13-0944 (RER)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
13-00000944
51735 AVENIDA DIAZ
773-114-013- - -
REMODEL - RESIDENTIAL
COVE RESIDENTIAL
35000
Architect or Engineer:
4�
VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTION'S (760) 777-7153
BUILDING PERMIT
--------------------------------------------------
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 Professionals Code, and my License is in full force and effect.
License Class: License No.:
Date: 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 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
(� plicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 1$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.).
( ) 1, as owner o(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 contractorls) licensed
pursuant to the Contractors' State License Law.)
l`I I am exempt under Sec. B(&17C-f9r thisson
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:
Owner:
ED FURLAN
385 22ND AVENUE W
VANCOUVER, BC V5Y-2-H5
(604)833-3285
Contractor:
Owner
Date: 8/08/13
tAuG o8 �p�
-______________________________________________
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 2010 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: Applicant:
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 1$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 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 he above infor ation is correct. I agree to comply with all
city and county ordinances and state laws relating to b '(ding constru on, and hereby authorize representatives
of this county t enter upon the above-mentioned prope for ' action purposes.
Date: $ 1 Signature (Applicant or Agent):
Application Number . . . . . 13-00000944
Permit
. . .
ELECTRICAL 2013
Additional
desc .
Permit Fee
. . . .
23.83
Plan Check Fee
.00
Issue Date
. . .
Valuation . . . .
0
Expiration
Date
2/04/14
Qty Unit Charge
Per
Extension
1.00
----------------------------------------------------------7-----------------
23.8300
LS ELEC
DEVICES, FIRST 20
23.83
Permit
. . .
MECHANICAL 2013
Additional
desc
Permit Fee
. . . .
107.26
Plan Check Fee
.00
Issue Date
Valuation . . . .
0
Expiration
Date
2/04/14
Qty Unit Charge
Per
Extension
1.00
35.7500
EA - MECH
FURNACE
35.75
1.00
11.9200
EA MECH
APPL REP/ALT
11.92
1.00
35.7500
EA MECH-CONDENSER/COMP
35.75
1.00
11.9200
EA MECH
VENT FAN
11.92
1.00
----------------------------------------------------------------------------
11.9200
EA MECH
EXHAUST HOOD
11.92
Permit
. . .
PLUMBING 2013
Additional
desc .
Permit Fee
. .
119.20
Plan Check Fee
.00
Issue Date
. . . .
Valuation . . . .
0
Expiration
Date
2/04/14
Qty Unit Charge
Per
Extension
.7.00
11.9200
EA PLBG
FIXTURE/TRAP
83.44
1.00
11.9200
EA PLBG
WATER HEATER/VENT
11.92
1.00
11.9200
EA PLBG
WATER INST/ALT/REP
11.92
1.00
--------------------------------------------------------=-------------------
11.9200
LS PLBG
GAS SYS, 1-4 OUTLETS
11..92
Permit
. . .
REMODEL 2013
-
•Additional
desc .
Permit Fee
. . . .
112.97
Plan Check Fee
.00
Issue Date
. . . .
Valuation . . .
. 0
Expiration
Date
2/04/14
Qty Unit Charge
Per
Extension
1.00
48.6200
LS MISC
REMODEL, 1ST 100 SF
48.62
3.00
21.4500
EA MISC
REMODEL, ADDL 500 SF
64.35
----------------------------------------------------------------------------
Special Notes and Comments
KITCHEN AND BATHROOMS
REMODEL RELOCATE
1
Application Number . . . . .
13-00000944
----------------------------------------------------------------------------
Special Notes and Comments
HVAC, HOT WATER HEATER AND RELOCATE
WASHER & DRYER. MISC. WINDOW AND STUCCO
REPAIR. CODE CASE. ALL REPAIRS
TO BE PER
2010 CALIF BUILDING CODES.
August 1, 2013 11:11:33 AM jjohnson.
----------------------------------------------------------------------------
Other Fees . . . . . . . . .
BLDG STDS ADMIN (SB1473)
2.00
PLAN CHECK,
ELECTRICAL
23.83
PLAN CHECK,
REMODEL
184.47
PLAN CHECK,
MECHANICAL.
61.97
PLAN CHECK,
PLUMBING
126.34
STRONG MOTION (SMI) - RES
3.50
Fee summary Charged
----------
Paid
----------
Credited
--------------------
Due
-----------------
Permit Fee Total 363.26
.00
.00
363.26
Plan Check Total .00
.00
.00
.00
Other Fee Total 402.11
.00
.00
402.11
Grand Total 765.37
.00
.00
765.37
Bin #
.50
.0ty of La Quinta
- Building &r Safety Division i ,
P.O. Box 1504, 78-495 Calle Tampico UL 3 0 2013
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking 1LA QUIN' A
70,YP- I)rw4het
Permit #
Project Address:
'Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:
Telephone:
Address:
Project Description:
City, ST, Zip:
Telephone:
.... ................
