05-1019 (RER)� ram 4�.•� I
O '�a • 1G�'ICV
O
BUILDING &'SAFETY DEPARTMENT
OX .1.504 (760):777-7012
or 7. CALLE TAMPICO FAX (760) 777-7011
IN ,, CALIFORNIA 9225.3 INSPECTION REQUESTS (760) 777-7.153
BUILDING PERMIT
O Q � Geo _ •
Number. . . . . 05-00001019 Date 3/22,/05
P pert Address . . . . . 79600 CORTEZ LN
AP. 649.-052-008-32 -26,67 -
Application description . . . REMODEL - RESIDENTIAL
Property Zoning LOW DENSITY RESIDENTIAL
Application valuation. 500
Owner Contractor
Laulie Smith OWNER
79-600 Cortez Lane
LA QUINTA aCA 92253
------ StructureInformation RESIDENTIAL REMODEL
Construction •Type. TYPE V _ NON RATED
Occupancy Type DWELLG/LODGING/LONG <=1G..
Other s'truct info'. CODE EDITION 2001
----------------
Permit' BUILDING PERMIT
Additional desc .
Permit Fee 54.00. Phan Cheek Fee 3'5.10.
Issue Date Valuation' 2500
Qty Unit _Charge Per Extension
BASE' ,FEE 45.00
1.00 9.0000 THOU' BLDG. .2, 001-25, 000 9.00
---- P------ ------------------------------ ---------------- --
Special Notes and Comments
Replace .existing insulation and---
-' . 1. _. el.-
at. Living Room ceiling with R-38 .and T&G
resawn lumber.. Replace six (6) broken
.windows.
Other Fee's ENERGY REVIEW FEE 3.51
STRONG MOTION (SMI) RES., .50
Fee summary Charged Paid. Credited Due
Permit Fee Total 54.00 .00 .00 54.00
Plan Check Total 35.10 :0'0. .,00 315.10
Other Fee Total 4.0.1 .00 .00 4.01.
Grand Total 93.11 .00 .00 93.11
P.O.. Box 1504' VOICE (760) 777`-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUIN:TA, CALIFORNIA 92.253 INSPECTIONS (760) 7774153
B'UILD1 G & SAFETY DEPARTMENT
Application Number: 03 /`0 9 Date;4
,Applicant: Architect'or Engineer:
Applicant's Mailing .Address: - , Architect or Engineer's Address:
0c. No.:
BUILDING PERMIT DECLARATIONS
LICENSED,CONTRACTOWS 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 Licenswis in full force.and effect.
License Class License'No.
Date- Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury tharl: am exempt from the Contractors Siate'License Law•for the followinpeason (Sec. 7031.5, Business:and Professions Code: Any
city orcounty'thatrequires a°permit to,construct„ alter, improve, demolish, or repair any structure; prior to ifs issuance, also requires the applicant for the permit to file a signed
statement that he or she is licensed pursuant to:the proyisions of the Contractors' State License Law, (Chapter 9 (commencing with Section 7000) ofDivision 3 of the Business
and Professions Code) or that he orshe is exempt therefrom and the,basis for the alleged exemption. Any violation.of 8,ection 7031.5 by any applicanffor. a pemut subjects
the applicant'to.a civil penalty ofnot.more than five hundred dollars 4504):
(� I, as.owner of the property, ormy employees With= their sole. compensation, will do the work, and the structure is not intended or offeredfor sale (Sec. 70.4 4,
Business and Professions Code:, The Contractors' State License Law. does notapply to an owner of pmpertywho'builds or, impmvesthemon, and oho does the work
himself or herself or through his or-her-owmemployees, provded,that the improvements are,not intended or offered for sale. If,. however, the building'orimprovement is
sold within one year of completion, the owner -builder will) have'the.burden of.pTving that he or did not build or improve for the purpose of sale.).
(, 1; as owner of the property,:am exclusively,contracting with licensedcontractors to constrict the project (Sec. 7044, -Business and Professions Code: The Contractors'
State License Law does not apply to:an ownerof property who builds or improves thereon, and who contractsforthe projects with a contragtor(s) licensed, pursuant to
the Contractors' State License Law:).
