11-0504 (DSF)P.O. BOX 1504. VOICE (760) 777-7012 -
78-495 CALLE TAMPICO FAX (760)777-7011
LA-QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT% _
Date:. 5/16/11
.
Application Number: =-r1-1-_OQ000504 Owner:
Property Address: •57395 -VIA VISTA ` 'PIERCE KEITH DOUGLAS
APN: 762-240-003-30 -300962- 57395 VIA VISTA
Application description: DEMO- COMML/OTHER y LA QUINTA, CA 92253
Property Zoning: MEDIUM DENSITY" RES D i
Application valuation: 0 - - MA !, F 2011
Contractor. CITY OF LA QUINTA.,
Applicant: - ' Architect or Engineer: �. Y PADGETT.' S -CLEANING/RESTORATION -
•' 535 NEW JERSEY STREET -
` REDLANDS,- CA 92373. `
(909)307-2769 c
Lic. No. 679028+ F. 7
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- - - - - - - - - - - - - - --- - - - , - -
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with - - �.'` - I hereby affirm'under penaltyof perjury one ofthefollowing declarations:
Section'7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect:_ _ I have and will maintain a certificate of consent to self -insure for workers' compensation,. as provided
License B ass: CIS - n eN 679028" -- + :' - `. for by Section 3700 of thdLabor Code, for the performance. of the work for which this permit is:
ate:1L C actor: v •.' r 1 have and *will maintain workers'. compensation insurance, as required by Section 3700 of the Labor
-. .; ,R
• '-. . 4 '.: '-r � • 't'- Code,for thepe performance of the work f h permit i ed. My workers' compensation •
((( •- r or whit this pe � 's issued.
,OWNER -BUILDER DECLARATIO w., •" 1 , ,,, - -- `•
insurance carrier and policy number are: - w
- _ I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law. for the >: Carrier TRAVELERS . PROP . - Policy Number DTJLTB6155PO3110 - following, reason (Sec: 7031 .5, Business and Professions Code: Any: city or county that requires a permit to•, t " `5, _- I certify that, in the performance of the work for which this permit is issued, I shall not employ any,
--construct, alter, improve, demolish, or repair any structure, prior to its issuance, also=requires the `applicant for F.� • ' person in any manner so es:tobecome subject to the workers' compensation laws of California,
_ permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State' - and agree that, if I should become subject to the workers' compensation provisions of Section
License .Law. (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or , " _ 3700 of the La r Code, I shall fo hwith comp with those Wvisions. r'
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).:plicant: -
(_ 1 I, as owner of .the property, or my employees with wages as their sole compensation,. will do the work, and - I - '
the structureisnot intended or offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURW RKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' ECT State License Law does not apply to an owner of property who builds or improves thereon, SUBJAN EMPLOYER TO CRINFFP AL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND '
and who does the work himself or herself through his or her own employees, provided that the .. ..,. - DOLLARS (9100;000)• IN ADDITION TO THE COST.OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. - -
• . 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 - - APPLICANT ACKNOWLEDGEMENT
1—) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of .� conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and
pursuant to the Contractors' State License Law:). whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_) I am exempt under Sec. , BAP.C.for .this reason - 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. -
4 Date: Owner: - - 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 willsubject'
CONSTRUCTION LENDING AGENCY permit to cancellation. -
I hereby -affirm under penalty of perjury that there is a construction lending agency. for the performance of the n I certify that I have read this application and state that the above information is correct. I agree to comply with all
- work for which this permit is issued (Sec. 3097, Civ. C.). - -city and county ordinances and state laws relating to building construction, and hereby thorize representatives '
' - of t ' 'county t enter upon above-mentioned p perty for inspecti pur _
Lender's Name:
Date: 7 P gnature (Applicant or Agent):
Lender's Address: -
LQPERMIT
Application, Number `. 11-00000504
Permit DEMO PERMIT
i
- ,Additional desc
s ,
Permit Fee 45.00= Plan-Check Fee
_ a .00
-
Issue Date Valuation
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-
Ex]#ration Date-:. 11/12/11
Qty Unit Charge Per ..
Extension '
BASE FEE -
t 45.00"
•
-----
----------- - -- --- ----
Special Notes and Comments
-_-- -- -
DEMO FIRE DAMAGE .IN PREPARATION FOR'.
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REMODEL. INCLUDES ROOF FRAMING
"-71
PLUMBING,.'INSULATION,DR'YWALL
& :TEMP. POWER 201-0 CODES.
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Fee summary Charged; -Paid Credited
Due
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it Fee otal
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LQPERMIT
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State of Calif is c
County of
before 'me,(
LTl�,��XiS�y �r1-�T�^y'
`Date
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4 • Here Insert Name and Title o4 the Officer +
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personally appeared
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` Name(s) of igner(s) ti v
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who ' proved to me on the basis of satisfactory
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evidence -to be' the person(s) whose name(s) is/are
" •"'
subscribed to the within instrument and acknowledged
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3 to 'me that. he/she/they executed the same in
his/her/their • authorized capacity(ies), and that by
C. L. HOLLENBAUGH
his/her/their signature(s) on the instrument the '
COMM. #1800892
person(s), 'or the entity upon behalf -of 'which the '
Notary Puwic,Catifomra .
