0310-337 (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. Cass Exp. Date
01/31/2(
Date Signature of Contractor's
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 t6 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.
( ) 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 STATE FU'Nfl Policy No. 1542972-03
(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
subject to the workers' compensation provisions of Section 37,00 of the Labor
Code, I shall forthwith comply withahose}provisions. r
Date: t z. ., - Applicant "�.. ✓L . . �1A.,
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 pton.
any permit issued as a result of this applicaton agrees to, & shall, i& hold harmless the City of La Quinta, its officers, agents and a2. Any permit issued as a result of this application becomes nullawork is not commenced within 180 days from date of issuanc permit, or cessation of work for 180 days will subject permit to ca c
I certify that I have read this application and state that the above infol mation iTi
correct. I agree to comply,with all City, and Stateilaws: relating to th buildrin Fli
construction, and hereby; authorize representatives of -this City to enter upon
,the above-mentioned property for inspection purposes.
Signature (Owner/Agent) 'w' - `� Date `
BUILDING PERMIT PERMIT# k.
�'���
DATE �— . VALUATION LOT 1 TRACT '
2 <'
JOB SITE
ADDRESS N3-20:5 XYiYDA OBKF. Nt
APN
774-044kM2
OWNER
CONTRACTOR/DESIGNER/ENGINEER
.00R0,N7LINTEPUP03ES
CORONE''LC:ON13'S". UC770M
PO BOX 389
51.105 AVIr.14'1'a.R.VILLA A] 01
1A QUIT~ rA CA 92253
i-. QIJMTA CA. 92253
(760)564--4604 C]" 22611
USE OF PERMIT
.gXGJ w I'Ah2LY'DW1EL3.Y1a0
14336 SIS. SYD PIMIMIT ]DOESNOT MCI UDE BLOCK WAL.L, POOUSPA OR
L)Ri1rE't'i°AY APPROACH
TRACT CONST RUCa ION 1,436.00 SF
PORCHIP.A.TIO 97.00 S?
GARAt1LiCARPORT 4.90.00 OF
LewmATED cosy op commucTiow
PEPI&T FTM �III:I Y
CONSTRUC T16N CRF 101-000.41 S-000
PIAN CHUCK >FIW, 1011-0001439-318 114s1.�a
n7E DEPOSIT 101-000-439-318 -9250.00
MECHANICAL FZZ s O I -000-4 21 ••000
ELECTRICAL FEE 101,000-420.000 $10836
PLUMBING F&E 101-000419-000 $118.00
STRONG MOTION YEE MID 101-000-241-000 99.39
CR DING FEE 101-000-423-000 $13.00
:. EVFJ.OPER IMPACT M- $2.,49.3,00
PRECiSt PI A14 101-000-3141-345 $100.Crt1
-TOTAL Cr NSTI?'EJCMOW AND PLAN CMCTG
X3.,889.57
a U23 PRF-PAU) M-3
-$250.00
2 3 2003 fGT Pr.4 R lrr xX S DUE 14001'
13,&19_57
OF LA QUINTA
3ANCE DEPT. /
RECEIPT
DATES ,.-:
6Y
D
INSPECTO
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 6 Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
L
F.A.U.
Framing
Compressor
Insulation
0 &r
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
.Cot
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
•Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool. Cover
Sewer Connection
O
Encapsulation
Gas Piping
Gas Test
Q
Appliances
Final
;.,COMMENTS:
- -
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) Cl/t
,N
Date
12/23/03
No.
25314
Owner
Coronell 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��tFiEDs
0:1 c�o
o
Q BERMUDA DUNES r
C/) RANCHO MIRAGE
INDIAN WELLS
PALM DESERT y
LA QUINT.107
A
�INDIO L�
O
774-044-022
La Quinta
1
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 53205 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 patios/walkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
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 /exempted by James Kozero Payment Recd $0.00
$3,073.04 Over/Under
Signature
NOTICE: Pursuaxa-Z5 Government Code Section 66g2,p(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or
other payment identified above will begin to run frorrfftthe 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 them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
Project Name
Project Number
Client
Testing Engineers -San Diego, Inc.
7895 .Convoy Court,'Soit6.-, San Diego; CA, 92111
[858] 7.1.5 5800;FaX'Y[858] 715=5810.
k
REPORT OF -COMPACTION TEST DATA
Established` 1946
,T bate Page of
C.0
Test #
Material
Structure
Test Location -and Elevation or Depth relative to... "
. 4 . .
fu
Q,
�:_
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4
5
A1. G,. ' , ti ti, r2. t. . , VA ( F 5.' �. ze,/
Wet Density (pcf)
/27 i
Z- e;.,
/7/.-7
r•
Dry Density (pcf)
Ind, �
tic.•o
Material: S = Soil, AC = Asphalt Concrete, ATB = Asphalt Treated base; .Ab = Aggregate Base; CTS = Cement Treated Soil
LTS .Lirtie Treated Soil; 0 = Other...
Structure: P-= Pavement Structural Section ;• F = General Fill N' Nauve Soil= = Waterline, SS-= Sanitary Sewer; ST =Storm Sewer,
U = Other Utilities; W = Wall Backfill, SC =Sidewalk, Curb/Gutter, 0 = Other
Test #
z. ;
3•
. 4 . .
Probe Depth (inches)
Q,
�:_
.'
„•
Wet Density (pcf)
/27 i
Z- e;.,
/7/.-7
r•
Dry Density (pcf)
Ind, �
tic.•o
Moisture (%)
. 4 /
P .4
� • 7
i. 2
MD Curve Number
1.2
Maximum. Density (pcf)
int
g
94.
Optimum Moisture (%)
el
Relative Compaction, RC
Relative Moisture,. RM (%)
Specified RC (%)
Specified RM (%)
Conformance.(Yes/No)
Nuclear Gauge Model and Serial Number: ;zl/ r 7 ;
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 of reworked: areas that, have previously failed to meet specifications.
See accompanying 'Daily Report for description of work and -observations.
TESD's Testing Technician: Name: Signature:
i
Client's or Contractor's Acknowledgement:. Name: Signature:
White- Office Yellow -*Contractor Pink- Field Technician
_ Certificate of Occupanry.,-.
I I
Ip'CDlOYA7FD . 1- a ,
9n, ' y +. {
r.
OF'I'1 Building, &.Safe_ ty,Department __ "
- - R S .. 'fir - - .. J � r r •• -
This Certificate is issued pursuant to the requirements of- Section 109 of the: California Building
_ Code; r certifying _tliat,. at the time ,of issuance, this structure. was 4n 'compliance with the, .
F provisions of the' Building Code` and- the various °.ordinances ~of, the "City regulating building
construction, and/or use: ' .
BUILDING ADDRESS AVENIDA OBREGON
- -53
Use classification: R3 ,t _ Building'PermitNo 0310-337
bccupancy,Group:.SFD `1 Type Of Construction: VNLand Use Zone: RC
r , S W
Owner_of Building: CORONEL"ENTERPRISES , = Address: PO BOX 389.
City, ST, -ZIP: LA QUINTXCA 92253
By: KIRK KIRKLAND
."( Date: 5-5=04
Building Official
POST IN A CONSPICUOUS PLACE }
MAY -05 -2004 -WED 01:24 PM. Cor one l Cons H' .0 6n FAX` ,No, 760-. 564. 4202 P. 001
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