9612-049 (RC)U)
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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
Icense Law for the following reason:
I, as owner of the property, or my employees with wages as their sole
cofhpensation, 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.Ifor this reason
Date �" `/ r� % Signature of Owner l
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).
XI 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 s.hallffortl�with comply with those provisions'
Date: ., ., l Applicant—
Warning:
pplicant 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
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) + t, ;l.JL? Cir: a Date,
BUILDINGPERMIT PERMIT Jt
CONTROL%/
96124149
4443
DATE 1,21 "6 VALUATION S�Y,'�30,0j) LOT- TRACT
JOBSITE
ADDRESS 78.105 CA LL E IMADO
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
JUAN is Rc YOl.,f KN 11k PM t 4
OWN EP,i 9U
S2tA1 AVC:NIDA R4i±;NDi: ZA.
l .fi. QG. INI-A 92251
USE OF PERMIT
I NANT UWROVt_NffiNT -. C'ONVO R 11ASU SPACE TO BAKERY
V ALUA1'.MAN 2,500.11)0 LS
�.i�'�.t�►��i��.�� .�.ga•�.�.�� w--a3i�gi�i .�i.�i~�i��'��r
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PLAN C."f-[F;CK F1?11 1131-(it1C1-d:z�a�:71t3 $3S.'[0�
{°f?AT y"17ti14,;'1'1SJf�i FEE $. , 0)
160.1-M[C.AE.. FEE -
EE
L N,`, V1 fCAL.F
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to
PLLF IBTAtGFEE 101-000-419-000 $ t.5{i
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r,r1JQN(3 M0TT3[�d lrli.E -1`� i M l004)[)0-241 ) $,52
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oa
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s[.Ifs x,y'i tl, cow sTR.ucr!ON -At P!..,kN C'H r!, k
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$170.82
ESS P1,11',PAJD FTMS
$0.00
"ff4'i'M, :f'C.YZiAUT F rUt-8 !D!UENOW
$170.82
RECEIPT
DATE
BY
DATE FINALED
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 —
POOLS - SPAS
BLOCKWALL APPROVALS
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
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final / —
Utility Notice (Perm)
Bin:;
.
City of .La ,Quanta
Building 81 Safe hDiv' ton
P.O. Box 1504
-495 Calle Tampico
co7
La Quinta,.CA 92253
Building Permit Application and Tracking Sheet
Project Address: — l O S C (t I P S 1 4
( C,>
Owner's Name:... Ct U 1'P
A. P. Number:
Address:. = Q -y elid o •Z c,—
Legal Description:
City,ST, Zip: " S
Contractor:
• l c �/
n
/JlJ l� ✓
Telephone:
Address:
Project Description:
04
City,ST, Zip:
ne:
.Telephone:
o
IOU v 1
State Lic. # :
City Lic. #:
Arch.. Engr., Designer:
Address:
City. ST. Zip:
-
Telephone: e
Construction Type: e: Occu Panc :
N
Lic#
Project type (circle
one): New Add'n Alter Repair DemoState
Name of Contact Person:
Sq. Ft.
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: Pz. O 0 ' 00 •
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
:ST FL. SO FT $
UNITS
SLAB GRADE
ROUGH PLUMB,
BONDING
YARD SPKLR SYSTEM,g
2ND FL. SO. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOSILEHOME SVC.
BAP SINK
POR. SO. FT QTc
GAS (ROUGH)
METER LOOP
GAR SO. FT. qt
POWER OUTLET
ROOF DRAINS
CAR P I j0. FTt
TEMP. POLE
DRAINAGE PIPING
WALL SO FT ':t
GROUT
DRINKING FOUNTAIN
SO CT. T
FINAL INS'.
URINAL
ESTIMATED CONSTRUCTION VALUATION L
WATER SYSTEM
WATER PIPING
NOTE: Not to to useu as ;Irooeny :ax a!ualion
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L :FOOD
SIGN
WASHER(AUTOIIOISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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.
SO. FT. ,&. c
BATH TUB
GAR. FIREWALL
SO. FT. ;p c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SU. FT. RESID 0 1?4 c
SEWAGE DISPOSAL
SO.FT.GAR 0 >.c
HOUSE SEWER.
GAS PIPING.
FEE
PERMIT FEE
PERMIT FEE
ET
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING A AIR COMO. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL AREA
SLAB GRADE
ROUGH PLUMB,
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL;
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER (I
SERVICE
FINAL INS'.
BOND BEAM
WATER SYSTEM
GRADING.
