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BDEM2015-000378-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application Description Property Zoning: Application Valuation: Applicant: ELIA CARBAJAL 53710 AVENIDA RUBIO LA QUINTA, CA 92253 COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT BDEM2015-0003 53710 AVENIDA- RUBIO 774113010 CARBAJAL DEMO CASE # CE2015-0561 $0.00 D Q 0 JUL d 1 2015 CRY OF LA QUINTA COMMUNITY DEVELOPMENT DEPARTMENT . 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: License No.::CONV:140528101253027402 Date: — Contractor: C \ � `� t "�`�)� \ 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 any 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 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 Name: Lender's Address: VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7/1/2015 Owner: ELIA CARBAJAL 53710 Avenida Rubio LA Quinta, CA 92253 Contractor:. ELIA CARBAJAL 53710 AVENIDA RUBIO LA QUINTA, CA 92253 (760)404-9292 Uc. No.::CONV:140528101253027402 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: _ 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 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: �— l Applicant: \ t CA, `0"V\00V WARNING: FAILURE 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 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 is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above- mentioned property.for inspection purposes. t Date: 7`-. �j Signature (Applicant or Agent): �\ t uw'co FINANCIAL .• 1• t `,'st 'DESCRIPTION ^y; �r $�`VeA =<sa`t * .'ACCOUNT zY'ir# wQTY�„�� AMOUNT,'• y-# PAID' PAID DATE DEMOLITION, INTERIOR 101-0000-42404 0 $36.26 $36.26 7/1/15 PAIDBYr, `"'fit, s'n" t,METHOD,<` gRECEIPT# s I '# CIiECK#= ` CLTDBYt+ ELIA CARBAJAL CASH R7477 EVA '.DESCRIPTION ¢ ' t ;% x`:. ACCOUNTS' ' p i'QTY i AMOUNT: ' 4;'" PAID PAID DATE DEMOLITION, INTERIOR PC 101-0000-42600 0 $97.17 $97.17 7/1/15 us $METHOD `' 4 z $:RECEIPT,# "r`CHECK #' "CLTD BY ate' ,wtr ELIA CARBAJAL CASH R7477 EVA Total Paid for DEMOLITION: $133.43 $133.43 TOTALS: $133.43 $133.43 r B1n # City of La Quinta Building 8i.• Safety Division P.O. Box 1504, 78-495 Calle Tampico (%�� La Quinta, CA, 92253 - (760) 777-7012. Building Permit Application and Tracking Sheet Permit # �E t Project Address:1�6 a ' Owner's Name: a Ye a )7'pp A. P. Number: Address: 53 I G �2 rLI A ltU �J I� p Legal Description: City, ST, Zip: LQ 0,J �/I fr e� G�2253 Contractor: _ Telephone: � <�r Address: Project Description: Arm l�'t- Gu�S..... City, ST, Zip: ; t Telephone: T ci State Lic. # : City Lie. Arch., Engr., Designer: L L Address: City, ST, Zip: Telephone: e one: P Con stru ti T Construction e• Occupancy: Type: P Y: State Lic. # Pro'e ct a (circle one • New Add' n Alter Repair Demo J h'P � ,Name of Contact Person: Sq. Ft.: # Stories: # Units: ;Telephone # of Contact Person: Estimated Value of Project: - APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Cates. Called Contact Person Plan Check Balance Title 24 Cales. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2-d Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN ROUSE: '"' 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 RECORDING REQUESTED BY: Fidelity National Title Company Escrow No. 416766 -CB Title Order No. 3.3 ii D(611 i' s When Recorded Mail Document ,.and Tax Statement To: Ms. Elia Andrea Carbajal 53710 Avenida Rubio La Quinta, CA 92253 DOC # 2011-0128552 03/23/2011 08:32A Fee : 21.00 Page 1 of 3 Doc T Tax Paid Recorded in Official Records (� County of Riverside Larry W. Ward Assessor, County Clerk & Recorder I . . IIIIIIIIIIIIIIVIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII S11 R U P E SIZE DA I MISC LONG RFD COPY LLA . L 465 426 'FCO R NCOR SMFNCHG WM UNI T: CTY GRANT DEED The undersigned grantor(s) declares) Documentary transfer tax Is -$148.50 [ X ] . computed .on full value of property conveyed, or [ ] computed on full value less value of liens or encumbrances [ ] Unincorporated Area � City of La Quinta remaining at time of sale, FOR A -VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, a public body corporate and politic, a Corporation hereby GRANT(S) to Elia Andrea Carbajal, A Single Woman -40L,L i 'L- La La Quinta sieve-, the following described real property in the.'City of La QuintaCounty of Riverside, 'State of California: SEE EXHIBIT "ONE" ATTACHED HERETO AND MADE'A PART HEREOF. DATED: January 28, 2011 State of California �j ) County of� tC l�%E��! USE ► On 1 P,bt/Itk. .