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13-1588 (DEMO)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description: Property Zoning: Application valuation: Applicant: 13-00001588 78430 HIGHWAY 111 604-050-044- - DEMO - COMML/OTHER COMMUNITY COMMERCIAL 30000 T44t 4 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Architect or Engineer: LICENSED CONTRACTOR'S 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 Class: License No.: Date: Contractor: 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 r she )s exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any plicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (_ 1 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 _ 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.). - - (_) I am exempt under Sec. , B.&P.C. for this reason Y 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: FIRST KARMA RESTUARANTS INC 3075 RUSTIC MANOR CIR C/O MORRIS SALEM RENO, NV 89509 Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 12/19/13 CITY OF LA QUINTA 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 t���GGin��sur ce carrier and policy number are: Carrier i�� �ii:,tr'•`- Policy Number I certify that, in the performance of the work for which this permit is issued, 1 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 shall forthwith comply with those provisions. ' Date: Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 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 to enter upon the above-mentioned property for inspection purposes. Signature (Applicant or Agent): Application Number 13-00001588 ------ Structure Information INTERIOR DEMO (NON-STRUCTURAL) ----- Construction Type . . . . . TYPE V, UNPROTECTED Occupancy•Type . . . . . . ASSEMBLY BLDG <1000 ---------------------------------------------------------------------------- Permit . . . DEMO PERMIT Additional desc . Permit Fee . . 35.75 Plan Check Fee 00 Issue Date . . . . Valuation . . . . 30000 Expiration Date 6/17/14 Qty Unit Charge Per Extension 1.00 35.7500 LS MISC DEMOLITION, INT 35.75 ---------------------------------------------------------------------------- Special Notes and Comments INTERIOR NON-STRUCTURAL DEMOLITION IN PREPARATION OF SEPARATE TENANT IMPROVEMENT PROJECT FOR PROPOSED "BROKEN YOLK CAFE". THIS PERMIT DOES NOT INCLUDE CONSTRUCTION OR ALTERATION TO THE EXTERIOR OF THE BUILDING. 2010 BUILDING CODES. _CALIFORNIA December 17, 2013 3:34:51 PM AORTEGA ---------------------------------------------------------------------------- Other Fees . . . . . . . . . PLAN CHECK, DEMOLITION 95.81 Fee summary Charged Paid - Credited Due Permit Fee Total 35.75 .00 .00 35.75 Plan Check Total .00 .00 .00 .00 Other Fee Total 95.81 .00 .00 95.81 Grand Total 131.56 .00 .00 131.56 LQPERMIT Bin # City of JLaQ[!I , Building & SafetyDivlsion Permit # P -O. Box 1504, 78-495 Calle J amps La Quinta, CA 92253 - (760) 777-70 Building Permit Application and Trac kin She t Project Address: 17'9'q (,j/ 11 Owner's Name: AkC A.?. Number: 23 Q Address: 3 OBJ ,�- u S � l L m 1, Li Legal Description: City, ST, Zip: R-4e(,l 6 N , f Contractor: D .5'0 Telephone: Q " 2� ^ 2-800 110 Address: Project Description: City, ST, Zip: Telephone: P OA S p 1 State Lic. # : City Lie. #: Arch., Engr., Designer: CPT— f Address: t' SZ DUB City., ST, Zip:IZJ790 Telephone: Z . =>::: �.;:.:.. -<.:>:::s:-:: Construction Type: Occupancy: Project type (circle one): New Add'n Alter epair State Lic. #:s:: Name of Contact Person: D (� (/ (� L Sq. Ft.: b / 00 1 # Stories: f # Units: f Telephone #,of Contact Person:O Estimated Value of Project: Oj QOO APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets 3 Plan Check submitted 17-1S11-2,Item Amount Structural Calcs. "' Reviewed, ready for corrections Plan Check Deposit Truss Cala. Called Contact Person Plan Check Balance Title 24 Cala, Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, ready for correctionsCssue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 3" Review, ready for correctionstissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees De -c.19. 