9712-083 (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.
License # Lic. Class Exp. Date
04913( H IrsIi98
.46atel f' "� ' f ' Signature of Contractor y�✓ -` "
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, 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 & Professionals Code).
( ) I, as owner of rthe property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( ) I am exempt under Section B&P.C. for this, reason
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.
Y. 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:
Carrier Policy No.
(7,01,012W ,,A(',*I.L 11NIS, NWC-421.19�'200
(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
workers' compensation laws of California, and agree that if I should become
syibject to the workers' compensation provisions of Section 3700 of the Labor
,,�, ode, I shall forthwith comply with those provisions.
VDate:`�',� •I.�' r Applicant �'—�, <:�_
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
t�above-mentioned property for inspection -purposes. �,
,,Signature (Owner/Agent),' "- = Date -•.�/-: " -
BUILDING PERMIT' PERMIT#^ . °°NTR°`#
9712-083
DATE f �. 1 . 1 VALUATION S,t�i 3 �� ,LOT TRACT
JOB SITE'
ADDRESS ��—eJ�j 1����1.J�i.Ik�$��i?.ic�)�!
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
/
I.i. ''SS 1..1.- l.. \�A i1.,i 1.r
.. i4\ YJ,y..:� teV L t .. ♦♦ 1
F1.0. BOX 3:3�
1' O. itOX 384
LA QUIN'►'A. t_'A *92253
!A OUI1`1' A CA 92253
I'7(cki"'If 12(1)
USE OF PERMIT
kit a
of;1, • I -10616T f K OE.C. i4C:r i U4C IAJ9 WALLS OR. PQYL ,A., i3(. I' O
(�FpXID
IW,3.00E, 24JO I._I:., 6' Virt,xJ0 VENCE,.
D
I"roA1"'i 11,121.00 Sr
PO RC.1i PATE ! 36.1211) SI a-r�/
01 l i
(fir
`�"
0ARA01YCAEtP1_)RT 514.00 3F
6 Fr. WOOL) .Ei?d+ `3 200.00 LF
8T 1. MA.'ED COST 0 F CONS' 1' 13i.•`CTTON
r.:'!)NST32,C!f.:°f ION )SEE at)1-000-418-000 $598.511
C-4rA,NCTIRC-Kht;F7• 10Ilp4 )-J3!>31,8 8.193:70
NI .11JU 1CALRM 10I-000-••3.'1=(9, $3;1:1
El FIEF S93, 52
PLIJivJ8rNG FF I; 14)I-(H)Cf-419 Q(1l) 6127.501
h7t2(lN(? cvt()"t'FOW FEE - RJ_7*T) 1.W_(,1414)_?_1I ow, -S&94
G1i;401N(:F FLE 101-0®0-42.3-0(141 S+'lU.l1fJ
ltYf'1 13"i'lLlfC"rll�t(; F'2'h 2: -(i0U �I tr 3�1 S1,!46 . 78
F'Id.ar.'iSE f.A1�t 101-000-441-345 V25.60
$1179 4.4
LESS PRI 41AID FEF'S
S). 001
TMAJ, FEE.S OUP N0"'
r
t
$3.129.44
RECEIPT
DATE
BY r
DATE FINALED
INSPECTOR
CW
INSPECTION RECORD
OPERATION
DATE INSPECTOR
-OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings14
Ducts
}
Slab Grade
Return Air
}
Steel
Combustion Air
I
Roof Deck
fj
Exhaust Fans
{
O.K. to Wrap
F.A.U.
{
Framing `
�n
C pressor
{
Insulation
70 /W
Vents
}
Fireplace P.L.
Grills
[
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
!
