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.