2013 2:54PM P.O. -BOX 1504 LA QUrNTA; CALIFORNIA 92247-1504 ?8-495' CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 No. 1521 P. 1 . / IV 1, �11 I BUILDING & SAFETY DEPARTMENT rROPERTY oWNE, R, s PACKAGE (760) 777-7012 fAX (760) 777-7011 DUclosures & POrius for fiwner Bndders Apply f6r CORWuedeij Permits AMMUN11 NO -T Cr 'nn ROPERTY ovvivra� DearPraperty Owner: AA. applicatiotz for -a building permit has' been: submitted in your Wme; listing yourself as the budder of 6e .property iiaA,pcd". =D s specified at Wr- arelu+arvi�ftg YOU with as Owns Builder AclmoMedguteaat.at d Wefinatien,Yeti&Adm Form to make yat awaae.0 your reRWANbiOU sand 'possible tiAlyou may incur by bxvige tura permit k6od'in your name as the O> BuiWer. We V0:mt,1ssue a buddlog;permlt until YwA Have read, l Wald yout.'vAderetanding of each'prra Mon, signed, attd redrrntil-d c form to us at out ofRcial address indicated. An agent of the oww t%mmot. execute d&-neticc unless you, the property owner, obtain the prior approval of the permitting authority. dors •!lrirlarstiviii' vi 1_.1 aaderstand a RvVent practice of unlicensed persons is to have the property 6wner obtain an "Own"uildef' building. permit that emm*uslyimplies that: the property owner is providing his or her own labor smA materal personally, I;.as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by.an unlicensed person and his or her employees While Wail* on my property_ My homeowners Worme may not provide coverage for those injuries. I am wrllfnlly acting as an Owner-Builderandam aware of the limits of my insurance•ooverage for injuries to workers //•on my prey. understand building permits atop not required to be signed by property owners; re unless they aresponsible for the construction and are not.huirrg a Li=sed Contractor to assume this responsibility.. 3. I uaderst W as 84 "Uwrler BoildW' f am use cespousible party of.rocgrd on the permit I understand Qat I may protect Myself from potential financial risk by hirings tictased Contractor and having the permit filed in hii or fier name jzsteed of my. Gown. I understand Contractors are required by law to be licensed and bonded m Cahfontia and to list their license numbers on permits and aontiacts. rt�,5. I understand if I employ or otherwise engage any persons, other than Califorol licensed Contractors, and the tonal value of niy oonstrvctigrr is.at least five hundred dollars.($500), including labor and materiels„ I may be considered ark "emploW, under state and feder31•1aW. DL -6- I. wwenland if I am considered :an "employee' under state and fe&W law, I must register with the state and federal govtxnment, withhold payroll taxa. provide workers' oompen"on disability W=Uce, . and contribute to tuumployment cOmpewatWn for each "employee" I also understand my failure to abide by these laws may subject me to serious furaucial risk ,. 7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot .legally build them with the intent 'to offer them for sa1c, unless all work is pytfortned by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. Dec, 19, 2013 2:54PM No. 1521 P. 2 • 1 understand as an Owner-0411der if I sell the property for which this pciv it it issued, I'may be h"I liable, for any fin Sial or personal itljarioti '�ualeined,by 1Y subsoqucnt owners) that result from any latent construction defoets in the workmanship ormateiids. 9. I understand I may obtain more eormatiou regarding my obligations as an "employee' from the total fteroenne Service, the United States Small Business Administration. the California Department of Benefit Payments, and the California Division of industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLH) at 1- 800 -321 -MLS (2752) or www_cslb.cagov for more information about Reenact centructots. 10. I= aware of and consent to an Owner -Builder building permit applied for in ray name, and understand that I am the ply legally, aid fgaucially reRnnsible ;for.. pmpagtd Goasawdoo activity at the following address: 1 L [ sgrre that, as.the p#rty.legally end figanci:tlly resprinsiblF fpr Ibis proposad.constnrotion activity,.I will abide 6y all applicable laws and iequiielrieihts drat govere �a►dec-�uildecs a� vVell as employers. 