SFD (0201-229)53785 Avenida Martinez
0201-229
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
634981 B 01.731121(
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).
() 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:
Cartier 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 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.
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 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) Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT Wj,422 'q TRACT
Wzv= W2,092.70 2 BM U7
JOB SITE
APN
ADDRESS
9•-?85.AVXRsTYA&W3:RXINRAZ
774-171-014
OWNER
CONTRACTOR / DESIGNER / EN (NEER
LA. QpAxY. A, CA 922 53
"V t}w ,,i CA 92253
(760)'$64-4,604, MR .161
USE OF PERMIT
i
.MD # tVT A SLCiC K 747 « MAVV& & Z1r.148'f. Pla'MIT I, 0& 4Uf
14CLUT-19 RLOCK WA,,%.,10014 ZPA. OR Dt?W +.. dAY APPROACH
TRACT C,'ONSTRUCT.I(M MON. Y
POR-CH7PAT.10 ; 35.017 S
0ARAMICsARPORT WI,!)tt I1;•
FT. b'+l'8D0.D Fr NCS 200.00 L?
. 3`k ,t4+A.k ' :` .1 C"O " " d3]P' 6 'd . d 'ka^.il °A°'
s ►1 ; 1 O
CONSrRUCTION451 t 101-100.418.000 HKOO
CHECK, FEE 1 8 $507. 111- . .
y F t."q /01-QC;0y,-4x39-3u` t
101,,000-421°000
MI RaCF.l.f7 IC.Y1L"241 101,,00 -421°VVN 100 ( ,
LZC.T ICAL PDX 10.1-00D-420-000 3125.56
PI,UVOING FER 101.000415-C1 O 4110.75
S`B".110140 MOT1014 PEE • 1' RSI.D 101-000-241-000 0.3'7
O1~,ADMO D' ;t 101 41=4213_ 4000 $20.00
p1r'` ELOPM IMPACT PE $1,90.00 .
PIIAME PLAN 101 -WO -441-343 S400160
ME 1T 101-000-439-318 0$250:m
OUB-IrOTAI COMM tTz.'' "I1 014 M3'. y 5`r _ 'i,, ,e5 ya-M./C r'J j-:
$3,,441.(25
q }C
h6T 50 ?.t E—PA' AM M:FY7
RECEIPT
DATE
BYD!_
INA) EDO 2--
INSPE_ CjOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_ o ;_
Underground Ducts
Forms & Footings
I
Ducts
Slab Grade
(
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
Z
F.A.U.
Framing
aze!2 -PZ .
Compressor
Insulation
j, c Z
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final �1�o Z—
BLOCKWALL APPROVALS
Final
Steel
POOLS - SPAS
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
_U
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
G`C
Pool Cover
Encapsulation
I Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole Z Q:
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) BG . az•O o2-
COMMENTS:
Building
Address -J l
Mailing r ,
Address
...wr9R y„w, v. ' y 6 . t„F•dC i. . • t, /., - 7fy.4.. per.._ RFCS` . .. - f+. • r- .: • . y,'' `
T4t!t 4
u l'ItrGv?
P.O. BOX 1504 APPLICATION ONLY
78-495 CALLE TAMPICO
c t )1", 1 sl "Z LA QUINTA, CALIFORNIA 92253
_ t
ID 1
City Zip Tel.
L,.L .r\1 `-ADa a.N
Contractor(/ (/'
Address %
City\
l _". c'-, • " lZip'--A Tel.
l
State Lic.^ r City
q
& Classif. l O(S r Lic. #
Arch., Engr.,
Designer
AddressTel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
that I em -licensed ynoer provis ons of Chapter 9 (commencing with Sec
3 of She Busines_ and,+Professions Codg, and toy license Is in full force
/N. , OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7p31.5,Busigess and Professions Code: Any city or county which requires a
permit to constnu t attey prove, demolish, or repair any structure, poor to Its Issuance also
requires the applicen or 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 thealleged 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 (E500).
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,
Pro
vided that such improvements are not intended or offered for sale. If, however, the builQing
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
doesnot 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? 1 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
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 (E100) valuation
or less.)
I certify that in the performance of thg 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
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, State, Zip
tiq
ti
ILDING: TYPE'CONST. OCC. GRP.
— I\
'. Number + ` u
lal Description / ; ' y- • 'i ' . DL
ject Description \) Y
Sq. Ft: k\,4
\ , No.
Size —1 Stories
New Q Add ❑ Alter ❑
Q
\cam . .
No. Dw.
Units
Repair ❑ Demolition ❑
tttl■Q.
PERMIT
AMOUNT
n
Plan Chk. Dep.
Z
Plan Chk. Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
cr 1 I A101 IL:/
1
M
`rry()r.i_AWNiA N
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
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 2/4/02 APN # 774-171-014
No. 22899 Jurisdiction La Quinta
owner NameCoronel Enterprises ! ` Permit #0201-229
No. 53-785 Street Avenida Martinez
City La Quinta zip 92253
Tract # BLK247
Type of Development
Comments I
Lot # 2
Single Family Residence
Log #
Study Area
Square Footage 1485
No. of Units 1
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
EXEMPTION NOT APPLICABLE ,
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
2.05 X 1,485 or, $ 3,044.25 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 B CCNalle Independent Bank - Ish Coroner
By Y p Telephone 564-4604
Name on the check "'..
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by
Signature
Juanita Green
Payment Received . $3,044.25
. Check No. 261975 '
NOTICE: Pursuant to F7th. bly 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 rundate 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 Dis)(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
10/22/2001 16:04 7607777011 LA QUINTA PAGE 02
No. 74O P. 3
$ALL ESCROW INSTRUCTIONS
71M ]DO i WA NT WILL AFFECT YOUR LEGAL RIGDTS -READ IT CA:R )r'ULLY!
