0310-338 (SFD)_ LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chanter 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
634981 n In(
ODate ? Z Signature of Contractor— I2�.
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 the 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.
J. ). 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 ;TATE FUND Policy No. 1542937-0.1
(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, i. any manner so as to/t ecome subject to the
workers' compensation laws of California, and'agreelthat if I should become
subject to the workers' compensation prSection 3700 of Sect3700 of the Labor
,
Code, I shall forthwith comply wit hose'provisions. X
Date: 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 to4he cost of compensation, damages as provided for in Section 3706
of the Labdr 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 & ea rson at 1A
whose request and for whose benefit work is performed under o
any permit issued as a result of this applicaton agrees to, & sh , ' emnify
& hold harmless the City of La Quinta, its officers, agents and loye
2. Any permit issued as a result of this application becomes nu I n void if
work is not commenced within 180 days from date of issua ce
permit, or cessation of work for 180 days will subject permit to ancella%—n)
I certify that I have read tthis application and state that the above ir5fr3rffratiorris�
correct. I agree to comply with all City, and State laws,relating to the building `
construction, and hereby authorize representativesof this City to enter upon
the above-mentioned property for inspection purposes.
/Signature (Owner/Agent), t�. Date _?
i
BUILDING PERMIT PERMIT _, i
V/
DATE _v LOT LOT ;1,'fl- TRACT
JOB SITE 6-3
ADDRESS is9�A ��
APN 774-04.4-014,
OWNER
CONTRACTOR /DESIGNER / EN INEER
CORON1: EITM. RM8
CO .cS z cO xx rc�.»
FU130 369
S1-1. At ►Aii'1I&4101
LA QtM4TA C`;A 92213
1A Q.U1 A CA '92253
(760),,564 7 60 CgLA 2261
USE
�O7F�P�E�RR�MIITTTr� �.
i7,73 OLEd`ipaal9La..3 ,L F!1Mf
47 �
1436 SF. SFD PERMIT f3C?ES bibT INCLUDE tLOCKG tesT.A.II,X., Po , • SPA. OIC.
13YtY'�`EVAY APPROA,CK 75!r 1t CED PLAi�T C�-1K K ,F
'
MULTIPLE HOUSE OF SAME:Kau, '! a lire y
a )p
TYLkell CONSTROCTJow 1,436.0 sP .
POKCWPdiTKO. -- 97.00 SF' .
aAP,AaFjc.r' RF(5RT a 490,004
1E F,lT1 C091s' OF CORNSY UrC7,1
AM90
P . RWf FEE SMA1i1A1 Y .;
CONSTRUCTION FU �:' 101=000.418.0(10
PLAN CHECK FFZ {'a' IA.9I
PES: DEPOSIT 101.000-439.318 42si 0
.
MECHAN1CALFE9 d 101-000-628-000
ELECT11:IC ALFLE ../:. 101.000-420.000 Slam.
PLUMBING FEE
IVRONG MOTIOA FEE - 10 Y -000- A.1-000GR.fi,: ING FMt7n71D
101-000-423-000 �K 3.00 k'
tit
DEVEIsO3'ER IMPACTFEK r �Cs'if►9,OW 4s
PRECISi? PLAN 1,01-000-441-343 $100.00
' -TOTA t3 'J'~ TION AND PLAN CHECK
L PRE- F.FES
--259;0e
2 22003
�tv
A'lJs
' �: 7('AL PM'?l�il T k FY..S 1D11JE d9 i;►1PV
t'I
u. 41
ICE DEPT.
RECEIPT
DATE
/!'���
BY
DATE, FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
--
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
O
F.A.U.
Framing
Compressor
InsulationVents
-
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali 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
-eveiz
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
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
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:
Date
12/23/03
No.
