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10-1326 (AR)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 10-00001326 Property Address: 52700 AVENIDA RUBIO APN: 773-283-025-13 -000000- Application description: ADDITION - RESIDENTIAL Property Zoning: COVE RESIDENTIAL Application valuation: 1000 Aunt: Tihf 4 BUILDING & SAFETY. DEPARTMENT BUILDING PERMIT Architect or Engineer: Owner: . CARL FISHER PO BOX 408 PAW, SPRINGS, Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 12/23/10 LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION CA 92263 I hereby affirm under penalty of perjury one of.the following declarations: Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect._ I have and will maintain a certificate of consent -to self -insure for workers' compensation, as pr6vided License Class: License No.: - - - - - - - - - - - - - - - for,by Section 3700 of the Labor Code, for the performance of the work for which this permit is - LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty,of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of.the following declarations: Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect._ I have and will maintain a certificate of consent -to self -insure for workers' compensation, as pr6vided License Class: License No.: - - - - - - - - - - - - - - - for,by Section 3700 of the Labor Code, for the performance of the work for which this permit is - issued. Date: Contractor: _ 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 OWNER -BUILDER DECLARATION insurance carrier and policy nZimber are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier NO Policy Number. following reason (Sec. 7031 .5; Business and Professions Cade: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 to 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 workers' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000). of Division 3 of the Business'and Professions Code) or 3700 o the Labor Code;"l shall forth ith c ply with those provisions. that he or she is exempt therefrom and the basis forthealleged 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).: Date: / Z8 Yplicant: - (_ 1 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State LicenseLawdoes not apply to an ownerof property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). 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 completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). APPLICANT ACKNOWLEDGEMENT 1 I 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project ISec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the' _ 7044, Business and•Professions Code: The Contractors' State License Law does not apply 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 contractor(s) licensed 1 . Each person'upon whose behalf this 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 under Sec. B.&P.C. for this reason 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 Date: �� 16wner: %2 Z.9 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 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. 1 agree to comply with all work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws relating to building construction, and hereby authorize representatives Lender's Name: oI is county to enter yyppon the above-mentioned property for in spa / 28 ro 9 Date: i nature (Applicant or Agent): Lender's Address: � LQPERMIT Application Number . . . . . 10-00001326 LQPERDIIT - . Permit BUILDING PERMIT INV FEE Additional desc . Permit Fee . . . . 50.00 Plan Check Fee 16.25 Issue Date Valuation . . . . 1000 Expiration Date 6/21/11 Qty Unit Charge Per Extension BASE FEE 30.00 5.00 4.0000 HND BLDG 501-2,.000 --------------------------------------------------------- -------- 2'0.00 ------------ Permit . . . . ELEC-MISCELLANEOUS INV FEES Additional desc . PermitFee, . . . . 40.50 Plan Check'Fee 5.06 Issue,;,Date Valuation 0 Expiratori Date 6/21/1T Qty Unit Charge Per Extension BASE FEE 30.=00 7.00 1:500,0 PER ELEC-DEVICE/FIXTURE 1ST 20 10':50 Permit PLUMBING I•NV FEE „ - Additional.desc, . 'Permit .Fee . . . . 69.00 Plan Check Fee 8.63 _ Issue Date . . . - Valuation 0. 