U I am exempt,underSec.,, Et&.P;C_for this reason
/Date. Qq
WORKERS' COMPENSATION DECLARATION
11terebyaffirm under penalty of perjury one"of'the following,declarations:
_ Chave:and',will maintain a;certificate of consent to self -insure for workers' compensation, as provided for bySection 3700 of the Labor Cod a16 performance
of the work for which this.permit;is. issued.
hhaVe.and.will,mainiain workers" compensatiominsurance,; as required by Section'3700 of the Labor Code: for the performanceofthe:work for which this permit is
issued. My workers' compensation insurance carnerand: policy number are
Carrier - Policy Number
.1 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 subje t to the workers'
compensation -laws of Califomia; and agree that;,if1shout&become subjectto the workers" compensation provisions of Section 3700'ofthe Labor code, llshall
for5 thwCith comply:withtho pro ' to •
Date 0414 ITA
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), INADDITION'"TO THE COST`OF`COMPEN8ATION,: DAMAGES AS PROVIDED FOR IN
SECTION 3706,00 THE LABOR CODE, INTEREST, AND.ATTORNEY'S FEES.
CONSTRUCTIONIENDING AGENCY'
I hereby affirm iinderpenaltyotpedurythafthere is a constructiontendi"ng agency forthei,perfonnance of the work for which this;permit is'issued (Sec, 3097, Civ: C.).
Lender's Name
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to,the Director of Building and Safety for aipermit subject to the conditions and restrictions set forth,on this application.
1: Each person upon whose behalf, this application is made, each person at whoseirequest and for whose benefit work is performed under or pursuant.to,any permit
issued as a resulE of this application, theowner, ;and the applicant, each agrees to, and shall, defend, indemnify and ,hold.harnless,the City of La Quinta, its
officers, agents and employees forany act or,omission related to;themork being performed under or following` issuance of this permit.
2. Any permit issued.las 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,pennitto cancellation,
I certify that l; haveread this application and state that the above infornationiis correct: I agree:to comply with all city and county,ordinances andistate laws relating to building
construction. and. hereby -authorize representatives of this Jontn1nan the above-mentioned property. for inspection:
Dat. Q'q' �� �l 'Signaiure(Applicant qr
Dear Property Owner:
78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253
TELEPHONE (760) 777-7012 FAX (760) 77.7-7011
OWNER/BUILDER INFORMATION
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 responsible party 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 than 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 put their license number on all permits for which they
apply.
If you plan to do your own work, with the exception of various trades that 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 not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and.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 contracts 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 an "Owner/Builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally
Building permits are not required to be signed by property owners unless they are ,performing their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at. 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so'that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(760) 777-7012
M:,6 77-7011
L_
o as /05
OWN'ER'S SIGNATURE/DA
79L&o Gw-4y ane- 9.a
PROPERTY ADDRESS
Oma- f
PERMIT NUMBER(S)
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69
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�. (� CITY OF LA QUINTA
BUILDING & SAFETY DEPT
`� APPROVED
DA:FOR CONSTRU N
47#L;J9y7
'Jow Aeof,lwr
Bin #
City of La Quinta
Building 8t Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760).777-7012
Building Permit Application and Tracking Sheet
Permit #
D5--1 °f9
Project Address:l •
Name: A u- Ll 5 rA 1
A. P. Number::
IIwner's
Address: �0 0 Ct) ?-4e. Z.
Legal Description: •
City, ST, Zip: LA Ou %n -VA
`
Contractor: � UUi� >✓!2elephone:
ZButt-Aer
Address:
Project Description: �r
City, ST, Zip:
(��'Ca� •dos �--� Wld/CO�U�
Telephone:
:,;�<.:>:•:::>...
l�c;1a4cC0 /V-s7'0.b4.i C�
State.Lic. #,: City Lic. #:
Arch., Engr., Designer:
lAi
Address:
City, ST, Zip:
4rF..,,OS'•.:Y.: Sif?'Stfr`�' :.
Telephone: ;w ¢ ' Y'?x .a
aa>s
9�f:•.t:.:�rr�aF:•ii•Y�'�.i%j�:t.L� ?a
State.Lic. #:
Name of Contact Person:
Construction Type; Occupancy:
Project,type (circle one): New Add'n Alter Repair Demo
S . F o ' # Units:
Telephone # of. Contact.Person:
stimated Value'of Project:.* 2
APPLICANT: DO NOT WRITE BELO
#
Submittal
Req'd
Recd
TRACKING PERMIT FEES
Plan Sets
Plan Cheek submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss.Calcs.