Party Wall Firewall
[
Exterior Lath
}
Drywall - Int. Lath
Final
I
Final
_
POOLS -SPAS -
BLOCKWALL APPROVA S
steel
Set Backs
Electric Bond
E
Footings
Main Drain
Bond Beam
Approval to Cover
i
Equipment Location
Underground Electric
;
Underground Plbg. Test
f
Final
Gas Piping
}
PLUMBING APPROVALS
Gas Test
I
Waste Lines
_
��'�
Electric Final
Heater Final
}
[
Water Piping
Plumbing Final
{
Plumbing Top Out
Equipment Enclosure
I
Shower Pans
O.K. for Finish Plaster
;
Sewer Lateral
p _ . /J
Pool Cover
}
Sewer Connection
�/p (f%y
Encapsulation
t
Gas Piping
Gas Test
RZ , /J
i
{
Appliances
-, tj
}
Final
[
COMMENTS:
I
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbctures
Main Service i
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final9�
OtIlly Notice (Perm)
Ceetif Ca e of Occupancy
Btu�ldng andS
a ety .epa et OF
This : Certificate` issued pursuant to the,,regdireihents .of.: Section 109 of the. Uniform Budding_ Code,
certifying. #hat,` at the ltiri�e of issuance; this„structure was. in comp/lance with the various oraliiiances
of the City rega/sting building construction r' use. ;For the following:;
BUfLD1^NG ADDRESS: 51.-9-30 AVENIDA;£0BRE.GON
a
Use Classification. SINGLE FAMILY'D.WELLING= 'Bldg Perrn_it' No:: 971':2-083
Occupancy Group R-3 ` Type of 'Consfructio.n: VN~, Land Use°'Zone: RCT
_ _
Owner of Building: ESEaUIEL�CORONEL- Address:, POSOX 389
City: LA AAU11MTA, CA., 92253
By: DANIEL P. CRAWFORD-JR.
Date: 3/11/98
Building Official
POST IN A CONSPICUOUS PLACE
7
P.O:•BOX'1504. - ' -
Building 78-105 CALLS COADO
Address �)d/ egoA LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address
City Zip Tel
97d s3 lam- yea
Contractors 14Eo Me ^J s�rue�L�4/✓
Address
City/JJ Zip Tel..
G.�'. s��-y6a
State Lic.�/ City
& Classif. 37 Lic. # Z �o
Arch., Engr.,
Designer
Address Tel.
V
City��p' I Sta-e�
Lic. #
`0CENSED CONTRACTOR'S DECLARATION. -
I hereby affirm thatl am licensed under prow ions of Chapter 9 (commencing with Section
70fN)) of Division -3 of the Business and Pr�fe�sions Code, and my license is in full fort and
effect. G--� ` I / cr J!1
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business.and Professions Code: Any city or county which requires .a _
permit to construct, after, 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).
1] 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner or 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
of proving that he did not build or improve for the purpose of sale.)
F1 I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct 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 contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
17 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 to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified -copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. ❑ 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 ($100) valuation
or less.)
I certify that in the performance of thg 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
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Seca 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and'validated, and is subject to
expiration if 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 -of this city to enter the above-.
mentioned property for inspection purposes.
.. f
Signature of applicant -Date-
Mailing
ateMailing Address '
City, State, Zip
BUILDING DIVISION
APPLICATION ONLY
JILDING: TYPE CONST. OCC. GRP:
P. Number 7��
,gal Description
oject Description
TOTAL I
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 0& Permit
Validated by:
Validation:_
Sq. Ft./ /
Size i /
No.'
Stories
No. Dw.
Units
New ®�-" Add O
Alter ❑
Repair ❑ Demolition ❑
9'7 j 1 -\o-7
Z
t 5t-5.55
Vey -ca\
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
X50.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing.
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL I
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 0& Permit
Validated by:
Validation:_
CONSTRUCTION ESTIMATE
NO, ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. r& $
UNITS
SLAB GRADE
2ND FL. SQ. FL
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT.
MOBILEHOME SVC.
BAR SINK
GAR. $0. FT.
POWER OUTLET
ROOF DRAINS
CAR P. I SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL S0. FT.
OTHER APP./EQUIP.
DRINKING FOUNTAIN
SQ. FT.
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP,
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U:
SO. FT. @ c
BATH TUB
SQ. FT. p c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11A c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR @ b'<c
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB,
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP,
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
Desert Sands,Unified School`District
hwa '111
82=879 Hi"
Notice: � g Y ;
Indio, CA 92201I`; r
1 Document. Cannot Be Duplicated 619=775 350.0:.
t
CERTIFICATE OF COMPLIANCE
'Date 12/18/97 ry APN # 773-1.64-004
No. 16417 Jurisdiction' La Quinta
k.'