San semardinoCounty '"•
{ " person*), acted, executed the instrument:
Cornet Expires Jun 9- 2D1 ,
-- I certify under PENALTY OF PERJURY under the
•
laws ;of the State- of California that the foregoing
k
paragraph is true and' correct: ' ,4
WITNESSI.my hand and official seal.
3 'Signature.,
Place Notary Seal Above
Signature, of Notary Public
`
f
'OPTIONAL
Though the information below is not required by law, it may prole valuable to persons relying on the document
and could prevent fraudulent removal and reattachment of this form to another document.`
Description of Attached'Document
Title or Type of Document.
Document Date
,�, ti ;` ,
Number of Pages:
Signer(s) Other Than' Named Above:' .
Capacity(ies) Claimed by Signers) `
Signer's Name:
Signer's Name..
❑ Corporate Officer-»Title(s)
r , ' ❑ Corporate Officer = Title(s): "
El Individual +'
❑Individual
"
❑ Partner - O Limited '0 General
slab!
Top of thumb here
"; "El Partner =� ❑ Limited p General
Top of thumb here
❑'Attorney in Fact
; ,, ",
'ElAttorney in. Fact.
❑ Trustee r
�' �•
,'
❑Trustee
❑ Guardian or Conservator
,' -
, p Guardian or Conservator
❑ Other:
_,.
❑'Other:
•
y .'.
Signer Is Representing '
Signer Is Representing.
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LLL'M*��G�'�•�1�•=%Cid._.`C%L"�•V"•�i��'�.gSG(i<�KZS'jv`C-'L�
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http://pro.realquest.com/j sp/repori. j sp?&client=&action=confirm&type=getreport&recordn... 5/16/2011
Owner Information:
Owner Name:
PIERCE KEITH DOUGLAS
Mailing Address:
57395 VIA VIS, LA QUINTA CA 92253-5033R001 ,
Phone Number:
Vesting Codes: ' UM//
Location Information:
I
Legal Description:
.11 ACRES NET IN LOT 30 MB 362/032 TR 30096-2
County:
RIVERSIDE, CA
APN:_ 762-470-030-
62-470-030
Census Tract / Block:456.03
Census
/ 3
Alternate APN:_ '762
Township -Range -Sect:
`.Subdivision:
j Legal Book/Page: , _
Map Reference / 7271A1 !.
Legal Lot:
:,,30
Tract #: ° 30096-2
Legal Block`
School District ` ' COACHELLA VLY
Market Area: ;<.
`.
Munic/Township: I
Neighbor Code:
Owner Transfer Information
Recording/Sale Date:
/
Deed Type;
"Sale Price:
1st Mtg Document #: �
1 Document #:
Last Market Sale Information:
,
s Recording/Sale Date:
06/16/2006 / 06/07/2006
1st Mtg Amount/Type: $311,992 / CONY
Sale Price:..
$390,000
'.
1st Mtg Int. Rate/Type: ';. 6.50 / ADJ
Sale Type:
FULL '`
_
•1 stMtg Document #:' 438915
Document #:.
438914
2nd, Mtg Amountrrype; I i
Deed Type:
: GRANT DEED
:.
2nd Mtg Int Rate/Type:
Transfer Document #:
Price Per Sgl=t: $284.46
New Construction:
Y,
Multi/Split Sale
Title Company:
STEWART TITLE
Lender:
• COUNTRYWIDE HM LNS'INC
Seller Name:
PUERTA-AZUL PARTNERS LLC
Prior Sale Information:,
Prior Rec/Sale Date:
/
1
Prior Lender.. '
Prior Sale Price:
Prior 1 st Mtg Amtlrype: 1, I
!,Prior Doc Number: ' _
Prior -1st Mtg:Rate/Type:
Prior Deed Type:
i
Property Characteristics
=
Gross Area:
1,629
Parking Type:
-ATTACHED
Construction:
GARAGE i
Living Area: '�
1,371
�� Garage Area:
258 `' Heat Type:' -CENTRAL
Tot Adj Area:
1,371 "
Garage Capacity:
Exterior wall:
Above Grade: "
Parking Spaces: '.
Porch Type:
Total Rooms:
Base merit
Patio Type: - s
Bedrooms:. :-
2
-Finish Bsmnt<Area Pool:
Bath(F/H):
2/
Basement Type:
Air Cond: CENTRAL
Year Built/ Eff: ,-
2005/
Roof Type:..
Style:
Fireplace:
Y/1 : `
Foundation:
„' Quality:
# of Stories:
1.00
Roof Material:
TILE -','Condition:
Other Improvements:
ADDITION
Site Information:
Zoning:
Acres:
0.11 County Use: SINGLE FAM
RESID (R1)
Flood Zone:
Lot Area
4,792 State User R01001
Flood Panel
Lot Width/Depth
x Site Influence:
Flood Panel Date:
Res/Comm Units
1°) .' Sewer Type: TYPE j
UNKNOWN
Land Use:
SFR
Water T TYPE
ypeUNKNOWN
!