'Exprat_ion Date 6/-21/11 _ Qty Unit Charge Per. Extension BASE FEE: :30.0;0. 1.00. 12-.0000 EA PLB`FIXTURE 12.00 1.00 15.0000 EA PLB WATER-HEATER/VENT 15.00 T.00 6.0000' EA' PLB:WATER INST/ALT/REP 6.00 . 1.00 6.0000':EA PLB.FIX TURE DRAIN/VENT REB/ALT 6.00 Speci"al Notes and Comments LAUNDRY..CLOSET,ADDITION (28:.5 SF) ,TO EXTERIOR OF. GARAGE At -.'SOUTH ELEVATION,.. .RELOCATE ELECT. WATER ' HEATER •'TO CL: AND 'REROUTE SANITARY DRAIN,.• 2007 CODES. '08-.. ENERGY: *INVES,TIGAtIVE FEES•ASSESSED FOR WORK'COMMENCING BEFORE PERMIT'ISSUANCE CBC APPENDIX .CHAPTER 1` SECTION 108.4.' CODE CASE'NO. 10-1589* --------------------------------------.-------------------------------------- Other Fees . . . . . . . BLDG:SIDS ADMIN (SB1473) .1.00 ' STRONG MOTION (SMI) - RES .50 LQPERDIIT - . ....... - ';6.!N LQPERA11T. Application Number . . . 10-00001326 Fee summary ----------------- Charged - - - - - - - - - - Paid - - - - - - - - - - Credited - - - - - - - ---------- Due ---------Permit Permit Fee Total 159.50 .00 7 .00 159.50 Plan Check Total 29.94 .00 ..00 29.94 Other. Fee Total 1.50 .00 .00 1-.50 Grand Total— 190.94. ..0.0 .00 190.94 Bin # . Ci of la u" �Y Q. eat Bu1(d1hrSafetyVyslon P.O: Bo1504845 Calle Ta mpico / 5 �9Perit La Quinta, CiA'92253 - (760) 777-701 Building Perrnit Application and Tracking Sheet # m ' Project Address: % 00 AvE-0I � Owner'sName:2L = `4Z�9' 'A. P. Number: 77 3— Z ,. — Z15 Address: LeLegal Description: $ ` : ;:ate` ' V NLF- road' c 7 gL, 1 i Contractor: CJ _ _ City, ST; Zip:. i Zu :Telephone:. Y : ' S. ll Address: Project Description: L_ AUtjDfLI'. City, ST, Zip: .. .YVAI�LIZ . HC.2- ..•Pt'T-F>IT1Otii 7-0 . Telephone:MIN ? , %.' ? :" _ 12A E J aJ 171= -X t S -T -T -b '7 State Lic. # : City Lic: #; Arch., Engr., Designer: 4 i Address: AdJ� �t_� t tJ i..rcG City., ST, Zip: !�LocT. .WASer1i? `3Reac.r� Telephone: i if?vi:'':: Construction Type:. Occupancy: State Lic. #:Pro ect type circle one 'N6v Add'n' Alter ' e air Demo Name of Contact Person: �L S Sq. Ft i :I (g # Stori ' :. ( #Units: Telephone # of Contact Person:. ( . , Estimated Value of Project: N j pip APPLICANT: DO„NOT WRITE:BEI.OW,THIS LINE # Submittal Req'd Recd,'TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Coles. Reviewed, ready'for corrections PIan.Check Deposit Truss Coles. Called Contact Person Plan Check Balance. Tide 24 Coles. Plans,picked up 61 / . Construction Flood plain plan Plans resubmitted . Mechanical Grading plan 2°° Review, ready.for correctionsAssue Electrical! Subcontoctor List Called Contact Person' Plumbing Grant Deed Plans picked up • S.M.I: H.O.A. Approval Plans resubmitted Grading IN HOUSE:- Review, ready for corrections/issue Developer Impact Fee Planning Approval • Called Contact Person A.LP.P. - Pub. Wks. Appr Date of permit issue School Fees . I Nv. ��' = f SIO •`� Total Permit Fees ` RECORDING REQUESTED BY First American Title Company AND WHEN RECORDED MAIL DOCUMENT TO: Carl T. Fisher Living Trust P.O. Box 408 Palm Springs, CA 92263 DOC ## 2010-0571452 11/30/2010 12:21P Fee:21.00 Page 1 of 3 Doc' T Tax Paid Recorded in Official Records County of Riverside Larry W. Ward Assessor, County Clerk 8 Recorder I IIIIII'illl�ll I IIII SII I�IIIII lIIII III�I III VIII IIII III S RMIPAGE1SIZE DLIMISC LONG RFD COPY EXAM M A426 PC4S.FCHGUNI 10(4 -GMNT DEED A.P.N.: 773-283-025-7 T.R.A. No.020-098 File No.: RPD -366155 p) The Undersigned Grantor(s) Declare(s): DOCUMENTARY TRANSFER TAX $128.15; CITY TRANSFER TAX $; x computed on the consideration or full value of property conveyed, OR rP'� computed on the consideration or full value less value of liens and/or encumbrances remaining at time of sale, e% ; ( x J City of La Quints, and FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Fannie Mae,A/K/A Federal National Mortgage Association organized and existing under the laws of the United States of America hereby GRANTS to Carl T. Fisher, Trustee of the Carl T. Fisher Living Trust dated August 6, 1997 the following described property in the City of La Quinta, County of Riverside, State of California: See "Exhibit A and B" attached hereto and made a part hereof as applicable Mail Tax Statements To: SAME AS ABOVE e" I , i, Grant Deed - continued A. P. N .: 773-283-025-7 Dated: 11 / 23/2010 Federal National Mortgage Association By: Old Republic Title Company, a California Corporation Its Attorney in Fact BY: • Karen Cooper Vice President STATE OF C.