indemnify 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. . j
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 county ordinances an tate laws relating to building
construction, and hereby authorize representatives of is ci to a ter u n the ove-
�pentioned property for inspection purposes.
Date: Signature (Applicant or Age( t):
Twit
VOICE (760) 777-7125
78-495 CALLE TAMPICO
D
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253
COMMUNITY DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 8/27/2015
Application Number:
BCOM2015-0044
Owner:
Property Address:
46520 WASHINGTON
ST STE 3
WASHINGTON 111 LTD
APN:
643020060
80618 DECLARATION AVE
Application Description:
HENDERSON / MY THAI/ COUNTERS ELECTRICAL AND WATER !
INDIO, CA 92253
Property Zoning:
Application Valuation:
$12,000.00
Applicant: U.27
I I Contractor:
GABRIEL LUJAN C U TENANT :DAVID HENDERSON
36947 COOK ST STE 104 Z 15 46520 WASHINGTON STE 3
PALM DESERT, CA 92211 LA QUINTA, CA 92253
LAOUw7AOPME9T DEPARTMENT (760)333-4535
Llc. No.:
LICENSED CONTRACTOR'S 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 Professions Code,
and my License is in full force and effect.
License Class: _ License No.:
Date:
Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair
any structure, prior to its issuance, also requires the applicant for the permit to file a
signed statement that he or she is licensed pursuant to the provisions of the
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Divisio 3
of the Business and Professions Code) or that he or she is exempt therefrom and the
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for
permit subjects the applicant to a civil penalty of not more than five 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, Business and Professions Code: The Contractors' State License Law does not
apply to an owner of property who builds or improves thereon, and who does the work
himself or herself through his or her own employees, provided that the 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 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 am exempt under Sec. P.C. for this r ason
rDa�o� I Owne
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 Na
Lender's
. 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 and policy number are:
Carrier: _ Policy Number: _
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 agreeth if I should beco ne subject to the
workers' compensation provisions of Se ion 37 0 of th ab r ode, ha
mll forthwith
comply with those provisions.
1
r �( 1—I
Date: l) Q f Applicant.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($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.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official 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, indemnify 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. . j
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 county ordinances an tate laws relating to building
construction, and hereby authorize representatives of is ci to a ter u n the ove-
�pentioned property for inspection purposes.
Date: Signature (Applicant or Age( t):
Fl NANCIAL NFORMATION
rvs > c_DESCRIPTION : B :: ACCOUNT r iQTY x AMOUNT * * PAID
=PAID*DATE
w x_, a
BSAS SB1473 FEE
101-0000-20306
0
$1.00 $0.00
wig 4 PAID".BY ':
` rrxR. METHOD=
RECEIPT#� S CHECK# '"
CLTDBY'�w'
n.z
f Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
3
' ' DESCRIPTION s
• ACCOUNTS �F
=QTYg
# �. AMOUNT
o"
PAID z'
PAID DATE
x , ,:�
FIXTURES, FIRST 20
101-0000-42403
1
$24.17
$0.00
: "> a
r,: METHOD s
RECEIPT #
'CHECK #,,'. t
CLTD BY;
,PAIDrBY6
y r Y"• ., ... ..
, .. ,-. ., .::. -a. „ r.S: ,<
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»:
"'DESCRIPTION ��,i
t . ACCOt NTsI
,
Q TY*
`AMOUNT $:
`� PAID
PAID DATE
,
x
FIXTURES, FIRST 20 PC
101-0000-42600
1
$24.17
$0.00
RECEIPT #
CHECK # {'
CLTD BY,
c
Total Paid for ELECTRICAL: ' $48.34 $0.00
DESCRIPTION
c4 ACCOUNT ' °;
CITY
[;;mss yA1MOUNT�'PAID,
<;•
PAID DATE
a"
APPLIANCE REPAIR/ALTERATION
101-0000-42402
0
$12.09
$0.00
"PAID:BY u'.
fir METHOD 7,
RECEIPT# a of
zs':. CHECK#
CLTD BY
E
x ,"
z;
,
DE RIP xz
" ACCOUNTS`s t
QTY
�AMOUNTp
PAID s *
PAID DATE
p r
APPLIANCE REPAIR/ALTERATION PC
101-0000-42600
0
$4.83
$0.00 .
