0309-323 (MISC)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
P(ul�essionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
Date �i "' + 2 ,Signature of Contractor �'`"� •y'' �' '' �`
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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 & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
( )/A am exempt under Section , B&P.C. for this reason
Date llI,If) s'� Signature of Owner
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:
Cartier Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) 1 -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 ob5ection 3700 of the Labor
Code, I shall forthwith comply with those provisions .
0,D'ate: Applicant—
Warning:
pplicant
/ter- `.f •,. .Y
Warning: Failure to secure Workers' Compensation coverage i/s 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
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 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.
e� rq
`Signature (Owner/Agent) ♦ ��,l�� Date - '
r
r BUILDING PERMIT PERMIT#
DATEJ VALUATION LOT Of!► 0-3>3 TRACT
G� .�1 / 1 $204W1W i
JOB SITE -
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN (NEER
- C'LAIR
USE OF PERMIT
,fiiNDlWW'S ,BAR 0%1N,'." • OCC. 11 AD rhe:. f;33 'D'L) 7,4) AT COURT
JNT'h ftCEPV,..)R C A O :OiTP TO 30001:614_ IJD1.4S. (TOTAL 'OCCr3F'.t V'r wt,7)! f/C,
V OL i f. 'A v'1s;3.^ ^�O,aA4. QCs La
CON"1' OF C-01+ I I: TYCI �i:[ N
ttD� .dam
rM
PLAN 0,P)E ;K %Efl. -M-1,5 6 alt a, sal
.
31111 ORNi".1t MY, 1(1'� -�,'1Q �.9 n•Pa(9iP '4'&.0'�
WWWL 11V11`Lk°'3t-0kT 101-ofxk ,,.- 3-uor, 31a� r,OL
Q D
D
SFP 30 2003
CITY OF LA Quim
FINANCE DEPT.
C),ga, rim [1 i i3 "1�3 ilii" i 2l1?YH;I�
' '2f .42 3
RECEIPT
DATE,
BY
DATE FAL E IN E TOR
a
$ - INSPECTION RECORD
-OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
t €i
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
; #�
Roof Deck
Exhaust Fans
tri
O.K. to Wrap
F.A.U.
4 X
Framing ,
Compressor
j
Insulation
Vents
f
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines ' •
f Y,
Party Wall Firewall
i
Exterior Lath
t
,9
Drywall - Int. Lath
I ,'
Final
Final
BLOCKWALL APPROVA S
POOLS - SPAS
a,4
Steel
fi
Set Backs
Electric Bond
Y'
Footings
Main Drain
€ t~
Bond Beam
Approval to Cover
1
i
Equipment Location
'
Underground Electric
Underground Plbg. Test
Final
t '
Gas Piping
PLUMBING APPROVALS i
i,
Gas Test;,'
Electric Final
} l
Waste Lines
Heater Final.
Water Piping
1 , .
Plumbing Final
t z'
Plumbing Top Out
Equipment-Ericlosure
4
Shower Pans
'O.K for Finish Plaster
>;
Sewer Lateral
'!Pool Cover -
Sewer Connection
Encapsulation
Gas Piping
; r
Gas Test
ry
Appliances
/&zLe
Final
COMMENTS: -
;
' • '
J .�
r
s
a
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)
V4
I
Bin ##
L_4-"w_ww
City of La Quinta
Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
V6011
On
Permit #
0301'3133
Project Address:0'bA
40t4 R/JbA
wner's Name:
A. P. Number:
rAddress:
Legal Description: hulm,
Contractor:
C
City. ST. Zip:
phone:
Address: r Oq
project Description:
City. ST. Zip:
Telephone:
.. . ..... ...... .
......... ........ . .. ...
State Lic. # 7" 5 03
Arch.. Ener.. Designer:
Cit., I 3f - P
A— n�a IzAk
Address:
City. ST. Zip: 67> 6V:S&1V_
...... . .. .......... ......
. . ........
Tel .........
.. . . ..... ..........
.......... ..
.............
State Lic.
e Name of Contact Person: 4
Construction Type: Occupancy:
Projec t type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: 9 Stories- 7#Un.t,:
Telephone # of Contact Person:
O 774--1
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
I TRACKING
PERMIT FEES
Plan Sets
a
Plan Check submitted 01ZI 10
Ulem
Amount
Structural Calcs.