-(,� L� )SS COUNTY OF �C f�L'Cr'111 On I �� -1�� before Public, personally appeared 4'.%1 Date: 11/23/2010 File No.: RPD -3661552 (dp) Notary , whol proved to me on the basis of satisfactory evidence to be the person(s) whose name(skis/are subscribed to the within instrument and acknowledged to me that he/6; /they executed the same in—his/tier/their authorized capacity(ies), and that by his/fie: their signature(s) on t4'instrument the person(s), or the upon behalf of which the person(s) 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. ". CAROLE JENSEN Commission # 1850621 Z Notary Public - California z Signature San Joaquin County My Comm. Expires Jun 8, 2013 V My Commission Expires: Lli tib_. 2'L' This area for ofl9cial notarial seal Notary Name: Notary Phone: 2-- % z— Notary Registration Number: l -1`Z/ County of Principal Place of Business: J07.0 i Page 2 of 2 Exhibit A LOTS(S) 12 AND 13 IN BLOCK 164 OF SANTA CAMELITA AT VALE LA QUINTA, UNIT#17, IN THE CITY OF LA QUINTA, COUNTY OF RIVERSIDE, STATE OF CALIFORNIA, AS PER MAPS RECORDED IN BOOK 19, PAGE(S) 19 AND 20 OF MAPS, IN THE OFFICE OF THE COUNTY RECORDER OF SAID COUNTY. 4 P.O. B.ox 1504 d LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMP(CO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPER'1"`Y .OWNER'S TACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures & Forms, for Owner -Builders Applying for Construction Permits �AN'1"1 1�IQ�CE l�RclrkrR'ry c� : Dm Property Owner . Ari. application .for `a building permit .has been sur mitted in your name listing yourself as the builder of the .pNOPerty -i4wvements specified at We we providing you with an Owner -Budder Ankn®Wlddoent-arid In&imati6h Verification. Form to mak you aw= of your nst", (hies and possible risk -you may incur by having Qdspermit issued in your name as the Ownes-Builder. we WW not issue a• bididl pe nit until you have waif, inid" your uudersading of ea&provislen, signed, and returned this form to us at our official address iadlcated. An agent of the owner cannot execute thi&Votice unless you, the property owner, obtain the prior approval of the permitting.authority. DfiW " NS• Read aW&dtkd eachstatemeni beio v W s'tgnlfy you Bund d der{ 'dds njb�iL . /I. 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`provWing his. or her own labor sad material phi. I, as an Owner -Builder, maybe held liable and subject to. serious. financial,risk fqr any injuries sustained by an unlicensed person and his or her employees while -working on my property. My homeowner 9 insurance may not provide covmge 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 'an -my. party. 2. I understand budding permits are not requited to be signed by property owners unless they are responsible for the construction and are not.hining-a licensed ConUaacciputo.:assume this responsibility- 3. I understand as afl `.Owner -Builder" Tam,the responsible party of record on the permit- I understaud.that I may protect myself from potential financial risk by hiring a licensed Compact andliavgeg the_permit-filed his. or her name instead of my own.-. V" 4. I understand Contractors are required by law to be licensed- and bonded in California and to list their license numbers on permits and contracts. ' VI'5. I 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. —:. 1//6. I .understand if I am considered an `° o , T^ empt yer'�der state andt ederal law, I must register with -the state and federal government, withhold payroll taxes,: provide workers'compensation disability insurance, and contribute to uuemtoyment compensation for each "employee:" I also understand my failure to abide by these laws may subject me to serious financial.,, risk 7. I 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 perforamed. by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is pecfgrmed under contract with a licensed general building Contractor. 