Owner!Name Esequiel Coronet Permit#
No.. 51830 Street. Ayenida Obregon Log #
City La Quirita' Zip' 92253` Study Area
Tract # Lot # 4 Square Footage 1421"
Type of Development gin gle;Fainily,Residence No. of Units .1
Comments ,
AtAhe present'time, the Desert .Sands Unified School District'does not collect fees: on garages/carports, covered
patios/walkways, restdegttal addittons`under 500 square feet,':detached�accessory;structures or replacement mobilehomes.
It has been determine d,'the above=named owner. is exempt from;::paying school, fees at. this time due to the following
reason:
y
EXEMPTION 'NOTAPPL'I:CABLE
This certifies that school-facitity fees'imposed.pursuant to'Governme-nt Code 53080 in the amount of
1.84 X 1,421 or $ 2,614.6.4, the'prop erty'hsted above and that building
permits and/or Certificates of Occupancy forAis sguare'footage in this proposed project.may now be issued
Fees Paid By ccNalley`Independent Bank/Coronel Enterprises `t&phone 564=4604
Name on`the'check
By Dr. Doris Wilson -
Superintendent
Fee collected /exempted ey Pauline. Pearson :`Payment Received �;" : $26°1'464
Check No. -50530
Signature�&,,
NOTICE: Pu}suant of Assembly Bill 3081 (CHAP'549 STATS.'1996) this will serve to notifyyou Gist the 90ay approval period ;in which'yau may protest the fees or other payment idenled
above will begin to run from the date"onrwhich}the budding'or installation,permiffoi this, project is sssued or ori which lliey are paid to the Disiricl('s) or to another public entity authorized to
collect them an the Disfrict('s)(s')'behalf, whichever isearlier.
�..4
Collector: Attach a copy of county or'city'plan check application form to district copy for all waivers.
Embossed Original- Building Dept:/Applicant .Copy - Applicant/Receipt`.' `-`Copy- Accounting
DEC. 17. 1,997 5:37PH COMMONWEALTH.
RECORDING REQUE5TEDiBY:
iI
OL0' RRPU5LIC'TITLE� 6- PACOMPANY
97,NN7005KC 104135=13 p
WH�NL O p R � O LOW p''
f .:
ESEQUIEL M, CORONEL
51-540 EISENHOWER-DRIVE
LA QUINTA, CALIFORNIA''92253
GRANT DFUIP
FOR. -RECORDER'
The undersigned:grantcr(s) declare, -W:
Documentary transfer tax is
(XXX) Computed;on'full value of. property conveyed,, or
( ) Computed.on`full value less l ens and encumbrances remaining. at time of sale.
{ i Uniiidorporated area.., and
FOR A VALUABL,fj CONSIDERATION, receipt of which is hereby acknowledged,
ST. ANASTASIA CATHOLIC CHURCH,.
hereby GRANT(S) to
ESEQUIEL M..CORONEL, A SINGLES MAN "
the zeal property in the City or LA QUINTA, County -.of Riverside, State of California,
described as;
LOT 4 IN BLOCK 36 OF SANTA CARMELITA AT VALE LA QUINTA, UNIT ATO: 2, AS PER MAP
RECORDED IN.BOOK 18, PAGE 55 OP MAPS, RECORDS OF RIVERSID8 COUNTY, CALIFORNIA
Dated November 20..997
State of California
County .of `_C.S-S. 4�IP'►
On b.
before me,
,-personally appeared
A 1c I
personally known to me (or proved to me on
the basis` of satisfactory evidence)., to, be
the pereon.W whose name(s) is/are suheer bed
i to the' within instrument and acknowledged to
me that he/she/they executed the same;n
his/her./.the'i'r authorized .capaci.ty(iee) , and
that -by his/her/their signature(a_) or :the
instrument the person(s), or the entity -upon
behalf of- which the person(s) aeted,,executed
the instrument.
WITNESS my haii an wof cial• eal,
Signature
MAIL TAX STATEMENTS TO.,
ST, ANASTASIA CATHOLIC CHURCH
BY
Name/Ticle,
IRAJ. WA(
NotdM P4�ile � Qa1f,
n s•: p100 ANGELAKOW&
i4PR &,1090
(This area for official nou;rial seal)