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BDEM2016-0015A 78-495 CALLE TAMPICO D 4 QuiRro VOICE (760) 777-7125 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 12/14/2016 Application Number: BDEM2016-0015 Q Owner: Property Address: 46520 WASHINGTON ST STE 1 Q a ASHINGTON 111 LTD APN: 643020060 D 618 DECLARATION AVE Application Description: TARR / PARTIAL INTERIOR DEMOPN MILk5r8�1�D 02016 1 DIO, CA 92201 Property Zoning: LLIICC jj Application Valuation: $2,100.00 CITY OF LA QUINTA Applicant: DESIGN AND DEVELOPMENT DEPARTMENI�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 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 at�D e:� Class: B License No.: 884711 Z on reactor: Vvuyar,& eAu-o XS 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.). (_J 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: (760)864-9448 LIC. No.: 884711 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: 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. i D ( iicaht 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 slate 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. j IQatate,:' ignafure (Ap`plicantor Agent): Application Number: BDEM2016-0015 Property Address: 46520 WASHINGTON ST STE 1 APN: 643020060 Application Description: TARR / PARTIAL INTERIOR DEMO / ASPEN MILLS BREAD CO Property Zoning: Application Valuation: $2,100.00 Applicant: MIRAGE DEVELOPERS INC 121 S PALM CANYON DR #208 PALM SPRINGS, CA 92262 Owner: WASHINGTON 111 LTD 80618 DECLARATION AVE INDIO, CA 92231 Contractor: MIRAGE DEVELOPERS INC 121 S PALM CANYON DR #208 PALM SPRINGS, CA 92262 (760)864-9448 LIC. No.: 884711 Date: 12/14/2016 Detail: SUITE #1 PARTIAL INTERIOR DEMOLITION - REMOVE ISLAND COUNTER & PLUMBING, 75 SQ.FT. OF FLOORING, 3 COMP SINK, 45 SQ.FT. WOOD PANELING PER APPROVED PLAN. 2013 CODES. FINANCIAL DESCRIPTION •1• ACCOUNT CITY AMOUNT DEMOLITION, INTERIOR 101-0000-42404 0 $38.00 DESCRIPTION ACCOUNT CITY AMOUNT DEMOLITION, INTERIOR PC 101-0000-42600 0 $101.84 Total Paid for DEMCLITION: • 1 $139.84 "AN ADEOUATELY -SIZED DEBRIS CONTAINER IS RERUIRED ON THE )OB SITE'DURING ALL PHASES OF CONSTRUCTION AND MUST BE EMPTIED AS NECESSARY FAILURE TO DO SO MAY CAUSE THE CITY TO HAVE THE CONTAINER DUMPED AT THE EXPENSE OF THE OWNER/ CONTRACTOR." �- w.® 1-6 TENANT IMPROVEMENT FOR "ASPEN MILLS BREAD CO." 46-520 WASHINGTON STREET STE 1 LA QUINTA, CA 92253 26'3 5/8" 147 13/16"1 11'3 3/16" A RE -INSPECTION FEE OF $ %F WILL BE CHARGED IF THE APPROVED PLANS AND 10B CARD ARE NOT ON THE SITE FOR A SCHEDULED INSPECTION. NO EXCEPTIONS! 40 ZMMMMMME v333370�o 3 x0000 om zMMM M r 'Qnp�voTv �. C X X OZ X r wAv�iavv�, 4�-2" pTpmGp Ln 9 on 11 0 W _ >0 20 • $ 00 o z p . 1oQ v -4 z Z G, � O w❑ •-- -- C6 L rn 8 2 0 W caiQ a N �� ® P"W Ogp40 9 ..WC L.8Z j�IJ:�.K ��6�tZ w o 3 i &f Irk ✓ // c:l d CITY OF LA QUINTA BUILDING & SAFETY DEPT. BUILDING OWNER: APPROVED GENERAL CONTRACTOR: JACK TARR z FOR �vvvLAlt"L€ TOD DAVIDSON 7 WASHINGTON 111 LTD _� MIRAGE DEVELOPERS INC. #884711 30240 RANCHO VIEJO RD., STE B DATE tv lV �----�-- 121 S. PALM CANYON DR STE 208 SAN JUAN CAPISTRANO, CA 92675 PALM SPRINGS CA 92262 - r IGN 111 CONSI"WiCl OURS - ., c. ji :secs ay - s c i:Liy: 7:00 a.rr3.2o 5:30 p.m. ";.ii €?igi': 8:00 c`B.➢Il. to:.5:00 p.m. 1. "� a-'^� i A h• 1 ��rl V. None c'�_ ii ;, s'i'.'1negflt Code Holidays: None t-ernber 30th �ja 6:`;l) a. m. to 7:00 p.m. Aft .: i •' 0 11.113. to 5:00 P.M. None Cone Holidays: None , trw� Constr;.lction is i= O P .. x 6TT 0- on the foilo;rrP1g'ce Holidays: Netm Year's Dav Dr. M,;,,r in Lut ier King Jr. Day PrPsirei'-,y Day IdIC rnorial Day 'W . Independence Day Labor Day Veteran's Day { Thanksgiving Day Christmas Da u` stma y;: 421 �M fw` yt ATwu r) Pi 90 YT ' q YFE I (i UJ • � �� fir. �'�L=£'3Y�:' � t °„l -3 Building Permit Number. bap Project Description: Tenant Improvement Exempt: El (Materials may contain hazardous wastes and are not subject to recydkrg provisions) Construction Debris Management Plan Plan Submittal Date l 12/13/2016 Job Site owners N Number, Street, or PO City, State, Postal C Owners Phone Nur Owners E -Mall Add 46520 Washington St Suite #1 Jack Tarr -Washington 111 Ltd 30240 Rancho Viejo Rd suite B San Juan Capistrano, CA. 52675 c/o 7e0-8649448 