8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal. bourns su"ined by any subsequent owuer(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 "employer" from the tutmud ROWnues Service, the United States Small Business Administration, the California DepaWnent of Benefit PaymettEs, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSL13) at 1- 800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. I0. 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 linencialty responses for proposed construction activity at the following address: �Z 700 AyG01 '12 ,1 j o, C=x- 1� 11. I agree that, as the party legally and fWatrciallyresponsible for this proposed-co�tcuction activity, I Will abide by all applicable tiws and regirireute t s that govern Owner -Builders as well as employers. agree to notify the issuer of this form immediately of any additions, deedetww, or cid to *my of the in€orumMon I have provided on this form. Licensed contractors are regulated by taws designed to protect the public. If you 001draet with -somoano who doesnot have a hoonse, the Cbntraetors' State IAOMse Dowd may be unable to-aseissfyou a� with any 6nal loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be inVivil court. It M also bwortsnt for you tan understand that if an untioensed Contractor or employee of that individual of &M is injured while vmdCmg on your property, you may be held liable for damages. If you obtain i permit as Owner -Builder and wise* to hirer Cont ors, You wed be .respottsle for v or not those Contractors are prope€ y licensed and the sMw of dim wa&crs' compensation iruutartoe ooveraga. Before a building permit can be issued, fids form must be completed and signed by the property owner and returned to the agency responsible for issaEng dw. w=tL !Notes: A copy of "proper ow4w's eWvec,'slil wvm fern notaq*aemn► or other verification aecep"Ja to the agency is required to be presented when tlta F ,MW is issued to. vw* the P:+ FaV owner's skmatuure. Signature of property owner Date: 2 G I o 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. AUTHORI7ATION OF AGENT TO ACT ON PROPERTY MftV_S B�,F Excluding.the Notice to Property Owner, .ti►¢ execution of which I understand is my personal Mgmhsibility. I hft*Y mthoriZe the following persons} to act as my agevgs) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for - 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 perjurythat I the property owner for the address listed above and I personally filled out the above information and certify its accuse ote- A copy of the owner's driver's license, form notarization, or other venfication acceptable: to the agency is m ired to be presented when the permit is issued to verify the property owner's signature.. Property Owner's Sigiiature: Date: R t r' >. 2 4`11`10N Z Q: _ ...... ,.:. pr r day: 7:00 a.m. to 5:30 p.m. f V: 8.00 a.m. to 5:00P m. N v -. Nome ::nment Code Holidays:- None _ :... I qt - September 30th ,, f -Friday: 6:00 a.m. to 7:00 p.m. -2 gay: 8:00 a.m. to 5:00 p.m. 0 ._( :. V ,,. ;. ,:...,_ ���y: None F,rament Code Holidays: _None W v. =: RxjsT#,Jy y'' _ Nrva.. WAS1+ait / DZYEM 2 .. HTS , en. Construction is NOT PERMITTED_ ni 2 Q . d -on the following Code Holidays: ' ' +Pi A J , 4' - New Year's Day _ Dr. Martin Luther Kin Jr.Da txt ST 1 r4c� Y Z��t� �t�G�,. J President's Day g -.4i x y Memorial Day 0 A 01 0 Independence Day C� L Labor Day x i ( e Veteran's Day i Thanksgiving Da J F� Ax.christrita I K "W. -2 U J AN ADEQUATELY SIZED DEBRIS CONTAINER I W %A REQUIRED ON THE JOB SITE DURING ALL U k PHASES OF CONSTRUCTION AND MUST k '`' , �1EM TIED AS NECESSARY FAILURE TO DO SO L\ MAY CAUSE � �1�tG3�. � E 2 DUMPED AT THE EXPENSEO HAU ONTAINER OF THE OWNER/ CONTRACTOR." CITY OF LA Q U I N TA Z 2 'I BUILDING & SAFETY DEPT.. WXWILL .�� ARE-tNSPECTtON FEE OF $30P BE CHARGED IF THE APPROVED ' APPROVED PLANS AND 106 CARD ARE NOT ON THE FOR CONSTRUCTION RPC MVF7 D �10 4 v iID �.. Q SITE E FOR A SCHEDULED INSPECTION. DATE IZ 23 Zo1D By DEC 2 2 2010 - -,. NO EXCEPTIONS# _ . A .,(:Z afclt-rA. , cA e�.i=:v. f :.. ITN z-� ��' z hq� o r ��Ay�® i � ; 't ,'��1a1. /�/y �i��qp �/A� - �%. �% ��/ ��./