10-0330 (DSF)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 10-00000330
Property Address: 51630 AVENIDA RUBIO
APN: 773-122-005- -
Application description: DEMO - COMML/OTHER
Property Zoning: COVE RESIDENTIAL
Application valuation: 0
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BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
alp
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
1 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
aany pplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
X
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.).
( 1 1, 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 contractorls) licensed
pursuant to the Contractors' State License Law.).
1 _ 1 1 am exempt under Sec. , B.&P.C. for this reason
�Date: er:
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:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 177-7011
INSPECTIONS (760) 777-7153
Owner:
AWTAR THIARA
2110 ARTESIA BLVD #175
REDONDO BEACH, CA 90278
---------------------------------
Contractor:
Owner
Date: 4/16/10
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' compe tic , as provided
for by Section 3700 of the Labor Code, for the performance of the work for whit his 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
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
700 of the Labor Co I shall f rth ' h mply with those provisions.
e: scant• 1
WARNING: Fk URE 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 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 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 Erebyauthorize representatives
of this co ty t enter upon the above-mentioned property for insp Y n os
9de ignature (Applicant or Agent):
Application Number 10-00000330
Permit . . . DEMO PERMIT
Additional desc .
Permit Fee . . . . 45.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
0
Expiration Date 10/13/10
Qty Unit Charge Per
Extension
BASE FEE
45.00
Special Notes and Comments
DEMO ILLEGAL GARAGE CONVERSION.AND
RESTORE TO ORIGINAL CONDITION. 2007
CODES.
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
P.O. Box 1504
LA QUINTA; CALIFORNIA -92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPERTY OWNER'S PACKAGE
(7 60) 777-7012
FAX (760) 777-7011
Disclosures & Forms for Owner -Builders Applying for Construction Permits
,l'11�T'Q.,(ZAIYT! NOTICE TO PROPERTY OWNER
. Dear Property Owner:..
;An. application for a building permit has been submitted .in your name listing yourself as the builder of the property
improvements specified at 5) - [ b &LEh1 IDA Rte 10 . L -Cr V 1 V.--'jia
We are providing you with an Owner -Builder Acknowledgment and nformation Verification Form tormake you aware of your
responsibilities and possible risk you may incur by.having this permit issued in your name as the
Owner -Builder. We will not issue a budding.perndt until youhave read, initialed your understanding of 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.
OWNER'S ACKNOWi,EI GMENT AND'VERIFICATION OF INFORMATION
-DIRECTIONS: Read and initial each. statement below to signs you understand or verify this information.
1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as
an Owner -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-
c ns2. I understand building permits are not required to be signed by property owners unless they are responsible for the
c nstruction and are not hiring a licensed Contractor to assume this responsibility.
4�k_3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect
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.
P�
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 $500), including labor and materials, I may be considered an "employee'
under state and federal law.
understand if I am considered an "employer" under state and federal law, I must register with the state and federal
government, 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.
11 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 performed.
under. contract with a licensed general building Contractor.
�8. I understand as an Owner -Builder ifI sell the property for which this permit is issued, I may be held liable for any
financial or personal. injuries sustained. by any subsequent owner(s) dot. result from any latent construction defects in the
workmanship or materials.
t9 understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue
>. the United States Small Business Administration, the California Department of Benefit Payments, and the California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CS R) at 1-
800-321-CSLB (2752) or www.cstb.ca.gov for more information about licensed contractors.
I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
p legally and financially responsible for proposed construction activity at the following address:
c�1 L I agree that, as the party legally and financially responsible for this proposed construction activity,.I will abide by all
applicable laws and requirements that govern -Owner -Builders as well as employers.
t I agree to notify the issuer of this. form immediately of any additions; deletions, or changes to any of the information I
h ve provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with
someone who does not have a license,. the Contractors' State License Board may be unable to assist you with any financial loss
you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also
important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while worlang
on your property; you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors,
you will be responsible for verifying .whether or not those Contractors are property licensed and the status of their workers'
compensation insurance coverage.
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 issuing. the permit. Note: A copy of the property owner's driver's.ficense, form notarization; or
other verification acceptable to the agency is required to be presented when the permit is issued to verify the property
owner's signature.
