0006-125 (SFD)LICENSED CONTRACTOR 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. fes^
Lice se # Lic. Class Exp. Date
634 981 J _
Date '� Signature of Contractor,-
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the, Contractor's
License Law for the following reason: i
( ) 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 & offered for
sale (Sec. 7044, Business.&Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct. the. project (Sec. 7044, Business & Professionals
Code). 1 /�
O I am exempt under Section ' B&SPC. for�this _reasonn
Date Signature of Owner
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 & policy no. are:
Cartier STATE FUND Policy No. 1943437-00
(This section need not be completed if the permit valuation is for $100.00 or less).
() 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
work4rs' compensation. laws of "California; and agree that if -la should become
s diect to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions. y
Date: ' k, c, o Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $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.,,
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
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 applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
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 State laws relating to the building
constydtion, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.; ;`
j,Signature (Owner/Agent) Date `
pfd {9 ' `�� BUILDING, PERMIT PERMIT#
DATE VALUATION 'LOT 0006-121IS TRACT '
06/13/200 S93 so 2 :��85Lr2
JOB SITE APN
ADDRESS 51-786 AVJMWA OEW-.ItiC N 731-030^.14
OWNER I CONTRACTOR/ DESIGNER/ EN (NEER
COMMCOMMUCnow CORONEL C0N9TRTJc-. 6N
51-540 h"Ib`' ITHOWFER iDk 51-540 M1-9110WER DP.
LA Q1.1T TTA CA 92253 LA QUINTA. ; dlik 92253
(160)564-4604 CE1# 22.61
USE OF PERMIT
ST(3I.Lr FAMILY L' WM.1..1WO
5012 -PERMIT DOES NOT INCLUDE BLOCK MALLS OR POOL
TRACT CONSTRUCTION 1,501.00 SF
PORCH/PATIO, 58.00 5F
GARACEICARPORT (SF) 9,11`14.30
5 FT. WOOD PENCE 300.00 LF
>s`lF'31> MD COST OF CoNsr 1Ct17CTION
PRIUVZr FEE GARY
CONSTRUCTION kU
101-000-418-000
$612,50
PLAN CIYECK FEE
101-000439-318
$313.43
MECIIA141CAL FRE
101-000.421.000
$60.00
ELECTRICAL FEE
101-000-120-000
$131.30
PLUMBING ".R
101-000.419.000
S110,75
STRONO MOTIOW FEE • RES10
101-000-241-000
$9.31
GRAiDINCI FPI?.
101-000-423.000
$20,00
T3WIELOP}4R IMPACT IEE
$1,907.00
t ;
PRECISE PLAN
101.000.441-345
$100.00
.•fl
FEE DEPOSIT
101-000-A39-318
n$I5p.00
8CJ'k- ii0'dAL C0140'iRUI'C 17014 ANID PLAN
CHE;c-'.
$3,464.:31
LESS PRE -PAID 14B.E.
4250,00
T'Q"1 A!, I.'FJLW f 11YES JAWS N0W $3,214.31
RECEIPT I DATE Aye _ /I DATE FINALED IINISPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
- 60
Exhaust Fans
O.K. to Wrap
Zjj e 1
F.A.U.
Framing
.91-0 K,
Compressor
Insulation
- a o 9.
Vents
Fireplace P.L.
Grills
Fireplace T:O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
of
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole _ Ot'
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) -
COMMENTS:
V �
Building
4
P.O. BOX 1504 APPLICAT N ONLY
�) 78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
t" 11 r r — x r .,�_>r. r "A : --,V
Mailing
BUILDING: TYPE•CONST. OCC. GRP.
Address
A.P. Number
Legal Description �• �< L �� . U -
�
City ' "
Zip
Tel.
Project Description <:�N.
Contractor
Address
City, Zip
Tel..
-
State Lic.
& Classif. �` C
City
Lic. #
y l
Sq. Ft. No. No. Dw.
Size _ �} Stories , Units
Arch., Engr.,
NAdd O rDemolition ❑Designer
r
Address
Tel.
