BCOM2016-006878-495 CALLE TAMPICO C 0 D VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 1/6/2017
Application Number: BCOM2016-0068 Owner:
Property Address: 46520 WASHINGTON ST STE 1 //\\ WASHINGTON 111 LTD
APN: 643020060 0618 DECLARATION AVE
Application Description: ASPEN MILLS BREAD CO / COM NDIO, CA 92253
Property Zoning:
Application Valuation: $8,000.00 JAN 0'6 2017
Applicant: CITY OF LA QUINTA Contractor:
MIRAGE DEVELOPERS INC DESIGN AND DEVELOPMENT DEPARTMENTAIRAGE DEVELOPERS INC
121 S PALM CANYON DR #208 121 S PALM CANYON DR #208
PALM SPRINGS, CA 92262 PALM SPRINGS, CA 92262
(760)864-9448
Llc. No.: 884711
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 Professions Code,
and my License is in full force and effect.
License Class: B License No.: 884711
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 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.).
(_) 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
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: C
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 and policy number are:
Carrier: EVEREST NATIONAL INSURANCE COMPANY Policy Number:
76000154571
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 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Date: `
r' --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 Building Official 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 city to enter upon the
above-mentioned property for inspection purposes.
Date: I / ID 111_ Signature (Applicant or Agent):.
Date: 1/6/2017
Application Number: BCOM2016-0068 " Owner:
Property Address: 46520 WASHINGTON ST STE 1 WASHINGTON 111 LTD
APN: 643020060 80618 DECLARATION AVE
Application Description: ASPEN MILLS BREAD CO / COMM T. I. INDIO, CA 92253 "
Property Zoning:
Application Valuation: $8,000.00
Applicant: Contractor:
MIRAGE DEVELOPERS INC MIRAGE DEVELOPERS INC
121 S PALM CANYON DR #208 121 S PALM CANYON DR #208
PALM SPRINGS, CA 92262 PALM SPRINGS, CA 92262
(760)864-9448
Llc. No.: 884711
Detail: INSTALL NEW EQUIPMENT AND CABINETS. PER 20113 -CALIFORNIA BUILDING CODE
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT
QTY
AMOUNT
BSAS SB1473 FEE 101-0000-20306
0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
NON-RESIDENTIAL, FIRST 2,000SF
101-0000-42403
0
$114.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
NON-RESIDENTIAL, FIRST 2,000SF, PC
101-0000-42600
0
$88.16
Total Paid for ELECTRICAL - NEW CONSTRUCTION: $202.16
DESCRIPTION
ACCOUNT
CITY
AMOUNT
FIXTURE/TRAP
101-0000-42401
0
$76.02
DESCRIPTION
ACCOUNT
CITY
AMOUNT
FIXTURE/TRAP PC
101-0000-42600
0
.$76.02
DESCRIPTION
ACCOUNT
CITY
AMOUNT
WATER HEATER/VENT
101-0000-42401
0
$12.67
DESCRIPTION
ACCOUNT
CITY
AMOUNT
WATER HEATER/VENT PC
101-0000-42600
0
$7.60
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WATER SYSTEM INST/ALT/REP
101-0000-42401.
0
$12.67
DESCRIPTION
ACCOUNT
CITY
AMOUNT.
WATER SYSTEM INST/ALT/REP PC
101-0000-42600
0
$12.67
Total Paid for PLUMBING FEES: $197.65
DESCRIPTION
ACCOUNT
CITY
AMOUNT
REMODEL, EA ADDITIONAL 500 SF
101-0000-42400
0
$68.40
DESCRIPTION
ACCOUNT
CITY
AMOUNT
REMODEL, EA ADDITIONAL 500 SF PC
101-0000-42600
0
$54.72
DESCRIPTION c
ACCOUNT
CITY
AMOUNT
REMODEL, FIRST 100 SF
101-0000-42400
0.
