MISC (9805-017)54990 Avenida Madero
9805-017
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Ch;Rpter 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 E- p. Date
t •4 .1 3 n 1i V00
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).
( ) 1, 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
: I 1WORKER'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.
(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`pe-rson in any manner so as to.become subject to the .
workers' compensation laws of Calrfd nia, and/agreefthat if I should become
subject to the workers' compensation` provisions o Section 3700 of the Labor
ith
Code shall•forthwith comply wthose proves ons. ,r
Dater a _72-1 12 APPlica ,
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-thls City to enter upon
the above-mentioned pro(ert'y for inspection purposes.
/ j 9 r
Signature (Owner/Ag nt) = °, ( / Daley f
BUILDING PERMIT
PERMIT# r y
CONTROL#
DATEVALUATION 6 . ;1> ,LOT
i s TRACT, .7 i j i;f
JOB SITE
ADDRESS 54WO A V IDA 1 :'D vR40
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APN
774-24,54112. v
'
OWNER
CONTRACTOR/DESIGNER/ENGINEER
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4r• 4JiV,4}r \.;'./i,'13 F. S .L1s.r J. xi.:,I4'
t PD, BOX 339.
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CA 92253 •
I.A. (NU1;N'I'A.
(--A 92253
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USE OF PERMIT
IVIS, :
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TRAICT COi4`JA'E UCTI St 385.61
SIF
SUMMARY
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RECEIPT
DATE r `
BY 1
DATE FINALED
INSPECTOR
t11
s
.st
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A".
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
CorgPressor
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
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
Cltitity Notice (Perm)
COMMENTS:
...............................
1
.. . ..... ........................
Ity- of La -Qu.i,nta
......... .......
•
Building ,& Safety Divisitin,
X.
Box J504
Petm
.... ...... ..... . ...........
78495. Calle Tam Pico
...................
O
La,Quinta, CA 92253'
MS.. ...'XXXX...
Building Permit Application and Tracking Sheet':
Project Address: ",—,Zl— 7 C/
AO
O vnei-;s Name: ,e
Number.
A'PNLI
Address: '0 is
on: -
Legal Description:
City,ST, Zip
Contrac t o r'
Telephone:
..... . ........
.Address: -3 e--,
e7
Proiect Description:
Citv,ST, Zip:
-r--.P—v evk
Tele phone:-
............
...................... X
State Lic. W.- 4/4 JV1,
J Ciiy Lc.#:.
Arcli'.. Engr—Designer:
',7
Addiess'
City: ST,.,Zip:,
Tel phbne:
...............................
..............
..... ...
Coistniction Type:' Occupancy:
State'Lic.
Project, type circle one): New Add'n 4 Alter Repair Demo
C
Name of Contact Person:
Sq. t
St ones:
# Units.
Telephone # of Contact Person:
Estimated Value of Project:,
...............................
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
N0. PLUMBING FEES
IST FL.
2ND FL.
POR
GAR
GAR Pj0
WALL
ESTIMA-ED CONSTRUCTION
SO FT S
UNITS
ROUGH PLUMB.
SO. FT. ,a
YARD SPKLR SYSTEM
SO. FT MOBILEHOME SVC.
BAR RINK
SO. FT. ,IT POWER. OUTLET.
ROOF DRAINS
FT .1
09AINAGE PIPING
SO FT .Z
DRINKING FOUNTAIN
jO cT
URINAL
VALUATION S
WATER PIPING
NOTE: Not to be useo as crocany tax +a:oauon
TEMP. POLE
FLOOR DRAIN
MECHANICAL FEES
GROUT
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL +OOD
SIGN
WASHER(AUTO$OISHt
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT - CFM
FINAL INSP.
KITCHEN SINK
ABSORPTION SYSTEM B.T.0
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE.TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. , c
BATH TUB
SO. FT. 0 c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESIO rd I% c
SEWAGE DISPOSAL
SO.FT.GAR 0 Xi c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
081-
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING d AIR GOND. 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 (FINAq
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARK&
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATK)NISOUND
FINISH GRADING
FINAL INSPECTION
~
CERT. OCC.
FENCE FINAL
mares wR a a uww uweanwn Www
GARDEN WALL FINAL
1 i ...1,- k 4.- ..Q
Desert Sands Unified School District
Notice:
82-879 Highway 111
r
DocumentIndio, CA 92201
Cannot Be Duplicated Indio,
C5-3500
CERTIFICATE OF COMPLIANCE
11
Date 5/5/98 APN # 774-265-012
No. 'y 16986 Jurisdiction La Quinta
Owner NameEsequiel Coronel Permit #
No. 54-990 Street Avenida Madero Log #
City La Quinta Zip 92253 Study Area.
Tract # Lot # Square Footage 38
Type,of Development Single Family Residence No. of Units 1
Comments
i
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:
r
r.
EXEMPTION NOT APPLICABLE ,
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
1.93 X 38 or $ 73.34 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 ccNalley Independent Bank/Coroel Construction Telephone 760 564-0640
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by
i
Signature
Olivia Aguirre
Payment Received $73.34
Check No. 166023
NOTICE: Pursuant drAssembly 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 r9n 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
collect them on the istricl('s)(s') behalf, whichever is earlier.
.r
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