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BCOM2017-005278-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Permit Type/Subtype: Application Number: Property Address: APN: Application Description Property Zoning: Application Valuation: c&'tY 4 4 Q'" DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT BUILDING COMMERCIAL/REMOD B8211HIHWAY �� 7827T HIGHWAY 111 604050061 VONS / INTERIOR REMODEL TOR GROCERY STAGING AREA $67,194.00 FEB 15 2018 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 2/15/2018 Owner: NS GROCERY COMPANY 2 1 SW SALMON STREET 4TH FLOOR P LAND, OR 97205 CITY OF LA DESIGN AND DEVELOPMENT(DEP F & SMITH P B M SERVICE Applicant: Contractor: KASEY WYBRANTARTM 139 NORTH MAPLE STREET #H CORONA, CA 92880 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, C15. C54 License No.: 9952D6' OWNER -BU I LD E R#fECLARAT I ON 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 az 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 Na Lender's Add (951)279-3386 Llc. No.: 995206 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' coTqejIsation, as provided for by Section 3700 of the Labor Code, for the performance Zf-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: STATE COMPENSATION INSURANCE FUND Policy Number: 9205182 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 o he labor Code, I shall forthwith comply with those provisions. Darp, 0--Z /rB �t. WARNING: FAILURE TO SECURE WORKERSKfiMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CR14INAL 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 ' correct. I agree to comply with all city and county ordinances and statjei I g to building construction, and hereby authorize representatives of this ci r upon the above-mentioned property for inspection purposes. Date: 2/15/2018 Application Number: BCOM2017-0052 Owner: Property Address: 78271 HIGHWAY 111 VONS GROCERY COMPANY APN: 604050061 1211 SW SALMON STREET 4TH FLOOR Application Description:. VONS / INTERIOR REMODEL TO CREATE GROCERY STAGING AREA PORTLAND, OR 97205 Property Zoning: Application Valuation: $67,194.00 Applicant: Contractor: KASEY WYBRANT HOFF & SMITH P B M SERVICE 139 NORTH MAPLE STREET #H CORONA, CA 92880 (951)279-3386 Llc. No.: 995206 Detail: INTERIOR REMODEL OF EXISTING OFFICE SPACE AND REMOVAL OF TWO CHECK STANDS TO CREATE GROCERY PICKUP AND STAGING AREA [ENGINEERED] THIS PERMIT DOES NOT INCLUDE ELECTRICAL LIGHTING ALTERATIONS OR CHANGES TO EXISTING OCCUPANT LOAD. 2016 CALIFORNIA BUILDING CODES. FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY AMOUNT HOURLY CHARGE -CITY BUILDING STAFF 101-0000-42600 0.75 $117.00 Total Paid for BLDG CITY STAFF - PER HOUR: $117.00 DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $3.00 . Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $3.00 DESCRIPTION ACCOUNT QTY AMOUNT DEVICES,- FIRST 20 101-0000-42403 0 $26.01 DESCRIPTION ACCOUNT CITY AMOUNT DEVICES, FIRST 20 PC 101-0000-42600 0 $26.01 Total Paid for ELECTRICAL: $52.02 DESCRIPTION ACCOUNT QTY AMOUNT FIRE COMMERCIAL TI PC 101-0000-42420 0 $234.00 Total Paid for FIRE FEES: .$234.00 DESCRIPTION ACCOUNT QTY AMOUNT PLAN CHECK DEPOSIT - COMMERCIAL 101-0000-42600 1 $125.00 Total Paid for PLAN CHECK DEPOSIT - COMMERCIAL: $125.00 DESCRIPTION ACCOUNT QTY AMOUNT RECORDS MANAGEMENT FEE - MAJOR 101-0000-42416 0 $20.00 Total Paid for RECORDS MANAGEMENT FEE - MAJOR: $20.00 DESCRIPTION ACCOUNT QTY AMOUNT 101-0000 42600 ($53.05) DESCRIPTION ACCOUNT QTY AMOUNT 101-0000-42600 ($71.95) DESCRIPTION ACCOUNT QTY AMOUNT REMODEL, FIRST 100 SF 101-0000-42400 0 $53.05: DESCRIPTION ACCOUNT QTY AMOUNT REMODEL, FIRST 500 SF PC 101-0000-42600 0 $71.95 DESCRIPTION ACCOUNT QTY AMOUNT REMODEL, FIRST 500 SF PC 101-0000-42600 0 $73.17• Total Paid for REMODEL: $73.17 DESCRIPTION ACCOUNT QTY AMOUNT SMI - COMMERCIAL 101-0000-20308 0.