$51.68
DESCRIPTION
ACCOUNT
CITY
AMOUNT
REMODEL, FIRST 500 SF PC
101-0000-42600
0
$141.36
Total Paid for REMODEL: $316.16
DESCRIPTION
ACCOUNT
CITY
AMOUNT
SMI - COMMERCIAL
` 101-0000-20308
0
$2.24
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $2.24
DESCRIPTION
ACCOUNT
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
Bin #
Pernut,l -
Project Address: L46-52-0
City of La Quinta
Building U Safety Division
�O0 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sheet
WG. t" .� , %.I_ T Owner's Name: I OLC V � 1 11 VYt • L f
A. P. Number:
Le al Description:
Contract r:
0 M�
Address:CaLik) L Vit? . e,
ity, ST, Zip: SU Ek A f\Q CL 2
S ele
J20
Address: pO
f roject Description-
City_ ST, Zip:
5pnvqA%
CCL
Telephone:
e h
Po . U Ciy a
H
........................ 5 1 -& Is.
State Lic. # : • c(jCKLA Z (1
Arch., Engr., Designer:
City Lic.
Address:
City, ST, Zip:
Telephone:
State Lic. #,.
' •ProJ'ect
Name of Contact Person:
an
Construction Type: Occupancy:
cY:
type circle one): :N w Add'n Alter Repair.air• Demo
Sq. Ft.: #Stories: #Units:
Telephone # of Contact Person:
- E timated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance.
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2wd Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
I-I.O.A. Approval
Plans resubmitted
Grading
IN IfOUSE:-
'"! Reyiew, ready for correct ionsrssuc
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. NVks_ Appr
Dale of permit issue
School Fees,
.
I
Total Permit Fees
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Riverside CoLmty Fire
• _ _ Office of the Fire Marshal
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TENANT IMPROVEMENT FOR "ASPEN BUILDING OWNER: GENERAL CONTRACTOR:
MILLS BREAD CO." JACK TARR z TOD DAVIDSON
46-SHINGTON STREET STE 1 WASHINGTON 111 LTD MIRAGE DEVELOPERS INC. #884711
520 WA
LA 520 WAQUINTA, CA 92253 30240 RANCHO VIEJO RD., STE B 121 S. PALM CANYON DR STE 208 ?- ;
SAN JUAN CAPISTRANO, CA 92675 PALM SPRINGS CA 92262
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` TENANT IMPROVEMENT FOR "ASPEN 'BUILDING OWNER: ;- - 'GENERAL CONTRACTOR:
` MILLS BREAD CO." JACK TARR L . Z + . _ _.. °'. _ TOD DAVIDSON -
46-520 WASHINGTON"STREET STE 1
WASHINGTON -111 LTD ,:t tti ; •' i .•s� w ~. "_ _ MIRAGE DEVELOPERS INC. #884711
LA QUINTA, CA 92253 30240 RANCHO VIEJO RD., STE B :(; f 121 S. PALM CANYON DR STE 208
SAN JUAN CAPISTRANO, CA 92675 PALM SPRINGS CA 92262 +
• ,� , tf, - ^. � � � t ,-,Vra �`�r. � a t iF -. i,. � ~. r f _ :• t •• r •
tP. r Proposed Plan,
76. On
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or
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ge r '
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Prep table
LA
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Scope of Work: f Y' CO
^� 1 Install approx 7Ssgft of matching quarry rile/cove bYy
ase p ' ` r
2 Install new sandwich prep table/kitchen prep table rOdia