`PAID BY '
i.METHOD
"* RECEIPT #�,
CHECK #x "
y CLTD BY
,
.
Total Paid forMECHANICAL: $16.92 $0.00
DESCRIPTION'
` ACCOUNT
'QTY
@'xq AINIOUNTs "
;PAID.}
PAID DATE
�,
FIXTURE/TRAP
101-0000-42401
0
$12.09
$0.00
' t SPAID:BY
METHODf
! r�r °RECEIPT #
CHECK #sCLTD
BYt
_At,Y
,`j ,�
av
ACCOUNT' x,
:'AMOUNTr�
PAID
PAID DATE
CITY
,
FIXTURE/TRAP
101-0000-42401
0
$12.09
$0.00
17
RECEIPT # ' ,� s
"<,. 'CHECK # #,
•° CLTD BY.
f,..
�i*`>DESCRIPTION'„�r”
''ACCOUNT r.i
QTY
PAID `t"
PAID DATE
rtsy��
Q&AMOUNT'yF
k
FIXTURE/TRAP.
101-0000-42401
0
$12.09
$0.00
METHOD ` `
;;s fRECEIQT # ' '
`CHECK #
CLTD BY
* DESCRIPTION ,z
a' ACCOUNT
;<
AMOUNT >'1:-
PAID
PAID DATE.
.sGQTY
FIXTURE/TRAP PC
101-0000-42600
0
$12.09
$0.00
PAID BY L ...
; : METHOD za"cA z
w E RECEIPT # "`
CHECK #
CLTD BY
DESCRIPTION''
x; ACCOUNT
PAID DATE'.
FIXTURE/TRAP PC
101-0000-42600
0
$12.09
$0.00
BYE
METHOD
-RECEIPT # s
t CHECK #
:CLTD BY '
}PAID
`•'DESCRIPTION'
r ACCOUNTS rt
CITY
�' AMOUNT
° SPAIDF�
`
'PAID DATE,
a :,:.
:.
FIXTURE/TRAP PC
101-0000-42600
0
$12.09
$0.00
'S k
'•RECEIPT #�;
F CHECK #
CL TD BYE,`
r
��METHOD .t
_
Total Paid for PLUMBING FEES: $72.54 $0.00
xYt DESCRIPTION
�a ACCOUNT'QTY
MOUNATr
� '
PAIDDATE
REMODEL, EA ADDITIONAL 500 SF
101-0000-42400
0
$108.75
$0.00
"PAID'BY�=g�
x , METHOD';",?
#:'
#CLTD
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a
I.fRECEIPT , : r.„_.:
tCHECK
$.DESCRIPTION
ACCOUNT {+;'
QTY
E �, AMOII'NTm `-
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,PAID DATE
Vis- a .,.:.
,
.. . -- ..{ rcix ti.
.�. :...:.'
•..x ..., . t eah,
.
t �:
REMODEL., EA ADDITIONAL 500 SF PC
101-0000-42600
0
$87.00
$0.00
;a ' ° ry PAID BY7 `e
r x
a== METHOD
RECEIPT #
CHECK #
CLTD BY
e i g
,
, ,
w *';DESCRIPTION
° ACCOUNTk}tAMOUNT
`
PAIDki, #
PAID DATE.
1E
$ ,;,
REMODEL, FIRST 100 SF
101-0000-42400
0
$49.31
$0.00
x.
L'ta t,
42 PAID BY
p1 t ? +fka t C M1 �
METHOD.
K 6
TRECEIPT # _'
tLL :r
CHECK #
,o .. -
' CLTD BY '.
