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13-1102 (RC)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 13-00001102 Property Address: 79845 HIGHWAY 111 STE 104 APN: 600-020-034- - - Application description: REMODEL - COMMERCIAL Property Zoning: COMMERCIAL PARK Application valuation: 85000 Tii!t " 4 . BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Applicant: Architect or Engineer: Aw- ----------------- I LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that 1 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 Class: B // License No.:/9+�74735 Date: l d `f Contractor: �MAI� (ON4riLytC7/aN 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 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).: (_) 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.). (_ 1 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.). ( 1 I am exempt under Sec. , B.&P.C. for this reason Date: Owner: 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 Name: _ Lender's Address: LQPERMIT Owner: KOMAR INVESTMENTS 23 CORPORATE PLAZA NEWPORT BEACH, CA 92660 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 10/04/13 Contractor: IPCOCT KMACK CONSTRUCTION, INC. 950 ELM STREET ORANGE, CA 92867 0� 1013 (661)616-4659 +� Lic. No.: 974735 ----------------------------------------------- WORKER'S COMPENSATION DECLARATION 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 fpr 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 EXEMPT Policy Number EXEMPT ,�_Z 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 agree that, if I should become subject to the workers' compensation provisions of Section 700 of the Labor Code, I shall forthwith comply with those provisions. Date: Applica ti C e? /(trait' ma=y I-sx, A* -to% eK WARNING: FAILURE TO SECURE WO RS' MPENSATION 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 Director of Building and Safety 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. 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 and state laws relating to building construction, and hereby authorize representatives of this county t enter upon the above-mentioned property for inspection purposes. Date: Q y 3 Signature (Applicant or Agent): - Application Number . . . . . 13-00001102 Permit . . . ELECTRICAL 2013 Additional desc . Permit Fee . . . . 23.83 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 4/02/14 Qty Unit Charge Per Extension 1.00 ---------------------------------------------------------------------------- 23.8300 LS ELEC FIXTURES, FIRST 20 23.83 Permit . . . MECHANICAL 2013 Additional desc . . Permit Fee . . . . 35.76 Plan Check Fee'. .00 Issue Date . . . . Valuation 0 Expiration Date 4/02/14 Qty Unit Charge Per Extension 1.00' 11.9200 EA MECH APPL REP/ALT 11.92 2.00 ---------------------------------------------------------------------------- 11.9200 EA MECH VENT FAN 23.84 Permit . . . PLUMBING 2013 Additional desc . Permit Fee . . . . 11.92 Plan Check Fee .00 Issue Date . . . . Valuation 0 Expiration Date 4/02/14 Qty Unit Charge Per Extension 1.00 ---------------------------------------------------------------------------- 11.9200 EA PLBG WATER INST/ALT/REP 11.92 Permit . . . REMODEL 2013 Additional desc . Permit Fee . . . . 134.42 Plan Check Fee .00 " Issue Date . . . . Valuation . . . . 0 Expiration Date 4/02/14 Qty Unit Charge Per Extension - 1.00 48.6200 LS MISC REMODEL, 1ST 100 SF 48:62 4.00 21.4500 EA MISC REMODEL, ADDL 500 SF 85.80 ---------------------------------------------------------------------------- Special Notes and Comments INTERIOR REMODEL NEW FIXTURES COUNTERS, _ RELOCATE TRACT LIGHTING ,ICE BIN, FURNITURE. THIS PERMIT DOES NOT INCLUDE SIGNS WILL BE UNDER SEPERATE PRMIT. October 4, 2013 10:22:02 AM jjohnson. LQPERMIT Application Number . .'. . . 13-00001102 ---------------------------------------------------------------------------- Other Fees . . . . . . . . PLAN CHECK, ELECTRICAL 23.83 PLAN CHECK, REMODEL 201.63 PLAN CHECK,.MECHANICAL 14.31 PLAN CHECK, PLUMBING 11.92 STRONG MOTION (SMI) - COM 17.85 Fee summary Charged Paid ---------- Credited -------------------- Due ----------------- Permit Fee Total ---------- 205.93 .00 .00 205.93 Plan Check Total .00 .00 .00 .00 Other Fee Total 269.54 .00 .00 269.54 Grand Total 475.47 .00 .00 475.47 LQPERA1IT w ' Cj4w, Bin: # Qty. Of La Quin to Building a Safety Division P.O. Box 1504,78-495 Calle Tampico CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Perinit I�la.Quinta, ✓' l Project Address: Z S (� ; �Q Owner's Name:. OM�IL M i A. P. Number. Q -.- 00 1 Address: 2 0 T - Legal Description: City, ST, Zip:At • e c as Contractor:on Telephone:'K : < Address: Project Description: 2 Y r /v'r' City, ST, Zip: BK! ITt.r(—Oi%tv Telephone: �< < ctUt t;S Fun tU2Gl 4- P Af 69. - vit;E State Lic. # : City Lie'. M. �✓ —. Wt .S.Ag Jae 0 K AIT6n Arch., Bngr., Designer: ,A2L Tutt6 4" r f Wriit Address: i AGF I Ch City., ST, Zip: Telephone:: • •Y• ,.