City Zip State
Lic. #
M i
//. LICENSED CONTRACTQ 'S DECLARATION
CI hereby affirm that I am,licensed under Prov ohe Chapter 9 (cbmmencing with Section
70001 of Division 3 of the'Business and Rrofe't a Code. and my Ilcwnaw l� in t„u•ra a...r
I hereby affirm thaQ am exempt from the Contractor's License Law for the following
reason: (Sec. 703, .5 Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to'Its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3, of the Business and Professions Code, or that. he 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).
L: I, as owner of'the property, or my.employees with wages as their sole compensation, will
do the work, andt the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code:- The Contractor's License Law does not apply to an owner of property who
builds or improves. thereon and who does such work himself or through his own employees,
Provided that such 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
.xw'of proving that he did not build or improve for the purpose of sale.)
I'I I, as owner of the property, am exclusively contracting with licensed contractors to con•
strucl the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who cbnfracts for
such projects. with a contractors) licensed pursuant to the Contractor's License Law.)
0 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent t0 self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company,
n Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (E100) valuation
or less.)
-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.
Date Owner
NOTICE TO APPLICANT., If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm;that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name-
Lender's
ame
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
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 sof this city to enter the above.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, Stale, Zip
1
r
stimated Valuation r
PERMIT - 1 LSU AMOUNT
Plan Chk. Dep.., ice-
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing,,Oe
S.M.I. r� A e NNW.
Grading
Driveway Enc.f rA
Infrastgructure"f� ly�j C�y
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW` APPLICANT PINK = BUILDING DIVISION
tDesert'Sands'.Unifed School.District
47 950:Dune:Palms Road
Notice: La QuintanCA.92253
Document Cannot Be Duplicated 760,;771=8515
CERTIFICATkO* F COMPLIANCE
Date 6/20/00 : , APN # - - .
No: - 20575 " . Jurisdiction La Quinta
Owner Name. Construction "� Permit #0006-125
'i:E
No. 51-785. Street Avenida Obregon Log ,#
City La Quiinta . Zip *92253 Study Area
Tract # BLK35U-2., • Lot # 2 ; Sq'uare,Footage 1501
Type of Development Sin&le atnily Residenee-. No,of Units 1
Comments
At the present time,. the Desert Sands Unified School District does not:collect;feesi on garages/carports, covered
patios/walkways, residential additions under 500 square-feet,.detached'access'ory structures or replacernenumobilehomes: It
has been determined the above-named•owner is exempt from paying.school fees at this time due to the following reason:
EXEMPTION NOT APPLICAOLE
This certifies that school facility fees imposed'pursuant to G.oviernment Code 53080 in the amount.of
2.05 X; ,1,501 or $ '3077:05.; the.property listed above and that building
Y,
permits and/or Cerrttificates:of Occupancy for this square'footagi mahis proposed project may now be issued
J -
Fees Paid By CC/Valley Independent Bank/Hazani Coronet e1TeiephYone 760-564-4604
Name on'the check
By Dr. Doris Wilson
-Superintendent
.A
Fee collected /exempted by $ 3;077.05`
�•
Yr ,
6ck:No. 216494
' Signature.
NOTICE: Pursuant of Asserrmbly'Bill 3061 (CHAP 5d9 STATS. 1996) this will serve to notify you that the 90day approval period ih.which you may protest the fees or other payment identified
. - above will begin to nin fromtlie date. -on which the building o4ihstallation permit for this proJect`is sssued or on which,they aiepaid to the District(s) or to another public entity authorized to
collect them on the Districtr's)(s') behalf, whicheveP is earlier•'
Collector: Attach a copy.. of'county orjeity plan check application forui,to district copy for alfwaivers.
Embossed Original- Building Dept:/Applicant ; Copy - Applica ia4eipt - ' (6: y- Accounting
?
SALE ESCROW INSTRUCTIONS,
.r
THIS DOCUMENT WELL AFFECT YOUR LEGAL RIGHTS —READ IT�,CAREFULLY!
TO: COMMONWEALTH LAND TITLE'COMPANY Escrow No.: 9897KC
72855 Fred Waring Dr. Date: 04/27/00'
Suite A5 Page: 1
Palm Desert, CA 92260
(760) 836-3726
Escrow Officer --Kelly Collier
THE ESCROW HOLDER IS' COMMONWEALTH LAND- TITL_ E COMPANY WHICH IS LICENSED
BY THE CALIFORNIA DEPARTMENT OF INSURANCE.
