SFD (0303-074)53436 Avenida Martinez
0303-074
LICENSED CONTRACTOR DECLARATION
U) : 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
N W Professionals Code, and my License is in full force and effect.
O =) ch License # Lic. Class Exp. Date
W
rC, Z r- Date! _ Signature of Contractor*t '
-J P: C:) OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ U) License Law for the following reason:
Z_ ( ) 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).
C'') () I am exempt under Section B&P.C. for this reason
LID
N Date Signature of Owner
ON
rn
U Q 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 37ATk,F,lAl0 . Policy No. W20""I.01 . .
(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 thatlf Il should become
subject to the workers' compensation provisions of Sectio'n 3700 of the Labor
Code, I shall forthwith comply wit14,thos6e provisions.
,ate: - Applicant I t
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to -the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person -at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void
work is not commenced within 180 days from date of issuance of Sul:
permit, or cessation of work for 180 days will subject permit to cancellati .
I certify that I have read this application and state that the above information
correct. I agree to comply with all City, and State laws relating to the buildi
construction, and hereby authorize representatives of1his City to enter up( n
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) \ - Date -
BUILDING PERMIT PERMIT f10111HY M
DATE VALUATION LOT zj TRACT.o S,,sA
JOB SITE i' ra, wa
ADDRESS
APN 174.4)92.0.61
OWNER
CONTRACTOR / DESIGNER / EN (NEER
O't:1P1011WT. F-67IMPM113M
:P0DOX, -38a
6 - 15 0 VAUF°v.,. r'+PA. '? f'U `"i l /<° z30
.I..A QUIN A i.IA 9725!
u, QuWrt" CA 92233
USE OF PERMIT
-
FENCRII, PLIC, L OR UWAK. a&,Pfl,R4V F PERht IT FOR Mt.V r YEA APPR.om'
1S 1Z,1 U1td.E.D 1+l;.C1E!§ '!'tllf Pif'L .;IS "dd'f)I@''i ' PJir.,l?1 P1.`3'► 1l:;.d`f,
;TeAC'•',';' 1 1 T a CTlO:t< f,4;,i. O
Pt'fRt.F3Jr)Yf1TIG 36.00 SI'
MAN, 12F
H:S".if'iYU) COSIT OF S'r:?.fi 511utrCIrf'M
pmmn M SuMMGI RY
CJN5nRUCT,117P,F M1.: 034,90-418- ftvS0
P1R AaI;".ECN rF x )i tion-• :1 -3'sr; i 3. 5
l ht DEPOSIT 4231MD
'
IAZCoV ,NICA€, t+ S s'! 1-OBJ-dp i -t3iiQ i9J,fft?
E+1.E iUCALW& 101-0410-420.000 lkc5$,
P11U''.M8a 0 VEE .101-000-419-000 16ti?.V
gLTRthl4f MOTY014 FEE i 981T) 101.001.241.000 MIX
(3111ADIING YEL' 101 -000-4-23-000 $15, Oct
i.)I<,V 140PF R IMPAt"1"FRF ,4n3.tlit
PRIt ISS PLAM 3 x)1 -000-441-341I UII.Ute
$3,574,79
•' Yc:}'. `91'?k lr?vx •.r i:III ,I.;
- ; ' A. ii
L 3'ICRIAIT F.. '8 i ,..€1 fib'
Ira'TGd. :5
APR 2 2 2003
R ANCE DEP DATE
'BY
D FI AL ED._
INSPECTOR
r
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
0-3,Underground
Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
— 3
Exhaust Fans
O.K. to Wrap
• O
F.A.U.
Framing
l/
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
i (/
Encapsulation
Gas Piping
Gas Test
p
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 — - O !(
Final
Utility Notice (Perm)
COMMENTS:
P.O. BOX 1504 APPLICATION ONLY
Building 7 A `. 7UINT CALLE CALIFORNIAIAMt-IO
Address IVB 1, -z_ LA QUINTA, ORNIA 92253
Address G
Ity Zip
Contractor(//+
X13' Q G
,(\. P : ql
el.
City I - I IZip _ ITel..