25315
Owner
Coronel Enterprises
Address
PO Box 389
City
La Quinta Zip 92253
Tract #
Type
Single Family Residence
CERTIFICATE OF COMPLIANCE
Desert Sands. Unified,School District
47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
APN #
Jurisdiction
Permit#
Study.Area
No. of Units
4���1Fi�sc�o
Q BERMUDA DUNES r
V) RANCHO MIRAGE
�J INDIAN WELLS
PALM DESERT y
LA QUINTA
�QIN0 L�
774-044-014
La Quinta
r
Lot # No. Street S.F. Lot .# No. Street S.F.
Unit 1 53045 Avenida Obregon 1436 Unit 6
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5 Unit 10
Comments
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, residential additions undgr, ,,
500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement molile,,,
homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.14 X 1,436 S.F. or $3,073.04 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By Valley Independent Bank Check No. 297774
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exe y mes Kozero Payment Recd
/ $3,073.04 aver/Under
Signature _ ��`%
NOTICE: Pursuarl ified
vemment Code Section 6 0(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or
other payment id � above will begin to run from the date. on which the building or installation permit for this project -is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect themon the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
APR -27-2004 07:39 AM P.03
1NSTAu_,A,ri0N 'CERT1FICATE CF -6R
�.tr •�clurit� Perm t Number
DUCT LEAFAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE REDUCTION
Results (CFM ct 25 PA)
Test. Leakage.(CFM) �5_ 7
400 cftTvion x number, of tons, or as 21.7 x -Heat in& Capacity
in Thousands of 6tufhi, enter calculated value, here
If fan now is measured, enter measured value here
Leakage Ffaction = Test Leakage/(Measured or Calculated Fan Flow) _ • " , o
Pass if leakage fraction S 0.06 0, ❑
Pass F-3.
Fur -\F ROSOI. TYPE SEALANTS ONLY - The following diagnostic testing was completed:
Duct Fan Pressurization at rough -in measured leakage (CFM)
t. Hi.Cl: FINISHING `PALL:
1 ; ❑ Nu ❑ Pressure pan test or House pressurization test
'1�' �� ❑ ❑
.� . , ❑ �'u ❑ Visual Inspection of Duct Collections
Pass i'�:.
THERMOSTATIC EXPANSION VALVE JXV)
Thermostatic Expansion Valve (or Commission approved
equivalent) is installed and Access is provided for,inspecuon ❑
Yes is a pass l'j�,; F;:.',
DUCT DESIGN
J , ACOA Manual D Design calculations haLc-been completed,
DW Design is on the plans and duct installation matches
plans.
'fXV is installed or Fan now has been verified. If no TXV, ✓1/ /�
verified fan (low matches design from CF. I R.
Measured Fan Flow
❑ ❑
Yes for both I and 2 is a lass Pass 17_j
:1:!c ii;:r_l'• N cr:t'y that the above diagnostic' test results and the work I performed associated
:.:iii, thv i..lutn:merus "or compliance credit. (The builder shall provide the FIFRS provider a -.,om u;'!1ic c.'I
,fr.plo; ve3 ur sub•connetors certifying that diagnostic testing and installation meet tic
�nat.rre; Date
ill kS Prov:dcr (if applicable)
Owner at Occupancy
n
Installing Subconrractor (Co.'Namc) OR
General Contractor (Co. Name)
10/29/200.3 02:40 FAX
First Arneijrafl Tiflf- C
Uownanv
REC-ORDING-REQUESTED,BY'-.
Fidelity National: Title Company
Escrow No. 410934. -CB
Title Order No.
FIDELITY NATIONAL TITLE
N00%,
When Recorded Mail Document,
and Tax Statement To:
Mr. Zeke Coronal
51105 Avenida Villa, #101 P7-�'A) tvOy?q7"�1
La Quint6, CA 92253
APN: 774-044-01.4--5-,
0002
.DOC M- ..,.200 --804-7918
I* of 'icoo Tex. Paid
Recorded -4n 60'iciail Records
county'af Riverside
O'rso
Asssasar, CounEy Clerk
M. S.. AGE 'WE OA POOR NOCOR SNi wSC.
... . . .......