CU. A
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REM"R&
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC,
FFNCF FINAL
INSIWECTORi >SIGNATu11ESINITIALs
GARDEN WALL FINAL
I,q11r
`9
e.4—
d. �a. RIVERSIDE COUNTY
'COUNTY
f FIRE DEPARTMENT
RIVERSIDE HA
J. M. HARRIS 210 WEST SAN JACINTO AVENUE • PERRIS, CALIFORNIA 92570 • (909) 940-6900
FIRE CHIEF
November 25, 1996
COU NTY
La Quinta Bakery DEPAR
78-105 Calle Estado
La Quinta, CA FIRE P
Subject conditon
TENANT IMPROVEMNT PLAN CHECK
You have been issued a release for a tenant improvemnt on an existing building. THIS IS NOT AN L—
OCCUPANCY PERMIT. Prior to opening your business, you must contact the Fire Department Planning t
Engineering office to schedule an appointment for a Fire Safety Inspection. You must be present at time of
inspection.
THE FOLLOWING CONDITIONS MUST BE MET PRIOR TO OCCUPANCY:
Install Knox Lock Boxes, Models 4400, 3200 or 1300, mounted Per recommended standard of the Knox
company. Plans must be submitted to the Fire Department for approval of mounting location/position
and operating standards. Special forms are available from this office for the ordering of the Key Lock
Boxes. This form must be authorized and signed by this office for the correctly coded system to be
purchased. If the building/facility is protected with a fire alarm system or burglar alarm system, the lock
boxes Neill require "tamper" monitoring.
2. Any modification of the Fire Sprinkler system must be done by a licensed sprinkler company, with plans
approved by the Fire Department.
3. A minimum 2A I OBC Fire Extinguisher, (State Fire Marshal Approved) must be mounted in a visible
location within 75' walking distance from any point in your building or suite. Fire extinguishers can be
installed by a licensed extinguisher company Nvith a State Fire Marshal service tag attached to the
extinguisher, or purchased from a retail store Nvith a sales receipt attached. Extinguisher must be serviced
yearly by a licensed fire extinguisher company.
4. Approved building address shall be placed in such a position a to be plain])' visible and legible from the
street. Said numbers shall contrast with their background.
5. A durable sign statin; "This door to remain unlocked durin, business hours" shn.11. be platted on or
adjacent. to the tiont exit doors. The sign shall be in letters,not less than one iF , i tiigh on a contrasting
background.
r
FIRE PREVENTION DIVISION
Q RIVERSIDE OFFICE PLANNING SECTION d'1`NDiO OFFICE
3760 12th Street, Riverside, CA 92501 46.209 Oasis Street, Rm. 209, Indio, CA 92201
(909) 275.4777 • FAX (909) 3697451 (619) 863.8886 • FAX (619) 863.7072
printed on recycled paper
'w
Please contact the Fire Department Planning & Engineering Staff for final inspection prior to occupancy.
Applicant/installer shall be responsible to contact the Fire Department to schedule inspections. A
reinspection fee will be required if more than one (1) inspection is necessary. Requests for inspections are
to be made at least 24 hours in advance and may be arranged by calling (619) 863-8886:
All questions regarding the meaning of these conditions should be referred to the Fire Department Planning
& Engineering staff at (619) 863-8886.
JP/th
V
Sincerely,
RAY REGIS
Chief Fire Dep ent Planner
By l
Tom Hutchison /
Fire Safety Specialist
-2-
ATTACHMENT III
PrOVidP..m.,akp_up air in
accordance to the Uniform
Mechanical Code, Chapter 20.
ATTACHMENT III
MECHANICAL EXHAUST VENTILATION SYSTEM PLAN CHECK DATA
1. .Submit three (3) sets of front and side elevations for each system with exhaust and make-up
air duct details.
2. Submit a separate data sheet for each hood within the establishment.
Identify each hood by*number. .
3. For clarification of requirements, refer to the Uniform Mechanical Code, Chapter 20,
"Commercial Hoods and Kitchen Ventilation."
*HOOD: (Check: applicable categories)
Type T Type El `ff
Canopy '�� Compensating!N,)¢3 Non -canopy
U.L. Listed Urease Extractor: Other (Describe)
SIZE: Length _ ft. X width �j ft. (inside dimensions) 1 ��
Distance from lip of ho to: Cooking surface in.; floor G iti.
Hf £ l_ S �� E „&C�v.rv.
Formula used for determining air flow: Q = ! e d_ or
Alternate formula =
Total CFM = �L
*Provide six (6) inch over ang beyond cooking equipment on all open sides.
FA 1J S i2_ C-5- 4b --&M I « � ; (I (k /\n l n Q_ N'` �� 0
NOTE: No exposed horizontal piping within the hood canopy.
EXHAUST DUCT:
Duct size 1. - 1,P
Square feet of duct are A-4 ..