M y
; , ,..0 _.
t DESCRIPTION"=h E u 4FACCOUNTr
i
QTY
AMOUNT
` PAID
PAID'DATE
ti
REMODEL, FIRST 500 SF PC
101-0000-42600
0
$134.88
$0.00
r r PAIDBY
METHOD, r
RECEIPTa#
4 CHECK# `1.
CLTD BY,
ES r"�sgwr
agi
Total Paid for REMODEL: $379.94 $0.00
TOTALS:00
f
Description: HENDERSON / MY THAI / COUNTERS ELECTRICAL AND WATER
Type: BUILDING, COMMERCIAL
Subtype: REMODEL Status: APPROVED -CONDITIONS
Applied: 8/10/2015 SKH
Approved: 8/18/2015 JJO
Parcel No: 643020060 Site Address: 46520 WASHINGTON ST STE 3 LA QUINTA,CA 92253
Subdivision: PM 32683-3 AMEND
Block: Lot: 3
Issued:
Lot Sq Ft: 0
Building Sq Ft 0 Zoning: ;
Finaled:
Valuation: $12,000.00
Occupancy Type: r ` Construction Type: -
Expired: {
No. Buildings: 0
No. Stories: 0No. Unites: 0 -
Details: RE -OPENING AN EXISTING RESTURANT PAINTING WALL REPLACING COUNTER PUTTING BACK IN. APPROVED PER JJ.
8
n
_ .. - ` , �pplied to Approved ss a r
Printed: Thursday, August 27, 2015 8:50:09 AM 1 of 4mw
SYSTEMS
ADD •
..CHRONOLOGY
" ;CHRONOLOGY TYPE=;
N
• STAFF NAME
`: ACTION"DATE COMPLETION DATE
,-, NOTES x� '
._
,�
h.
Ek„
DAVID HENDERSON 760-333-4535 TENANT OF "MY THAI"
NOTE
PHILIP JUAREZ
8/27/2015
8/27/2015
CAME_ IN AN BROUGHT NECESSARY DOCUMENTS TO ISSUE
3
PERMIT APPROVED PER JJ.
PLAN CHECK'SUBMITTAL
STEPHANIE KHATAMI
8/10/2015
8/10/2015
RECEIVED
JJ EXPLAINED TO TENANT NEED HEALTH DEPARTMENT
PUBLIC COUNTER VISIT
PHILIP JUAREZ
8/21/2015
8/21/2015
APPROVAL LANDLORD- RENTAL AGREEMENT.SUBLIST OR
OWNER BUILDER FORM.
TENANT OF NEW PROJECT MR. HENDERSON CAME IN AGAIN
AND ONLY WANTED TO SPEAK TO JIM JOHNSON IN REGARDS
TO HIS PROJECT SO I CALLED JIM UP TO COUNTER FOR
PUBLIC COUNTER VISIT
PHILIP JUAREZ
8/25/2015
8/25/2015
ASSISTANCE. JIM GAVE HIM ALL INFORMATION AGAIN AS TO
J
WHAT HE NEEDED FOR ISSUANCE OF PERMIT.
Printed: Thursday, August 27, 2015 8:50:09 AM 1 of 4mw
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-
THE PLANS SUBMITTED ARE MISSING SHEET A2 AND REVIEW
TELEPHONE CALL
I -
8/14/2015
8/14/2015
tu
QTY
.
.r, N
.PAIDDATE
FLOOR PLAN, REQUESTED SHEETS TODAY IF HE WOULD LIKE
.,CHECK#:'
METHOD
��» ' PAIDBY�Kr
THE REVIEW TO BE COMPLETED TODAY.
n
'.}
f5`°.��
.
CALLED GABRIEL LUJAN TO INFORM HIM PLANS ARE READY
4 , �. ra .
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Printed: Thursday, August 27, 2015 8:50:09 AM 2 of 4
' SYSTEMS
LEFT MESSAGE FOR GABRIEL LUJAN TO INFORM HIM THAT
THE PLANS SUBMITTED ARE MISSING SHEET A2 AND REVIEW
TELEPHONE CALL
AJ ORTEGA
8/14/2015
8/14/2015
COULD NOT BE COMPLETED WITHOUT THE ARCHITECTURAL
QTY
AMOUNT; .I'
;PAID
.PAIDDATE
FLOOR PLAN, REQUESTED SHEETS TODAY IF HE WOULD LIKE
.,CHECK#:'
METHOD
��» ' PAIDBY�Kr
THE REVIEW TO BE COMPLETED TODAY.