R L [ COPY L... REFUND I NCHC EX
A'. 1WThe undersigned grantorsjc�
rp(s)
Documentary transfer. tax Is 5302':50
r X I - computed on full velue-of'prdPerty conveyed, or
I computed, on full valueless value of liens -or encumbrances remaining at time of sale, SP
I Unincorporale6 Area City of La Quinta
FOR A VALUABLE CONSIDERATION; receipt of which Is here'iby4cknowledged, Frank . M. Griswold, Successor
Trustee of The Henry Giiswold Living Trust dated June 19, 1995
hereby GRANT(S) to Coronet Enterprises, lhc.,.a Calif ornia-Corporatio n
the following described. realpropierty In the CIty of La, Quinta
County of Riverside, State of California:
SEE EXHIBIT ONE ATTACHED HERETO AND MADE A PART HEREOF
DATED: September 19, 2003
STATE OF CALIFORNIA
COUNTY OF
ON. 5 &4—INbefore me,
k rsonally appeared
Personally known to me (or proved to me on the basis
Of satisfactory evidence) to be .the personN, whose
name(bLis/aN subscribed,to thewith.ih*instrurnent and
acknowledged to me that WN4/it)Wy�dxecLl I ted the
same inhNr authorized cap -66 ity, A , and that
by his/h signatureNi on the instrument n.trument the
personN, or the entity upon be . half of , which the
person( acted, executed the instrument.
Witness my hand and . official seal.
Signature
Fiank M.'Grisyyold, Successor Trustee of The Henry
Griswold Livi h*g'Trust-datedju'oe'�.'I 1995
9
, 2,44141
;z ,
Y.
Frank M, Griswold', Trustee
LINDAA..GAGNdN
COMMISSiori 0 131-3093
Notary Pu411c
ta - Calitomis
Orange Coynty-'
My Comm Expires Jul 13,:2005
MAIL TAX STATEMENT'S�ASDIRECT . EDABO . VE
FD Z
-213 (Rev 7/96) GRANT
RANT DEED
. 0or prop - RV:2003 00804798 1 o.1-2
10/29/2003 02:41.FAX FIDELITY NATIONAL TITLE 1a003
Escrow No. 410934•CB
Title Order No.
EXHIBIT ONE
Lots 2, 7 and 10,, Block 175 of Santa Carmelita at Vale La Quinta, Unit #18, as per map recorded in Book 19, Page
31 of Maps, in the Office of the County Recorder of said County.
known as APN ✓•1774-044-014-5, 774-044-019-0 and 774-044-022-2
Lot 7, Block 281 of Santa Carmelita at Vale La Quinta, Unit #26, as per map recorded in Book 50, Page 20 of Maps,
in the Office of the County Recorder of said County,
known as APN #774-215-007.7
Lot 8, Block 137 of Santa Carmelita at Vale La Quinta, Unit #14, as per map recorded in Book 19, Pages 82 - 83 of
Maps, in the Office of the County Recorder of. said County.
known as APN #773-093-003-0
cor prop - RV:2003 00804798 2 of 2
Test.i•ngEngirneers-:San D.iego,.� Inc. Established 1946 .
q •7895 Convoy Court, Suite 11 .San Diego; CA`92111
s� g [858] 71°5=5800 Fax [858] 7154810
REPORT' OF QOM'PAQTIO;N'TEST° DATA
Project Name OVA_ An,--- 64,,;-;u
r'cu n
Project Number Test Date / 17 %J Page of
Client `./o Q." nom. / . C✓ rsf2u�ron
Test #
Material
Strucfure
Test Location and ,Elevation.or,Depth:relative to...
C✓R�e.R f/�r (�Q%I 7','1 tr r7.:clp;
;L.
S
(-
. Z;.'J . a 2 ri.;( 1, u i` .` 7`Y c Yi•1 Cf .1 • ' '� i(�.. fC
It ri 4 i L� � �.
Wet Density (pcf)
'
i 2. ?•
I Z3,.
