SFD (9708-155)54225 Avenida Madero
9708-155
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
%Date 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).
O 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.
KI 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.
r51'.1l •f l':id I;AOLU iii IN"W4 1119W O
(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- uld become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall,fo thwith comply with those provisions/
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 persor'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 cancellatiQ,
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
/Signature
Ae above-mentioned property for inspect on purposes.lA71
(Owner/Agent) Date fl 1
PERMIT# CONTROL# .
BUILDING PERMIT 9709.111" 5887
DATE-1('? VALUATION E'}7ib. . d,:;{0 LOT 1 TRACT 11121*. V11t 11
`i/? -
ADDR613 TEjj
ADDRESS X lt ,t 4 4<
APN 77 4il..9-2 -if 22.
OWNER
CONTRACTOR/DESIGNER/ENGINEER
f." )iiONle1, COIN 1"Et(1CY10"?F
!'.0 BOX 389
"P.O. BOX310
1.e3rQUIN1'r'1 ("A 4'2253
FAQt,WI-A CA 022.51
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USE OF PERMIT
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il-AN r.IfFFICK FFrF f0f,f1f3 -4399118 t +Y ^S
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1"3.1997
.
SEP f "3 r,'e .I_, I"ER'4M; C V F ES I)I:.f.1+, N0W
$3,13wmi
L
C.
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 rox
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
_
Insulation
Vents
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 APPROVA S
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
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL AP R, ALS
Temp. Power Pole
Underground Conduit 41
-
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:
_
P.O. BOX 1504
Building47&105 CALLE EST ADO
AV-- _
Address - 2 2 / ` DC' A QUINTA, CALIFORNIA 92253
Owner
t 5 Ui r" - lG,'e.-7e
Mailing
Address
City Zip Tel.
Contractor 1 _/
DI^ov't'' rS / rlir Ti0/
Address
61
p ,
CI y l/ ZiT
el.
:S
State Lic. City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full o ce and
effect.' %
SIGNATURE DATED DATE
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, 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 rive hundred dollars ($500).
I-; 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 of 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.)
I 1 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.)
I 7 I 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
F1 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 ihwork 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 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 applicant Date
Mailing Address
City, Slate, Zip
BUILDING DIVISION
R'7C6 -15J
APPLICATION ONLY
JILDING: TYPE CONS T./ OCC. GRP.
P. Number 7 77 —1 Z7
;gal DescriptionJ -IK U 71-Z
oject Description
Sq. Ft. 1,qo No. No. Dw.
Size ! Stories / Units
New ❑D-- Add ❑ Alter ❑ Repair ❑ Demolition ❑
65S18LE lig f ucTio>3 -sEE 53-9 o I%r+-I_r (9708-15
;timated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
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 Street Setback from Center Line
Side Setback from Property Line
`Tt
FINAL DATE INSPECTOR
Issued by: Date Per A Irl
Validated by: 1 ff
Validation: AUG 2 5 199%
CITY 4 LA C UI fiA
CONSTRUCTION ESTIMATE ,
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. @ $
2ND FL. SO. FT. @
POR. SQ. FT. @
GAR. SO. FT. @
CAR P. S0. FT.
WALL SO. FT. @
SO. FT. @
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
SLAB GRADE
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
HEATING (ROUGH)
STORAGE TANK
FLOOR DRAIN
SEWER OR SEPTIC TANK
MECHANICAL FEES
DUCT WORK
ROCK STORAGE
WATER SOFTENER
GAS (ROUGH)
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
OTHER APP,IEOUIP.
WASH ER(AUTO)(DISH)
GAS (FINAL)
APPLIANCE DRYER
GARBAGE DISPOSAL
WATER HEATER
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
LAUNDRY TRAY
WATER SYSTEM
AIR HANDLING UNIT CFM
GRADING
cu. yd.
$ plus x$
_$
KITCHEN SINK
ABSORPTION SYSTEM, B.T.U.
TEMP USE PERMIT SVC
FINAL INSP.
WATER CLOSET
ROOFING
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ c
BATH TUB
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11A c
SEWAGE DISPOSAL
LATHING
SO.FT.GAR @ 3/<c
MESH
HOUSE SEWER
INSULATIONISOUND
L
GAS PIPING
FINISH GRADING
PERMIT FEE
PERMIT FEE
\ t ,
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE
ELEVFEE
SMI FEE PLUMB. FEE
INSPECTOR'S SIGNATURESJINITIALS
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,IEOUIP.
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESJINITIALS
GARDEN WALL FINAL
Desert Sands Unified School District
Notice: 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201619-775-3500
CERTIFICATE OF COMPLIANCE
Date 9/17/97
No. 16092 Jurisdiction
Owner Name Esequiel Coronel
No. 54225 Street Avenida Madero
APN # 774-192-022
Permit #
Log #
City La Quinta zip 92253 Study Area
Tract # Lot # Square Footage 1400
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 Coronel Construction
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received
Signature P__ _
Telephone' "564-4604
r
i ^
'$2,576.00
Check No. cash
VOTICE: 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
above 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
allect 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
SALE ESCROW INSTRUCTIONS
THIS DOCUMENT WILL AFFECT YOUR LEGAL RIGHTS - READ IT CAREFULLY!
TO: COMMONWEALTH LAND TITLE COMPANY Escrow No.: 97.6486KC
72855 Fred Waring Dr. Date: 08/22/97
Suite A5 Page: 1
Palm Desert, CA 92260
(760) 836-3726
Escrow Officer: Kelly Collier
THE ESCROW HOLDER IS COMMONWEALTH LAND TITLE COMPANY WHICH IS LICENSED
BY THE CALIFORNIA DEPARTMENT OF INSURANCE.
Buyer will hand you additional funds prior to closing in the amount of .......... $ 15,000.00
TOTAL CONSIDERATION
$. 15,000.00
and any additional funds and instruments required from me to enable you to comply with these
instructions, which you are to use on or before September 18, 1997, and when OLD REPUBLIC TITLE
COMPANY can issue a Standard Policy of Title Insurance Owners form, with liability of
$15,000.00, on real e—i of LA QUINTA, County of Riverside, State of CALIFORNIA viz:
Commonly kno as: APN 774-192-022, LA INTA, CALIFORNIA
LOT 11 IN BLOCK 258 OF SANTA CARMELITA AT VALE LA QUINTA, UNIT NO. 24, AS PER
MAP RECORDED IN BOOK 19,. PAGES 44 AND 45 OF MAPS, RECORDS OF RIVERSIDE COUNTY,
CALIFORNIA
Except any reservations of record of minerals, oil, gas, water, carbons and hydrocarbons:
Showing title vested in:
ESEQUIEL M.. CORONEL,.A SINGLE MAN
Free from encumbrance except:
A. Current general and special taxes for the fiscal year in which this escrow closes, and
taxes for the ensuing year, if any, a lien,not yet due or payable.
B. The lien of supplemental taxes, if any, assessed pursuant to the provisions of Chapter
3.5 (commencing with Section 75) of the Revenue and Taxation Code of the State of
California.
C. Special improvement assessments, if any.
D. Easements, rights, rights of way, covenants, conditions, restrictions -and reservations o -
record.
Certificate of Occupancy
City of L,a QUinta
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:
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group:
54-225.AVENIDA MADERO
Bldg. Permit No.: 9708-1.55
R-3 Type of Construction: VN Land Use Zone: RC
Owner of Building: ESEO.UIEL CORONEL
Building Official
Address: P.O. BOX 389
City: LA QUINTA, CA., 92253
By: DANIEL P. CRAWFORD JR.
Date: 12/22/97
POST IN A CONSPICUOUS PLACE