0103-005 (SFD)LICENSED CON TRACTOR 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 # Lid. Class Exp. Date
✓z
6534981
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). .
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).. i
( ) 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 Policy No.
STAT911 1110D OAZW-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
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: `k int Applicants t I. `
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for. in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
i
Signature (Owner/Agent)-- l ^ ( Date'" --r-' ! ° ✓1
-BUILDING PERMIT PERMITk
DATE VALUATION LOT (jtty-.�j!„rj TRACT
JOB SITE
APN '
ADDRESS
OWNER
CONTRACTOR/ DESIGNER/ EN INEER
��,�yy'T['����••1�,,'�{{,, `•�� p(u��,r�j.�3 yy,� p' 7,y
�✓.SCWA�'d> Yl�.I.Atl"<:/.I,,AT.1J''S./ 1Z`aiJV
f� �`�A�-'�I�� J0 p�+�q��aj ('��'$/+J��y f'�
�.e®JiI.�,Fa[�l.C� 4w\JA�7✓..iY%�.P.i �� LJ.1./�
�
ti -15 5 a6u.3” ° I'anco a3urnMwo
x£3.150 (141Ir:£t:id1WIIG'•O 31111W230
L&QUIMA CA 92253
L&(� )'Uwn%. 6.4 1)2,253
(7760)5(W4604 cav, 2,61
,
USE OF PERMIT
•
I
U12 F��°i�LY .1a MLI Ni G
SPO - PERMIT DO&S NOT 9:PICUJIUK HOCK WAT;L,°P€1►0)e RA Oft -; . y
APPR PICI 1 DRIVEWAY MAS!°ER IS -1 9*11 CODE
rl. PUIC3 C014STRUC° ION
PORCH/PATIO 36.00 SF
(.1ARA,MCMPOR."1' (10) 9.996,5,+
3 Pr,1''00.1) 7°1i'�iCE 200,00 U
"KaMINMD COST OF CONSUMMOIN
CCiHMUCT-.1014 M
PiAR CHWK :F&
,ail 9C.HANICAL FEW. 101-000-421-000 b4.90
1?-I,.WrXLCAL Fiii, 1.01-000-420-000 $129.44
P1Gilhffl1R0FEE 1(12f-00 -4196000 �1IA<JS
S'`t IZIONO MOTION FEW, - aRMI1D 101-000-241-000
0PADR40MF' IM -000-423-000 SAW
k};i!V'1"LfJ,PRR IMPACT FE $1,"17.00
PRELI SK1;UW 301-0010441-30 $110..0
Ta Er i; i� 1'i7`3l r 101-000-•439-118 4'A'50,00
4
i�'C1'S-UYS'.�;C.0",04��'ERTR',1TONAI���y�+��������y�yy�����.1�tfpp�y�y•��.
$3t{,,05. 6.5 .,
77�� ����9����yy
3
i3'ES 3d CT I NOW
s
RECEIPT
DATE /
BY
D. FIN'AL•ED 9
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
L_
Underground Ducts
Forms & Footings
2 7�
Ducts
Slab Grade
7
Return Air
Steel
Combustion Air
Roof Deck
chi_ 7
Exhaust Fans ,
O.K. to Wrap
Framing�
(
F.A.U.