CityIZip ^ ILic.#
that I am li ns d nder,provisions of Cha ter 9 (commencing with Section
3 of }ff B in and Profe SsI, nj Code, d my license i Q full force„gnd,
OWNER -BUILDER DECLARATION
I hereU"lat I am exempt from the Contractor's License Law for the following
reason:(SS,thBusiness and Professions Code: Any city or county which requires a
permit to calter, improve, demolish, or repair any structure, prior toffs 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 five hundred dollars ($500).
C-1 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 soldwithin 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.)
17 1 am exempt under Sec. B. 8 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
n 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
of less.)
I certify that in the performance of thq 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.
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
1hereby 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 a0plicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE'CON[ST. OCC. GRP.
A.P. Number -17 --T-L —ni q ` -6 1 I
Legal Description`\14
N, - "V: ,A-• _D_ \ —2—
Project
Project Description
Sq. Ft. \,4 \ No. ` No. Dw. 1
Size [ Stories Units \
New Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
67-11 U
III
TOTAL
REMARKS
FINANCE DEPT. j
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
FINAL DATE
INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
T v ..
State L'C. G
& Classif. n I ''
l
City `
Lic. # a l
Arch., Engr.,
Designer
Address
Tel.
CityIZip ^ ILic.#
that I am li ns d nder,provisions of Cha ter 9 (commencing with Section
3 of }ff B in and Profe SsI, nj Code, d my license i Q full force„gnd,
OWNER -BUILDER DECLARATION
I hereU"lat I am exempt from the Contractor's License Law for the following
reason:(SS,thBusiness and Professions Code: Any city or county which requires a
permit to calter, improve, demolish, or repair any structure, prior toffs 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 five hundred dollars ($500).
C-1 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 soldwithin 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.)
17 1 am exempt under Sec. B. 8 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
n 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
of less.)
I certify that in the performance of thq 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.
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
1hereby 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 a0plicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE'CON[ST. OCC. GRP.
A.P. Number -17 --T-L —ni q ` -6 1 I
Legal Description`\14
N, - "V: ,A-• _D_ \ —2—
Project
Project Description
Sq. Ft. \,4 \ No. ` No. Dw. 1
Size [ Stories Units \
New Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
67-11 U
III
TOTAL
REMARKS
FINANCE DEPT. j
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
FINAL DATE
INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
CERTIFICATE OF COMPLIANCE'
.FIED
Desert Sands Unified School District
47950 Dune Palms Road ¢ BERMUDA DUNES r
Date 4/21/03 La Quinta, CA 92253 RANCHO MIRAGE CJ
. INDIAN WELLSLM DESERT
ti
No. 24347 (760) 771-8515 PALA QUINTA y
11 I 0
1yp
Owner Coronel Enterprises APN # 774-092-011
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 14 53412 Avenida Martinez
Unit 2
Unit 3
Unit 4
Unit 5
Comments
1421 Unit 6
Unit 7
Unit 8
Unit 9
Unit 10
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 1,421 S.F. or $3,040.94 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. 277728
Name on the check Telephone 760/564-4604
Funding Residential
By Dr. Doris Wilson
Superintendent
.l
Fee collected /exempted by Sharon McGilvrey $3,040.94 $0.00
Payment Recd Over/Under
i
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or
other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the Districtfs) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building DepartmenUApplicant Copy - Applicant/Receipt Copy - Accounting
May - 19 , 20033=12 : 39PM FR
TO 9-5644202 No.40041.00, 2
REPORT OF FIELD COMPACTIONiESTS
TESTED FOR: P,40UV f L' PROJECT: 5 3-- 4 2 , o-& & i 4
/zQ, 9L"kl. '-J-"
"". 5j 1 103 OUR IPM NO:O4 3 -- -30 t s P
TEST DATA:
rrgT
NO.
DATE
ELtV.
DEPT
s41L ID
NUMBEA
LAS DRY
LAS DRDENSfTY
WATER
C fiY IF MCE
OBHrir
P ClDvlErrrS"
OOuP/ICi10P1
s I
d
445.0
1,c'
I/;.q
if -3
t,a
s) }
y
125, o
a>'S,
X12 • ,
I
3
51)
lip.