CALLED GABRIEL LUJAN TO INFORM HIM PLANS ARE READY
TELEPHONE CALL
JIM JOHNSON
8/18/2015
8/18/2015
BSAS SB1473 FEE
101-0000-20306
0
$1.00
TO ISSUE.
�..,
^1uu�i times .mmnrmm.m nrd „owu+ural: ne di dn,(M:.:q _ `- • •
1,:f7ku+YWu.YfwLrOi 4F n iunl nrua r6M ei ,eiy+ a s Yui µ
= -. .. "
r v.. vuew .fYwwWWrurllWpni,d!e!i iL
$1.00 $0.00
,�<_'
FIXTURES, FIRST 20
`•DA_TE�DATE
1
$24.17
$0.00
<CONDITION
s CONTACT,`��;
DATE ADDED
'
s.+
STATUS<�
_ REMARKS'° ,-'<NOTES� �s
_ TYPE-
1
v ;:;
REQUIRED
SATISFIED
READY TO ISSUE
Total Paid forELECTRICAL:r $48.34 $0.00 "
y
8/18/2015
PENDING
NEED FIRE AND HEALTH DEPT APPROVAL
CHECKLIST
n.p•n
a<' nNC W9mmOmwv, RW&'ydWf 4b'MP 1A 1 l9P AIi li41 f:Rn oa.". ux> y; .., m ...mm mgr • � ,y or, 'y •n .. .i u�•�} i W b
!AM �l iP PA,?fl T1b4NP�1VI�DlW' y..l fir,•• 4 T.m „�'V 'M'JptlP84°! .,R 1 9 b! 'd�l �' W A fl'PI f.':IfV ni 'f M. d'� 'dry v .l'', V^"..
�e_NAMEaTYPE
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.'=,;;xNAME::` f
,.. ..._ •:.... +e.:.tiy X• E
ADDRESSl-
''35P-. _ ,�
CITY
-
STATE
- _
ZIPS
PHONE;
FAX'
a-Yc:. •.2-,r
111AAll
,_ M _"t.
_
,
g
APPLICANT
GABRIEL LUJAN
36947 COOK ST STE 104
PALM DESERT
CA
92211
(760)333-4535
CONTRACTOR
TENANT :DAVID HENDERSON :
46520 WASHINGTON
" LA QUINTA
CA
92253
(760)333-4535
STE 3
. . ,..
OWNER, -
WASHINGTON 111 LTD
80618 DECLARATION
INDIO
CA
92253
(760)333-4535
AVE
,TENANT
DAVID HENDERSON
46500 WASHINGTON
-.LA QUINTA
CA
.92253
(760)333-4535
STE 3
Printed: Thursday, August 27, 2015 8:50:09 AM 2 of 4
' SYSTEMS
ACL
'DESCRIPTION
•"ACCOUNT n�:
QTY
AMOUNT; .I'
;PAID
.PAIDDATE
',RECEIPT#
.,CHECK#:'
METHOD
��» ' PAIDBY�Kr
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION
$1.00 $0.00
BSA:
FIXTURES, FIRST 20
101-0000-42403
1
$24.17
$0.00
FIXTURES, FIRST 20 PC
101-0000-42600
1
$24.17
$0.00
Total Paid forELECTRICAL:r $48.34 $0.00 "
Printed: Thursday, August 27, 2015 8:50:09 AM 2 of 4
' SYSTEMS
v
k•:.;.
cry '° " �8. +x
--�-r
77 7
z
ys"'�.".�
a
j'
777777777
'METHOD:-
e y
L
TD C'P
ACCOUNT;x^
we .r
QTY
-4'AMOUNT
A
�-,-AIDESCRIPTION D BY
Y• -
APPLIANCE
101-0000-42402
0
$12.09
$0.00
REPAIR/ALTERATION
APPLIANCE
101-0000-42600
0
$4.83
$0.00
REPAIR/ALTERATION PCI
Total Paid for MECHANICAL• $16.92 $0.00 _
FIXTURE/TRAP'
101-0000-42401
0
$12.09
$0.00
FIXTURE/TRAP .