Called. Contact Person
Plan Check Balance
Title 24 Cales.
Plans picked.up
Construction
Flood plain plan
Pians resubmitted
Mechanical
Grading plan
2" Review, ready for correctio -sue
3 f/t Electrical
Subcoutactor List
CalledContact-Person /N muly
lambing
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
,J -g A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Tdf 4 449wfij
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINT'A, CALIFORNIA 92253
BUILDING PERMIT
BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-71.53
Application Number . . . . . 05-00001.019 Date 3/22/05
Property Address 79600 CORTEZ.LN
APN: 649-052-00.8-32 -2'667 -
Application description . . . REMODEL - RESIDENTIAL
Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL
Application valuation . . . 2500
Owner
Laulie Smith
79-600 Cortez Lane
LA QUINTA CA 92253
Contractor
------------------------
OWNER
------- Structure Information RESIDENTIAL REMODEL --=--
Construct,ion Type . . . . . TYPE V - NON RATED
Occupancy Type . . . . DWELLG/LODGING/LONG <=10
Other struct info . . . CODE EDITION 2001
Permit. . . . . . . BUILDING PERMIT
Additional, desc .
Permit Fee 54.00 Plan Check Fee 35.10
Issue Date . . . . Valuation . . . . 2500
Qty Unit Charge Per Extension
BASE FEE 45.00
1.00 9.0000 THOU BLDG 2,001-25,000 9.00
Special Notes and Comments
Replace existing insulation and drywall
at Living Room ceiling with R-38 and T&G
resawn lumber. Replace six (6) broken
windows.
Other Fees . . . . . . . . . ENERGY REVIEW FEE 3.51
STRONG MOTION (SMI) - RES ..50
Fee summary
-------------
Permit Fee Total
Plan Check Total
Other Fee Total
Grand Total
Charged Paid
54.00
.00
3.5.10
.00
4.01
.00
93.11
.00
Credited Due
.00
54.00
.00
35.10
.00
4.01
.00
93.11
P.O. BOX 1504 • VOICE (760) 777-70121`
78-495 CALLE TAMPICO FAX -(760) 777-701 I .
LA QuINTA, CALIFORNIA 92253 INSPECTIONS (760.) 777-71.53
BUILDING & SAFETY DEPARTMENT
Application Number: 05-1019 Date:
Applicant: I Architect or Engineer:
Applicant's Mailing Address:
Architect or Engineer's Address:
Lic. No.
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I herebyaffirn'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 fulbforce and effect:
License Class License No.
Date Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for thefollowingreason (Sec. 7031.5, Business and Professions Code: Any
city or county thatrequires,a permit to construct, alter, improve, demolish, or repairanystucture, prior to itsIssuance, also requires'the applicant for the permit to file a signed
statement that he or she is licensed pursuant to the provisions of the -Contractors' 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).):
1, 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 or through'his or her own employees;.provided4hat 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 thathe or she did not build or improve for the purpose :of sale.).
U 1, as owner of the property, am exclusively contracting with licensed,contractors to construct the project (Sec. 7044, Business and Professions Coder The Contractors'
State License Law does, not -apply to an owner of propertywho builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License, Law.).
U I am exempt underSec. , B:8 P.C. for this reason
/Date Owne✓
✓ WORKERS'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 woikers" compensation insurance carrier and policy number are:
Carrier Policy Number
_ I certify that, in the performance of the work for which this permitts issued.:1 shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree'that, If 1! should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith complywith those provisions.
Date Applicant
WARNING: FAILURE TO SECUREWORKERS' 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 3708 OF THE LABOR CODE; INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affinmunder 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.).
i
Lenders Name
Lenders Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made'to.the Director of Building and Safety for a, permit subject to theconditions 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 benefitwork is performed under or pursuant` to any permit
issued as a result of this application, the owner, and the applicant, each agrees to,end shall, defend.indemnify and hold harmless the City of La Quints, its
officers; agents and employees for any actor omission related to the work being performed under or following issuance of this permit.
