04-3596 (RC)a
o wr
BUILDING& SAFETY DEPARTMENT'
c - P.O. BoX 1504 (760).7774012
78-495 CALLE TAM.PICO FAX (760) 777-7011.
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-.7153
.'BUILDING PERMIT
Application Number 04-00003596 Date 5/11/04
Property Address. 47150 WASHINGTON ST SUITE A
APN:
643 -200 -,0267 -
Tenant nbr, name A LOUISE11S PANTRY.
Application description REMODEL - .COMMERCIAL
Property Zoning COMMUNITY COMMERCIAL
Application valuation ,82'000
Owner' Contractor.
DR KOURI CONSTRUCTION DESIGN SYSTEMS, I'
1 REGENCY ,LANE 78401. HIGHWAY 111, SUITE F=2..
RANCHO. MIRAGE CA 92270. LA QUINTA CA 92253 '
('760) 771-3593
'WCC:- ' STATE FUND
1709,785-03 02/01,/05,
CSLB: ..767086 08/3.1/05
CCC:. B� HIC A
--=------------------ Structure Information ----=----------=---------
• .Const=ruction Type TYPE V - 1 -HR
Occupancy Type . . . . . . ASSY BLDG <300 NO STAGE,
Flood Zone . . NON-AO.FLOOD ZONE
Other st.ruct info CODE 'EDITION 2.001
FIRE SPRINKLERS YES
_ MIXED-USE OCCUPANCY A3
OCCUPANT - LOAD, 0 0
"`FIRS.T FLOOR SQ FTG 3283.00
Permit . . . ... BUILDING PERMIT.
Additional desc :
Permit Fee 558.50 Plan Check Fee 363.03
Issue Date Valuation' 82000
Qty Unit Charge Per Extension
`BASE FEE 414-.50.
32.00 4.5000 THOU BLDG 50,001-100,000 144.00
7 -77 --
'Permit. . . . MECHANICAL
Additional desc .
Permit Fee 187_.50 Plan Check Fee 75,00
Issue Date . . . . Valuation 0
Qty Unit Charge Per Extension
BASE FEE 15.00
P.O. BOX 1504
VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Applicant's Mailing Address: .
Date:
Architect or Engineer:
Architect or Engineer's Address:
Lic. No..
BUILDINr pGaMIT DECLARATIONS
CENSED CONTRACTOR'S D TION
1 hereby affirm under penalty of perjury that I am li nsed un provisions of Chapter 9 (commencing Section 7000) of Division 3 of the Business and Professionals •.
Code, and my License is j�full force and effect. 7
*007G7 4
License Class_ rise No.
Date Contractor
�1�OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 am exempt P m Contractors' 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, im ve, d fish, 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 piovisio a Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 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 a permit subjects
the applicant to a civil penalty of not more than five hundred dollars ($500).):
U 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 safe (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 or through his or her own employees, provided that the improvements are not intended or offered for safe. 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 d'rd not build or improve for the purpose of sale.).
U I, as owner ofthe 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.).
(--) 1 am exempt under Sec. , BA P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
_ I have and will maintain a certificate of consent to self4nsure for workers' compensation, as provided for by Section 3700 of the Labor Code, for Vie performance
of the work for which this pernit is issued.
_ I have and will maintain workers' compen insurance; permitas required by Section 3700 of the Labor Code, for the performance of the work for which thispermitis
i o ensation ins
Cart&ier po r ,� G
_ I cerbfy at in —
performance of the ork or which this permit is issued. -I sha not a any person In any manner so as to become subject to the workers'
compensation laws of California, an a that, if I should become subject to the worke 'compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisio
Date Applicant
WARNING: FAILURE TO SECURE WORKERS' C SATION COVERAGE IS WFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND D ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ORNEY'S FEES.
1 hereby affirm under pens of CONSTRUCTION LENDING AGENCY
penalty rj 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 Name
Lenders Address
IMPORTANT Application hereby made to the Director of BuildingAPPLICANT SCKNOWLEDGEMENT
1.. Each person upon whose behalf this PP Safety Apermit subject to the conditions and restrictions set forth on this application.
s a lication 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 a a t agre nd shall, defend, indemnity and hold harmless the City of La Ouinta, Its
officers, agents and employees for any act or omissi ted to the work being pe d under or following issuance of this permit.
2. Any permit issued as a result of this application ull and void if work is not menoed within 180 days from date of issuance of such permit, or
cessation of work for 180 days will subject peri to Ilation.
I certify that I have read this application and state that the a ve f rmation is correct. I agree comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this co n enter upon the a boned property for inspection purposes.
Date l" Signature (Applicant or Agent): _��
ca 6of.Occanany
0000f
<OOPOYA7FD w R , - M `..+' t a 1/ y+•. n` �.
AM -
of � A 'Building &-:Safety Department ;
�
C
This ;Certificate 'is issued-pursuant'to the requirements of Section'. 109`'of the CaliforniaBuilding ,
Code,• tcertifying� that,, ,at the time of issuance, l''this " structure -was jin ..compliance ''"with the -
;provisions of the Building "Code -,and the various' ordinances t of .,the `City regulating building
construction and/or use.
'BUILDING ADDRESS. -47-150 Washington Street Suite A
a _ry
`+ C
G Use classificatior : Commercial Restaurant "Loulse's Pantry" TI "Building;Permit'No:: 04-3596':
4
Occu anc Grou A3 - T e of Construction: VN Sprinkled Land UseZone: CR'
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Owner of Building: Dr. Kouri a _ Address.,1f"Regency Laney V
,• ,
y r. 1 ,� ' .� t .l � `• �._`. � r-- '•J
4 •1 it City, ST; ZIP. Rancho Mirage, CA 92270•' '
_
By: Daniel P:'Crawford Jr'..,
• _ ' j �' `Date:, 3/25/05
.lY
- Building Official
'POST IN A CONSPICUOUS' PLACE'