Signature of property owner Date: qllr- 1r)
Note: The following Authorization Form 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 AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding. the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize
the following person(s) to act as. my agent(s) 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): V)pw. b
Project Location or Address:,i`((r, 36 k ��„t'o (� z � ' �-4 er A 9aaS3
Name of Authorized Agent:' I L�1 A M Lt S Tel No (, (� -
Address of Authorized Agent: b Z j �� 1 S t N ti ti l 5<-tZ 1�) R LA 4u
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'C b presented when the permit is issued to verify the property owner's signature..
Property Owner's Signature: Date: Iff, /Z6 C7
/0Ito
Bin #
City of La Quinta
Building 8i' Safety Division
P.O. Box 1504, 78-495 Calle Tampico T�1 arm �trtaR
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and'Tracking Sheet
Permit #
Project Address: Q
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor: '
t.�Q
Telephone:
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<,>
Address:
Project Description: .
City, ST, Zip:
L M Q L
nTelephone:
�3 IL �
State Lic. # :
City Lic. #:
I (q i�1 tr COI`% r l
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone: 'i? a '< `'> r4gEfv
ti ;. •s•: ::.•>s> >>
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State Lic. #: ` >'. " << <'<:<%> >:'} {%>r.:.•;;%:'� �
Name of Contact Person:
Construction Type: S Occupancy:
project type (circle one): New Add'n Alter Rep Demo
Sq. Ft.: #Stories: #Units:
Telephone # of Contact Person: 4d�b Lt Estimated Value of Project: 2 omn
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°' Review, ready for correctionsAssue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
7rd Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
,
Total Permit Fees
V.
1
RECORD/NG REQUESTED BY
AND WHEN RECORDED MAIL TO:
Veronica J. Montecino, City Clerk
CITY OF LA QUINTA
P.O.-Box-1504
La Quinta, Ca. 92247-1504
Exempt Recording Fees per Government Code Sections 6103 and 27383
NOTICE OF SUBSTANDARD BUILDING AND OR PROPERTY
Notice is hereby giJ to all persons, pursuant to the provisions of the La Quinta Municipal Code, a"e'
adopted by Title11 of the La Quinta Municipal Code that the property described below has been
inspected and found to be substandard as defined in Chapter 11. 72 of the above code and the
owner of record have been or will be notified.
Violations consist of:
11.72.030 (N) Maintenance of Property
8.01.080 Building and Safety Permit Required
9.50.090 (A-12) Landscaping be Maintained
California Building Code 302.4 Fire Rating for Occupancy Separations
Uniform Housing Code 1001.5 Hazardous Electrical Wiring
Uniform Housing Code 1001.8.2 Faulty Weather Protection
This document will be terminated only when the City Building Official finds that the public nuisance
has been abated and either that such abatement has been accomplished at no cost to the City or
that any such costs have been repaid to the City or that such costs have been placed upon the tax
rolls as a special assessment pursuant to Section. 25845 of the Government Code. Detailed
information regarding this Declaration, Code Violations, or any costs or fees that must be paid the
City, may be obtained by contacting the Building & Safety Department, Code Compliance Division .
LEGAL DESCRIPTION
Owners of Record: US Bank NA Area: 020-017
Situs: 51630 Avenida Rubio
APN #: 773-122-005
THE NORTH HALF OF LOT 9, BLOCK 22 OF SANTA CARMELITA AT VALE LA QUINTA UNIT
NO. 2, AS SHOW AP ON FILE IN BOOK 18, PAGES(S) 55 AND 56 OF MAPS, RECORDS
OF RIVERSID CO TY, CALIFORNIA.
By: DATE: February 11, 2010
City of La Quinta
George Munoz; Code Compliance Officer
State of California
City of La Quinta
County of Riverside
On February 11, 2010, before me, Pamela Nieto, Notary Public personally appeared George Munoz, who proved to me
on the basis of satisfactory evidence, to be the person whose name is subscribed to within said instrument and
acknowledged to be that he/she executed the same in his/her authorized capacity, and that by his/her signature on the
instrument the person or the entity upon behalf of which the person acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and
correct.
WITNESS my hand and official seal S NIETO
Signature:L "I
Notary Public
PAMELA .
Commission # 1723211
Notary Public - California
Z Riverside County
My Comm. Expires Feb 2, 2011
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