BWFE2019-002478-495 CALLE TAMPICO Tihf D `1it.�IL1�i1
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype: WALL/FENCE/CITY STANDARD/PRE-APPROVED
Application Number:
BWFE2019-0024
Property Address:
78650 CALLE TAMPICO
APN:
770106006
Application Description:
LECLERCQ TRUST/6' BLOCK WALLS ON EAST PL AND INSIDE WEST PL
Property Zoning:
Application Valuation:
$5,150.00
Applicant:
DONNA MARIE POLMOUNTER, TRUSTEE
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.:
Date
Contractor:
OWNER -BUILDER DECLARATION
I herebyaffirm under penalty of perjury that I am exempt from the Contractor's State
License Law fijr 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, priorto 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 any applicant for a
per ' ubjects the applicant to a civil penalty of not more than five hundred dollars
Zm
sowner of the property, or my employees with wagesas their sole
pensatla.n, 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
wit• one year of completion, the owner -builder will have the burden of proving that
ti f-she did not build or improve for the purpose of sale.).
�e i, as owner of the property, am exclusively contracting with licensed contractors
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
Stat ense Law does not apply to an owner of property who builds or improves
then n, and who contracts for the projects with a contractor(s) licensed pursuant to
L. ractors' State License Law.).
I am exempt under Sec. B.&P.C,.fdr r ason
Date: _l Owner
CONS ION 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 Na
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/8/2019
Owner:
ROBERT F LECLERCQ CREDIT SHELTER TRUST
5225 CANYON CREST DR NUhj 71324" , :T�
RIVERSIDE, CA 92507 �
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rri
TI
C=)
Contractor:
OWNER BUILD tiD
Llc. No.
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: orkers' compensation insurance carrier and policy number are:
Car
Policy Number:_
t ertify that in the performance of the work for which this permit is issued, I
s not employ any person in any manner so as to become subject to the workers'
ompensation laws of California, and agree that, if I shoul a subject to the
workers' compensation provisions of;Section 3700 of Code, I shall forthwith
comply with those provisions.Date: Applic
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). 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 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 above information jSCorrect.
I agree to comply with all city and county ordinances and state laws relat a to hullding
construction, and hereby authorize representatives of this city to en upon
above -mentioned property for inspection purposes.
G f C
Date: v _/ 4Signature (Applicant orAger _
I cs
Lender's Address: /
Date: 2/8/2019
Application Number:
BWFE2019-0024
Property Address:
78650 CALLE TAMPICO
APN:
770106006
Application Description:
LECLERCQTRUST/6' BLOCK WALLS.ON EAST PL AND INSIDE WEST PL
Property Zoning:
Application Valuation:
$5,150.00
Applicant:
DONNA MARIE POLMOUNTER, TRUSTEE
Owner:
ROBERT F LECLERCQ CREDIT SHELTER TRUST
5225 CANYON CREST DR NUM 71324
RIVERSIDE, CA 92507
Contractor:
OWNER BUILD
Llc. No.:
Detail: 6' BLOCK WALLS ON EAST PL AND INSIDE PL ON WEST WITH (5) PILASTERS. YARD [CITY SPECIFICATIONS] PRECISION CONCRETE BLOCK SHALL BE
COVERED WITH STUCCO, PAINT, OR TEXTURED COATING WHERE VISIBLE FROM OUTSIDE THE PROPERTY. THE AREA BETWEEN THE BACK OF CURB AND ANY
FENCING SHALL BE LANDSCAPED, HAVE A SUITABLE PERMANENT IRRIGATION SYSTEM, AND BE CONTINUOUSLY MAINTAINED BY THE PROPERTY OWNER.