12. I -agree to notify the issuer of this form immediately ofairy tidditivns; Mitioom, or db*%". to any of the-infrifrmatioa I have provided on this form Licensed contractors are regulated by laws designed to protect the public. -If you, contract with someone who,doea. not have a limn,• pre Oonlmtors' State Li censo Board -may be uarible tot—tl dttgdW-less you may sustain as a result of a complaint Your only te+pcdy againstuolieous'ed Contractors away by in;eivd covet. It Is also important for you tah *mtand that -if as tlicesW Cehbutor or etrployee of that -individual orrfta is ittjtdod while wonting on your property,• you may be held• llsblsft damages: If -you obtain a pantie as Owner -$hitter aid Vigth•to MM CoWrenolors, you wM bO aespon:uUe for. vosdying .Or°Act tho9c Coutractote•am pr periy Iieensed•and the staW of.tWir ve&esa' ooMPensatioa ii m mrEo oovmge. Before a building permit cart be issued, this form must be completed and signed by the.property owner and returned to the agency responsible for gye permit, N •.4 .copy of �4't'apa!�'vw!!sr's.t6iglver'*J%WtWt fArm. �!e► or other veriJtcatiorc agrxptabllr to' the �ttry 9 ed to ba Qr etiteil; welt rite, pt'?m�t Ia is"a to voifx die pmpery owner's signature. i , Si natum of pmpertyowner Date: Note. The followingAuthm isation Form is required to be completed by the property owner only, when designating an agent of the property owner to apply for a construction permit for the Owner - Builder - 'Excluding the notice to property Owner, the exec ation of which i undcTsw d.is my personal tesponsibility, I hereby authotim .the'followirig persob(s) to ad'acs ray nisi —to apply for, Sim and Wthe documents necessary to obtain so 0w6u Builder Permit for rgyprojWL' Scope Of Construction project (or Description of Work): Project Location or Address: %ll� L �}N�.�fTC� Name o.f ikurthoriaed Agent:. Tel No hL[ _. % Addiess of Authorized Agent: rn I declare undcrpenalty of perjury that I am the property owner for the address listed above and I petsonglly filled out the above informatidn and cer*'its accuracy. Role: *A copy of the owner's driver's license, form notrudxation, or other verification arcceptable to lire agency is reque:+ed'to be ' when the permit is issued to verify the prop" owner's signature. Property Ownees Signaha Date; a ?i All r BYPD, INC. 'W-10% 16iy.mP. 78430 Highway 111 La Quinta, CA 92253 Web: thebrokenyolkcafe.com December 10, 2013 Dear Mr. Morris, The City of La Quinta has requested the following documentation in order to proceed with issue of permits. First a document such as a grant deed or similar that verifies you are the owner of the building and second a letter that allows our demolition and construction work to take place. I have drafted the letter for you to sign, and would ask if you could please provide the documentation to verify ownership. I very much appreciate your time and assistance in this matter. Sincerely, Oscar Babb LETTER FROM PROPERTY OWNER GRANTING AUTHORIZATION To Whom It May Concern, I, Morris Salem, declare that I am the owner of the property involved in the application. I hereby grant BYPD Inc. dba The Broken Yolk Cafe permission to make modifications to the building including partial demolition of the property. Address of Property: 78430 Highway 111, La Quinta, CA 92253 Signature: Pis �v' O Date: a I � x �M1cl�cv G "r or DEMOLITION PERMIT REQUIREMENTS The following items are required prior to the issuance of a Demolition permit. • Two sets of plans showing the complete scope of work. Proof of property ownership (e.g., Grant Deed). • Letter from property owner authoring demolition with scope of work. • Asbestos Report for all pre-1979 Properties. If asbestos is present, proof of removal by a licensed Asbestos Abatement Contractor. • HOA Approval, if applicable. Public Works PM-10 Approval. • Building Department Management Approval. 6.