07-2198 (RR)r. PO
.
7 8 BOX 1504
e''=495 CALLE TAMPICO
LA QUINTA; CALIFORNIA 92253
i
-tit- 4
t►;K;w
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS. (760) 77777153
Date: 7/26/07
Application Number:07-:00002198 Owner:
Property Address: "52860 AVENIDA OBREGON MIRIAM KAHN
APN- 773-335-025-6 -000000= 52830 AVENIDA OBREGON
Application description: RE -ROOF LA QUINTA, CA 92253
Property Zoning_ ••`` COVE' RESIDENTIAL �t -----------------'-------.---------
Application valuation: 5000
Contractor INW
Applicant: Architect or Engineer: Owner } U
------- -- -r------ -- -
_ G11Y OF LAQUINTk 4�1
—
FINANCE DEPT:
--————-,--————————-—————————————--—-—————=——-——————————————— — — — — —— --- --- ---'—----=-•-----——----—----
LICENgl CONTRACTOR'S DECLARATION, - - _ WORKER'S COMPENSATION DECLARATION
I•hereby affirm under penalty ofperjury that I am licensed under provisions,ofChapter_9.(commencing:with - - , I hereby affirm under penalty of perjury one of the following declarations
Section 70001 of Division 3 ;of.'the Business and _P.rofessionals Code, -and my License is in full`force.pntl effect. _ I have and will.maintain a,certificate of,-consen_t to•self-insure for workers' compensation, as provided
License Class: License No.: t•. • for by Section"3700'of the Labor Code`, for the performance of_the'v;brk.for which this permit is
,. issued.
Date: "Contractor: s _ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performanceof the work for which this permit is issued. My workers' compensation .
OWNER -BUILDER DECLARATION - insurance carrier _and policy number are:
1 hereby affirm under penalty of perjury that I am exempt frorrthe Contractor's State License Law for the ' Carrier I Policy Number
following reason (Sec. 7031 .5, Business and Professions Code: Any city or.county that requires a permit -to I certify that, in the performance of.the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner.so as to become subject io the workers' compensation laws of California,
.. - permit to file a signed. statement that he or she is licensed, pursuant:to the provisions of the Contractor's State ' and agree that, if I should'become subject to the work ompensation provisions of Section
License Law`(Chapter 9 (commencing with Section,700dfof Division 3'of the Business and'Professions Code) or " 700 of the Labor Code,I shall'forthwith comply wi se provisions. _
that he or she is exempt therefrom and the basis for the alleged exemption.; Anyvialation of Section 7031.5 by . - -
a pplicant for a permit subjects tfie applicant to a civil not more.than.fivehundred�dollars (55001.: Date:,.- _ 'Applicant: i.
' - ( &) .I; as owner'of,the property, or my employees. with wages as their•sole compensation, will do the work, and ��
the structure isnoiintended oroffereil.for sale (Sec: 7044, Business and Professions Coce: The WARNING: AILURE TO SECURE WORKERS', COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors'`State'License Law does not apply to'an owner of property who builds or improves. thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED fHOUSAND.
:and who does:the.work:himself or herself through his or her own employees, provided that the.. DOLLARS (5160,000).* IN ADDITION TO THE'COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are. not intended or offered' for. sale. If, however, the building or improvement is sold within SECTION 3706'OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.- - -
- _ - .one year of •completioii,.the owner-buildei will have the burden of proving that he or she -did not build or - -
-improve for the purpose of sale.). ' - - - ` APPLICANT ACKNOWLEDGEMENT- -
.(_ 1 I, as -owner of the property, am exclusively -contracting with licensed contractors to.construct the project (Seci IMPORTANT .Application is.hereby made to the Director of, 'Build'ing-and Safety for a permit subject to the
7044,. Business and•Professioris Code:. The Contractors' State License Law does'riavapply to an owner of conditions and restrictions' "set forth on this application..
- property who builds or -improves thereon, and who:contracts for the projects with a contractors) licensed 1. Each person upon whose behalf ihis'application is made, each person at whose request and for -
pursuant to the Contractors' State License Law.). - whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_ 1. I am exempt rider Sec. ' , B.&P.C. for this reason . ' the owner, and the applicant, each agrees to,.andahall defend, indemnify and hold harmless the City
of.La Quinta, its officers, agents and employees for a'ny act or omission.related to the work being
performed under or following issuance ofthis.permit.
.Date: Owner: / 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
CONSTRUCTION LENDING AGENCY permit to cancellation. '
1 hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). - city and county ordinanc/andtate laws relating to building construction, and hereby authorize re sentatives
of this co ty t enter uabove-mentioned property for inspection purposes. '
Lender's Name:-
te`:G' - "` GZ = nature'IApplicant-or_Agentl:�P '/ Lender's Address:
. LQPERMIT - - ,
Application Number . . 07-00002198
Permit .