3 Install saved cabinets from demo approx IOLF rO4 Install saved hand sink and new prep sink; run new 3' drain lines to existing floor sink5 Install condensation line for sodastation ;. coffee6 Install ice machine; run condensation line to existing floor sink ' maker7 Install fridge and freezer r � N� = . area KKitchen/Service Area SgFt =approx. 437Total Unit Space SgFt = approx..1367. s ` rs;40
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TENANT IMPROVEMENT FOR ASI�PFN , 0 D BUILDING OWNER:+ ti a `^ z!►we y :/ GENERAL CONTRACTOR:
MILLS BREAD CO." C (I IACK TARR 3 Z . f- r a TOD DAVIDSON
46-520 WASHINGTON STREET 1 .0 WASHINGTON 111 LTD { ♦ �/ f.. 6," �• ^.'J ' Y MIRAGE DEVELOPERS INC. 88$4711 ,
LA QUINTA, CA 92253, —) 30240 RANCHO VIEJO RD., STE B: a , 4: i t' s �I g + .121 S. PALM CANYON DR STE 208
Z
SAN JUAN CAPISTRANO, CA 92675 " + * ! [ G ? + ♦ PALM SPRINGS CA 92262 i
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FOODSERVICE-EQUIPMENT SCHEDULE
EQUPMENT
Item
Qty
IDescription
Base
Make
Mod # NFS Certified
Exsisting
1
1
Mop Sink w/ Faicet
Floor
Tabco
yes 71
2
1
Employee Locker
Post
TBD
~
No
1
Cleaning Storage
Shelf Wire
TBD
Li 03 O
Yes
4
1
1 Ice Maker
PostHoshizaki
America
IU
F-SOIIMAH-C U
No
5
1
Wire Shelving
Post
TBD
C<
N>-
6
1
Wire Shelving
Post
TBD
o6 Z
No
7
1
Hand Wash Sink
Wall
Regency
600531620218 s (D U
7A
1
Soap &Towel dispenser
Wall
TBD
CC
Yes
8
1
Three Compartment Sink
Post
Regency
LL�
9
2
Sink Faucet
Wall
GSW-USA
AA-714 -Yes
Q
10
1
Water Filter
Wall
3M
CICE120S Yes
No
11
1
lWaste Receptacle
Floor
TBD
No
12
1
Freeezer Reach in , 3 section
Caster
TRUE
T-72F Yes
No
13
1
Refrigerator Reach in , 3 section
Caster
TRUE
T-72F Yes
No
14
1
Back Counter
Formica
Yes
15
1
Front Drop in Hand Sink
Regency
Yes
16
1
Soap & Towel dispenser
Wall
Yes
17
1
Drop in Rinse Sink
Regency
Yes
18
1
lCaoDuccino Machine
Counter
Cutis
FBTPSSS63A11000 Yes
No
19
1
Tea Brewer
Counter
Curtis
FBPCGT3
No
20
Ice Coffee Machine
Counter
Good West
TCTS10600
No
21
1
Display Case
Post
TBD
No
22
1
Front Counter
Formica
Yes
23
2
Cash Register w/ POS
Counter
TBD
No
24
1
Knox Box
Wall
Knox Co.
Yes
25
'12
Table with chairs
Floor
Yes
•
26
6
Bar Stools
Floor
Yes
27
1
Self Serve Beverage Dispenser
Counter
Other
PepsiCo Yes
No
28
1
Backflow Regulator
Wall _
Watts
009M2QT No
No
29
1
One Compartment Sink
Post
GSW-USA
SE15151L Yes
No
30
1
Sanwich Prep Table
Caster
Everest
EPBR3 Yes
No
31
1
Sneeze Guards
Counter
TBD
No
32
2
Hot Water Heater lFloor
140gal
Yes
' Room Finish Schedule
Room / Area
Floor
Floor Cove Base
Smooth / Textured Floors
Walls
Ceilings'
ti,cr —
Bathroom(s)
Ceramic Tile
6" cove base - existing
Texture- Existing
FRP to 4' AFF / Drywall / Paint
Drywall / Paint - Existing
Walls/ Cei _ ted with • ss finis
Dinning Area
Wood Floor
Wood Base -Existing
Smooth - Existing
Drywall /Paint
FSK - Existing
Walls Pain • h gloss fi
Paint / stain - Wood finish to 4' AFF /►
Service Area
6" Quarry tile
6" Cove Base - Existing ,
Textured- Existing
Drywall to ceiing
Drywall / Paint - Existing
Walls/ Ceigrainted widl6gss fini ;
Back of House
6" Quarry Tile
6" Cove Base -Existing
Textures- Existing
Drywall / Paint - Existing
Drywall /Paint -Existing
Walls Palr�'te h gloss fi•
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