2. rAny permit issued as a result of this application becomes null and void if work is notcommenoed within 186 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 aboveJnfornation is,correct. tagree to comply with all city and county ordinanoes,and state laws relating to building
construction, and hereby authorize representatives of this county tg-enter upon the above-mentioned property for inspection purposes.
'Date Signature,(Applicant or Agent):✓//
CITYrF LA QUINTA SUB -CONTRACTOR LIST
JOB ADDRESS 794PW A,�Z PERMIT NUMBER OWNER BUILDER
&L
This form- shallbe posted on the job with the Building Inspection Card at. all - im s in a conspicuous place.Only persons appearing on this list or their employees are authorized to work
on this job. 'Any- changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of building -permit. For each applicable trade, all information
requested below must be completed bV
applicant. "On File" is not an acceptable response.
Ji WN
Company Name
Classification
Ucense Number
ExP. Date!
carrier Name
Policy Number
Exp. Date
Ucense. Number
Exo. Date •
(e.g. A, 8, C-81
(XXXXXXI
x1x
(kx/xl XX)
(e.9, State Fund, CalCompl
(Format Varies)
(Xxfx)i/XXI
(XXXX)
`X
(XX/XXIXX)
IXW
0
IM:
00534 -Ib.
I6
7ZZ-
... . .....
UM.
`6
.
......... ......... . .......
.......... ..... . . . . . . . .
... .......
. . . . . . . . . .
3L~W
............
Le
0A:SkPINI:GO
RECORDING REQUESTED BY
AND WHEN RECORDED MAIL THIS DEED AND; UNLESS
OTHERWISE SHOWN BELOW, MAIL TAX STATEMENTS'TO:
t
114
"41 NAME Mr. & Mrs. David Smith
' STREET 79-600 Cortez Lane
ADDRES
DITy SLa. Quinta, CA 92253
M STATE
ZIP
L+J
Title Order No: Escrow No.
GRANT DEED
JOINT TENANCY
IiD PE
P10
-��
d fd
n.
Q .J
-SPACE ABOVE THIS LINE, FOR RECORDER'S USE
DOCUMENTARY TRANSFER TAX I • �=
❑ computed on full value of ,property conveyed, or
• computed on full value less lien and,
encumbrances remaining at time .of sale.
signature of Declarant or Agent Determining Tax. Firm Name
FOR VALUABLE CONSIDERATION, receipt of which is.acknowledged, I (We), JOHN E. DILLON AND JACQUELYN
J. DILLON, HUSBAND AND WIFE-, (name ofgramor(s))
granttoDAVID WAYNE SMITH AND LAULIE SMITJ, HUSBAND AND WTFE, AS
(name of grantees)
JOINT TENANTS
AS JOINT TENANTS,
all that real property situated in the City of LA QUINT'A
(orin an unincorporated area of) RIVERSIDE County, California,
(name of County)
described as follows (insert legal description):
LEGAL DESCRIPTION IS ATTACHED HERETO & BY THIS REFERENCE IS MADE
APART HEREOF;
Assessor's parcel No. (a 17/ 0,2042 3
STATE OF CALIFORNIA_
ss.
COUNTY OF Riverside
On this 17th day of A= r i l in the year 199 Q,
before me, the undersigned, a Notary Public`in and forrsald State, personally,appeared John E . Dillon -and
JacquelynJ. Dillon ---------------------------------------
personally known to me (or provedto me on the basis of satisfactory evidence) to be the persortE; Whose named --ax eubscribed to the
within instrument, and acknowledged to me that __lite�L executed it.
WITNESS my hand and official seal,
- - - - - - Z �q,
QFFICIAL SEAL Notary Public in and for id State.
B. T. 'MORRINO
Notary Public-Witomta
= RNIERi o eCOUNTY
MY Cofrtm: FJP. Dec. 27, 1001
MAIL TAX
STATEMENTS TO
NAME
ADDRESS
ZIP
YDyEpED—GRANT—JOINT TENANTS Thisstandard form is Intended for the typical situations, encountered In the field indicated. However. before you sign, read It, fill in all blanks_;
V C.O YVOLCOM 768—W 5-83 (price class 3) and'make.whate"' ctaeges'are appropriate and'necessary;to your particular transaction.. Consult a lawyer if you doubt the loim's.fitness for
your purpose and use.