BRES2015-023378-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253-
Application
2253
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
JUSTIN RUBERG
79090 KRISTIN CT
LA QUINTA,
Twit 4 4 QuIIN&
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
BRES2015-0233
79090 KRISTEN CT CT
604361011
RUBERG / CHANGE LIVING SPACE TO BEDROOM
$2,500.00
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.:
ate: 2— Z 7' /-s Contractor
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 Divisio
of the Business and Professions Code) or that he or she is exempt therefrom and th
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant f a
permit subjects the applicant to a civil penalty of not more than five hundred doll s
($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: t,
Lender's Add
Y
Owner:
JUSTIN RUBERG
79090 KRISTIN CT
LA QUINTA,
Contractor:
JUSTIN RUBERG
79090 KRISTIN CT
LA QUINTA,
(760)578-2167
Llc. No.:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS(760)777-7153
Date: 7/24/2015
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: 7' Z y^/� Applicant:
WARNING: FAILURE TO SECURE WORKE ' 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 wprk 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.
)Qte:7_-2A/-/L/
mentioned property for inspection purposes.
Signature (Applicant or Agent):
DESCRIPTION
FINANCIAL •
ACCOUNT
•
QTY AMOUNT PAID
PAID DATE
BSAS SB1473 FEE
101-0000-20306
0
$1.00 $0.00
PAID BY
METHOD
RECEIPT # CHECK #
CLTD BY
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
DEVICES, FIRST 20
101-0000-42403
0
$24.17
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
DEVICES, FIRST 20 PC
101-0000-42600
0
$24.17
$0.00
PAID BY
METHOD
RECEIPT#
CHECK#
CLTD BY
Total Paid for ELECTRICAL: $48.34 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
REMODEL, EA ADDITIONAL 500 SF
101-0000-42400
0
$21.75
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
REMODEL, EA ADDITIONAL 500 SF PC
101-0000-42600
0
$17.40
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
REMODEL, FIRST 100 SF
101-0000-42400
0
$49.31
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
REMODEL, FIRST 500 SF PC
101-0000-42600
0
$134.88
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for REMODEL: $223.34 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
SMI - RESIDENTIAL
101-0000-20308
0
$0.50
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total.Paid forSTRONG MOTION INSTRUMENTATION SMt $0.50 $0.00
TOTALS:• 0•
Description: RUBERG / CHANGE LIVING SPACE TO BEDROOM .
ADDITIONAL
Type: BUILDING, RESIDENTIAL
Subtype: REMODEL
Status: APPROVED
Applied: 6/11/2015 SKH
Approved: 7/24/2015 JJO
Parcel No: 604361011 Site Address: 79090 KRISTEN CT CT LA QUINTA,CA 92253
Subdivision: TR 27899
Block:
Lot: 59
Issued:
Lot Scl Ft: 0
Building Scl Ft: 0
Zoning:
Finaled:
Valuation: $2,500.00
Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0
No. Unites: 0
Details: CONVERT DINNING ROOM TO BEDROOM
CONTACTS
Printed: Friday, July 24, 2015 12:12:05 PM 1 of 3 CJ
SYSTEMS
ADDITIONAL
CHRONOLOGY
CHRONOLOGY TYPE
STAFF NAME
ACTION DATE
COMPLETION DATE
NOTES
TELEPHONE CALL
LUIS URIBE
6/22/2015
6/22/2015
SPOPKE WUTH JUSTIN. 1ST REVIEW OF PLANS IS READY TO BE
PICKED UP.
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESSI
CITY
STATE
ZIP PHONE FAX EMAIL
APPLICANT
JUSTIN RUBERG
79090 KRISTIN CT
LA QUINTA
(760)578-2167
CONTRACTOR
JUSTIN RUBERG
79090 KRISTIN CT
LA QUINTA
(760)578-2167
OWNER
JUSTIN RUBERG
79090 KRISTIN CT
LA QUINTA
(760)578-2167
Printed: Friday, July 24, 2015 12:12:05 PM 1 of 3 CJ
SYSTEMS
Permit Details
City of La Quinfia
P.ERKH
i NtOP
QTY
AMOUNT —
ER
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY�
CLTD
DUE DATE
9
STATUS
-
NOTES
ES2015-0233
DATE
BY
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
'DESCRIPTION
T ACCOUNT
QTY
AMOUNT —
TPAID -
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY�
CLTD
DUE DATE
STATUS
-
NOTES
DATE
BY
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00
BSA:
DEVICES, FIRST 20
101-0000-42403
0
$24.17
$0.00
DEVICES, FIRST 20 PC
101-0000-42600
0
$24.17
$0.00
Total Paid forELECTRICAL: $48.34 $0.00
REMODEL, EA
101-0000-42400
0
$21.75
$0.00
ADDITIONAL S00"SF
REMODEL, EA
101-0000-42600
0
$17.40
$0.00
ADDITIONAL 500 SF PC
REMODEL, FIRST 100 SF
101-0000-42400
0
$49.31
$0.00
REMODEL, FIRST 500 SF
101-0000-42600
0
$134.88
$0.00
PC
Total Paid forREMODEL: $223.34 $0.00
SMI - RESIDENTIAL
101-0000-20308
0
$0.50
$0.00
Total Paid forSTRONG MOTION INSTRUMENTATION SMI: $0.50 $0.00
na �.. b. :s
2'Moff
01
a'PHREN P
r�.FRIT ,� ROJECTS
Printed: Friday, July 24, 2015 12:12:05 PM 2 of 3 OFSYS7EMS
RETURNED
REVIEW TYPE
REVIEWER
SENT DATE
DUE DATE
STATUS
REMARKS
NOTES
DATE
Printed: Friday, July 24, 2015 12:12:05 PM 2 of 3 OFSYS7EMS
�`• Permit Details PERMIT NUMBER
C.• BRES2°0115-023.3
ity of La Quanta
NON-STl K URAL - I JIM JOHNSON 16/11/2015 I 6/18/2015 I 7/24/2015 I APPROVED I APPROVED PER JIM I
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Attachment Type
CREATED
OWNER
DESCRIPTION
PATHNAME
SUBDIR
ETRAKIT ENABLED