Buyer, or his agent, will hand you or cause to be handed you upon signing of
these instructions a deposit in the amount of....... .............................$ 500.00
Buyer will hand you additional funds prior to closing in the amount of..........$ 12,500.00
TOTAL CONSIDERATION $ 13,000.00
and any additional funds and instruments repaired from me to enable you to comply with these
instructions, which you are to use on or before May 25, 2000,.and when CHICAGO TITLE COMPANY can
issue a Standard Policy of Title Insurance Owners form, with liability of $13,000.00, on real
property in City of LA QUINTA, County of Riverside,.State of CALIFORNIA viz:
Commonly known as: APN 773-163-014, LA QUINTA, CALIFORNIA 92253
LOT 2 OF BLOCK 35, OF SANTA CARMELITA AT VALE LA QUINTA, UNIT NO. 2, AS SHOWN
BY MAP ON FILE IN BOOK 18, PAGE 55 OF MAPS, RECORDS OF RIVERSIDE
COUNTY, CALIFORNIA
Except any reservations of record of minerals, oil, gas, water, carbons and hydrocarbons.
Showing title vested in:
CORONEL ENTERPRISES, INC., A CALIFORNIA CORPORATION
Free frc encumbrance except:
A. Current general and special taxes for the fiscal year in.which this escrow closes, and
taxes for the ensuing year, if any, a lien not yet due or payable.
B. The lien of supplemental taxes, if any, assessed pursuant to the.provisions of Chapter
3.5"(commencing with Section 75) of the Revenue"arid Taxation Code of the State of
California.
C. Special improvement assessments., if any.
D. Easements, rights, rights of way, covenants, conditions, restrictions and reservations of
record.
r..
&C
W DISTRICT -..PLA G REVIEW :FORM
- This,form is to be used by. CDD'
staff for.review of:single family dwellings in the RC (Cove Residential)
District, in order to determine the.applicabiliiy of compatibility issues'or�need to require the filing of Master
Design Guidelines by the apphcarit It shall be. tran§mftted to the Building and Safety Department as your
correction list. Please attach additional-explanations,as necessary.
APPLICANT CORONEL CONSTRUCTJION
SITE ADDRESS ; 51 '7 AVerrda.< Obregon
APN 773 - 163 - 014• BIN, NO.: CASE NO.:2000_235
LEGAL: .'LOT 2 : BLOCK' 3.5 UNIT :3 S.C.@V.L.Q.
CHECKED BY:" Leslie; Mour: quand DATE: R —0 0
Inform the assigned Bui1d'ing plan checker' upon .your assignment io this case. The CDD Executive
Secretary maintains•a log book to1rack.4pplications,an& case numbers.
REQUIRED j1TEM Y. ` N. COMMENUCORRECTION .
Compatibility Review
Case logged -and number assigned
Verffy legal aid APN infori�nation
Consistent with MDG -on file (as.applicable:
MDG _filing •required (5 filings since 9/3/98)
Consistency with street/surrounding. area:
- Colors
. Materials ✓: '
D
Architecture
Other Requirements: APPOOV�0'BY GOM I liar., ..
EMENT GEi'DATE XT
Vu� --
This. Certificate .issued pursuant .to the,requiiements of Section '109 of the Uniform Bui/ding Code,
:
certifying that; at the time of issuance, ttiis sfructure was in compliance with thea various. ordinances
r
of theCityregu/ating building construction or use. For the fo/%wing:'
BUILDING ADDRESS: 51=7$5 AVENIDA• OBREGON. '
Use. Classification: SFD
Bldg,* Permit No.: 0006425..
Occupancy.Group: R 3 Type of Construction: VN Land Use Zone:' RC
Owner of Building: CORONEL CONSTRUCTION Address: 51-540 EISENHOWER DR.
City: LA QUINTA, CA 92253
By: STEVE TRAXEL
.R: , -.-- — -_&c
Building Official
Date: 10-27-.00
POST IN A CONSPICUOUS PLACE