SFD (0303-097)53340 Avenida Martinez
0303-097
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
634981
t• , [ t t
ibate''} 1' —*5 Signature of Contract
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason: a
( ) 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 $TA,TIg FL;14C3 Policy No. 1;502937^0
(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.
,,.dated ,., Applicantti 'J. rl•< .
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 tq
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.
1 certify that I have read this application and state that the above information is
correct. I agree to complytwlth 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) '" t ^ - Date
BUILDING PERMIT PERMIT#
M3-fl97
DATE _ VALUATION y+ y LOT TRACT
4498, PN 20 R X 212
JOB SITE iu E.Z.
ADDRESS ,-,3 `{ ,7 AV. :.b YDA, W, 'WU
APN
7?4-092-005
OWNER
CONTRACTOR / DESIGNER / EN (NEER
'C) RO : 38-9
'Y6-150 CA:,LE' TAT-,cPIC;O SUITAf230
I.Aq 1bUrAi ch 921253
.1.&,'?17111T,A CA. 92253
(?60)5634-4604 ML41 2261,
USE OF PERMIT
SWIM YAM.U,Y DWE3.:I,3?+1'C;
7.4.31 s.F'. SFD IJIMMIT 0025 NOT MCL.UDE BLOCK ` lil,1, P001, 011
DRIVEWAYAPPROACH
TRACT COMSTRUC 1,014 1,431.00 S
'lpOf?fM±•ili'J3TIO 94,00 SP
GARAGUCAMPO T 4x).00 OF
EI T, I4 i.'Y &ID COST OF COIK STRUCITOW
09,4 98470
q ` y {p1 v 7 ( ' ¢p -tom p !,g
X'3~:C S.rR.4A..x1YUi4 9 SJA`YS,4'Y.II. riCT6.3
CONSTRUCTION FEL 101.00D- •1"00 MOM
PLAN CFIECK 1r'I:r - 301-000-4139-31 5 $491.%
FEE DEPOSIT 101,,000-439418 -92$00
MIPSCHALNIC.A1., FEE 101.000-421-.000 $52.50
ELECTRIC',A.T :. FEE 101.000.420.000 $10&33
PIIUMB1140 rn 1.01 ^'0CQ•-41.9-000 $118.00
STRONG MOTIO 'FER. -REBID 101-W-241-000 -. $5.3s
ort4ozia FrE 101 000-4.23-004 415.00
DE V91,0PER IMPACT TEE $2,40&OD
l R .C'I F1.AA7 1i t__ f10 441-3ti.5 s3ti0.g0
SL' B-TUr.4iL C1*O'N°3rRt JCT1MT 41*' 7ai)% 4-1•+f C'1 'ICK
$3 q,.889.2;4
[
Srh A7\1 I'.A\ iai'J'1d.LJ wS`f7 i'b7
-N iT•. 'Nf Vlf' 1^'f°
2 2003 ,
r
CITY OF LA QUINTA 1
Ig
BY
DA 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
_
Z %
Exhaust Fans
O.K. to Wrap_
Framing
_
_ l/
F.A.U.
Compressor
Insulation
j6e o
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final ' 25
BLOCKWALL APPROVALS
Final
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
_ 3
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
— j J
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 3
Final
Utility Notice (Perm) - Q
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 (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 1,431 S.F. or $3,062.34 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 Cornel Check No. 277724
Name on the check Telephone 760/564-4604
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sharon MCGllvrey
Signature
$3,062.34
Payment Recd
$0.00
Over/Under
NOTICE: Pursuant to Government Code Section 66020(d)(Tj 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
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Rog
q c' o
Q BERMUDA DUNES r'
Date
4/21/03
La Qu etf ta CA 92253
RAN S d
WEti
INDIANWELLS
No.
24346
(760) 771-8515
LM DESERT
d PALA QUINTA y
QINDIO yJ
Owner
Coronel Enterprises
APN #
774-092-005
Address
P O Box 389
Jurisdiction
La Quinta
City
La Quinta Zip 92253
Permit #
Tract #
BLK212
Study Area
Type
Single Family Residence
No. of Units
1
Lot # No. Street
S.F. Lot # No.
Street S.F.
Unit 1 20
53340 Avenida Martinez
1431 Unit 6
Unit 2
Unit 7
Unit 3
Unit 8
Unit 4
Unit 9
Unit 5
Unit 10
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 (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 1,431 S.F. or $3,062.34 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 Cornel Check No. 277724
Name on the check Telephone 760/564-4604
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sharon MCGllvrey
Signature
$3,062.34
Payment Recd
$0.00
Over/Under
NOTICE: Pursuant to Government Code Section 66020(d)(Tj 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
May, 8. 2003 2:39PM
Infonnation
~ ." oBuiId On
Engineering * Consulting * Testing
No•3713 P- 1 '
REPORT OF FIELD COMPACTION TESTS
TESTED FOR: CORONEL CONSTRUCTION PROJECT: 53-340 AVENIDA MARTINEZ
PO BOX 389
LA QUINTA, CA 92253
DATE: April 30, 2003 OUR REPORT No.: 073-30154-2
TEST DATA: (1) Medium to coarse grained sand. OPT. MOIST. = 11, OW
TEST LOCATION: Building pad.