T0; COMM NWEALTH LAND.TITLE COMPANY
7285 Fred Waring Dr. Escrow No.: 11165KY
Suit A5 pate: 10/19/01
Palm Desert, CA 92260 ppb Page: 1
( 760 ; g36-3726 YS
Escr , Officer: KATHY M. YASI
TM C QW JIOLDER XS COMMONWEALTH LANA TITLE COMPANY W)EIIcH XS .LICENS
BY T A LIFORN.A DEPART ENT OF AYSUIt.ANCE. 'D
l
Buyer wil. hand You additional funds prior to closing in the amount of,.,.,,,
' ....E
TOTAL
and any a
instructi
COMPANYc
$35.000.0
IDERATION
.E
35,000.00
35,000.00
itional funds and instruments required from me to enable you to Comply with these
s, which you are to use on or before December 19,
issue a Standard Policy of Title Insurance Ow19r 20001, andwhenCHICAGO TITLE
on real property in City of La Quanta. County of Riverside, Stdteilit
Commonly k;ow as: APN#774-171-014, La Quinta, California 92253 California viz;
Lot 2. Blok 247, Unit 23 „ Tract Santa Carmeluta
20, Pages, 25 inclusive of Miscellaneous maps,/ nVthe officeQofnthe Coupty Repcorde rofdsai gook
county, d
Except any reservations of record -of minerals, oil, gas, water, carbons and hydrocarbons.
Showing t1 ;le vested in:
William Thtas Buffin, or Nominee;
Free from Elcumbrance except:
A. Curr nt general and special taxes for the fiscalea.r in
taxe for the ensuing year, if any, a lien not yet due orwpayable s escrow closes, and
B. The ien of supplemen't6l' taxes, if any, assessed pursuant to t
3.5 commencing with Section 75) of the Revenue and Taxation Codeofofapter
Caliornia. o
C. Spec al improvement assessments, if any.
D. Easerents, rights, rights of way, covenants, conditions, ditions, restrictions and reservations of
t
DEC 1Ij
RC DISTRICT - PLANNING REVIEW FORM
CITY Gi- LAOUJ,,, gyp,
_PLANNING _DEPART. 1r'"
This form is to be used by CDD staff for 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 house 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
transmitted this information to the Building and Safety Department as part of your.correction
list. Please attach additional explanations as necessary. pv s ea5r%'
APPLICANT Coronel Construction
SITE ADDRESS 53-785 Avenida Martinez
APN 774 - 171 _ 014
LEGAL: LOT
CASE NO.: 2001-5.97
2 BLOCK 247 UNIT 23 S.C.@V.L.Q.
CHECK AND APPROVED BY:
Wally Nesbit
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
✓
'TrP1.(vr-r ra skf-o-ow e7 go
Consistent with MDG on file (as
applicable
MDG filing required (5 filings since
9/3/98)
J
/
Architectural variety within 200 feet of
the surrounding area:
Colors
Materials
Architectural design features
iZ
ib
I ov i g ommeiissT on ..,..__.,....
City council
Comm It Dev. Dept 2 Zo
nitii .....r....,..•
se No. a,1.
ix"fbit...,......._.
With uoncitions -u czisg %-13 -v-
....,.
Certificate of Occupancy
City of La 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: R-3 Type of Construction
53-785 AVENIDA MARTINEZ
Owner of Building: CORONEL ENTERPRISES
Building Official
v ni
Bldg. Permit No.: 0201-229
Land Use Zone: RC
Address: P.O. BOX 389
City: LA QUINTA, CA 92253
By: RICHARD KIRKLAND
Date: 05-15-02
POST IN A CONSPICUOUS PLACE
.02 01 :12 PM
OF FIE,GD VERIFI
TION AN
GNOSTIC TESTING
Project Title
-6,31. 7t5
rl Fes'' / ' /41Y/)I • I .-......._ --
Projelbddress oq1
Buil2d9r Pontact - Telepnone3
Q' "r 45
HERS Rater T lap one
rtlfying Signature
Firm: cre '/QSSOL/ iTCS
Street Address:
Copies to, Builder, HERS Provider
Builder Name
Plan Number
Sample Group Number
Sample House Number ,
HERS Provider:G
City/State/21p: G •1NT - %1 2. 3
P.02
CF -4R
HERS R IER COMPLIANCE STATEMENT
The house was: Tested [J Approved as part of sample testing, but was not tested
As the HERS rater providing diagnostic testing and fleld verification, I certify that the houses Identified on this form
comply with the diagnostic tested compliance requirements as checked on this form.
Distribution system is fully'ducted (I.e., does not use building cavities as plenums or platform returns in lieu
of ducts)
Where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used In combination
with cloth backed, rubber adhesive duct tape to seal leaks at duct connections.
Z MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) Measured
Duct Pressurization Test Results (CFM @ 25 Pa) values
Test Leakage Flow in CFM
If fan flow is calculated as 400cfm/ton x number of tons enter
calculated value here yrz7
If fan flow is measured enter measured value here %
Leakage Percentage (100 x Test Leakage/Fan Flow) 'o D
Check Box for Pass or Fail (Pass=6% or less) pass Fail
❑ THERMOSTATIC EXPANSION VALVE TXV or Commission approved a uivalent
—Yes ❑ No Thermostatic Expansion Valve (or Commission approved
equivalent) is installed and Access is provided for inspection pass Fall
Yes is a pass
❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
1, ❑ Yes ❑ No ACCA Manual D Design requirements have been met
(rater has verified that actual installation matches values in
CF -1R and design on plan.
2. ❑ Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV,
verified fan flow matches design from CF -1 R.
Measured Fan Flow =
❑ O
Yes for both 1 and 2 Is a Pass Pass Fail