1ST REVIEW
1st Review Corrections
DOC
6/22/2015
LUIS URIBE
0
CORRECTION LIST
List.docx
FA
Printed: Friday, July 24, 2015 12:12:05 PM 3 of 3 OW
SYSTEMS
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 #
Project Address: p 1,S4r-r\ G+
Owner's Name:
A. P. Number:
Address: q O
Legal Description:
Contractor:
City, ST, Zip: L C,} 9 z ZS
Telephone: e.% � �
Address:
Project Description: T,,, h
City, ST, Zip:
/ h fo 6 c{1 r • owl ai .c Z
Telephone:
.
I -c
o O w.a � e_
State Lie. # : City Lie. #;
Arch., Engr., Designer:
1
Address:
City., ST, Zip:
Telephone:
e one:
P
€<:«:
Con structi n Type: e: O ecu ane
Y P C 5 W P Y•
Lie. #
ProJState e ct hPa (circle one): New Add' n te Repair Demo
Name of Contact Person: VAS iR"I., r •
S . Ft.:� [f
#Stories:
#Units:
Telephone # of Contact Person: i Ey ('_ 5 —7 g — 7 /(
Estimated Value of Project: Z.SUD
APPLICANT: DO NOT WRITE BELOW THIS LINE
tl
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd 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 HOUSE:-
3d Review, ready for corrections/issue
Developer Impact Fee ffllpoAft
Planning Approval
Called Contact Person
A.I.P.
12r. CF
Pub. Wks. Appr
Date of permit issue
School Fees
"CM OF iViEA1T
-Totalec"es
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504 BUILDING & SAFETY DEPARTMENT
78-495 CALLE TAMPICO (760) 777-7012
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
PROPERTY OWNER'S PACKAGE
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 your name listing yourself as the builder of the property
improvements specified at '- J !q Bq Q LAC 5 {pA c—+-.
We are providing 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 until you 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.
/g1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
uildinpermit 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.
hI 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.
/I understand as an"Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect
yseli from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
44. I understand Contractors are 'required by law to be licensed an
and contracts. d bonded in California and to list their license numbers on
emmits
I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
f my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer"
under state and federal law.
I understand if I am considered an "employer" under state and federal law, I must register•with the state and federal
ovemment, 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..
4es
I understand under California Contractors' State License Law,an Owner -Builder who builds single-family residential
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 if I sell the property for which this permit is issued, I may be held liable for any
nancial or personal injuries sustained by any subsequent owner(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 Internal Revenue
ervice, 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 (CSLB) at 1-
800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.'
410. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
1egally, and financially responsible for proposed construction *activity at the following address:
1. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
pplicable laws and requirements that govern Owner -Builders as.well as employers.
12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
ave 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 Date:
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: Tel No
Address of Authorized Agent:
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:
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6/9/2015 79090 Kristen Ct, La Quinta, CA 92253 is off Market I Zillow
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California • La Quinta - 92253 79090 Kristen Ct
79090 Kristen Ct,
La Quinta, CA 92253
3 beds • 2 baths • 2,220 sgft Edit
Edit home facts for a more accurate Zestimate.
Gorgeous former model North La Quinta home in prime
area with huge yard, pool and spa, covered patio, BBQ
island, 3 car garage. This well kept one owner home features
living room, family room, formal dining room, upgraded
kitchen with island with breakfast bar, eating area, fireplace,
3 bedrooms including oversized master suite with 2 closets
and large soaking tub, 2.5 baths. The lushly landscaped extra
spacious'backyard features a pool and spa'and covered
patio with BBQ island. With over 2220 sq. feet, this home has
it all and in a prime area of North La Quinta and great
schools too.
FACTS
• Lot: 0.27 acres
■ Single Family
FEATURES
■ Fireplace
■ Flooring: Carpet, Tile
■ Hot Tub/Spa
■ Built in 1998
■ Views: 679 all time views
• Parking: Garage -
Attached, 651 sqf
■ Pool
• Sprinkler System
OFF MARKET
Zestimate°: $360,437
Update my Zestimate
Rent Zestimate: $2,325/mo
Est. Refi Payment
$1,371/mo ® -
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■ Cooling: Central
■ Last sold: Jul 2000 for
$265,000
• View: Mountain
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