101-0000-42401
0-
$12.09'
$0.00
FIXTURE/TRAP
101-0000-42401
0
$12.09
$0.00
_
FIXTURE/TRAP PC
101-0000-42600
0
$12.09
$0.00
FIXTURE/TRAP PC
101-0000-42600
0
$12.09
$0.00
FIXTURE/TRAP PC
101-0000-42600
0
$12.09'
$0.00
"
Total Paid for PLUMBING FEES: $72.54 $0.00
REMODEL,EA
101-0000-42400
0
$108:75
-$0.00
ADDITIONAL 5000 SF
-
REMODEL, EA
101-0000-42600
0
$87.00
$0.00
ADDITIONAL 500 SF PC
-
REMODEL, FIRST 100 SF
101-0000-42400
0
$49.31.
$0.00
REMODEL, FIRST 500 SF
101-0000-42600
0
$134.88
$0.00
_
PC
Total Paid for REMODEL: $379.94 $0.00
L"
Printed: Thursday, August 27, 2015 8:50:09 AM 3 of 4
srsreMs
TQTALS
L"
Printed: Thursday, August 27, 2015 8:50:09 AM 3 of 4
srsreMs
NON' -STRUCTURAL - I JIM JOHNSON 18/10/2015 I 8/17/2015 18/18/2015 I APPROVED
JOB ADDRESS_ 3
•CITY. OF LA •QUINTA..SUB- ONTRACTOR LIST .. _
PERMIT. NUMBER i -GO NER __ BUILDER 0U)sJe� Q
This form shall be posted on the joWwith the Building
Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved .by the Building Division prior to commencement of work. Failure to comply will result in .a stoppage of work and/or the. voidance.
of building permit. For each applicable trade, all information requested below must be completed by, applicant. "On File" is not an acceptable. response..
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License Number
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City of La Quinta
Building iii Safety Division
P.O. Box 1504, 78-495 Calle Tampico
0044 La Quinta, CA 92253 - (760) 777-7012
_ Building Permit Application and Tracking Sheet
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Project Address: F-itg.SZ�j 5
Owner's Name:
A. P. Number.
Address:
Legal Description:
City, ST, Zip:
Contractor
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Telephone:ZpO'• 3 a y t'"f�'srsz':
Address:
Project Description:
City, ST, Zip: . '
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Telephone:
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State Lic. # :
City Lie. #:
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Arch., Engr., ig rer. n qql N \ V.•
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Address:
City, ST, Zip: �1{'
Telephone:c . P{`wf�s
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Lic.
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Construction Type: v , Occupancy:
Projecctype (circle one): New Add'n Alter a air Demo
Name of Contact Person: t n
Sq. Ft.: q�a
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# Units:
Telephone # of Contact Person: -7(G ^ "a"
tstimatedValueof Project: r
APPLICANT: DO NOT WRITE BELOW THIS LINE
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Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Cheek submitted
Item
Amount
Slructural'Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cafes.
C211ed Contact Person
Plan Check Balance
Title 24 Cafes:
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
P' Review, ready for correUi srssue
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Electrial
Subeontaetor list
Called Contact Person
'Plumwg
Gran(Deed
Plans picked up
S:M.I.
II.O.A. Approval
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IN IIOUSE:-
' Review; ready for correctionsfissue
,Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School.Fces
Total Permit Fees
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WASHINGTON III, LTD
30240 Rancho Viejo Road, Suite B . r 949.423.1234 Office
San Juan Capistrano, CA 92675 949.661.6971 FAX
August 24, 2015
t
City of La Quinta �T ,
Building and Safety Department
Regarding Owner Occupancy Permit = My Thai 46-520 Washington Street
•
Dear Building and Safety Official,
We hereby allow David Henderson of My Thai Restaurant to act under Owner
Occupancy to do basic cosmetic upgrades to the property. A licensed and approved
contractor for such things like HVAC, Fire Hood, Fire Ansul, Electrical and Plumbing must
perform all upgrades. -
Mr. Henderson must make his contractor list available to the City of La Quinta and
Washington -111, LTD.
Thank you
Bill Sanchez.
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