12-1378 (DEMO)4
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 11/26/12
Application Number: 12-00001378 Owner:
Property Address: 54280 AVENIDA MONTEZUMA KOWALEWSKI PAUL
APN: 774-231-002- - - 112 S PLYMOUTH BLVD
Application description: DEMO - COMML/OTHER LOS ANGELES, CA 90004
Property Zoning: COVE RESIDENTIAL ---------------------------------
Application valuation: 0
Contractor:
Applicant: Architect or Engineer: Owner D n
I ---------------------26 2011
CIN OF I.A QuINTA
FINANCE DEPT.
. 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 or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
n 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—) I am exempt under Sec. 0
/Data: G ner.
CONSTRU T N DING AGENCY
I hereby affirm under penalty of perjury that there is a con uction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.I.
Lender's Name:
Lender's Address:
LQPERAI IT
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 Policy Number
1 c=at, in the performance of the work for which this permit is issued, 1 shall not employ any
person in any manner so as r� hcrom ub'ect to the workers' pensation laws of California,
and agree that, if I 'oulme subject to t to rk rs' co ensation provisions of Section
3700 of the Labor C all fc '1 p y wit th prov' ions.
ate�LJ
cant
WARNING: FAILURE TO SECURE WORKERS' COMPENSATIOICOVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIV FINES UP TO ONE HUNDRED THOUSAND
DOLLARS J$1 00,000). IN ADDITION TO THE COST OF CO PENSATION, 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 worki not commenced
within 180 days from date of issuance of such permit, or cessation of work f r 180 days will subject
permit to cancellation.
I certify that I have read this application and stat rect. ogre to comply with all
city a d county ordinances and state laws r ting to building construction e orize representatives
of is county to enter upon a above -men ' ned property for ' n purpo
Da (Applicant or Agent):
Application Number . . . . . 12-00001378
Permit . . . DEMO PERMIT
Additional desc .
Permit Fee . . . . 45.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date 5/25/13
Qty Unit Charge Per
Extension
BASE FEE
45.00
-----------------7----------------------------------------------------------
Special Notes and Comments
DEMOLISH UNPERMITTED, UNCONFORMING
STRUCTURE IN BACKYARD TO RESOLVE CODE
CASE #12-6138.
Fee summary Charged Paid
--------------------
Credited
----------
----------
Due
-----------------
Permit Fee Total 45.00
.00
.00
45.00
Plan Check Total .00
.00
.00
.00
Grand Total 45.00
.00
.00
45.00
LQPERMIT
V
wA�
P.O. BOX 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPERTY OWNER'S PACKAGE
(760) 777-7012
FAX (760) 777-7011
Disclosures & Forms for Owner -Builders Applying for Construction Permits
NOTICE Tn>fiQr.MTY .0M i j>i
Dear Property Owner.
An. aN"caiion for a building permit has been submitted in your name listing yourself as the buildef of the property
improvements specified at
We we providing You with an O -Builder Acknowledgment.and Information Verification Form to make you aware of your
mspowi4ilities and possible risk you may incur by having tfrispemnt.isaued.in your name as the
Ownes,43uilder. we Will not issue a brriiding.peV`H* untll have read} initialed our. understandingof each provision,
signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice
unless You, the property owner, obtain the prior approval of the permitting authority.
r'
E 's Ae»wiJ) HG74EM ANDYKAMMMN OF rt
D Read and antral each statfrr W_bp&W tb signify you widdenwand or very this KormaEion:
1. 1 understand a? frequent practice of unlicensed persons is to have the property owner obtain an "Ova= -Builder"
building. permit that erroneously implies that the property owner is providing his or her own labor and material pemmnelly. 1, as
an Ownr-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 working on my property. 'My homeowner's insurance may not provide coverage for those
injuries• I am willfully acting as an Owner -Builder and am aware of the limits of my insurance _coverage for injuries to workers
on my property.
— yp2. 1 understand building permits are not required to be
construction and are not hiring a Licensed Contractor to assume this y owners unless they are responsible for the
'• 'understand as an "Owner -Builder' I am theresponsible party of record on the tmit. I understand that I may rotect
myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
(/ 5.1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
of my construction is at least five hundred dollars (5500) including labor and materials, I may be considered an "employer"
under state and federal law. '
6. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal
vernment, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment
compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial
risk.
7. [ 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 sale, unless all work is performed by licensed
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is perfonnei
under contract with a licensed general building Contractor.
8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, 1 may be held liable for any
financial or personal. bouries sussed by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
9• I understand I may obtain more information regarding my obligations as an "employee' from the latcMA Revenue
Service, the United States Small Business Administration, the California Department of Benefit Payments, and ihie California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSM at 1-
800-32 j-CSLB (2752) or www.cslb.ca gov for more information about licensed contractors.
10_ I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
ply legally and financially responsible for proposed construction activity at the following address:
(A. I agree that, as the party legally and f-waacially responsible for this proposed construction activity,.1 will abide by all
applicble laws and requirements that govern Owner -Builders as well at employers.