. RE -ROOF
Additional desc .
Permit Fee . . .
. 30.00
Plan Check
Fee
.00
Issue Date
Valuation
. . .
. 0
Expiration Date
1/22/08
Qty Unit Charge Per
Extension
BASE
FEE
30.00
---------------------------------------.-------------------------------------
Special Notes and
Comments
RE -ROOF WITH CLASS
"A" MATERIALS
Fee summary
Charged
Paid Credited
Due
Permit Fee Total
30.00
.00
.00
30.00
Plan Check Total
.00
.00
.00
.00.
Grand Total
30.00
.00
.00
30.00
LQPERMTT
Bin
City'of La Quetta.
Building U SafetyDivision
P.O. Box 1'504,1'78-495 Calle Tampico
La Quints, CA 92253 - (760) 777-7012
..Building Permit Application and Tracking Sheet
Permit #
a
A
Project Address:
Owner's Name:
A. P. Number:
Address: G "
�F
Legal Description: "
Contractor:
Address:
City, ST, Zip:
Telephone: 7 Q %
Project Description:
City, ST, Zip:
Telephone:
State Lic. # : City Lic. #:
Arch., Engr., Designer:
Address:
City, $T, Zip:
Telephone:
State,Lic. #:
Name of Contact Person:
Construction Type:, Occupancy:
Project type (circle one): New Add'n Alter Repair Demo .
Sq. FL:
# Stories:
# Units: . .
Telephone # of Contact Person:
Estimated Value of Project:Soo(') .1
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
keq'd
"Reed
TRACK NG
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
Energy Calcs.
Plans picked up "
Construction
Flood plain plan
Plans resubmitted
Mechanical.
Grading:plan
2°" Review, ready for" correctionsrssue
Electrical "
Subcontactor List
Called Contact Person
Plumbing. .
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmittedGrading
INHOUSE:-
'` Review, ready for correctionsrssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees .
Rea1.Q_pest.00 M07Report
Property Detail Report
For Property Located At' -
.52830 AVENIDA VALLEJO, LA QUINTA CA 92253,75302
.'Owner Information:'
:Ciwner Name -
.Mailing Address:
Phone Number:
Location Information:
.Legal Description:
County:
Census Tract / Block:
Township -Range -Sect
KAHN MIRIAM
PO BOX 936, LA QUIIqTA:*CA.92 Codes:. 2 47-01936 8009
Vesti'n*, g 7de- UW
LOT 23 BILK 159 MB 018/099 SANTA: CARMELITA VALE LA cluiNTA
UNIT 16.
RIVERSIDE, CA APN: .7737324-004
451.1011 Alternate APN:
Legal Book/Page: 18-99
Legal Lot: 23
Legal Block: 159
Market Area:
Neighbor Code:
6wner:Trah.sfer Information:
Recording/Sale
* Date:
Sale Pride:
Document
Last Market Sale Information:
Subdivision:
Map R&f6re_n'c'e:
Tract.#:
School District:
Munic/Towns hip:
Deed Type:
Ist Mtg Document #:
Recording/Sale bate:
08/16/1990 06/1990.
1 st�Mtg Am6untlType:.,
.Sale -.Price:
$73j560
1st Mtg Int. Rqte/T.V�`e:
Sale Type:
FULL
1 st.Mtg .Dobui men t`#:�
Document #:
296956-
2nd Mtg',Amnountltype:.'
Deed Type.-
DEED (REG)
2nd.Mt.6 Ih.t,.,Riie/Type:
Transfer'Document #:
Rooms:
Total;Rooms:
Price Per-SoFt:..
New Construction:
Patio Type:
Multi/Split Sald.
Title Company:
FIDELITY NATIONAL'TITLE
Lender:
GREAT WSTRN' BK
2/
Seller Nafme:
VETERANS AFFAIRS
Year:Built / Eff:
Prior Sale Information:
Prior Rec/Sale Date' 09108/1989 08/1989
Pri6rSale- Price: $169,000
Prior Doc Number: 309402
Prior Deed Type: DEED (REG)
Property. Characteristics:
Prior. Lender:
Prior1 st Mtg Amt/Type:Prior . 1 st Mtg Pat.6/Type:
SANTA ,
'CAR* MELITA VALE
LA-QU INTA. U NIT
16
1'879-.E2
DESERT
'iN'Dib u .
t58,600 CONV
ADJ
296957
$48.61
iIMCO RLTY SVC
INC
$126,500 / CONV
Gross. . Are a:
1,800
Parking Type:
GARAGE/ Construction:
CARPORT
Living Area:
1,512
Garage Area:
288 -Heat Type:
Tot:Adj Area:.