Compressor
Insulation
a O C 7
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
I
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
Water Piping
_
C
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
0. K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
/�,�/� a
Encapsulation
Gas Piping
r (�
Gas Test
- �'
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL A PROVALS
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)
,
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 3/16/01
No. 21769 Jurisdiction
Owner NameCoronel Construction
No. 53-905
city La Quinta
Tract #
street Avenida Obregon
Lot # 8
IAPN# 773-154-020
La Quinta
Permit # 0103-005
Log #
Zip 92253 Study Area
Square Footage 1421
Type of Development Single Family Residence No. of Units 1
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 or replacement mobilehomes. It
has been determined 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 Government Code 53080 in the amount of
..'-n
2.05 X 1,421 or $ 2,913.05 the property listed above and that building
W
permits and/or Certificates of Occupancy for this square footage in this proposed project may now;
Fees Paid By CC / Valley Independent Bank - Ahazany Coronel Teleptcce 7
Name on the check*
By Dr. Doris Wilson
Superintendent
Fee collected /exe pted by Annette Barlow
Signatur
Payment Received
Su
r► 4
602 564 4604
44
fes-
Check No. 242862
$2,913.05
40TICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
rbove will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
:ollect them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
•'=l`i't 1:.;'.^„ _ ��„�=�•%—ti.ti.,..---^Js='-2rr�ii �.'g'�'��.__ � .�-. . —.�... .4'..> .:.v%r-•�'S�'' r*."�:v:::.:.». .-"F.;✓�..t. •...
P.O. BOX 1504'
Building 78-495 CALLE TAMPICO
Address ) o C� �\ ><•� . C N r ;cam-, V ^ LA QUINTA, CALIFORNIA 92253
Address V - V `syr v
City Zip
Contractorf% / f
Address n
(J, Nom, (_, Ss 1
I+r.. -.;� - >, ,tip.. "'�.rF.s�-'�.�.•+Q _ . �•,T,�T_ _ �.r.,,�.
Z/$ D O�
APPLICATION ONLY
BUILDING: TY�P-E'C�OtNSlT. t` OCC.GRP.
A.P. Number I 1� 1 'I ` c)c .� b
Tel. Legal Description
•J Project Description tc_-3, • \ 3? \ v . �� u,r�
City Zip . Tel V
State Lic. + City
& Classif. �,yC, 4� 1�J�" Lic. # D;c
Arch., Engr., M
Designer
Address Tel.
City (Zip (State I
Lic. #
affirm that I am Iidensed under provisions of Chapter 9 (
'trvision 3lbf the Business a gd.Profassibns Code,oand my
i OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,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 foris 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, and the structure is not intended or offered for sale. (Sec. 7044, Bulsness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and no 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.)
111, 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 contractors) licensed pursuant to the Contractor's License Law.)
i 7 1 am exempt under Sec. f B. 8 P.C. for this reason
11,
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
Fl Copy is filed with the city. OCertified 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. (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 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.
Signature of aQplicant Date
Mailing Address
City, State, Zip
\ I \, ut :�s -7r- C ' ! C-\ V. '---
Sq.
Sq. Ft.IA f No. No. Dw.
Size "\ �ij Stories Units
New B" Add ❑ Alter ❑ Repair ❑ Demolition ❑
ee a S E
sslet.� fGo' I,CIi -
r
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep. _-Z5- 01*
` Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Stree; Setback from Center Line 4
Side Setback from Property Line r
FINAL DATE
-INSPECTOR
r
Issued by:
Date �P�ermit
Validated by:
Validation:
-oil Y QV LA V.Uk" r
a
e
WHITE = FINANCE YELLOW = APPLICANT PINK ='BUILDING DIVISION i
4
a
Fidelity National. Title Company
72171 Highway 1 1 1 Suite 201 • Palm Desert,. CA 92260
(760) 776-5770 • FAX (760) 779-0394
SALE ESCROW INSTRUCTIONS
Date: January 4, 2001
Escrow No.:. 42150 -CB
Escrow Officer: Cathy Boyd
Buyer(s) will deposit with escrow an initial deposit in the amount. of ....... $ 1,000.00
Prior to the close of escrow, Buyer will hand you the balance of down payment
$ 22,000.00
(plus closing costs, if applicable) the sum of ........ • • • ' ' ' '. • ' ' ' ' ' '' ' ' $ 23,000.00..
TOTAL CONSIDERATION......... ...... • • • • • • • • • •
AND, on or .before February 16, 2001, Escrow Holder will 'be handed additional funds and/or
instruments required to enable Escrow Holder to comply with these instructions, which Escrow Holder .
is instructed to use when in a position to-procure/issue a CLTA Standard Policy - 1990 Form coverage
form Policy of Title Insurance from Chicago Title Insurance Company with a liability of $23,000.00,.
covering the following described property located in the City of La Quinta, County of Riverside, State
of California:
Lot 8, Block 202 of Santa. Carmelita at Vale La �Quinta, Unit 419, as per'map recorded in Book 19,
Pages 33 and 34 of Maps, in the Office of the County Recorder of said County.
SELLER/TRANSFEROR STATES THAT PROPERTY ADDRESS IS:
APN #774-154-020-0, La Quinta, CA. 92253
SHOWING TITLE VESTED IN:
Coronel Enterprise, Inc., a California. Corporation.
FREE FROM ENCUMBRANCES EXCEPT:.
1. .Current general and special taxes for: the fiscal year in which this.escrow. closes, and taxes for. the ;
_I ensuing year, if any, a lien not yet due and payable; _rn`Lici r% nR_nf_Chaoter 3.5
•'.'r' .'� r .•� !; `"'. �.� Ic:�laS, i
�!t[�'.� t � 'i .�II`.')i Sl' j BSiif CJUIt�Cjt {'Lr ;<t3 lU2Tk}l^.F,»l1? ?I �`y
� � ..0 ..I �0 .:.ry,..' :1Lt1 !i'.�' 4^.,l'��•`ri3 Mt 1#rtti'd�l rtSi�i: sJ 11�.
•-` }:i.' , . +_ _tr ou• ra..�►t w �.',' �c' �l ;*:! lfre 'c8 �'"_t^.v 'ts� -` -.. .. r
F � * � , � ti. 1✓•, bv"t4'y,.7wi�,71� G�� ni � jar I ti',�ran (Q� 7.'}»LS �j''d" '`� `r; � :J'.1
.+ r ts!~ ^►+...h, t }' ' ^c )r". ?ta
' -.w y. ' � t�12�►+i �^} Srt' ,rir iiia- • . +ry�?F'1 . L°�}?. f!r, i.��
1 t3. , _=1 .�}l �v. i �f,.i i-.: ~ )=E.•4 r• •��: L3;'3 �� �A�"'' n• .j
-a: t'ji Ji��, r=� moi• 1•.tt T -n4 i�=:'1;1 SJ .t �t.:�2:.�'r .�'r7:11T.ii `. G.�,n.
. r• ' .. r � � ., � ti � '� 1 "� { v� 7'.:�'�'L :.4it�.�'.1 ���;? (,fJ�. � ?i :7S `1.I tt�d? pfj^•_j,�
J - .3• � � ..' �' � ]." s7'", .'",�` �i i a 'if •. s` :• i's'il't !fi"�� r �,`;r'I+t r $•� � � .w.
2 t
RC DISTRICT -PLANNING 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 applicability of compatibility issues or need to require the filing of Master
Design Guidelines by the applicant. 'It shall be transmitted to the Building and Safety Department as your
correction list. Please attach additional explanations as necessary.
APPLICANT Coronel Construction
c
SITE ADDRESS 53-905 Avenida Obregon
APN' 774 _ 154 _ 020 'BIN NO.: CASENO.: 2001-4.10
LEGAL: LOT 8 BLOCK 202 UNIT S.C.@V.L.Q.
CHECKED BY: Greg Trousdell DA E:
Inform the assigned Building plan checker upon your assignment to this case. The CDD Executive
Secretary maintains a log book to track applications and assign case numbers.
REQUIRED ITEM
Y
N
COMMENT/CORRECTION
Compatibility Reviewe5°
Case logged and number assigned
0000,
Verify legal and APN information
Consistent with MDG on file (as.applicable
b '•.
���Ss
r
MDG filing required (5 filings since 9/3/98)p.
Consistency with street/surrounding area:
_ Colors
Materials
�. Architecture
c\a�
Go
E
Gov
s
•�
�� peg
G°,\%°
Other Requirements:
�Pl