State Lic. #
City Lic. #.-..
Arch., Engr., Designer. Azw%"e—
Address: vVV-) 'Fayl 0 m
A
City., ST, Zip: Dt
Telephone: (b. eC7 45
... ..... 1. ...
... .......
ke. ...
Construction type: Occupane y:
State Lic. #:
Project type (circle one): New Add'n Alter (gpair Demo
Name of Contact Person:ri L
V Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: :
Estimated Value of Project: I �Ci
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Reqld
RecId
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance.
Title 24 Calcs.
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 HOUSE:-
Review, ready for correctii—sr.ssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P
Pub. Wks. Appr
Date of permit issue
Schodl Fees
Total Permit Fees
:7N -,r
QCs T\Z 1-6 Is s
PF70
owris-' _ (.A) R
To r,4m-sy- '�,P&zKR--f- \P&kkT
fpK N6 z"D rk ub
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
WORTANT1 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 5-1 7 3 5-, . , .gyFroor /4 • D
We are providing you with an Owner -Builder Acknowledgment -and Information Verification Form to make you awm of your
responsibilities and potxrble risk you may incur by halving this permit issumd in your name -as the - -
Owner -Builder. We Will sot Issue a buRdlag permit until you have read, inis;" your andersMndiag of each provision,
signed, and returned this form to us at our ofAcial address indicated. An agent of the owner cannot execute this notice
unless you, the property owner, obtain the prior approval of the permitting authority.
DIRECHUN- Read'artd i+riliiil eRcli stiildneial: below to Jigriify you imderstdnd or verify Ain K'oimadon.
understand a O'equent practice of unlicensed persons is,to�have the. property owner•obtain-an "Owner=Buildee'
building permit', that eeroneously implies that the property owner is pro ding lus. or.•hcr cjwn labor and mato4al-personelly: I, as
as Owner -Builder; inay [ie held. liable and subject to serious financial, risk for say injuries sustained by an unlic used'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:coveragc for injuries to workers
on my property. ,
tIJ 2. 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.
ky 3. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that 1'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.
4� 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.
�V 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, I may be considered an "employer"
under state and federal law.
r 6. 1 understand if I am considered an "employee, 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
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 performed by licensed
subcontractors and the number of structures does not exceed four within any calendar year, of all of the work is performed
under contract with a licensed general building Contractor.
8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be be'B liable, for any
financial or personal bouries sustained by.any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
4,"*' 9. 1 understand 1 may obtain more information regarding my obligations as an "employee" from the internal Revenue
Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California
Division of Industrial Accidents. 1 also understand I may contact the California Contractors' State License Board (CSLB) at 1-
800-321-CSLB (2752) or www.csib.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 I am the
party legally and financially responsible for proposed construction activity , at the following address:
le 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
applicable 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 chon8es 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, dw Contractors' State License Board may be tenable to assist you with any &mmvial loss
you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in,eivd court- It is also
important for you to. understand that if an unlicensed Contractor or employee of that individual or fum is iajwed while working
on your property; You may be held liabtu fuer. damages.. Ifyou obtain a permit as Owner -Builder and-wisti fo We Coatierciors,
you will be responsible for veritjring whet& or not those Contractors are properly licensed and the status of dwir 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 isw%dW l w permlL Noir. A copy of Ae property owner's Mver's.illosnsw farm notapip IM or
other verification acceptabk to the agency is required to be prmaded when the permit is inued to verify the property
owner's signature.
Signature of property owner.Date:
0?/31
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 persons) to act asmy agents) 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): 2t' Mpp t�
Project Location or Address.
Name of Authorized Agent:
5^%
35 /�✓LN/�f�
Dm -Z LRS
QcJ/q!7/1 ,
CRTC
r-t0/Lt No
Tel No
Address of Authorized Agent:
I declare under penalty of perjury that 1 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 wlpn the permit is issued to verify the property owner's signature.
Property Owner's Signature` �( /`� �� Date: C�' /3,/ 13.
RECORDING RJZQVLS'FEr).t3Y.
Orange Cbw3t: Tide Company
WHEN WECOkI)PO', NIAIL TO:
Ed F urtati
Phil Gertsman
:SS.ES$QR:.S PARCLL NO79- i t4-013
`11TLE ORDER N- 0.< "i it- # 41313933>.# (t
ESCROW NO.: 13.144 €-.C)M
CERT1i"iCATiCLN.
