SFD (0103-007)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
Date i i ' Signature of Contract6l'—
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). 1:•
( ) 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 followingtdeclarations:
() 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.
VATE nigra 054207-04
(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. i7` -
Date: '•- ) t - C: -t ApplicantU _1J n
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. n
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. t
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 44I
the above-mentioned property for inspection purposes. t
/
Signature (Owner/Agent)Date`'
BUILDING PERMIT PERMIT #
DATE VALUATION LOT 0UXI--W 7 TRACT
1'sDriC9,.1(J 9
JOB SITE'
ADDRESS
APN
=.
OWNER
CONTRACTOR / DESIGNER / ENGINEER
C'C3:4 ()W!L CK)t`T43°C�2i�E"�CC��
.78-150
LA QVINU. t"'1: 9225.3
LAQi311+ A CA 9.2253
"
(760;1564-4604 CBLA.,1261
USE OF PERMIT
%xry - f mmT orar;7 NOT FNfv:f;€Il, F .ISLOCX "WAWPOCJ1-&RA oR
r�i�llks�t1' lrlraii�iE1'`1 E48. 8-109 Coft
'TRACT4(017:EAE'RVCL 1,'_X14 1,421.,00 OF
..
PC11a..1~3F�!'�'ATIO 36.00 SF
GARAGWARPO T (SP) 9,40(ao
S rr. 'i7>7OOD PENCE 200.00 LF
COA"0 ROC ION a'7:Ir 101-000-4118-0100 $.ga S*"
r`LAII CHL��C X FFI-e 1014WO.4.3$-318 $.123.00
MECHANICAL FEZ, 101-M-421-000 W9.00
E •twTRIC.1 L FEE 101 -000-420-000 �.i fig,+ttl
P"sPL1k![1 N1 0 FIN, 101-000-419.000
,7 7F ONO 9 J 1'1021 FFX-,, ,-' ii°'N1D 101->,3'00-241-000
011.F DIN10 FEE 101.-L3M423.000 3�0:115's
DEVE t)PER.IMPAC"1' 1001
PREM PLAN � 101.000.441.345 $100.00
WE DEPOSIT �-f�31-Cat10-X33-`?71fi .$250.00
t
SUB-WIAl, WWI RdC-1:1OKJVM PLAN CHECK
$3,055,62
I =9 M-11ATDIMM
4250.00
'TMAL FEffl1A1'3 3T?`:A�n`� DUE 1`+lOW
$2,W5,62.
�t
RECEIPT
DATE I f
.BY
DATE FI LED
INSPECTOR
t ��
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
_!
Underground Ducts
Forms & Footings
. ?i
Ducts
Slab Grade
(�'f
Return Air
Steel
Combustion Air
Roof Deck
Jc - 3 -,p [
_
S'2"•
Exhaust Fans
O.K. to Wrap
t
F.A.U.
Framing
„�' •� 7 .�
57
Compressor
Insulation
S •�. oe
s7
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
.Exterior Lath
Drywall - Int. Lath
`
Final �3�` p S -j
BLOCKWALL APPROVALS
Final
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
Water Piping
frQ'
/
S7
Heater Final
Plumbing Final
Plumbing Top Out
Q�
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole 3 •,,� • O C
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) ���• p S
_
Inc _ a � -P
P.O. BOX 1504
'Building �/ � • `�!1� ��.. c c.CALLE O
APPLIA NLY
Address ��! LA QUINTA, CALIFORNIA S
92253
Owner
C—Q
Mailing BUILDING: TYPE'CONST. OCC. GRP.
�-
Address F � 3 - S3 a .� � D
A.P. Number t ,
City r Zip Tel. r
�Qy c.. ` ` -1 �� J3 .i�`� Legal DescriptionL•u� T�� ,�� t , i s`, i s
Contractor C �� .A \ 1�
Project Des tion _ .-,
^.. �ice; k c. \' tr� \ `�•»'"
Address f r
VI (-)`
City Zip Tel.
State Lic. V City
& Classifiy c J Lic. # � ! Sq. Ft. ` l No. NO. Dw.
Arch., Engr.,
Size Stories Units
Designer New 8 Add O Alter ❑ Repair ❑ Demolitionyp �
Address Tel.
City Zip State
%1 Lic. #
LICENSED CONTRACTOR'S DECLARATION
I herebyy affirm that I am licensed under provisions of Chapter 9 (commencing with
70pp) of Divlion Soff the Buttinesj�.andytProfess�ribns C We, and my lidvensetis in fu f4
effect. //17 h'f 1 f i
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its 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 thathe 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., 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 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'
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.)
1? I 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 0 the permit is for one hundred dollars ($100) valuation
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.