Project Managers Name Patrick Sauer Project Managers Phone Number 760-272-8742 Project Managers E-mail Address ostriclAmiraaedevelooer com Builder / Corrtrr Number, Street or PO CRY, state, Pastel C Project Square City Approval By Date of City Approval Materials To Be Discarded: Product Trash Asphalt BrIck/Block Cardboard Commingled Concrete Drywall Donated / Reuse' 'Describe Items Mirage Developers 121 S. Palm Canyon Dr. #208 Palm Springs, CA. 92262 1,700 square feet Renado GouIdIockMAa4--1&L&-qtV- mom I2%% Not recyclable Product Tons Recyclable Masonry (broken) 0.t Recyclable Plaster 0.t Recyclable Scrap Metal 0.1 Recyclable Tile (floor) 0.1 Recydable Tile (rood) 0.( Recyclable Wood 0. i Recyclable Landscape Debris 0.( Totals: Recycle Trash Projected Diversion: 5.5 1 4.3 56A1 °j6 I understand It Is the property owner's responsibility to submit copies of weight tickets or receipts to the District Environmental Coordinator as these hauls occur. I hereby certtly that completion, implementation and adherence of the Debris,Menagement Plan (DMP) for the above named project shall guarantee that at least 50% of the jobatte waste Is diverted from landfilling. The remaining material will be recycled or reused. I will divert, for recycling or re -use, remaining materials generated from the first day of the project through the completion of the project in axordence with this plan. This DMP is Issued in the name of the properly owner(&) and shall remain their properly throughout the construction and/or demolition project A contractor serving as agent of the owner may obtain a DMP for the owner. However, the DMP Is still issued in the name of the property owners) and the owner retains legal responsibility for ensuring that the provisions of the DMP are adhered to. The property owner(s) and general contractor shall be kept informed of the diversion progress through bi-monthly reports. If se f auling, all refuse material from this project site must be taken to an approved recycler or bwvftr -17 Owner / per / P Jct Hager / Superintendent Date RECEIVED WASHINGTON 111, LTD. DEC 0 6 2016 30240 RANCHO VIEJO ROAD, SUITE B CITY.OF LA QUINTASAN JUAN CAPISTRANO, CA 92675 COMMUNITY DEVELOPMENT Telephone: (949) 443-1234 Facsimile (949) 443-1233 Email: iacktarr@lacktarrdc com December 5, 2016 City of La Quinta Building Division 78495 Calle Tampico La Quinta, CA 92253 Re: 46-520 Washington Street, Unit 1 La Ouinta, CA Dear Sirs: Let this letter serve you as our written authorization to Aspen Mills Bakery and its general contractor, Mr. Patrick Sauer, Mirage Developers, Inc., 121 S. Palm Canyon, Suite 208, Palm Springs, CA 92262, (760) 864-9448, to pull out the building permits for their Tenant Improvements per attached approved plans: 1) Proposed Plan 2) Demolition Plan 3) "As Is" Floor plan Please contact our office should you have any questions. Sincerely, Jack Tarr Managing. General Partner I Bin # Permit City of La Quinta Building 8£ Safety Division 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-701,2 s �IfBuilding Permit Application and Tracking Sleet 1ProjectAddressH6-5�C) �l�lG fYl 7��'f� gwwhcr'sName: A. P. Number./� `Address: �^I ` •3�o`7 � Ian C V C> f 0 g N - Legal Description: City, T, Zip: Sc,n JVGn. Cz")s krcm 0 .. -ontract �x C o r: ..r f I aer ' � v� S C n t -i T ehoc.• eI G u� U- 9V8 t GA7ddrestz) s: ) ect Description: or j_ :1y.1 ST, zip: G/y� fl�fyl TelePhone: �r r tate Lic. # :36q7 l 1t City Lie. Arch., Engr., Designer: Address: City, ST, Zip: Telephone:ne: Constructionn Type: O ccu� aneY• - State Lie. Demo oProJecthPe�ctrete one • New Add'n AIter Re air Name of Contact Person:rUGl �YJ Sq. Ft.://UZ #Stories: # Units: `ol,� `�— Tcl?P`hone # of Contact Person: ?GU��/ Estimated Value of Project: # Submittal APPLICANT: DO NOT WRITE BELOW THIS LINE Rcq'd Rce'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Cates. Called Contact Verson Plan Check Balcnee. Title 24 Cates. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.T. M.O.A. Approval Plans resubmitted Grading IN HOUSE:- 3" Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. NVI s. APPr Date of permit issue School Fees, I Total Permit Fc -:s RECEIVED DECO 12016 CITY OF LA AUINTA COMMUNITY DEVELOPMENT &-7