U6
tl�r to
ptovistons ot'Governmet�t Code 27361,71
terfity trndet the pent�tty that the following is a
true copy dt iflegible'w Ir'# qh found in the attached
docU00t:
Date: ey— I.—J,
Print Nance:
THIS SPACF POR
GRANTDEED
t7tc uryd€ sit rs aE:f'srinurdsl ttt�htre iliac the DOtt-AliIN' [:At2Y `I'li AjV',F K R "i`AX f3:
fug ctrnsputaf oil the fUll,valuc of she inrettV ofprcpen.yCg1).vi: vd.or
carnrputix! rrn the iuir sifur i �;: the vutue:ni ,c�is.rx.ertrurnbiisi<.t�+ r�iiiiiiniii� tli�t <tt.Ute time r�i sa#i:"
OR rranofor i:; EXfMfgr.ftrn tar: torr the fitf#t�wi g, reg su
FOR A VAt.FJ llliLE C:OX4D.ERAT ON, receipi of NvhiCh is hereby ackliowledged, Vici;.i .K:w' tkncvski, ti married
wornin as Iter sole; and separate property
C:i:,�ItEB GRANT(-'-,.) (o &XIMU ?�tQRWkI MM. F,D Ft1RT;AtV, :?t maxr red man and
PHIL GERTSMAN, a .married. man As z. wits .in. doe irtioi
r'g ll .thRt: re tl pr party situated in the Gity of l.-i,Qiuinta, Cowit;y of it.i:vet`stde, State cal'C;.A,'�lcsi died as:
See Exhibit "A„ attached hereto an.d.m.idr a part hereof.
C,`oninconly K.nnwn As: 51731 Avenida Vi .T;.,a Q4 ta,.0 A, 92151
Dated-. April. 29, 2013
�"r`�•f�t t)[= C`��.l:t:t�Urt�lA. ;:
COUNTY OF
Orsbc:l arc ttta, Vic;k.i. Kwiatkowski
��.._................ .._........... ____
f here inscn narne sttd title,6fi le 6(rt4l)
pem tally 601vared
..................._..._..............,...................,..............................................__._ _ _ ......_...____VC
cyto pro c et too rrtc on the' baais of satissPhetory evidence• to . hc: d'
persvtr(sl ixhose narie(s) is;/are subsoribcd to the within instrureten.t
and acknowledged to ine that halsheltheyuXet t(A the: salla: in
hie #tertthcir . crt;tltc.�ritar� capacity(im). and that by likibcr'their.
Sinn rturG(s) txt .the instrument( the: person(sj, ur the aniity.upon bchal€
vi'which. the gcnwn(s) acwd< executed die instrutneoL.
# certify ugdcr PENAL "l"Y 01 PERJURY undeeti1c State.
of C'atiforrtia that the fbref tring� paragraph is tme anel.ctrrr&t,.
!r •ITINESS my harid acid official wal.
Sigparurem.."......W..._.._...__._...,"...-W........._......._.._.._.._M.. (SEAL)
-Orlet.Nd., 21-0'-1480032=10
ExhibiUIW�
The Southvne-half of Loi -4, Block 24,.or Santa L"glita at Viijeta. oulnta:Unil.
dk;PCr MaYreWr
515 Maps: iwthe Office. -Of the:6oun(y Record C fit�:
. I — . . - .... .. . , I . ., ..- .. the -.. -Cr 4 ou -
S
CITY, OF LA QUINTA-SUB-CONTRACTORLIST
JOB ADDRESS S123'5- 614z - f I OZ PERMIT NUMBER/3—e?"y� - OWNER. F -A BUILDER C -A
This form shall beposted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to wor
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 voidanc,
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
11 Trade / Classification . Contractor :: .::> > . :`:'; S t ;Contrac n.....' Cit . Busse '�
::::;:::: <:::• - tae tot's Lice se ;:'::.:'<:::::>:. :~ :::.:> :.Workeis Comnerisation:fristuance:".:: ::;:.. :<;: V ss Lr ense'<-
Company Name
Classification
(e.g. A. B, G-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK (C-12)
CONCRETE (C-8)'
FRAMING
STRUCT'. `STEEL• (G-5 a )
MASONRY (C-29)
PLUMBING (C-361C.o
9 51l
G
I
LATH; PLASTER (C.=35)
DRYWALL (C-9) ..: • :
HVAC.(C-20) .°.::;'':..:: ::.
.� J� 3
—
' 1nZ 5 O
2
/ �'.
A-01 Ilii lg01�
(''
O
ELECTRICAL. (C=10!' :. ; :
-
s
/ (
N
'
AV4�4yq( 3o
Ilii
/
.....::..:......:: .
SHEET.METAL (C'=43) _.,
FLPOiRING
GLAZING (C-17);
INSULATION".(C-2) .
SEWAGE DISP (6-42)'
PAINTING (C=33) .
CERAMIC TILE (C-54)
CABINETS (C-6)
FENCING (C713) '
LANDSCAPING (C=27)
POOL (C-53)