Reviewed. ready for corrections IV1119
Plan Check Deposit
Truss CaIcs.
Called Contact Person
Plan Check Balance
IL
Title 24 CaIcs.
Plans picked up M/P
C 0 ns�?fflu. n
(,=>,0 x>,_>
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd Review, reav_for cor�recti s/issue
Electrical
Subcontactor List
I -Called Contact Person
PluWAng
Grant Deed
Plans picked up
SALT
H.O.A. Approval
Plans resubmitted
Grading
IN' HOUSE:-
Z_k
Review. readv for correctitiss"U9
Developer Impact Fee
Planning Approval
Called Contact Person
A.L-P_P��
Pub. Wks. Appr
Date of permit issue
School Fees
4wds &� 7;;,&v
At- AAft- e44—
01, 7d,�7�47
Total Permit Fees
�/ s T
ID 11?f 4�9
7' CDD N 601 D, > y� 406ell yCUAXb UAW I
J CITY OF LA QUINTA SUB -CONTRACTOR LIST I
JOB ADDRESS 'g'�°�� Avg l,A l=oar%®sI PERMIT NUMBER OWNER CASA-!-j-i kinc. 15& CvSe�— BUILDER
This form shall be posted on the job with 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.
Trade /Classification '
Contractor
:. ... ;' State:.Contractor: s License.: _
- Workers Com ensat on.lnsurance.
City: Business
License
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK (C-12)
CONCRETE (C=8)'
FRAMING '(C=5)
STRUCT. STEEL (C-51)..
MASONRY (C-29)
PLUMBING (C-36)
LATH, PLASTER (C=35)
DRYWALL (C-9)
HVAC (C-20) .
ELECTRICAL (0710):..
ROOFING (C-39)
SHEETM.ETAL (C=43)
FLOORING `(C 151: `...
GLAZING (C=17)
INSULATION, (C 2) .
SEWAGE bISP (C 42)
ZR S03�
D X989
PAINTING iC 33)
CERAMIC TILE
CABINETS (C.' 61
FENCING (C=13)
LANDSCAPING
POOL (G 531
+_ rWATER
')/ST RICA
COACHELLA VALLEY WATER DISTRICT
P.O. BOX 1058
COACHELLA, CALIFORNIA 92236
(760) 398-2651
FOR OFFICE USE ONLY
1410072
ED COSEK
74-860•FAIRWAY DRIVE
PALM DESERT, CA 92260
INVOICE NO. 18711-
PLEASE.
8771.PLEASE. INCLUDE INVOICE NOON CHECK
DUE AND PAYABLE ON RECEIPT
AMOUNTDUE
DATE THIS INVOICE
6/24/03 10, 780.00.
PAGE 1
TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH REMITTANCE
DATE
DESCRIPTION
AMOUNT
6/24/03 SUBJECT: ANDREW'S
BAR & GRILL, 78-121
AVENIDA LA F
;
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COUNTY OF RIVERSIDE COMMUNITY HEALTH AGENCY AssessoR's PARCEL NUMBER
DEPARTMENT OF ENVIRONMENTAL HEALTH
APPLICATION FOR WASTE WATER DISPOSAL APPROVAL
APPLICANT: Submit this form with four copies of a SCALED plot plan (1"=20' to V=40' 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
application. shall remain valid for a period not to exceed one year from date of payment.
LMS #
Agent, Contractor, Contact Person
�'>E'nelaA
Address _ City / State Zip
i%��
Telephone
Owner
Address City State Zip
Telephone
Q
C—D. Cr.'s k
T�-- ��1 i4r, t� 1A h,
OJob
Property Address
City V
Zip
Lot Size
Water Agency/Well
Use of Permit, P/P, SUP, PUP, etc.
Legal Description
DBAA, rLC 5
IU
fJ7
1 i y,
/lv�a4tt+✓� S�srT J
`fJJI^L
A/�
Dwelling, MH Site Prep., etc.
It
Signature of Applicants )
Date
FOR OFFICE
USE ONLY =
CHECK BOX IF REQUIRED
If any box is checked, this application shall be considered rejected until the
❑ Detailed Contour Plot Plans Required (1 to 5 foot interval)
information is provided and the fee paid. Resubmittals later than 90 days
after date noted below may require repayment of fees.