TEST LOCATION:
NOTES; DENSrfIES SHOWN: Lbe, per cubiotoot
WATER CONTENT: Percent of dry weight
PERCENT COMPACTION: Based on maximum dry
density obt in'd An sample indIcAtotl by
soil ID number.
REMARKS -
M A•1C04 (3)
*COMMENTS- 1. RLL MATERIAL
2. BACKFILL
3. BASE COURSE
4. SUBBASE
S. SOIL CISMENT
& OTMER
A TEST RESULTS COMPLY WITH SPECIFICATIONS
B. PERCENT CQMPAcnoN DOE$ NOT COMPLY
WITH SPECIFICATIONS
C_ RETEST OF PR£YIOUS TEST
D. MOISTURE IN EXCESS FICAVONS
C MOISTURE BEL CATI Ks
a
NOTES; DENSrfIES SHOWN: Lbe, per cubiotoot
WATER CONTENT: Percent of dry weight
PERCENT COMPACTION: Based on maximum dry
density obt in'd An sample indIcAtotl by
soil ID number.
REMARKS -
M A•1C04 (3)
*COMMENTS- 1. RLL MATERIAL
2. BACKFILL
3. BASE COURSE
4. SUBBASE
S. SOIL CISMENT
& OTMER
A TEST RESULTS COMPLY WITH SPECIFICATIONS
B. PERCENT CQMPAcnoN DOE$ NOT COMPLY
WITH SPECIFICATIONS
C_ RETEST OF PR£YIOUS TEST
D. MOISTURE IN EXCESS FICAVONS
C MOISTURE BEL CATI Ks
Lod -, Certificate
Cof Occupancy
4
IriooroinTm
ilex
OF w 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. -
BUILDING ADDRESS: 53-436 AVENIDA MARTINEZ
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0303-074
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 .
By: KIRK KIRKLAND
-!ate Date: JULY 25, 2003
Building Official
11
H
POST IN A CONSPICUOUS PLACE
JUL-17-2003 08:19 PM P.'03
INSTALL.ATION, CERTIFICATE CF -6R
Citi . cldress
Permit Num er
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE REDUCTION
i'r >.urtzal un l est Results (CF•'vt to 25 PA)
Test Leakage (CFM)
('<ticttlatecl as 400 efnvton x number of tons, or as 21.7 x Heating Capacity
in Thousands of Btuft enter calculated value here
If fan now is measured, enter measured value here
Lc:,kagc Fraction = 1'est Leakage/(Measured or Calculated Fan Flow) _ D
Pass if leakage fraction 5 0.06 ❑
Pass Fail
❑ For ,k.EROSOL TYPE SEALANTS ONLY - The following diagnostic testing was completed:
Duct Fan Pressurization at rough -in measured leakage (CFM)
CHF.C'K ;kFTE:R FINISHING WALL:
❑ l ci ❑ No ❑ Pressure pan test or House pressurization test
❑ Ycs ❑ N0 ❑ visual Inspection of Duct Connections ❑ ❑
Pass Fall
THERMOSTATIC EXPANSION VALVE (TXV) _
1'r; ❑ ; o Thermostatic Expansion Valve (or Commission approved ❑
VV equivalent) is installed and Access is provided for inspection
Yes is a pass Pass Fail
❑ DUCT DESIGN
Q_....❑ No
❑ Yes ❑ No
RCCA Manual D Design calculations have been completed,
Duct Design is on the plans and duct installation matches
plans. )
TXV is installed or Fan now has been verified. If no TXV, /
verified fan now matches design from CF -1R.
Measured Fan Flow =
❑ ❑
Yes for both I and 2 is a Pass Pass Fai.
I .hc -\)hLlemgned, verify that the above diagnostic test results and the work I performed associated with the test(s) is in
:.: «•Ith the reclmrements for compliance credit. (The builder shall provide the HERS provider a copy of the CF•6R
?clrr employees or sub -contractors certifying that diagnostic testing and installation meet the regutrements i.or
Installing Subcontractor (Co, Name) OR
General ConlTaCtor (Co, Name)
Ao 4
Signature, Date
t. (W\.. F0 f.1u:!dL1)g Uepurtmcnt
HERS Provider (if applicable)
.1c 1ding Owner at Occupancy