DRVA2018-00084tthcta1
- GEM cfc.,e DESERT
DRIVEWAY APPROACH PERMIT APPLICATION
Applicant Information:
Applicant/Owner (please print name.here):
Applicant Address: . . c Pr 611-7.CL
Code Number Street City State Zi D
Address or Parcel No. of work location, if different from applicant's address abov
15 2i20
Number -Street City Stdté Zip Code
Date: Z41 Applicant's Phone No: (q1.q ) 'i 70 1 0
Applicant's Signature: c.fr')t4 11T
Approximate Start Date: //_ Approximate Completion Date: J_I2IJT
Contractor Information:
Address:
Number Street City. State Zip-Code
Phone Number: (_- Contractors License Number:
City Business License Number:
.
General Liability Insurance Company: Policy No.
Request for Inspection - Please call (760) 777-7097 before 1:30pm to request an inspection at least 24 hours
prior to your requested inspection date. The Hub Counter (760) 777-7125.
Please Note: Inspections are normally performed Monday through Friday between 8am and 4pm
Permit Fee $156 + $5 Technology Enhancement Fee = $161 Total Fee
Permit No ° Expiration Date
Permit Issued by: Jii11//4i1L )4á111/U!f*fl_\... Date Issued 1r/_z_P/ if
Sinatuofdministratie Authority
Work Inspected by: Permit Completion Date: __I__I
Inspector's Signature
Comments:
Note: Driveway approach must be constructed per City of La Quinta Standard #221
Permit application submittal requirements:
Application completely filled out with the following items attached
a. Ensure there's a City Business License # on application
.
Current Certificate of Liability. Insurance -
City of La Quinta as additional insured with endorsement if work is being done in the
public right of way . . . S . ... . ...
3. Traffic Control Plan if there are lanes on public streets being closed
S
Traffic Control plan must be stamped by a Civil or Traffic Engineer or;
Applicable traffic control plan from 2012 WATCH Manual or 2012 California MUTCD.
4. Bonds or cash deposits maybe required for grading, off-site improvements, and/or dust control
t~ QX&rCV
-- GIM of:.e 1ESERT -
PROPERTY OWNER'S PACKAGE
Disclosures & Forms for Owner-Builders Applying for Driveway Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a driveway permit for work within the public right-of-way has been
submitted in your name Listing yourself as the builder of the driveway improvements
specified at 532_00 pçJ r.rn" p, j2jt
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
driveway 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 signify you understand or verify this
information. S
11: I understand a frequent practice of unlicensed persons is to have the property owner
obtain an "Owner-Builder" building permit 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.
A. I understand driveway 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.
3. i 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
licensed Contractor and having the permit flied in his or her name instead of my own.
.I4. I understand Contractors are required by law to be licensed and bonded in California
to list their license numbers on permits 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
($500), including labor and materials, I may be considered an "employer" under state and
federal Law.
6. I understand if I am considered an "employer" under state and federd law, I must
register with the state and federal government, withhold payroll taxes, provide workers'
compensation disability, insurance, and contribute to unemployment compensation for
each "employee." I also understand my failure to abide by these laws may subject me to
is eious financial risk.
stand as an Owner-Builder if I sell the property for which this permit is issued, I
may be held liable for any financial or personal injuries sustained by any subsequent
Lwnes) that result from any latent construction defects in the workmanship or materials.
1I!1J 8. I understand I may obtain more information regarding my obligations as an
"employer" from the Internal Revenue Service, the United States SmaL' Business
Administration, the California Department of Benefit Payments, and the California Division
of Industrial Accidents. I also understand I may contact the California Contractors' State
License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information
licensed contractors.
9. I am aware of and consent to an Owner-Builder driveway permit applied for in my
name, and understand that I am the party legally and financially responsible for proposed
construction activity at the following address:
5,3 200 PrJ01b,4 ,ttPckr
4lj_J 10. I agree that, as the party legally and financially responsible for this proposed
con$ruction activity, I will abide by all applicable laws and requirements that govern
tTnerBuildets as well as employers.