1,512
Garage Capacity:.
1 Exte ' rionwall:
Above. Grade:
0.11
Parking Spaces:. •
2 :Porc h.type?
Rooms:
Total;Rooms:
6
Basement Area:
Patio Type:
Bedrooms:
4
Finish bsmnt Ar6a:
Pool:
Bath(F/H):
2/
Basement Type:.
Air Cond:
Year:Built / Eff:
1978
Roof Type:
Style:
Fireplace:.
Y
Foundation:
SLAB Quality:
.# .of. Stories:
1:00
090f M30ri5l'SHINGLE
COMPOSITION
Condition:
Other Improvements:
ADDITION
Site information:
Zoning:
R-1
Acres:
0.11
Count' Use:
County
Flood Zone:
X500
Lot Area:
4,792
State Use:
Flood Panel:
0607090005B
Lot Width/Depth:
50
0 i-100
Site Influence:
FloodPanelDate:
08/19/1991 .
Res/Comm Units:.
1/
Sewer Type:
STUCCO
CENTRAL
TRADITIONAL
AVERAGE
SINGLE FAM
RESID:(R01)
NONE
http://w.ww.rea..I.quest.com/jsp/report.jsp?serverid=rq03&cl'ien.i—&'a,ctio'n=co*nfifrri&type=ge... 6/28/2007
RealQuest.com ® - Report
o
Land Use: SFR
Tax Information:
Total Value: $96,335
Land Value: $32,988
Improvement Value: $63,347
Total Taxable Value: $96,335
Page 2 of 2
http://www.realquest.com/jsp/report.j sp?serverid=rg03 &client=&action=confirm&type=ge... 6/28/2007
Water Type:
TYPE
UNKNOWN
Assessed Year: 2006
Property Tax:
$1,282.78
Improve %: 066%
Tax Area:
20017
Tax Year: 2006.
Tax Exemption:
http://www.realquest.com/jsp/report.j sp?serverid=rg03 &client=&action=confirm&type=ge... 6/28/2007
OWNER/BUILDER INFORMATION
Dear Property Owner:
d
An application for a building permit has been submitted in your. name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Owner/Builder" you. are the responsiblep arty of record on such a
permit. Building permits are not required to be signed by property owners unless they.are;personally performing their
own work. If your work is being performed .by someone other'th'an yourself, you may protect yourself from possible
liability if that person applies -for the proper permit in`his or her name.
Contractors are required by law to be licensed and'bonded'by the State of California and to have a business license
from the'City or County. They are also required by law to Out their license number on'+all permits for which they
apply.
If you plan to do your own work, with the exception of .various trades thar.you plan to subcontract, you should be
aware of the following information for your benefit and protection.
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire project, and such persons are notlicensed as contractors or
subcontractors, then you may be employer.
If you. are an employer, you must register with .the Stateand Federal; Government as an, employer and you are subject
to several obligations include State and Federal income tax withholding; - federal social security taxes, worker's
compensation insurance, disability insurance costs and,unemployment-,compensation contributions.
There may Be financial risks for you if you do not carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance.
For more specific information,about your obligations under Federal Law, contact, the Internal Revenue Service (and, if
you wish, the U.S. Small Business.Administration). For: more specific information -about your, obligations under State
Law, contact the Department.of Benefit Payments and the Division of Industrial Accidents.':
If the structure is intended .for: sale, -property owners_ who are not.licensed contractors; are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice. of unlicensed persons. professing to be contractors is to secure ad "Owner/Builder" building
permit, erroneously implying 'that "the '.property owner ' is' providing his or hers oWwAab`or and material personally.
Building permits' are not required ao be signed by. property owners`unless'they arep''erforming their own work
personally:
Information about licensed contractors may be obtained' byr,contacfirig the Contractors' State License Board in your
community or at 1020-N. Street, :Sacramento, California 95814:
Please complete: an& return 'the enclosed owner -builder verification form so that we can -confirm that you are aware of
these matters:_ Th'e building permit -,will not be issued until the yerification..is:ceturned'!',�
Very truly yours,
CITY OF LA.QUINTA
DEPT. OF.BUILDING'AND SAFETY
78 -495 -Calle Tampico
La Quinta, CA 92253
(760) 777-7012
FAX: (760) 777-7011
OWNER'S SIGNA URE/DA E`
,5o2 -860 09 ®-n
PROPERTY ADDRESS
:0 -7- 198
PERMIT NUMBER(S)