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12-0912 (DEMO)P.O. BOX 1504 •---� 78-495 CALLE TAMPICO --a- LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 12-00000912 Property Address: 52165 AVENIDA VELASCO APN: 773-224-019-8 -000000- Application description: DEMO. -. COMML/OTHER Property Zoning: COVE RESIDENTIAL Application valuation: 0 Applicant: Architect or Engineer: 6lerebyaff* --------------- LICENS TRACTOR S DECLARATION er penalty of perjury that I am ad under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business an ro ssionals Code, and my License is in full force and effect. License Class: License No.: Date � ntractar: - 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 islicensedpursuant 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 sheds exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: l 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 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, an who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State Licens w.l. (_ 1 I am exempt under Sec. , BAP r this reason Date: r. I hereby affirm under penalty of perldry that ttfere is a construction len)�iyig fgency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.)• U Lender's Name: - P,6-- - Lender's Address: r LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/14/12 Owner: LYA STAFFORD 75520 PAINTED DESERT DRIVE INDIAN WELLS, CA 92210 Other struct info . . . . . C Contractor: Owner ID '� r - ------------ ------------ ---- -------- WORKER'S COMPENSATION DECLARATION . 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 jopl certify that, in the performance of the work for which,this permit is issued, I shall not employ any person in any mXWKERS'COMPENS ecome subject to the workers' compensation laws of California, and agree that, e subjec to the wor 'compensation provisions of Section 3700 of the Labforthwi with thos provisions.0000elate plicant- WARN NG: FAILURE TO SECU I C ERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AN CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST 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 abA formation is correct. I agree to comply with all city and county ordinances and state laws relating to buildingruction, and h reby authorize representatives of thispopnty-tgrenter upon the above-mentioned property fection purpoi, ,x (Applicant or Agent): Application Number . . . . . 12-00000912 Permit' DEMO PERMIT Additional desc . Permit Fee. 45.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 2/10/13 Qty Unit Charge Per Extension BASE FEE 45.00 Special Notes and Comments REMOVE UNPERMITTED.SINK, TOILET, SHOWER &CABINETS RESTORING GARAGE TO ORIGINAL CONDITION, PER CODE CASE # 12-3309. 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 � A r_,_4_rWVA,U?RdP1_P ' mt= P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT — (760) 777-7012 PROPERTY OWNER'S PACKAGE FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits �11h(P�1R��t1VT� NOTICE TO VROPERTY OWNER Dear Property Owner An application for a building permit has been submittedin ut name listing yourself as the b=.� of the property impraovements specified at S� Flo S ��/tn/ia-¢ We are providing you with an Owner -Builder AcknevAedp2ent-and Information Verification Form to make you awam of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We � i not issue a built.permit until yoir 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. OV 'S ACKNOWi;) HOMENT ANI) YVAInCATION O> 1100M "TION ;7�C7: Read and antral each. staterirPart -b��v tvsignifyyouunderstand or verify this information. . rstand a frequent practice. of unlicensed persons is to have the property owner obtain an "Owner -Builder" building perinit 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 y property - 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the co traction and are not hiring a licensed Contractor to assume this responsibility. 3. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that 1 may protect m 1f from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my 0 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on 7pe is 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 ($500), including labor and materials, 1 may be considered an "employee' 1and r state and federal law_ 6. 1 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 ris 7. 1 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. A k8. I understand as an Owner -Builder if 1 sell the Property for which this permit is issued. I may be held liable for any rnancial or personal injuries sustained by any subsequent owners) that result from any latent construction defects in the Womanshipor materials.9.1understand Imay obtain more information regarding my obligations as an "employee ' from the' lutermlRevalue ce, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand 1 may contact the California Contractors' State License Board (CSLIi) a1 1- 800 321-CSLB (2752) or www-cslb.ca.gov for more information about licensed contractors. 