ZZZ..,r
I'Zd, 4 ..
Dry Density (pcf)
l r ' '
l a• 3
(/ x..
+:
Material: S = Soil, AC = Asphalt Concrete, ATB = Asphalt Treiated'Base, AB = Aggregate,Base; CTS:= Cement Treated Soil
LTS = Lime Treated Soil, O = Other.. Y
Structure: P = Pavement Structural'Sectiorr, F'= General Fill,.N = Native Sbil,VIL = Waterline, SS = Sanitary Sewer, ST- Storm Sewer,
U = Other Utilities, W = Wall Backfill, SC = Sidewalk, Curb/Gutter,.O = Other
Test #
j
Z.
Probe Depth (inches)
Wet Density (pcf)
'
i 2. ?•
I Z3,.
ZZZ..,r
I'Zd, 4 ..
Dry Density (pcf)
l r ' '
l a• 3
(/ x..
Moisture
7Y..
MD Curve Number
/Z-3
t
ZS.a
Maximum Density (pcf)
Optimum Moisture
Relative Compaction, RC %
y
-`'
Relative Moisture, RM (%)
Specified RC (%)
Specified RM (%)
Conformance (Yes/No)r
Nuclear Gauge Model and Serial Number: 4//(" Cs S- z", ; -7 3 -3
This report does not relieve the contractor of their responsibility for' performance in, accordance with the. plans, specifications and. applicable
codes. The contractor is responsible for scheduling retesting cfl'feworked'areas that•have previously failed to meet specifications:
See accompanying Daily Report for description of. -work and observations.
TESD's Testing Technician: Name: �S' n yt!�r�o 2 SignafUre:.�
Client's or Contractor's Acknowledgement: Name: Signature:
White- Office Yellow- Contractor Pink- Fjeld Technician
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4 : This,rCerfificate is issued�pursuant�to .the requirements of.Section .109 of -the California'Building
Code;_ certifying. that, " of the _ time � of issuance, `this structure, � was in compliance . with. the -`
'provisionsr of'the .Bciilding' Code and'; the ,variocisr ordinances`�of the. City regulating building � a
.construction and/or.�use. � � � i. _ � � r ; ,. .�: - _ r - ; ' • -. .
BUILDING ADDRESS: 53-045'AVENIDA OBREGON'
.. � � Use classification:. SINGLE FAMILY DWELLING,--:, Building, Permit N6.:'0310-338.
- ' Occupancy Group: R3 '� , � - , • � =Type of Construction: 41
,VNLand Use Zone: RC•
Owner;of Building: CORONEL ENTERPRISES Address, 51=105 AVENIDA VILLA #101
:r • ' - � � - � � _ �� City, ST, ZIP: LA QUINTA, CA 92253
By: KIRK KIRKLAND
�b7"L _Date: April 28, 2004
. � .• ;Building Official
- � � POST INA
CONSPICUOUS PLACE
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4 : This,rCerfificate is issued�pursuant�to .the requirements of.Section .109 of -the California'Building
Code;_ certifying. that, " of the _ time � of issuance, `this structure, � was in compliance . with. the -`
'provisionsr of'the .Bciilding' Code and'; the ,variocisr ordinances`�of the. City regulating building � a
.construction and/or.�use. � � � i. _ � � r ; ,. .�: - _ r - ; ' • -. .
BUILDING ADDRESS: 53-045'AVENIDA OBREGON'
.. � � Use classification:. SINGLE FAMILY DWELLING,--:, Building, Permit N6.:'0310-338.
- ' Occupancy Group: R3 '� , � - , • � =Type of Construction: 41
,VNLand Use Zone: RC•
Owner;of Building: CORONEL ENTERPRISES Address, 51=105 AVENIDA VILLA #101
:r • ' - � � - � � _ �� City, ST, ZIP: LA QUINTA, CA 92253
By: KIRK KIRKLAND
�b7"L _Date: April 28, 2004
. � .• ;Building Official
- � � POST INA
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