SFD (0312-292)51420 Avenida Martinez
0312-292
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!! ate
694.981 P i 1131 /2c
Date r 'j Signature of Contractor I^f 110
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 STA7,, F`U1'ID Policy No. j342937.09
(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,&e me subject to the
workers' compensation laws o4 `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: , Applicant6^A - --/
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.
Signature (Owner/Agent) - ti Date y
'BUILDING PERMIT PERMIT#
0312-25*
DATE . VALUATION ,Aye d, •t ren . LOT TRACT Y tr y ry y
• tr• 1 D- "71r.i.' .21i. i J. (rh, A w I f
+
JOB SITE
ADDRESS _42 AVI'.I'TI!?P:?PV@ '1`iI J :'7
APN _
'l I3-093-000
OWNER
CONTRACTOR /DESIGNER /ENINEER
wOR01rGy3r—R.Pt.0
A07
COR4NF.li ClNAEINC
PO BOX 989
51.105 AMMA:WDA 31101
LA QLTJRXA CA 92253
I,A Qi7itJ°I.`A 'CA 92253
('760)564.4604 C'33' j: # 7261
USE OF PERMIT
nr#1pdME FAlv9UX DWY—W- 0
/A
,
1560 S,?, SK), PNRM11T. DOES NOT INCLUDE iILOCK WA.Lt,
USP.A
OR DR.WWAYA PROACH
FEB 02 2004
FIS..
7'RAC7' :Ca1 iST.1ilOTI033 3,Sd0„110 SIi
POkCHWATIO 32.00 SF
t' ARAWCAIt PORT 462.00 MIS
1?:g.1ImAm COST OF C;on'grnyiarim
94,188”
CONOTRUC2TION FFX 161-000.418.000 $617.00
'
PLAN CHECK IrEF, 1.01-000-4.99- 318 $313.49
1U. DEPOSIT 101-000.439-3113 42$0.00
33tMRANIC.A.1,IES, 101-000-4.2.1-000 $.59.00
ELECTRWAI, PRE 101.000-420-000 $02,34
P3.?33y1BING FFZ 101-0C1d9419••000 $11 & 00
STRONS' MOT [ON FEF: - I1. OID 101000441-000. $9.42
C1_t{.t4I"nd1`iO PEP 101-Co.e)-423-000 $35.00
1DEV E1.41F R MIPAC T RE W03.00
P`RFCI$Z PLAN 101.000-441.345 511 ;i l1
`iTf9-T07 cAI. CCfIviS' 7?T S®fid I'd iy GFIT
$3.349.21
J111603 PRE -PAW, FEW
425U0*
TOTAT. PEF—hUT MES DW. HOW
RECEIPT
DA l /
r
BY
DATE FINALED_
L
O
INSPECTO
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
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
d
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail 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 Pibg. 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
Utility Notice (Perm)
COMMENTS:
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
Date 2/2/04 La Quinta, CA 92253
No. 25441 (760) 771-8515
Owner
Coronel Enterprises
APN #
Address
PO Box 289
Jurisdiction
City
La Quinta Zip 92253
Permit #
Tract #
BLK 137
Study Area
Type
Single Family Residence
No. of Units
Lot #
Unit 1 8
Unit 2
Unit 3
Unit 4
Unit 5
Comments
No. Street
51420 Avenida Martinez
S.F.
1560 Unit 6
Unit 7
Unit 8
Unit 9
Unit 10
4 ZFIEDSC O
Q BERMUDA DUNES r
RANCHO MIRAGE d
J INDIAN WELLS
PALM DESERT y
LA QU INTA 4
Q INDIO y
O
773-093-003
La Quinta
0312-292
1
Lot # No. Street S.F.
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, 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 1,560 S.F. or $3,338.40 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 CC/Valley Independent Bank - Ish Coronel Check No. 293819
Name on the check Telephone 760/564-4604
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sh on Mc * vrey Payment,Recd $0.00
$3,338.40 Over/Under
Signature (; /
NOTICE: Pursuant to Government Code Section 66020(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 from the 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
11,
G
.())A) ✓
2 -
RC DISTRICT = PLANNING REVIEW. FORM
This
This form is to be used by CDD stafffor review of single family dwellings in the RC (Cove
Residential) District per Section 9.50.090 of the Zoning Code. Its purpose is to determine: 1)
that the proposed housing design does not duplicate the same architectural style of any house
within 200 feet of the applicant, and/or 2) if there is a need for the applicant to file for Master
Design Guidelines. If the applicant does need to file a Master Design Guideline, please transmit
this information to the Building and Safety Department a& part of your correction list. Please
attach additional explanations as necessary.
APPLICANT:
SITE ADDRESS:
0
APN 7%3. - Oq3 - 0,03 CASE NO.:
LEGAL: LOT 8 BLOCK - UNIT S.C.@V.L.Q.
CHECK AND APPROVED.BY:
DATE:
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
Verify legal and APN information
Consistent with MDG on file (as
applicable)
MDG filing required (5 filings
since 9/3/98)
Architectural variety within 200
f gbh surrounding ..a
..:tPa:Date
13 Planning Commission
13 City Council
:Community Dev. Dept
nitials r
ase No. C- D2 -9Z%
Exhibit
w"UrclnVec?0Pa'h M9ff °fea
Res
#
77
Other Requirements:
1 ESP
C• -
Project Name
Project Number
Client
V
Testing Engineers -San Diego, Inc.
7895 Convoy Court, Suite 18, San Diego, CA. 92111
[858] 715-5800 Fax [858] 715-5810 -
S
REPORT 'OF COMPACTION TEST DATA
Test Date Z/= /, /
:8
Established 1946-
- 9
Page of
Test #
Material
Structure
Location and Elevation or Depth relative to...
Te/st
R
J
s
F
.t. ; 2. e.P
4.
Wet Density (pcf)
Dry Density (pcf)
Material: S = Soil, AC = Asphalt Concrete, ATS = Asphalt Treated Base, AS = Aggregate Base, CTS = Cement Treated Soil
LTS = Lime Treated Soil, O = Other
Structure: . P =Pavement Structural Section,.F =General Fill, N = Native. Soil, WL =Waterline, SS _ Sanitary Sewer, ST =Storm Sewar,
U = Other Utilities, W = Wall Backfill, SC = Sidewalk, Curb/Gutter, O = Other.
Test #
Probe Depth (inches)
'3"
Wet Density (pcf)
Dry Density (pcf)
Moisture (%)
a
MD Curve Number
--•--
// 7. s—
--`-
/ -7.
/i7.
Maximum Density (pcf)
—
—
--
Optimum Moisture (%)
Relative Compaction, RC (%)
Z
7 ,- , ,/
;, .7
Relative Moisture, RM (%• .
Specified RC (%)
Specified RM (%)
Conformance (Yes/No)
j s
/• s
5+
: ,
Nuclear Gauge Model and Serial Number: _ } ` - 1// z /
This report doles not relieve the contractor of their responsibility for performance in accordance with the plans, specifications and applicable
codes. The cotltraotor 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: 3`" ` " ; 4 ' Signature: /-
Client's
Client's or Contractor's Acknowledgement: Name: Signature:
White- Office
Yellow- Contractor
Pink- Field Technician
L l ,- Certificate of Occupancy0o
G OFBuilding & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, , this -structure was in 'compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 51-420 AVENIDA MARTINEZ
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0312-292
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RC
Owner of Building: CORONEL ENTERPRISES Address: P.O. BOX 389
City, ST, ZIP: LA QUINTA, CA 92253
By: KIRK KIRKLAND
Date: July 1, 2004
Building Official
POST IN A CONSPICUOUS PLACE