Q Other
Z❑
Holding Tank Agreements Completed
❑ Staff Specialist Lot Inspection Required
0
❑ Certification of Existing S.D. System Required
Thomas Bros. Page Grid
I-
LU
-❑ WQCB Clearance Required
❑ Date Lot Inspection Completed: Initials
U)
; .(Attach for DOH-SAN-007, Santa Ana Region Only)
Remarks:
❑ . Soils Percolation Report Required
❑ Maintenance Booklet Provided
❑ Special Feasibility Boring Report Required
❑ Final Inspection by Department of Environmental Health is required.
❑ Rereview Required Initials Date
I Please call 24 hours PRIOR to inspection.
C/421/'96ils Percolation Boring Report By Lic/Project # Date
//
Soils Map PageSoil Type Approved By Date a� t7:�b�A
No. of Systems
Type of System(s)
No. Dwelling Units
(1) Septic Tank
Soil Rate
Grease/Sand:,:
❑ Holding Tank 'Replacement
Bedrooms, Fixture Units
rease Intc /Lint Trap;
❑ New ❑Addition-
IX 6
�r
❑ Existing ❑ Connect to Sewer
Gal.
1900 Gal,
Sq. Ft. `�
Total Linear
Sidewall Allowance
Leach Bed sq. ft.
Bottom Area
Ft.
ft. rock/ sq. ft. running ft.
Install Lines) ft. long ft. wide
of Bottom Area
Inlet Tested Depth ❑ N/A
with min. inches rock below drainlines
U
Proposed Bottom Tested Depth
or
Z
Leach lines/bed special design for slope:
(3) Pit Diameter
No. Pits
Pit Below Inlet (131)
Seepage Pit
Maximum
Other:
O
Applicable
Total Depth
Allowable
H
Depth
C)
N/A Overburden Factor
❑ 5` ❑ 6'
TD
0
Well Review Approved: Date: Well Drilling Permit#
SIGNATURE
Grading Plan Approved: Date:
SIGNATURE '
Plan Check Only-Approveed:_ Date:
n O / �(_ f'�
REMARKS: 711siwE�' wee at',rr[o �.e�.� r a 1� ✓ � A c - 46. 7L'itAf C 1s% . SX�
/ IV C,,
OT �V 42 �.� ;'.47
d,, .. _ C / S & AII. c v X144 ee- AR
/��?1�
/J
�r
C (73-59- ��l�n
tstio lY4t 1� i VaZ .24 S>/ +��(l JNS�nT .7►� �i LtJ+Fda l} G end .r .tom_
This application is APPROV Y/DENIED for the category checked in
SECTION B above l eg�arding,ihe design of a disposal system as indicated
! ��
.on the accompanied plot plainn, using the requirements set forth in SECTION
'$
C above. A building permit is necessary for the installation of the above-
Revenue Code S��S _Fee
designed system. No construction is permitted in the reauired reserved
100% expansion area.
S,
Check #
(1) Septic Tank must be 100'.minimum from any wells.
Leach lines be 100' from including
/j � �./ � �
a�
Z
(2) must minimum any wells, expansion
Date s /�.r Initial
O
area.
/
L)
(3) Sewer lines must be 50' minimum from any wells.
W
U)
(4) Seepage pits must be 150' minimum from any wells, including expansion
RIVERSIDE: 909-955-8980
area.
INDIO: 760-863-7000 _
SOUTHWEST. 909-600-6180
Signature '
9 ? .S
I
Date 1
DEH-SAN-199
1P.. R/n1\ r.:_._...:__...,
r� ..... �.. .._.. _... -
ISM UtIcni. "H iE—vmce He, rE�ww—Nppucanr, FINK—aklg. Dept.; GOLDENROD—Plans/Records
Tom Tisdale
Fire Chief
Proudly serving the
.unincorporated
areas of Riverside -
County and the
Cities of:
Banning
4 -
Beaumont
4.
Calimesa
Canyon Lake
Coachella
4 -
Desert Hot Springs
11.
Indian Wells
Indio
Lake Elsinore
4.
La Quinta
4.
Moreno Valley
Palm Desert
y.
Penis
4.
Rancho Mirage
4.