(( loll before me, S SELS Notary Public (here insert name and titl of jhe officer personally appeared '�l'iDr�/l7Q.5 �% _t4 -1��[ who proved to me 'on the basis :of satisfactory evidence to be the person(s) whose name(s). is/are subscribed to the , within instrument and acknowledged to me that he/she!the.y executed the same in his/her/their authorized capacitylies►; and that by his/her/their signatures) on the. instrument the person(s), or the entity 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. 21L2013 La QuID*Gr-IR)Reekw44eF, a public body corp . at d politic By: T omas Genovese ------------ WITNESS my hand and official seal. SUSAN MAY9ELS COMM. 01844479 Signature (Seal) NOTMYPU" * C"O" RNA =110 3 Ca►>Ai�ton MAIL TAX STATEMENTS AS DIRECTED ABOVE FD -213 (Rev 12/07) GRANT DEED (grant.wpd) (08.09) �F.fwa�rw 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 IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit has been submitted in our name listing Y � g yourself as the builder of the property improvements specified at t C_ 5� 7 �l �(�.� I We are providing � �� Q�1 ��• p g you with an Owner -Builder Acknowledgment and Information Verification Form to make 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 building permit untilyou have 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 ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION DIRECTIONS: Read and initial each statement below to signer 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. 1, 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. .,I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. L 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. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. L5. 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 "employer" under state and federal law. Ems. I understand if I am considered an "employer" understate 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. CZ. 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 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. E L8. 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 injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. 1E C-9. I understand I may obtain more information regarding my, obligations as an "employer" from the Internal Revenue Service, the United States Small -Business Administration, the California Department of Benefit Payments, and the Califomia Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- 800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. L 10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally, and financially responsible for proposed construction activity at the following address: 3 > 1 Q 'Pix). 12� t 6 oA t ISA ,Z�D—��!_ -- sJi3 jEL11. 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 govem Owner -Builders as.well as employers. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have 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 working 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 properly 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 license, 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 r \`, Qk C qk�_ \] M' C-\ Date: l — ` — 1 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): 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 presented when the permit is issued to verify, the property owners signature. Property Owner's Signature: Date: w Description: CARBAJAL DEMO CASE # CE2015-0561 ADDIT CI Type: DEMOLITION Subtype: SINGLE FAMILY Status: UNDER REVIEW Applied: 7/1/2015 EVA Approved: Parcel No: 774113010 Site Address: 53710 AVENIDA RUBIO LA QUINTA,CA 92253 Subdivision: SANTA CARMELITA AT VALE LA QUINTA Block: 190 Lot: 15 Issued: UNIT 19 Lot Sq Ft: 0 Building Scl Ft: 0 Zoning: Finaled: Valuation: $0.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 NAME TYPE Details: DEMO WITHIN GARAGE, BATHROOM, KITCHEN, PARTITION WALLS, DOORS, REMOVE AC UNIT, LIGHT FIXTURES. PER 2013 CBC. RETURN GARAGE TO ORIGINAL EXISTING CONDITIONS CONTACTS r : STATE Printed: Wednesday, July 01, 2015 3:43:40 PM 1 of 2 CRWIYSTEMS ADDIT CI I ONAL SITE IS IRONOLOGY • NAME TYPE NAME tp "'§ ADDRE581'CITY CONTACTS r : STATE ZIP � PHONE' ` FAX, -EMAIL APPLICANT ELIA CARBAJAL 53710 AVENIDA RUBIO LA QUINTA CA 92253 ( Printed: Wednesday, July 01, 2015 3:43:40 PM 1 of 2 CRWIYSTEMS Permit Details PERMIT NUMBER'' d Y. City of La Quinta BDEM2615 0003. » .. r ; DESCRIPTION ` "ACCOUNT i "i 7777 QTY . g AMOUNT PAID PAID DATE ; RECEIPT # CHECK #, > , METHOD,.,,-,,,-_ `PAID�BY CUD DEMOLITION, INTERIOR 101-0000-42600 0 $97.17 $97.17 7/1/15 R7477 CASH ELIA CARBAJAL EVA PC Total Paid forDEMOLITION: $133.43 $133.43 TOTALS: $133.43 $133.43 SEQID INSPECTION.TYPE - INSPECTOR SCHEDULED j.e6MPLETED RESULT REMARKS t NOTES DATE,. DATE : .y PRE -SITE BLD FINAL" I BLD PARENT PROJECTS Printed: Wednesday, July 01, 2015 3:43:40 PM 2 of 2 C SYSTEMS _ lip,,i � I i --I CITY I F t ;---'-- jl.A CUTA-- 1 - IN E' T. ' BUILDING &SAFETY PIP VE -FOR-�� RI�CT O DA'i 1 i