41!1 ii. 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 form. Licensed contractors are
regulated by laws designed to protect the public. If you contract with someone who does
not have a licehse, 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 driveway 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 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: f:~19K
_____________________ Dote:
78-495 Calle Tampico La Quinta, CA 92253 760.777.7000
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 exécutidn of which I undértand is my
personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to
apply for, sign, and file thedocuments necessary to obtain on Owner-Builder Permit for my
project. 0 S S
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 owner's
signature. S
Property Owner's Signature: Date:
-a- --- .---- -
78495 cane Tampico La Quinto, CA 92253 . :. 760.777.7000
ALIFORN1A DRWERUCENE
DL136517,658
- -
E,(P 12/13/2019 CND NONE
i NAVA
IN FRANCtSCOJR
5SSWIST
ONTARIO, CA 91762
uO8 12113/1979
RSTR CORR LENS
12131979
SEX, M HAPC4RA4 EYES BRN
HGT 5-I1 WGT 180 lb
ISS E) 1210312009612RB1AAF0/19 I 11/25/2014
ording Requested By
First American Title Company
RECORDING REQUESTED BY:
First American Title Company
MAIL TAX STATEMENT
AND WHEN RECORDED MAIL DOCUMENT TO:
Francisco Nava, Jr.
555 West "I" Street
Ontario, CA 91762
DOC # 2017-0495515
11/27/2017 03:05 PM Fees: $18.00
Page 1 o 2
Recorded in Official Records
County of Riverside
Peter Aidana
Assessor-County Clerk-Recorder
'This document was electronically submitted
to the County of Riverside for recording"
Receipted by: TONI #642
Above This Line for Recorder's Use Only
GRANT DEED
A.P.N.: 774-065-009-6 T.R.A. No.020-015 Ale No.: RIW-5581933 (SW)
The Undersigned Grantor(s) Declare(s): DOCUMENTARY TRANSFER TAX $82.50; CITY TRANSFER TAX $;
X ] computed on the corslderatlon or ftdl value of property conveyed, OR
I ] computed on the consideration or full value less value of liars and/or encumbrances remaining at time of sale,
[ ] unincorporated area; [X] City of La Qutn, and
FOR A VALUABLE CONSIDERATION, receipt of which Is hereby acknowledged, William Shields, an unmarried
man
hereby GRANTS to Francisco Nava, Jr., a single man
the following described property in the aty of La Quinta, County of Riverside, State of California:
LOT 15 IN BLOCK 204 OF UNIT NO. 20, SANTA CARMELITA AT VALE LA QUINTA, IN THE CITY
OF LA QUINTA, COUNTY OF RIVERSIDE, STATE OF CALIFORNIA, AS SHOWN BY MAP ON FILE
IN BOOK 19, PAGE 38 OF MAPS, RECORDS OF RIVERSIDE COUNTY, CALIFORNIA.
Mall Tax Statements To: SAME AS ABOVE
DOC#2017O495515 Page 2of2
Grant Deed continued
Date: 11109/2017
Dated: November 0 2017
William Shields
A notary public or other officer completing this certificate
verifies only the identity of the Individual who signed the
document to which this.certlflcate Is-attached, and not the •
truthfulness, accuracy, or validity of that document.
STATE OF Cc( va C,. )SS
COUNTY OF Je4SA )
On '1 Z0 11 before me; ). P( (1 ((ILL , Notary Public, personally appeared
who proved to me on the basis of satisfary evidence to be the p*ersonV3 whose name($are subscribed to the within
instrument and acknowledged to me that(Ishe/they executed the same In1er/thelr authorized capadty(Ie), and that by
M1er/theIr signatureo on the Instrument the personç), Or the entity upon behalf of which the persono acted, executed the
'ilistrument. •
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregofrg paraqraph pçand
0.PEIION
COMM. #2148320 c
NOTARY PUBliC • CP1JF0IA
FA*es Aid Z 2120
This area for offidalnotafia/seal
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