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. For questions, please
contact a local UL Customer Service Representative at v—.ul.comlcontaclus
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