Number of ducts_ (I) outlet per 12 feet or fraction thereof
Exhaust duct velocity -FPM (CFM divided by sq. ft. of duct)
;-)
GREASE FILTERS or EXTRACTORS:
Ra ' FM
Dimers X -------- in./
Fu onal suz area per filter:
Number of filters to be used:
MAKE-UP AIR:
CFM's_-: ,DSO
Electrical interlocking switch with exhaust fan
N1 -
77.
=:
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.:
ATTACHMENT III
MECHANICAL EXHAUST VENTILATION SYSTEM PLAN CHECK DATA
1. .Submit three (3) sets of front and side elevations for each system with exhaust and make-up
air duct details.
2. Submit a separate data sheet for each hood within the establishment.
Identify each hood by*number. .
3. For clarification of requirements, refer to the Uniform Mechanical Code, Chapter 20,
"Commercial Hoods and Kitchen Ventilation."
*HOOD: (Check: applicable categories)
Type T Type El `ff
Canopy '�� Compensating!N,)¢3 Non -canopy
U.L. Listed Urease Extractor: Other (Describe)
SIZE: Length _ ft. X width �j ft. (inside dimensions) 1 ��
Distance from lip of ho to: Cooking surface in.; floor G iti.
Hf £ l_ S �� E „&C�v.rv.
Formula used for determining air flow: Q = ! e d_ or
Alternate formula =
Total CFM = �L
*Provide six (6) inch over ang beyond cooking equipment on all open sides.
FA 1J S i2_ C-5- 4b --&M I « � ; (I (k /\n l n Q_ N'` �� 0
NOTE: No exposed horizontal piping within the hood canopy.
EXHAUST DUCT:
Duct size 1. - 1,P
Square feet of duct are A-4 ..
Number of ducts_ (I) outlet per 12 feet or fraction thereof
Exhaust duct velocity -FPM (CFM divided by sq. ft. of duct)
;-)
GREASE FILTERS or EXTRACTORS:
Ra ' FM
Dimers X -------- in./
Fu onal suz area per filter:
Number of filters to be used:
MAKE-UP AIR:
CFM's_-: ,DSO
Electrical interlocking switch with exhaust fan
N1 -
i'
COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY
DEPARTMENT OF ENVIRONMENTAL HEALTH
ENVIRONMENTAL HEALTH SERVICES
SUPPLEMENTAL REPORT TO SAN. FORM # DATE / 12-
SUBJECT
(A trtl4n< f5f", t p'r^. ��a : rr ��. fin PERMIT NO.
ADDRESS 7�� P) r�� Cca Of F r•II a i f A ti.1� TX LC/ O U I In�q_
INSPECTOR
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REMARKS: l ! 1 Cce -i- ., r e -n ,� IM o llr.. rn'h �(' .r� f i,.0ac.,n; n0 .l l t�lnf,C �n k
o u V G ,
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DEH -SAN -118 (Rev 2/96)
Distribution: WHITE—Office; CANARY—Owner; PINK—Office
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DIST. # COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY
DEPARTMENT OF ENVIRONMENTAL HEALTH
PLAN CORRECTION
Plan Check # S 3 rop 0 Date 11104 &
DBA (Vu I c, Ra It e rc, Address -7 a
Plans Submitted by Phone
Owner Address Phone
The plans are now approved subject to thef conditions listed below and the attached compliance sheet.
-
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3
CONSTRUCTION INSPECTIONS: Contact the Plan Checker for a Preliminary Inspection when,construction is approx-
imately 80% complete, with plumbing, rough ventilation, and rough equipment installed. Request fr inspection should be
made at least five (5) working days in advance.
A FINAL INSPECTION MUST be made upon completion of ALL work including finished details. APPROVAL to operate shall
not be granted, or remodeled areas approved to operate, until the facility has passed the FINAL INSPECTION, and
"APPLICATION TO OPERATE" has been completed and PERMIT FEES have been paid.
Request for inspection should be made at leas five (5) working days in advance.
�o /
PLANS CHECKED BY (� �s Phone
I acknowledge the corrections noted herein and as indicated on the plans and agree to incorporate them during construction:
Signature
Company ��- 1 �� r '� �� i���O►+- L c,�(!��
Date
DOH-SAN-178(Rev1/92) W -OFFICE — Y -APPLICANT — P -BLDG. DEPT.
".;1 tr^
ASSESSOR'S PARCEL NUMBER
COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY 769
DEPARTMENT OF ENVIRONMENTAL HEALTH
PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM
APPLICANT: Submit this form with four copies of a SCALED plot plan (1-20 SCALE) drawn to County specifications as indicated on the attached check list.