San Jacinto
Temecula
Board of Supervisors
Bob Buster,
District 1
John Tavaglione, '
District 2
Jim Venable,
District 3
Roy Wilson,
District 4
Marion Ashley
District 5
RIVERSIDE. COUNTY FIRE DEPARTMENT
In cooperation with the
California Department of Forestry and Fire Protection
210 West San Jacinto Avenue • ems,a� 92570 • (909) 940-6900 Fax (909) 940-6910
August 11, 2003
Andrew's Bar & Grill
78-121 Avd. La Fonda
La Quinta, CA 92253
Re: Non -Structural Building TA PlanReview,
LAQ-03-TI-058 /Andrew's Bar & Grill
Fire Department personnel have reviewed and approved the plans you submitted for the above
referenced project. Please be advised the following conditions apply as a part of the conditions for the
issuance of a building permit.
1) All egress doors shall comply with CBC Sec. 1003.3.1.8 for proper door hardware.
2) Room capacity shall be posted in a conspicuous place on an approved sign near the main exit from
the room.
Please contact the Fire Department Planning & Engineering staff for final inspection prior to occupancy.
All questions regarding the meaning of these conditions should be referred to the Fire Department
Planning & Engineering staff at (760) 863-8886.
Sincerely,
FRANK KAWASAKI
Chief Fire Department Planner
By
Walter Brandes
Fire Safety Specialist
EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE
82-675 Highway 111, 2^a FI., Indio, CA 92201 *(760)863-8886 • Fax (760) 863-7072
1.
° ,lot
V �
5
CSM OF �9ti .
MEMORANDUM
DATE: SEPTEMBER 5, 2003
TO: DANIEL CRAWFORD
BUILDING INSPECTOR 11 a
FROM: MARTIN MAGANA �I: -
r ASSOCIATE PLANNEFR
RE: ANDREWS.BAR & GRILL
Please allow this memorandum to stand as confirmation that the additional seating
,proposed by owner of Andrews Bar & Grill is approved. The additional parking required '
for the expansion has been addressed by a lease agreement the owner has with Mr.
Wells Marvin to use approximately twenty. (20) parking spaces of the office building
Located south of the existing restaurant across the alley.
Should you need additional information please call me at (760) 777-7068.
Memo.wpd , .
� � - l ?tom. r .� t .� ,:.r64r�F, F� c�+w �, .V'7�-J e `'' ;A �S` _' r s' •� �� :"�' •
01
c•
Cettificate of ',`0 cu anINC
s
LIM
•ICS,"^�
`-�
-` .(7 .(>�Gj - .. J .� y'-" `� .' j • - i,.
OF,T1 Buildhig ,& sSa�fety.De_ partmeent -
.y
� � . ' y Ali � - - ., '• O F ` e � l� t". k. it �� _,
= This 'Certificate is= issued pursuant -to the' requirements of Section 109 of the California VBuilding
Code,f: certifying -that,.:: at the time of issuance; . this. structure. "was in 'compliance . with -the'
provisions`.of the Building Code and . the various °ordinances of the ,City regulating `-building
constructionand/or use.
,'y '!r' '�, •
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BUILDING ADDRESS: 78-121',:LaFonda _
r
Use' classification: Commercial (Andrew's Bar &Grill Building, Permit, No:: 0309.323',
` Occupancy Group; A-3 V a �' _ !Type• of Construction:.VN `* z, f' ,Land Use Zone.'VC
^. v r.' e.:' . C 3 .•r;7. a
._�1 ".!y`." :� a -.r.; �. ;� ,., _�' ,yJ r ,-,;; t .• r, -,
r Owner.of Building. Ed:Cosek•> J
74=860 Fairway Drive,
Address: arwayve
.. a• •
'City,.ST,•ZIP-. Palm Desert,•CA'92260 -
IV
�. `� � •�, � • -$y:�Dariiel P,Crawford Jr.
,�
y R _ _`�! u •� 7 ,� �I, / a.^i Lam,. j '. V .Yi; �
Date: 10/21/0
'�
.Building Official , : ,~ r
POS r'N A CONSPICUOUS PLACE �Y F.
� � - l ?tom. r .� t .� ,:.r64r�F, F� c�+w �, .V'7�-J e `'' ;A �S` _' r s' •� �� :"�' •