2016 CALIFORNIA BUILDING CODES.
FINANCIAL
DESCRIPTION
INFORMATION
ACCOUNT
QTY
AMOUNT
WALL/FENCE - EA ADDITIONAL 50 LF
101-0000-42404
0
$48.03
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WALL/FENCE - FIRST 100 LF
101-0000-42404
0
$53.37
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WALL/FENCE - FIRST 100 LF PC
101-0000-42600
0
$66.71
Total Paid for BLOCK WALL: $168.11
DESCRIPTION
ACCOUNT
QTY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RECORDS MANAGEMENT FEE
101-0000-42416
0
$10.00
Total Paid for RECORDS MANAGEMENT FEE: $10.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
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CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE
ALB Y�
!-f16uSE
PERMIT #v V —
- - CF\fl ofrl,, DFS Fwr --
PLAN LOCATION:
Project Address: 7g 6 S O Ci4LO-714MPI C O Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
APN #: 7 7 0— 106 _ 0 0 6
ZO '
,6 `L 4t.FT_
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Applicant Name: 00 A/n, 14-9 1 F
Address: N Vjv FS T" 0a '
71
City, ST, Zip: { VE1—S l /J! QR )-
Telephone: 760- S-78— OS-2q
Email: 80G UP-J%)c
Arch/Eng Name:
Address:
City, St, Zip
Telephone:
Email:
State Lie:
City Bus Lie:
Property Owner's Name: SA_wF
Address:
City, ST, Zip
Telephone:
Email:
Valuation of Project $ 0
Construction Type:
Grading:
Bedrooms: I Stories:
Occupancy:
# Units:
New Commercial / Tenant Improvements:
Total Building SF
Construction Type: Occupancy:
78495 CALLE TAMPICO
LA QU I NTA, CA 92253
760-777-7000
MAIL TAX STATEMENTS TO:
Donna M. Polmounter, Trustee
5225 Canyon Crest Dr Num 71324
Riverside, CA 92507
WHEN RECORDED MAIL TO:
CHRISTINE C. WEINER, ESQ.
A PROFESSIONAL LAW CORPORATION
620 Newport Center Drive, Suite 1100
Newport Beach, CA 92660
DOCUMENTARY TRANSFER TAX $ -0- No Consideration
THIS CONVEYANCE IS FOR TRANSFERRING PROPERTY TO
IRREVOCABLE TRUST BETWEEN SPOUSES R&T 11930
.....Computed on the consideration or value of property conveyed; OR
.....Computed on the consideration or value less liens or encumbrances
remaining at time of sale.
APN: 770-106-006
03/01/2017 09:25 AM Fee: $ 18.00
Page 1 of 2
Recorded in Official Records
County of Riverside
Peter Aldana
Asses$or--County Clerk —Recorder
1111Pra 111*8WAIi,V11 III
R A Exam:
Page DA COW) Misc Long RFD 1st Pg Adtl Pg Cert CC
SIZE NCOR SMF NCHG T.
SPACE ABOVE THIS LINE FOR RECORDER'S USE
DORIS E.
GRANT DEED
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
DORIS E. LECLERCQ, Trustee of the ROBERT and DORIS LECLERCQ 1988 TRUST DATED JANUARY 28,
1988
hereby GRANTS to
DONNA MARIE POLMOUNTER, TRUSTEE of the ROBERT F. LECLERCQ CREDIT SHELTER
TRUST, dated December 31, 2016.
the following described real property in the City of La Quinta, County of Riverside, State of California:
Lot 122 of Desert Club Tract Unit 5, in the City of La Quinta, County of Riverside, State of California,
as per Map recorded in Book 21, Page(s) 61, of Maps, in t1le Office of the County Recorder of said
County. -
MORE COMMONLY KNOWN AS:
78650 Calle Tampico,
La Quinta, California 92253.
APN: 770-106-006
THE FOREGOING INSTRUMENT WAS PREPARED BY CHRISTINE C. WEINER, ESQ., A PROFESSIONAL LAW
CORPORATION, 620 NEWPORT CENTER DRIVE, SUITE 1100, NEWPORT BEACH, CA 92660. THE LEGAL
DESCRIPTION AND STATED TITLE OWNER(S) CONTAINED HEREIN WERE SUPPLIED BY THE PARTY(IES),
AND THE DRAFTSMAN ASSUMES NO RESPONSIBILITY FOR THE CORRECTNESS THEREOF.
Page 1 of 2
Dated: Februarys 2017
THE ROBERT and DORIS LECLERCQ 1988
TRUST dated January 28, 1988
N
DORIS E. L CLER Q, Trustee
A notary public or other officer completing this certificate verifies only the identity of the individual who
signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of
that document.
STATE OF CALIFORNIA
COUNTY OF RIVERSIDE )
On Februoa 28 2017. before me, J. STANGE, Natary Public, (insert name and title of the officer), personally appeared
DORIS E. LECLERCQ, who proved to me on the basis of satisfactory evidence to be the peraonl�) whose name(w) WgFd
subscribed to the within instrument and acknowledged to me that hels'1 ,they executed the same in hiV/ heir authorized
capacity(ie,�}, and that by his1&;r-/heir signature(s) on the instrument tthe person(o, or the entity upon a alf of which the
person($) acted, executed the insstrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and
correct.