A non-refundable filing fee is required when the application is submitted. Check must be made payable to the County -of Riverside. Approval of this applica-
tion shall remain valid for a period not to exceed one year from date of payment.
LOG #. L i Y Of LA iV:i/ml
Agent, fCpntractor, Contact Person
J/AA.'4 YOC4A/DA fif"-9
Address City State Zip
S.?-6VI /4VfAl/o,a *F44Ooz44 14a1w1ti,W (.4. 9Ja)!"
Z
0
Job PropertyAddr s -6ity
V-10 AC(f ErPAP 0 su/, 1,Ar, LA Qu,�✓7
Zip
U
N
Lot Size•
VW4
Use of Permit, P/P, SUP, PUP, etc. Legal Description
fw' Fe L.o7s 8y 9 Bck.9 jaEWr Cc a6 %Aa 7r 41*1
c@Af•NEf.t A«E
�rru rjr
reran 0; eft u n
Signatu� of A
{
Date
CHECOX IF REOUIR D
❑ HolTank Agreements Completed
❑ Detailed Contour Plot Plans Required (1 to 5 foot interval)
❑ Certification of Existing S.D. System Required
❑ Grading Handout Provided
m
❑ WCICB Clearance Required _
❑ Staff Specialist Lot Inspection Required
Z
O
(Attach For DOH -SAN -007, Santa Ana Region Only
❑ Lot Inspection _
U❑
Soils Percolation Report Required
`
W
❑_ Date Lot Inspection Completed: Initials
rn
❑ Special Feasibility Boring Report Required
«
_ ...
Remarks:
❑ Maintenance, Booklet Provided
Initials Date
❑ Final Inspection -by Department of Environmental Health is required.
C/42 / Soils Percolation Boring Report by �~ UglProjefct If ( Date
Soils Map Page Soil Type � ` Approved Date
of Systems
Tystem(s)
No. i?)rrbNh+9 Units Xrl )
optic Tank
Rate
Grensnd�__
d Hdding l O Replacement
4 New dditlon
Aii 77 k AlOWt
G ease •Igtcp/hin�ep
/�/A(� /[EQ"i...--.-.
_
4
ME Gal.
ExistingA{fr
_
a,
om Area
otal Linear
Side II Allowance"
ck/ sq. ft. running ft.
Of ap)1 @asi sq. It. of
(" /Ir ! F
Install s) ft. long ft.ietiv
Inlet Tested Depth ❑ NA
min. inc drainlines•or - \
U
'Proposed Bottom Tested De
_
s
Z
Leach line bed special design for slope:
( Pit Diameter
No. Pits
Pit Below Inlet (BI
Seepage Pit Maximum
Other:
O
al Depth llowable
Applicable7%th
W
N/A Overburden Factor
❑ 5' ❑ 6'
D
Well Review Approved: Date: Well Drilling Permit If
SIGNATURE—
Grading Plan Approved: Date:
SIGNATUR p 004 (4 F t t A j/A[ C FF.
Sewer Verification Approved: Litt. �_ �N-6 Date: �/ `T- no EXjSrlAk((
VrJtl
;
REMARKS:
� L!
This application Is'APPROVED D-eaFegoRy-otaeoked Ia SEC_T.ION B
FOR OFFICE USE ONLY
above, regarding the design of a subsurface disposal system as Indicated on the
acompanied plot plan, using the requirements set forth in SECTION C above. A build-
73 n
'73q
Ing permit is necessary for the installation of the above -designed system. No construc-
Revenue code t {$ Fee $
tion Is permitted in the required reserved 100% expansion area.
f
Septic Tank from
Check #
(1) must be 100' minimum any wells.
(2) Leach lines must be 100' minimum from any wells, including expansion area.
Date ! / Initial f
O
(3) Sewer lines must be 50' minimum from any wells.
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(4) Seepage pits must be 150' minimum from any wells, including expansion area.
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Signature Health Official
/of
Date
DOWSAN 122 (Rev 9193) Distribution: WHITE—Office File; YELLOW—Applicant; PINK—Bldg. Dept.; GOLDENROL—rlanslnecords
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Certificate of Occupanc,y
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: 78-105 CALLE ESTADO
Use Classification:
COMMERCIAL
9612-049
Bldg. Permit No.:.
Occupancy Group:
F1 Type of Construction:
VN Land Use Zone:
VC
Owner of Building: JAUAN C & YOLANDA PEREZ
Building Official
13
Address: 52-641 AVENIDA MENDOZA
City: LA QUINTA CA 92253
By: KIRK KIRKLAND
Date: 1-23-97
POST IN A CONSPICUOUS PLACE