- $18.81 Total Paid for STRONG MOTION INSTRUMENTATION SMI: $18.81 DESCRIPTION ACCOUNT QTY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 DEC 0.8 201? gat'. UPLAr F914Mt1NOMOF LA QUINTq COMMUIVITII DEyELOPMENr Cid}/ Of % Qilfflta Building ez Safety Aivtsion P.O. Box 1504,78-495 Catle Tampico U.Quinta, CA 92253 -:(760) 777-7012 Building Permit Application and Tracking Sheet Permit # Projectaddress: 78-271 State Hwy 111 (VONS #2175) Owner's Name:. Vons Grocery Company A. P. Number: 60405006-4 Address: 1121 SW Salmon Street, 4th Floor Legal Description: City, ST, Zip: Portland, Oregon 97205 Contractor: TBD at 'C >s= Telephone: 3r,�.`' WIN ac. 'r. s• y Address: Project Description: Interior renovation to consist of new roce City, ST, Zip: staging area. Telephone:°' ;% State Lic. # : City Lie'. #.: Arch., Engr., Designer. James E. Downs Jr. Address: 1925 Prospect Ave. City, ST, Zip: Orlando, FL 32814 Telephone: 407-661-9100 V.� State Lic. #: C-28049 r Construction Type:. Occupancy: Project type (circle one): New Add'n Alter Repair Demo Ft.: # Stories: #Units: Name of Contact Person: Kasey Wybrant Kase W@C- Corr Telephone # of Contact Person: 407-66179100 EXT 2413 Estimated Value of Project: $67,194 APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit, Truss Cates. Called Contact Person Pian Check Balance Title 24 Calci. Plans picked up Construction Flood plain plan Plans resubmitted,'. Mechaideal Grading plan 2id Review, ready for correctionVissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '^' Review', ready for eorrectionsfissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees ermit Fees DEC 0.8 201? gat'. UPLAr F914Mt1NOMOF LA QUINTq COMMUIVITII DEyELOPMENr Plan Check # County of Riverside DEPARTMENT OF ENVIRONMENTAL HEALTH P.O. BOX 7909 • RIVERSIDE, CA 92513-7909 lvtu STEVE VAN STOCKUM, DIRECTOR JAN 0 4 2018 CCITY OF LA QUiNTA OMMUNITY E ELOP&IENT FOOD ESTABLISHMENT PLAN APPROVAL NOTICE Project Name Vons 2175 Plans Submitted by Date 12-26-17 Address 78-271 Highway 111, La Quinta CA Kasey Wybrant Phone 407-661-9100 Owner Vons Grocery Co. Address 1121 SW Salmon Street, 41h Floor, Phone Portland OR 9705 The plans are now approved subject to the conditions listed below and the attached compliance sheet. This plan approval is for a new grocery staging area only. 1. All floor sinks under refrigeration cases must be half exposed. The back half of each floor sink is to have a one inch berm (concrete or stainless steel). CONSTRUCTION INSPECTIONS: Contact the Plan Checker for a Preliminary Inspection when construction is approximately 80% complete, with plumbing, rough ventilation, and rough equipment installed. Request for inspection should be made at least five (5) working days in advance. A FINAL INSPECTION MUST be made upon completion of ALL work including finished details. APPROVAL to operate shall not be granted, or remodeled areas approved to operate, until the facility has passed the FINAL INSPECTION, and "APPLICATION TO OPERATE" has been completed and PERMIT FEES have been paid. Request for inspection should be made at least five (5) working days in advance. PLANS CHECKED BY Tracey Ford Phone 760-863-8287 I acknowledge the corrections noted herein and as indicated on the plans and agree to incorporate them during construction: Signature Company Name Corona Hemet 2275 S. Main St #204 800 S. Sanderson #200 Corona, Ca 92882 Hemet, Ca 92545 (951) 273-9140 (951) 766-2824 Indio 47-950 Arabia St "A" Indio, Ca 92201 (760)863-8287 Murrieta 38740 Sky Canyon Dr. Murrieta, Ca 92563 (951) 461-0284 Date Palm Springs 544 S. Paseo Dorotea Palm Springs, Ca 92264 760-320-1048 Riverside -west 4065 County Circle Riverside, Ca 92503 (951) 358-5172 Riverside -East 3880 Lemon St. Riverside, Ca 92501 (951) 955-8982 Office Locations a Blythe • Corona • Hemet • Indio • Murrieta • Palm Springs • Riverside Phone (888)722-4234 www.rivcoeh.org Building Permit Number: I Project Descri tion: Econtain rovement Exempt: zardous wastes and are not subject to recycling pr Construction Debris Management Plan VE Um Plan Submittal Date! 1/2/2018 Job Site Address) 78271 Hwy 111 Owner's Name Number, Street, or PO Box City, State, Postal Code Owner's Phone Number Owners E -Mail Address Project Manager's Name Project Manager's Phone Number Project Managers E-mail Address Von's (Harsch Properties) 1121 SW. Salmon St Portland, OR. 97205 505-242-2900 c/o kaseyw inc-o.com