VOTES: TESTS PERFORMED PER ASTM 02922.98 $ ASTM D3017-96 *COMMENTS: 1. FILL MATER AL A. TEST RESULTS COMPLY WITH SPECIFI ATIONS
DENSITIES SHOWN; Lbs. per cubic foot 2. BACKFILL B. PERCENT COMPACTION DOES NOT CO PLY
WATER CONTENT: Percent of dry weight 3. BASE LOUR 3E WITH SPECIFICATIONS
PER
TCO
COMPACTION; Base tl On maximum dry 4 SUBBAJE C. REFEST OF PREVIOUS TEST
den alty obtained on sample indicated by 5. OIL C MEP T D. M I TURE IN EXCESS OF SPECIFICATIONS
soil 10 number. Q. OTHER E MOISTURE BELOW SPECIFICATIONS
* (1) ASTM D1557-00 METHOD .A,
LEST INSTRUMENT:
2EMARKS: PSI did not monitor the material placement.
TECHNICIAN: Vinnie De Souza
HESE TEAT RESULTS APPLY ONLY TO THE SPECIFIC LOCAnciNs NOTED AND MAY NOT REPRESENT ANY OTHER LOCATIONS OR ELEVATIONS.
EPORTS MAY NOT BE REPRODUCED. ExOEPT IN FULL, NATHOUT WRITTEN PERMIaSICN 5Y PROFESSIONAL SERVICE INDUSTR!EB, INC,
STANDARD COUNT M: D:
ADJUSTMENT DATA M: D:
Respectfully submitted,
Professional Service Industries, Inc,
61 A-iPa2 (a)F Professlonal Service Industries, Inc. • 42-240 Green Way, Suite C • Palm Desert, CA 92211 • Phone 760/341-5790 • Fax 760/341.5794
MAXIMUM
µ•
COMMENTS
TEST
NO.
TEST
DEPTH
ELEVATION
301E ID
NUMBER
t,AB DRY *
DENSITY
WATER
CONTENT
W=T
DENSITY
DRY
DENSITY
PERCENT
COMPACTION
I Spec . 90$c Min
1
81'
FG
1
124:0
10.3
132.2
119.9
96.7
1 - A
2
B"
FG
1
124.0
16.4
135-7
116.6
94.0
1 - A —I
3
811
FG
1
124-0
16.7
135.8
116..4
93.9
1 - A
4
81'
FG
1
124.0
15.1
I
I
132.4
115.0
92-7
1 - A
TEST LOCATION: Building pad.
VOTES: TESTS PERFORMED PER ASTM 02922.98 $ ASTM D3017-96 *COMMENTS: 1. FILL MATER AL A. TEST RESULTS COMPLY WITH SPECIFI ATIONS
DENSITIES SHOWN; Lbs. per cubic foot 2. BACKFILL B. PERCENT COMPACTION DOES NOT CO PLY
WATER CONTENT: Percent of dry weight 3. BASE LOUR 3E WITH SPECIFICATIONS
PER
TCO
COMPACTION; Base tl On maximum dry 4 SUBBAJE C. REFEST OF PREVIOUS TEST
den alty obtained on sample indicated by 5. OIL C MEP T D. M I TURE IN EXCESS OF SPECIFICATIONS
soil 10 number. Q. OTHER E MOISTURE BELOW SPECIFICATIONS
* (1) ASTM D1557-00 METHOD .A,
LEST INSTRUMENT:
2EMARKS: PSI did not monitor the material placement.
TECHNICIAN: Vinnie De Souza
HESE TEAT RESULTS APPLY ONLY TO THE SPECIFIC LOCAnciNs NOTED AND MAY NOT REPRESENT ANY OTHER LOCATIONS OR ELEVATIONS.
EPORTS MAY NOT BE REPRODUCED. ExOEPT IN FULL, NATHOUT WRITTEN PERMIaSICN 5Y PROFESSIONAL SERVICE INDUSTR!EB, INC,
STANDARD COUNT M: D:
ADJUSTMENT DATA M: D:
Respectfully submitted,
Professional Service Industries, Inc,
61 A-iPa2 (a)F Professlonal Service Industries, Inc. • 42-240 Green Way, Suite C • Palm Desert, CA 92211 • Phone 760/341-5790 • Fax 760/341.5794
{ IC '5
Certificate of Occupancy
-MOM
INCORMIAM
OF Building & 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.
4
BUILDING ADDRESS: 53-340 AVENIDA MARTINEZ
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0303-097
Occupancy Group: R-3 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
rd By: KIRK KIRKLAND
Date: JULY 25, 2003
o
Building Official
POST IN A CONSPICUOUS PLACE