Tax Information:
Total Value:
$208,000
Assessed Year: ,
- 2010 ,' Property Tax: $2,902.70
Land Value:
$59,000
Improved %:. "
72% Tax Area: 20183
! Improvement Value:
$149,000
Tax: Year:
2010 Tax Exemption:
Total Taxable Value:
$208,000
http://pro.realquest.com/j sp/repori. j sp?&client=&action=confirm&type=getreport&recordn... 5/16/2011
05/16/201.1 09:44 FAX 9093072775 PADGETTS (a 001/001
JIMk
Contents [leanillig'& Restoration Restoration 'Authorization Contract {
1
:512/2011 z
r
Keith Pierce
57395'Via Vista n 57395 Via Vista
La Quinta CA - 92253`- F: La Quinta CA 92253
•Contract Date: `
:Contract Amount: Full Amount Agreed Upon .,
Client ID Invoice # R1'105001 _ Adjuster's Dollars, Including
Supplements or Change Orders
Scope of Work z y Depreciation, Deductible and
To be Performed s Overhead Profit
To authorize our services, please read the following information and complete the signature below:
1) Padgett's Cleaning & Restoration, Inc. is hereby granted•access to the property described above and is
authorized to perform restoration services.Lien release notices will be provided upon request. ."Right to Cancel" r
begins when homeowner receives copy of this contract..
2) The Insured's insurance company is.'hereby authorized to include the name "Padgett's Cleaning &
Restoration, Inc." on any check or draft which is issued in honor and for payment of the services provided herewith
and/or to pay "Padgett's Cleaning & Restoration'; directly for the services provided herewith. 1 will forward any funds
received for services supplied by Padgett's to their office immediately upon receipt'of those funds. x
3) Padgett's Cleaning & Restoration;, . Inc. will not be responsible for Leaning, moving, or storing money, liquor,
firearms, ammunition, ,cameras, audio/visual equipment, jewelry,, collectible and/or china,,crystals and after market
assembled particle board. INITIAL
a) Padgett's Cleaning & Restoration will not be responsible for any -damage caused by reinstalling 'existing
supply lines, appliance hoses (both water and gas) and plumbing drains.. Padgett's will not be liable for damage to
materials or systems that are concealed.
5) All services are provided by Padgett's Cleaning & Restoration, Inc, with the Insured's consent and at the '
insured's request. Should the services performed or the material furnished as, part of the Services be denied, whether
in full or in part, by the insurance company or,its authorized agent, the Insured agrees to assume sole responsibility ._
for payment of the services performed or the materials furnished `;- -
6) Any bill from Padgett's C&R, Inc: for labor, services, equipment, and/or materials furnished which is unpaid•after
completion may subject the improved property to.a Mechanic's Lien/Collection Agency;which may affect your
credit. If Padgett's Cleaning & Restoration must pursue legal action to collect thea mount due, the Insured will be
liable for any and all reasonable.attomey's fees, collection and court costs. Padgett's reserves the right to charge
1.5% interest per month for any outstanding balances 30 or more days.
By signing below, I hereby grant access and authorization to Padgett's Cleaning & Restoration for the purposes of providing
Restoration Services and acknowledge that I have read,: understand and accept the terms and conditions outlined in this
'Restor Authorization and any attachments thereto.
Keith Pierce ` Date
�.
'
Project Manager Kevin Cobb Date
CA -LIC# 679028
Redlands: 535 New Jersey St. Redlands, CA 92373 Toll Free (800)273-1194 Fax (909)307-2775, -
Bin #
City Of La Quinta.
Building &r Safety Division
r P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:
Owner's Name:
A. P. Number:
Address: U1 N U1 S
Legal Description:
City, ST, Zip: t- A, C%
p y: .}.v: .., �(µv. � ••5:`t«'/.ham
'Telephone:
ele hone:
Address: 3
Project Description:
City, ST, Zip: ( `7 j
A 1
Telephone:
�;t;.:�z:::;:;�,::?�z%�>s:>?�<
•,\vi::;t:i:::: •:vt:3�t i5i:•v:'1:+5. 2hk:::
State Lic. # : n`% City Lic. #.:--fJ
Arch., Engr., Designer:
T^ l
l
Address:
•
City., ST, Zip:
`
Telephone: k` -`"t 'ry•'• �y "":
r 5;.:v.;?>; >°'''':<<.z`z
.O •ny tc5:Wv.tfnv:S:A
State Lic. #:
Name of Contact Persozao etu
Construction Type. p y,
Occu anc
Project a circle one): New Add'n Alte Rep ' Demo
Sq. Ft.: #Stories: , #Units:
Telephone # of Contact Person:. Q'1— —'�
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
# •
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
5 t'6
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan.
2°" Review, ready for correctionVissue
Electrical
Subeontactor 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 correctionstissue`
Developer Impact Fee
Planning Approval
Called Contact Person
A,I,P,P,
Pub. Wks. Appr
Date of permit issue
School Fees .
16.
i
Total Permit Fees