� <,.. ,.:, `c. Construction Type:.Occupancy: Project type (circle one): New Add'n. to Repair ' Demo State Lic. #: Name of Contact Person: at. " Sq. Ft : # Stories: # Units: Bir Lt Telephone # of Contact Person: 0� — TQ x Estimated Value of Project: �OQ APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Plan Sets Req'd Recd TRACKING Plan Check submitted PERMIT FEES Item Amount Strgctural Calcs. Reviewed, ready for corrections / Plan Check Deposit, . Truss Calcs. Called Contact Person Plan Check Balance Title 24 Cake. Plans picked up Construction Flood plain plan Plans resubmitted.'. Mechanical Grading plan 2" Review, ready for correcGous/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S,M.L MOA. Approval Plans resubmitted Grading IN ROUSE:- '^' Review, ready for corrections/issue Developer Impact Fee Planning Approval. Called Contact Person A.I.P.P.IL Pub. Wks. Appr Date of perm sue School Fees Total Permit Fees AT >fl C 3 �,"16110 N Date: October 2, 2;0`13 Department of Building & Safety/Development Services RE: Starbucks #1: ��277 Located at:79.845 Hi hwa � g y 111, La Quanta, CA 92253 Letter.of Authorizat'-on To whom it may:o§ncern, 1 hereby authorize lGlassman Planning Associates Inc. (GPA Inc. - David Glassman, Keith Glassman, Yen Glassman, Spencer Regnery, Hai Ngo, Thy Ngo to pull permits, obtain business license, pay fe.e.s, sign applications or conduct any business related to obtaining permi�.(s) on my behalf f. Key i1' MacDonald President Kmack ConstrucioAh (714) 997-3778 Qaw fi (877) 797-2460 Fax> 950 N. Elm Street, Orange; GA 92867 714.997.37.78 Fax: 714.99.7:3048 ENVIRONMENTAL HEALTH FOOD ESTABLISffidENT PLAN APPROVAL NOTICE SR# 29275 Date 9/26/13 Project Name Starbucks #142777 Address Plans Submitted by Yen Glassman Owner Starbucks Coffee Co. Phone n/a 79845 Highway 111, La Quinta Phone 888-285-6022 The plans are now approved subject to the conditions listed below and the attached compliance sheet. This approval is for remodel of the drive thru area, minor case work and restrooms. 1. The light at the back bar must be shatter proof. 2. Install the multi use sink as per manufacturer specifications. 3. The Interior of cabinets must be light in color. 4. Sneeze protection will be evaluated on site. CONSTRUCTION INSPECTIONS: Contact the Plan Checker for a Preliminary Inspection when construction is approximately 80% complete, with plumbing, rough ventilation, and rough equipment installed. Request for 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 least five (5) worldng days in advance. PLANS CHECKED BY Tracey Ford, EHS III Phone (760) 863-8287 I acknowledge the corrections noted herein and as indicated on the plans and agree to incorporate them during construction: Signature. Company Name DEH -SAN -178 (Rev 2/06) Corona Hemet Indio 2275 S. Main St 800 S. Sanderson 47-950 Arabia St Suite 204 (951) 766-2824 "A" (951)273-9140 Fax(951)766- (760)863-8287 Fax(951)520-8319 7874 Fax(760)863- 8303 Date Murrieta Palm Springs Riverside 38740 Sky Canyon 554 S. Paseo Dorotea 4065 County Dr (760) 320-1048 Cir (951) 461-0284 Fax (760) 320-1470 (951) 358-5172 Fax (951) 461-0245: Fax(951)358- ax(951)358- 5017 5017 Department Web Site — www.rivcoeh.org J CERTIFICATE OF COMPLIANCE Certificate Number Report Reference Issue Date 20141006-E157132 E157132 -A36 -UL 2014 -OCTOBER -06 Issued to: Global Display Solutions SPA Via Tezze 20/a 36073 Cornedo Vicentino VI ITALY This is to certify that INFORMATION TECHNOLOGY EQUIPMENT INCLUDING representative samples of ELECTRICAL BUSINESS EQUIPMENT Monitor, models MIDAS Series. Have been investigated by UL in accordance with the. Standard(s) indicated on this Certificate. Standard(s) for Safety: Standard for Information Technology Equipment - Safety - Part 1: General Requirements, UL 60950-1 and CSA C22.2 No. 60950-1-07. Additional Information: See the UL Online Certifications Directory at www.ul.com/database for additional information Only those products bearing the UL Listing Mark for the US and Canada should be considered as being covered by UL's Listing and Follow -Up Service meeting the appropriate requirements for US and Canada. The UL Listing Mark for the US and Canada generally includes: the UL in a circle symbol with "C" and "US" identifiers: "(9)"1 the word "LISTED"; a control number (may be alphanumeric) assigned by UL; and the product category name (product identifier) as indicated in the appropriate UL Directory. Look for the UL Listing Mark on the product. CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTR CTION • [DATE_11b4kBy. William R. Camey, Director, North American Certification Programs UL LLC Any Information and documentation Involving UL Mark services am provided on behalf of UL LLC (UL) or any authorized licensee of UL. 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