WITNESS my hand and official seal.
sT
'*,Comm,
ANGF
a COMM. #2052714 z
ci _($cal) z Notary Public - California
¢ Riverside County
Sign ure F _ Comm, Expires Jan. 17, 2018
Page 2 of 2
Agreement between neighbors
February 8, 2019
Between:
Donna Marie Polmounter Trustee of
The Robert F. Leclercq Credit Shelter Trust
Lot 122 of Desert Club Tract 5 In the City of La Quinta
County of Riverside State if California, AKA
78650 Calle Tampico
And
Toms & Eva Stoianovici
Lot 121 of Desert Club Tract 5 In the City of La Quints
County of Riverside State if California, a vacant lot
The parties agree to share a block wall on the north / south line between their properties.
The parties further agree that the wall will be centered on the property line.
Donna Marie Polmounter Trustee of
The Robert F. Leclercq Credit Shelter Trust
Tityol 4 4 a"
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
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a buildin,Ppermit has ben ubmitte in your name listing yourself as the builder of the property
improvements specified at L S 9GI_aW6
We are providing you with an Owner -Builder Acknowledgment an 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 ACKNOWLEI)GMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
91.
I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
ing permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, 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.
$2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the
A?3. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect
myself from potential financial risk by hiring a Iicensed Contractor and having the permit filed in his or her name instead of my
own.
ng4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
g5. I 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.
Y6. I 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
risk.
APT 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, or all of the work is performed
under contract with a licensed general building Contractor.
� I r
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
(760) 777-7012
FAX (760) 777-7011
Considering Becoming an Owner -Builder?
Important information you need to know BEFORE pulling your permit!
The term "Owner -Builder" can mean three different things:
"Owner as Worker", "Owner as Contractor" or "Owner as Employer"
Understand each has Benefits or Risk, and it is possible to combine them!
Hiring a California Licensed Contractor means you do not personally perform any of the construction work, the permit is not taken
out in your name, you are not personally responsible for the construction and you are not an Owner -Builder. Instead, you become a
"Customer" and California law provides you the benefit of protection from poor workmanship, failure to finish the job and financial
risk due to worker injury.
Benefit/Risk: Highest Benefits and the Least amount of Risk
Owner -as -Worker is a type of Owner -Builder where you personally perform the construction work, the permit is taken out in your
name and you are personally responsible for the construction management, knowledge, workmanship, and completion of the job. You
benefit by not paying others to perform this work for you and your risk depends on your own ability to complete the job successfully.
Benefit/Risk: Possible Benefit with Low F ittancial Risk
Owner -as -Contractor" is a type of Owner- Builder where you personally act as your own General Contractor, the permit is taken out in
your name and you hire California licensed sub -contractors to perform portions of the construction work. WARNING: The benefit of
Protection provided by law when you hire only California licensed sub -contractors can turn to serious financial risk if you hire
unlicensed contractors to perform any of the work.
Benefit/Risk: Possible Benefit and Significant Financial Risk
Owner -as -Employer is a type ofOwner-Builder where you pay any unlicensed individual to perform any construction work valued at
more than $500,00, the permit is taken out in your name and you are personally responsible for their employment requirements,
supervision, performance, safety and welfare while on your property. WARNING: Cost savings benefit can turn to serious financial
risk if you fail to deduct payroll tuxes or provide workers compensation insurance for each worker.
Benefit/Risk: Possible Benefit with pnificant Financial Risk
Of 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
financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
W. I understand I may obtain more information regarding my obligations as an "employer" from the internal Revenue
Service, 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-
P
21-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors.
ld. Iam aware of and consent to an Owner -Builder building permit applied for in my name, and understand that address
party legal) and financial1 responsible for proposed construction activity at the following
11. I agree that, as the party legally a�d financially responsible for this proposed construction activity, I will abide by all
ap�pli�cabLe laws and requirements that govern Owner -Builders as well as employers.
0171 12. I agree to notify the issuer of this form immediately of any. additions, deletions, or changes to any of the information I
have provided on this forth. 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 presenters when the permit is issued to verify the property
owner's signature.
Signature of property owner,,
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: O K 0 � � e Jp i
Tel No 7it�D —578 —O 5 2q
Name of Authorized Agent: _ Teo be tr+- Le_GA e-yrc Q _ _._
Address of Authorized Agent:
v• Boy 11Io85 PMM Desert CA Q z5 _
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 requ' . d to be presented when the rmit is issued to veri the raperty owner's signature.
Property Owner's Signatur
w ate: -7 —