10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that 1 am the party legally and tally responsil3 for proposed co�� tion activi at the following address: —11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, 1 will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, Of changes to any of the tnformatton l have provided on this form. Licensed contractors are regulated by laws designed to protect the public- If yon 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- 11 is also important for you to understand that if an utilicenaed Contractor or employee of that individual or firm's injtucd while wwlong on your property; you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you wdl be reWons" for verifying whether or not those Contractors are properly lic-eftst'd and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form most be completed and signed by the property owner and returned to the agency responsible for issuing. tba psrn it. Neta: A copy of the property awmff's dtiver's1%e0st'1a M "W*06�M or other veriftcation acceptable to the agency is required to be presented when the permit is, issued to resift' the pr'opem owner's signature. �j� Signature of property owner -� _Date: 0 % 11 1 Note_ The followi g Authorization Form�iirequired 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 BEHAL Excluding the Notice to Property Owner, the execution of which 1 understand is my personal responsibility,1 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: r + Address of Authorized Agent: ! 00. I declare under It of that `FN ='►ersonallled out the abov, y fil penalty Pent►rY information and certify its accuracy.. �T -_" _ bre, or other verification acceptable to the agency is required nY owner's signature- : r 9S27lIK_7 r, Property Owner's Signature:----- '_�;��N�1ott RECORDING REQUESTED BY AND WHEN RECORDED MAIL THM DEED AND, UNLESS OTHERMSE SHOWN BELOW, MAIL TAX STATEMENTS TO: DOC # 2012-0081929 02/24/2012 12:15P Fee:15.00 Page 1 of 1 Recorded in Official Records County of Riverside Larry U. Uard Assessor, County Clerk b Recorder . 1111111 1111111 IIII 111111 VIII VIII VIII 111 11111 1111 1111 - S R • U • PAGE SIZE DA MISC e Name LYA STAFFORD S"-' 49357 COLORADO ST Address INDIO,'CA 92201 city SMF state EXAM 5 Z,p CTY DOC # 2012-0081929 02/24/2012 12:15P Fee:15.00 Page 1 of 1 Recorded in Official Records County of Riverside Larry U. Uard Assessor, County Clerk b Recorder . 1111111 1111111 IIII 111111 VIII VIII VIII 111 11111 1111 1111 - S R • U • PAGE SIZE DA MISC LONG RFD I COPY M A L i 465 426 OR COR SMF NCHG EXAM 5 T: . CTY I UNI KLL'UKULKS USE UNLY y CANT DEED TAX PARCEL NO. 773-224-019-9 The undersigned declares that the documentary transfer tax is $0.00 ' and is X computed on the full value of the interest of the property conveyed, or is computed on the full value less the value of liens or encumbrances remaining thereon at, the time of sale. The land, tenements.or realty is located in unincorporated area X city LA QUINTA and FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged; DESERIGREAT,DEA LS,.INC- ' hereby: QRANT(S)to LYA STAFFORD, AN UNMARRIED WOMAN The following described real property in the City of LA.QUINTA County of Riverside, State of California: LOT 8 OF BLOCK -75 OF TRACT NO. SANTA CARMELITA AT VALE LA QUINTA UNIT 10, 1N THE CITY OF LA QUINTA, COUNTY OF RIVERSIDE, STATE OF CALIFORNIA, AS PER MAP RECORDED IN BOOK 18, PAGES) 70 OF MISCELLANEOUS MAPS,.IN THE OFFI �( OF THE COUNTY RECORDERS OF SAID COUNTY. Dated �` STATE OF CALIFORNIA, ,q�! DESERT G T DEALS, INC . lb's) COUNTY OF RIVERSIDE • On before me, Notary Public, may: ADR A VERSON personally appeared ADRIANA EVERSON who proved to me on the basis of satisfactory evidence to be the person(In, whose name(fi is/* subscribed to the within instrument and acknowledged to me that W1 K GONZALEZ hd/shc/th jy executed the same. in hiAer/4eir authorized capacity(i ft and that by higher/thf it signature{N ) on the instrument the person(), or the entity upon behalf 1615/9/ my Public • CtOtomta of which the person(] acted, executed the instrument n RlvmWe Coi. 1 certify under PENALTY OF PERJURY under the laws of the State .of California mycomm. es ep 11 2011 that the foregoing paragraph is true and correct., W ITH.ESS..my hand erld.of(cial Signature iArt Notary Public - (Notary Seal) . MAIL- TAX STA •M S TO PART) SHOW ELOW:' IF NO PARTY SO SHOWN, MAIL AS DIRECTED ABOVE. Name Sorest Address Ctry & Stets Bin.# • CIt}r of La Quanta Building 8L Safety Division P.O. Box 1504,'78-49S Calle Tampico 14.Quinta, CA 92253 - (760) 777-7012 Building Permit: Application'and Tracking Sheet Permit # /v Project Address: � A�J—2 : ` ���� Owner's Name:.L - A. P. Number. 3--2 2 " 67 Address: , �� f Legal Description:&a , ,847l '� City, ST, Zip: ' Contractor. Telephone: �_� — .:, + ' Address:75,s ,,Z,a� &/` ,rej) QfZ�.� Project Description: City, ST, Zip LAIt: t L. c4 Telephon1 if 17 State Lic. #: City Lic. #c Arch, Engr., Designer Address: City., ST, Zip: Telephone:Construction State Lic. #: ' �C Name of Contact Person: Type:. Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq..Ft.:. #Stories: #Univ: Telephone # of Contact Person: Estimated Value of Project APPLICANT: DO NOT WRITE BELOW THIS UNE q Submittal Req'd 'Ree'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cales. Reviewed, ready for corrections Plan Chcck Deposit. . Truss Calci. Called Contact Person Plan Check Balance. Title 24 Calci. Pians picked up Construction Flood plain plan Plans resubmitted.. Mechariical� Grading plan 2'd Review, ready for correctionslissue Electrical Subeoutactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.L H.O.A. Approval Plans resubmitted Grading IN $OUSE:- "d Review, ready for correetionsPissue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees