SFD (9711-012)53360 Avenida Madero
9711-012
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chaptzr 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
r A
\1Date', r r 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, 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.
(\ ) 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.
y f•i/ .fir' /' l w0 i• ae \PF'1'lf lGf -1"t1
u 5')l ,t, _[Y '\;',9 :1-, 41, c.: ^-t' B!'F-a•1<V t.l;
(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' compen sation,provisions of Section O.of-the-babor
,Code, I shall forthwith comply with•thcs provisiens.- —
J 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 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 informatior%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.
1Si nature (Owner/Agent)'- - - Date
BUILDINGPERMIT PERMIT# CONTROL#
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DATE VALUATION. 4 LOT f e, TRACT }: 41 1JOB
SITE
ADDRESS 7i4- EA.t I . 1 . A..
APN . 774-3,34-Wi° 6
OWNER
CONTRACTOR / DESIGNER / ENGINEER
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USE OF PERMIT
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1013 ill,, PCIr4CU FEWS' 01,114 NOW
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
� wY
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs A
Underground Ducts
Forms & Footings
Ducts
Slab Grade y
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
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
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 - 5'
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
F'rdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
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"9-7 tl - 0 102ft a(p a
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(/-,/, 4. , r P.O. BOX 1504 APPLICATION ONLY
Building / /f 78-495 CALLE TAMPICO
Address +- f0 MA , i lil (/U QUINTA, CALIFORNIA 92253
Owner ` er
Mailing BUILDING: TYPE'CONST. OCC. GRP.
,J
Address
A.P. Number ! v e3cl`. l✓O&, -
City Zips Tel. r G f P F AW, Z; til l) ( f
G . I. '(ay - Q Legal Description I •/ .. -
Contract0r% f Project Description
Address ,
City Z Zip :r Tel.
State Lic.
8 Classif. j 3 ( /
City
Lic. #
I l
Sq. !/
Ft. / ,\ No.
Size ` Stories ! Units
Arch., Engr.,
New fa-" Add ❑ Alter ❑ Repair ❑ Demolition ❑
Designer
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION +
1 hereby affirm that 1 am licensed undePiirovisions'o f Chapter 91c- MMM— ci-- with Section
7000) of•DlVision 3 of the Business1nd Professions Code, and my license is In full force and
effect:i
r
:• ^
SIGNATURE 0 DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law toe the following
Estimated Valuation -
'
reason: (Sec. 7031.5,8usiness and Professions Code: Any city ,or. county which requires a
aP3
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
'
PERMITv, AMOUNT
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
- . V '
Plan Chk. Dep. •:
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
Plan Chk. Bal.
!.: 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
Const.
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,
Mech.
provided that such improvements are not intended or offered for sale. If, however, the building
Electrical
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.) '
Plumbing
I'1 1, 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
S.M,I,
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.)
Grading
11 I am exempt under Sec. B. & P.C. for this reason
Driveway Enc'
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
::X 4
•?;''
I hereby affirm that 1 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
fpr
n Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(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.
y,
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
6
ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must toes
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comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances: `Y
Front Setback from Center Line
Rear SetbalYk from Rear Prop. Line
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cf
CONSTRUCTION LENDING AGENCY
r
Side Street Setback from Center Line
work1 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.)
-
Side Setback from Propey r:e
Lender's Name
G`"
FINAL DATE INSPECTOR
Lender's Address
This is a building permit when properly tilled 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.
y OCT F t1it1(]r't
Issued by: Date
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 properly for inspection purposes.
Validated by:
_
Signature of applicant Date
Mailing Address
(
i.' Y OF Ltd 08 c 4Ni rm
Validation:
'
City, State, Zip
a -
k
WHITE =FINANCE YELLOW =APPLICANT
PINK =BUILDING DIVISION
• Desert Sands Unified School District ;
Notice:82-879 Highway y 111'
r Indio, CA 92201
Document Cannot Be Duplicated
619=775-3500 - ,
CERTIFICATE OF COMPLIANCE' `
Date_ 11/12/97 ' APN # '774-034-006.1
No. - °16269 Jurisdiction La Quinta .
Owner Name Esequiel Coronet Permit #
_ No. 53360, Street : Avenida Madero • Log #
City La Quinta Zip 92253 Study Area
.Tract #Lot # + 19 Square Footage 1'400
! . .
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
1.84 X 1,400 or $ 2,576.00 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 ccValle Independent BankCoronel Enterprises G T e le`
pbone 564,1.4,604
Name on the check
By Dr. Doris Wilson# ly
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received ,,t$2;576.00
`
Check No. 150386
Signature Q 5AA 0 P a
_ 3
OTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
Bove will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
Aect them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
141
Pacific Coast EscRow ConpoRation
74920 HIGHWAY 111 INDIAN WELLS, CA 92210
TELEPHONE (619) 568-0344
ESCROW INSTRUCTIONS
Cindy Burgin
Escrow Officer
Escrow No. 17221
Date: October 22, .1997
This escrow company holds Department of Corporations Escrow License No.