L---(2. I agree to notify the issuer of this form immediately of any additions; deletiens, or changes to Sny of the information 1
have provided on this form Licensed contractors are regulated by laws designed to protect the public. If you contract with
someone who dor not have a beense, the Contractors' State Lioerise Board may be unable to Weir$ you with any fiw=ial loss
YOU may sustain as a result of a complaint Your only remedy against unlicensed Contractors may be in'civil Wort- It is also
ihWurtlkw for You to. understand fat if an w*censod Contractor or employee of that individual or firm is i*ucd while vwrldng
on your property; you may be held Liable for damages. If you obtain a permit as Owner-BmIder and wish to hire Contractors,
YOU will be re%mmW for verging whether or not those Contractors are prope&iy licensed and the status of their workers'
Compensation insutanve coveraga-
Before a building permit can be issued, this form must be completed and signed by the property -owner and returned to
the agency responsible for issue; &a.perm#. Neee: j.4 copjttec gr properowner's d%iv 'S!i#aer*ati ferac' or other verification aseaptable so dee ae red a be presented when die permit is issuuf to v4ff j' the POP"
owner's signature. i_
Signature of property owner
Date Noy - W r e z
Note: The following Authorization Fortis 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.
AUTHORIZATION OF AUNT TO ACT ON PROPERTY 0"l4R'S MHA�,F
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize
the fo@owing peraon(s) to act as my agents) to apply for, sign, and file the documents necessary to obtain an Owner -Builder
Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of (Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above
information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification
acceptable to the agency is required to be pnesstrted when the permit is issued to verify the property* 's signature.
Property Owner's Signature: Date:
Property Detail Report
Page 1 of 1
0
DIGITAL MAP
Property Detail Report for. PRODUCTS
54280 AVENIDA MONTEZUMA, LA QUINTA CA, 92253-6608
Owner Information:
Owner Name:
KOWALEWSKI,PAUL J & KAREN M
Mailing Address:
112 S PLYMOUTH BLVD, LOS ANGELES, CA, 90004- 3836
$230,000 1 It Mtg Amount:
Vesting Code:
COMPANY/CORPORATION/INCORPORATED
Phone Number:
Location Information:
Improvement %:
Legal Description:
LOT 15 BILK 260 MB 019/044 SANTA CARMELITA VALE LA QUINTA UNIT 24
County:
RIVERSIDE FIPS Code: 06065
Census Trct/Blk: 0451092/2
APN:
774231002 Alternative APN: 774231002
Map Ref: F3
Twnshp-Rnge-Sect:
-- Legal Book/Page: 774-23/
Tract No:
Legal Lot:
15 Legal Block: 260
GRANT DEED/DEED OF TRUST
Subdivison:
SANTA CARMELITA VALE LA QUINTA
Title Company:
Last Market Sale Information:
Sale Date:
02/17/2012 Sale Price:
$230,000 1 It Mtg Amount:
$184,000
Sale Doc No:
0000073707 Price Per SgFt:
$168 1St Mtg Int Type:
Improvement %:
Transfer Doc No:
Price Per. Acre:
2nd Mtg Amount:
Multi/Split Sale:
1 It Mtg Doc No:
2nd Mtg Int Type:
Assessor Acres:
Sale Type:
FULL CONSIDERATION .
Assessor Lot SgFt:
No of Buildings:
Deed Type:
GRANT DEED/DEED OF TRUST
Res/Comm Units: 1
County Use Code: R1
Title Company:
FIRST AMERICAN TITLE
Calculated Lot Sq Ft:
Lender:
FRANKLIN LOAN CENTER
Seller Name:
RW REAL ESTATE INC
Property Characteristics:
Building Area:
1,373 Total Rooms:
Construction:.
Living Area:
1,373 Bedrooms
3 Heat Type:
CENTRAL
Garage Area:
420 Baths:
2.0 Air Cond:
CENTRAL
Basement Area:
Fireplace:
Roof Type:
Parking Type:
GA1 No of Stories:
1 Roof Material:
COMP SHINGLE
Yr Built/Effective:
1979/ Quality:
Style:
Pool Code:
YES
Tax and Value Information:
Assessed Value: $134,000
Assessed Year: 2011
Est Market Val: $121,511
Land Value: $33,000
Property Tax: $1,860
Assessor Appd Val:
Improvement Value: $101,000
Improvement %:
Total Taxable Value: $134,000
Tax Exemption:
Site Information:
Assessor Acres:
Zoning: R1
Land Use: 163
Assessor Lot SgFt:
No of Buildings:
Land Use Desc: SFR
Assessor Lot W/D: I
Res/Comm Units: 1
County Use Code: R1
Calculated Acres: 0.1149
Sewer Type:
Calculated Lot Sq Ft:
Water Type:*
http://maps.digitalmapcentral.com/production/citygis/v07_03_001/index.p7.aspx 11/26/2012
i
Bin.#
CIta
�y of.La QC±111
Builtftng &r Safety Division
Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #P.O.
13
Project Address:ZS-0
Owner's Name:. ea r-ell f- Pa Ao Leia sh
A. P. Number.
Address: �<,
Legal Description:
Contractor.
City, ST, Zip: L,�Z5 e e-s e,4 goon
Telephone: 23 —376 —mss y/
Address:
Project Description:
City, ST, Zip:
em D �iUh Q and S KcfLii'
Telephone:
City Lie. #:
State Lie. 4:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone: �.
�iy Y r
State Lie. #:,w
Construction Type:. Occupancy:
Project tYPa circle one)New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft..
# Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
N
Submittal
Req'd
Recd
TRACKNG
PERMITFEES
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 Calci.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
V Review, ready for correetions(issue
Electrical
Subcontactor List
Called Contact PersonPlumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
IPI ROUSE:-
'^' Review; ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
Schobl Fees
Total Permit Fees