Carl Hoff 951-279-3386 service(cilhsobmservice com JAN 0 4 2018 CITY OF LA QUIr4TA COMPUNITY DEVELOPMENT Builder / Contractor Hoff & Smith PBM Service Number, Street or PO Box 139 N. Maple St #H City, State, Postal Code Corona, CA. 92880 Project Square Footage 354 square feet City Approval By Renado Gouldlock-DEC/Burrtec Wastp, Date of City Approval 0.75 Materials To Be Discarded: Product Tons Trash 0.75 Not recyclable Product Tons Asphalt 0.00 Recyclable Masonry (broken) 0.00 Recyclable Brick/Block 0.00 Recyclable Plaster 0.00 Recyclable Cardboard 0.00 Recyclable Scrap Metal 0.00 Recyclable Commingled 0.00 Recyclable Tile (floor) 0.04 Recyclable Concrete 1 0.75 Recyclable Tile (roof) 0.00 Recyclable Drywall 0.19 Recyclable Wood 0.50 Recyclable Donated / Reuse' 0.00 Recyclable Landscape Debris 0.00 Recyclable 'Describe Items Totals: Rec cle Trash 1.51 1 0.8 Projected Diversion: 66.37% 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 certify that completion, implementation and adherence of the Debris Management Plan (DMP) for the above named project shall guarantee that at least 65% of the jobsite 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 accordance with this plan. This DMP is issued in the name of the property owner(s) and shall remain their property 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 owner(s) 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 self -hauling, all refuse material from this project site must be taken to an approved recycler or transfer Owner / Developer / Project Manager / Superintendant Date y Construction Debris Management Plan Summary of Requirements As of January 1, 2017, The Green Building Standards Code (CALGreen) requires that the construction of most new structures in the State of California comply with sections 4.408 and 5.408 of the code in accordance with Assembly Bill 939 requiring that no more than 35% of jobsite waste be disposed of as trash at local land fill sites and transfer stations. Exceptions may be made for certain projects under certain conditions. The City of La Quinta is committed to the highest level of environmental respect, to conserving our precious natural resources and setting an example to provide for a better world for generations to come. Recycling helps keep reusable resources out of landfills and will also reducedisposal costs. IMPORTANT: Burrtec Waste & Recycling Services is the City's franchise hauler. If you choose to self -haul any recyclables or trash, you must provide copies of all weight tickets and/or receipts from the transfer station, landfill, or recycler as the job progresses. Clean-up companies and other haulers are not permitted to haul waste or recyclables from the City of La Quinta. Self -haul weight tickets should be submitted to: Renado Gouldlock, District Environmental Coordinator - rgouldlock@burrtecdesert.com, or faxed to (760) 340-0417; or mailed to: 41575 Eclectic Street, Palm Desert, CA. 92260. • ... _...... __ ` PERMIT # M -�o PLAN LOCATION:. .Project Address: "�� r b Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech APN #: Telephone: Patio/Porch SF Email: Applicant Name: State Lic: City Bus Lic: �a Address: State Lic: City Bus Lic: City, ST; Zip: Telephone: qD Email: Valuation of Project $ . Contractor Name: -New SFD Construction: Address: Conditioned Space SF City, St, Zip Garage SF Telephone: Patio/Porch SF Email: Fire Sprinklers SF State Lic: City Bus Lic: Arch/Eng Name: Construction Type: Occupancy: Address: Grading: City, St, Zip Construction Type: Occupancy:. Telephone: Bedrooms: Stories: # Units: Email: State Lic: City Bus Lic: r Property Owner's Name: New Commercial / Tenant Improvements: Address: Total Building SF City, ST, Zip Construction Type: Occupancy:. Telephone: , E-mail: 78495 CALLE TAMPICO LA QUINTA, CA 92253 760-777-7000 ' # . Sulimittal. " Req'd -Rec'd Plan Sets. Structural Calcs Truss Calcs Title 24 Calcs Soils Report Grading Plan.(PM10) Landscape Plan ' Subcontractor List Grant Deed HOA Approval School Fees •Burrtec Debris Plan Planning approval . i Public Works approval Fire approval City Business License