Date Owner
NOTICE TO APPLICANT., If, atter 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 it 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
Estimated Valuation
PERMIT 1 1, /j AMOUNT
Plan Chk. Der
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
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
r
47-950 Dune Palms Road ,
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 3/16/01 APN # 773-332-022
No. 21770 Jurisdiction La Quinta
Owner NameCoronel Construction Permit # 0103-007
No. 52-905 Street Avenida Mendoza Log #
City La Quinta zip 92253 Study Area
Tract # Lot # 9 Square Footage 1421
Type of Development Single Family Residence No. of Units 1
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 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:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
2.05 X 1,421 or $ 2,913.05 the property listed above and that -building'
permits and/or Certificates of Occupancy for this square footage in this proposed project maymow be;ssue& r,
Fees Paid By CASH - Ahazany Coronel Til fionex'60 5`64-4604
U
Name on the check
By Dr. Doris Wilson
k.r,
Superintendent
Fee collected /e a pted by Annette Barlow
Signatur 1Mttc6Lr
Payment Received $2,913.05
Check No.
OTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
bove will begin to run 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
)Ilect them on the DistrictCs)(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
- 113 oe 01
01:16PM CUSTOMER SERVICE
'
k=*01NQ REOUEGrED OV; 047M
I rivestats, Irlill Company - t4crow 01VINIOn PXLCEWN OW RECORD.
AND WIM 11111CONOM #A#A rat AT RAO CYC LOOK
Mr. slaqw2l M. coronal
Saforil conettuctlon PAID FEB 7
I
61.640 Aiijeriltawar Orive Ooc. TMMW,14x
LeAulinta, CAM2253 r -of
DELINK K. froom c
R4. CO. PAMORW
W"'aft
tM10 SPAM FCN 1119CORDER's U89 Or&r,
Eawtow 40. m 10977 TITILIP. ORDER NO. R. 149001.1
INIVIDIJAIL. GRANT Q1FQ
uNjop"ION'10 GRANTORIS) CECLAPIP(s)
DOGIMMANY TPANWIM TAX is 0 1 a, ?o
IXI *60
Whpiutsd On IUII:Vmlum Of Property conveyed, or.
1: j.'cctnPut8fi On full value lose value of Ilene or encumbrances rartialmirig at lime a - f sale,
Aron IX I CITY Of LN QuInta, Ak.D'
POR A VALUA'BLG CONSIDERATION, receipt of which Is hereby saknowledgiod,
,MAX 8fGkI!4wnhgdG15%Nff' rAkd JW4ka1twHjx 8 &Jtor
Will' us Www,"m as joint Tenants
to;
a GIW@t loan
the'
I' n the elty-ot La Quinta. County of Itiveraldo, State of California, described me;
,
S. !lUrAt Me. Its, 91swistow, toatvm"LaauhuaoelhownbvMap onfila inmftk
119 .4=92naft,602 In the Offte of the Comly wilmldw or Rhpwokk County. Calfletwole.
#0.L80 KNdwN,^G; APM 773-332-022, Le Gult". OA 02163
zirArs or CALIFO*IA
coulirry OF OR
on J"A
b1h. rrEwl
e Ne a It. Fa so" an, 04Mnalty ow—brus
ce 0 or
pa►aaegpy known w rrww
(0! pro VM bolms of
hidall I to ta"ttw
MAWMWt and 4akna
aim I by hu
n' M
mrww-h�nq POM 61, WIM $11 ter UW MW of
��dpffgiwtl 1. a KEUV COLOR
my "and
(Tvft aftti for Official W401 61 small
U=014A at* Aunts a: ft jag LA 11.1vies- Qgg
P.2/2
k1
O
nit
Ca
RC DISTRICT - PLANNING REVIEW FORM
This form is to be used by CDD staff for review of single family dwellings in the RC (Cove Residential)
District, in order to determine the applicability of compatibility issues or need to require the filing of Master
Design Guidelines by the applicant. It shall be transmitted to the Building and Safety Department as your
correction list. Please attach additional explanations as necessary.
APPLICANT CORONEL
SITE ADDRESS 52-905 Avenida Mendoza
APN 773 - 332 - 02'2 BINNO.: CASE NO.: 2001=415
LEGAL: LOT 9 BLOCK 146 UNIT 15
CHECKED BY: wally Nesbit DATE:
y
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
Compatibility Review
y✓%/�
Case logged' and number assigned
Verify legal and APN information
Consistent with MDG on file (as.applicable
MDG filing required (5 filings since 9/3/98)
Consistency with street/surrounding area:
Colors
Materials
Architecture
oL° �°' XvvlGs of uMy,.�c
tor-.srw v Gr►.i^j lis
Malsquirements:
�Ianning Commission
'ty Council
ommunity Dev. Dept. -
ais �i�..�_........ ,,,.,.,,,.,....
e No. pec
r7 o. -,S f
0 vst- a 1Ac4- Co (.o/d S iN 44 £A
-
hi
With Conditions ,;,�
c