963-0473.
CASHTHROUGH ESCROW .......................... ....................$ 15,000.00
TOTALCONSIDERATION ...............................................$ 15,000:00
Buyer shall deliver to you any instruments and/or funds required from Buyer to enable you'
to comply with these instructions, all of which you are authorized to use and/or deliver
on or before 11/21/97, and when you are in a position to obtain a standard Policy of
Title Insurance through CHICAGO TITLE INSURANCE COMPANY, provided that said policy has a
liability of at least the amount*of the above total consideration, covering the following
described property in the City of -La Quinta, County of RIVERSIDE, State of California:
LOT 19 OF BLOCK 182 OF SANTA CARMELITA AT VALE LA QUINTA „ UNIT NO. 18.,.AS PER MAP
RECORDED'IN BOOK 19, PAGES 31 OF M APS, RIVERSIDE COUNTY, CALIFORNIA.
PROPERTY ADDRESS VACTANT LOT, APN: 774-034-006,1,a Quinta,CA 92253
SHOWING TITLE VESTED IN: Zeke Coronel, a single man
FREE FROM ENCUMBRANCES EXCEPT:
General and Special Taxes for current fiscal year, including any special levies, payments
.for which are.included therein and collected therewith. Covenants, conditions,
restrictions, reservations, easements, rights of way, of record, if any; also exception
or reservations of oil,gas or mineral rights, if any.
1). Buyer herein will pay All Cash for subject property and shall deposit into escrow
prior to the close of escrow, the balance of total purchase price plus buyer's portion.of
escrow and recording fees as required in the form of a Cashier's Check or Wire.Transfer.
2). The parties herein agree that the closing of this escrow is subject to the Buyer's
approval of Preliminary Title Report, CC&R's, if applicable within 3 days of receipt.of .
same. Buyer's failure to notify Escrow Holder of any disapproval, in writing, within
specified time limit, is deemed to be Buyer's approval of same and this contingency.
eliminated.
3). Covenants, conditions, reservations (including exception of oil, gas, minerals,
hydrocarbons, and/or lease without right of surface entry), restrictions, rights of way,
and easements for public utilities, districts, water companies, alleys, and streets.
4•). Buyer is aware and acknowledges and accepts and holds Seller harmless for said
property in regards to geological, flood hazard, seismic hazard and any special studies.
zones. Buyer has satisfied himself as to making any further inquiries at appropriate
government agencies, lenders, insurance agents, or other appropriate entities,concerning
use of the Property under local building, zoning, fire health and safety codes as may be
applicable under the Special Studies zone act, seismic Hazards mapping act, ,and local..
geological ordinance(s).
5). Buyer and Seller acknowledge that state laws prohibit this escrow from closing
(recordation of Deed) until buyer's funds, including new loan proceeds, have been
collected; as defined by law. The undersigned Buyer (Borrower) understands that it is
their responsibility to determined from lender of their choice what type', -6f funding
instrument will be used. Also per diem interest will be charged to buyer and seller by
their respective lenders while Pacific Coast Escrow Corporation determines that all funds
required to close have been legally collected. It is recommended that Buyer have all
funds wire transferred to close escrow without delay or additional interest expense.
6). SPECIAL CLOSING INSTRUCTIONS AND RELEASE FROM BLANKET ENCUMBRANCE: This -escrow shall
not close and funds shall not be released from impound until title to the lot has been
conveyed to the purchaser free and clear of any blanket encumbrance(s).
7).. SPECIAL CANCELLATION INSTRUCTIONS. FOR NON -DEFAULTING BUYER:. "
If, through no fault of the Buyer herein, this escrow shall not close within one-year''.
from the date of the Agreement to Purchase, (signed by bother Seller and Buyer), Buyer
shall have the right to the return of all monies then deposited by him into escrow.'.'
Escrow holder is hereby authorized and instructed to refund said monies to Buyer. All
SELLER(S) INITIALS:_ BUYER(S) INITIALS:_ 1
71
Cc l
f Occup"a*ilcy.-, - -
Certificateb
Cit of La Quinta
y
Building and Safety Department, -
This -Certificate issued pursuant. to the requirements of Section 109 of the. Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 53-360.AVENIDA MADERO .
Use Classification:' SINGLE FAMILY DWELLING Bldg. Permit No.: 9711-012
Occupancy Group: R-3 Type. of Construction: VN LandUseZone: RC
Owner of Building: ESEQUIEL CORONEL Address: PO BOX 389
City: LA QUINTA, CA., 92253
By: DANIEL P. CRAWFORD JR.
- Date: 2/25/98
Building Official
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-POST IN A CONSPICUOUS PLACE