SFD (9911-176)LICENSED CONTRACTOR DECLARATION
0ereby 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
t,13441,�31
Dat./1-Arl
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:
1, 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).
1, 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 G FAGI� L 14 '�' Policy No. . NXVC 11011i'&11460_01_1
(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 becomd
subject to the workers' comp�ensation " ovisions of Section 3700 -of -the Labor
r
p
tho,
Cod , I §,hall forthwith comply with Se ppvisionv
Dg-:- I -el Applicant—
ij, i
Warning: Failure to secure Workers' Co4ensation 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 Sect6 3706
of the Labor Code, interest and attorney's fees.
IMPORTAN ' T Application is hereby made to t he 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 ot 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) D"'a t e
PERMIT#
BUILDING PERMIT
DAT� "�VALUATION LOT TRACT
tea M
J406P SITE
ESS
APN
OWNER
CONTRACTOR DESIGNER ENGINEER
CORVIINN-1�
I E I S �,N K CA& rt R DR,
3 1 - 5;1
1,ik Qowr,,�, �,2,,A 10153
L A 4 1 NMA 01 11102"0
USE OF PERMIT
mA�i if,.k t;; PLAIuvb�'t, I klEl.'N kol. tAU�:,r�*;�LUS d
TkAf_—, CONSTRUCTION i..240W ISIF
PlAkewP110 i0
9 -Z, .1 IT N,
f7f�J'
iVWA �J IANP.. At. b
04 ! Wfli f',,% i VP P, till 00-414-0W)
�1WIINIOO "Vil"11 IN 0M.""41 000
11 1,0111 10 i,U30(11, 41,341,50
It) 1 0,60 -441 - V! S s It o fb)
NNO PIAN, (Ill' V�-",
I'll, L-1 AID Y1,111S
0 (11
�R�K)
I
RECEIPT
DATE
14-1
1 DATE FINALED
INSPECTOR
I N -
INSPECTION RECORD
OPERATION I
DATE
I INSPECTOR
OPERATION .
T DATE
I INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
-57
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
OX to Wrap
43
C
Exhaust Fans
F.A.U.
Framing
Insulation
Fireplace P.L.
S-7
Compressor
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final 0,0
BLOCKWALL APPROVALS
Final
POOLS -SPAS'
Steel
Set Backs
Electdc Bond
Footings
Main Drain
Bond Beam
ij=-4 57
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
57
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APkOVALS
Temp. Power Pole
Underground Conduit
Rough Widng
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
4:4 Quh46
P.O. BOX,1504 APPLI"TI N ONLY
Building 78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253
Owner �',) / e_T;1C.
Mailing BU
Address JA P
City Zip Tel.
741 b1_11 1A 1 C"?,?53 1 / I
Contraptor
( 0160," / I
-.7'.0-6ox 14 %
_TJ GIA) 4--e 1""l`77?53
State Lic. city
& Classif. 19 91 Lic. # 44
Arch., Engr.,
Designer
Address Tel.
City Zip State
I I Lic. #
LICENSED CONTRACTOR'S DECLARATION
rhe I ti—apterm9y-i mmencing
;raf r94s ons of C with Section
I taffirm that I am licensed unoer pi d
70 Nision 3 of the B sines 8 essions Code, ani 9 nse I�PIIIV epnd�
..9 MY I -c
,9�04 Prot
SIGNATURE I e --
OWNER -BUILDER DECLARATION
I hereby (Ifirm'Zt I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5.Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure. prior to 'its Issuance also
requires the applicant lot 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 rhe.applicant to a civil penalty of not more than five hundred dollars (S500).
t, - �, 1, as owner of the properly, or my employees with wages as their sole compensation, will
d t t u -d for sale. (Sec. 7044, Buisness and
. he wo rk and he str c lure is not intended or offers
P.I..'sions 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 impro vements :to not intended or offered for sale. If, however, the building
or improvement is sold within on year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
1*1 1, 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.)
1-1 1 am exempt under Sec.—B. & P.C. for this reason
Date—Owner
WORKERS' COMPENSATION DECLARATION
klehereby affirm that I have a certificate of consent to self -insure, or a certificate of
Wor r's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
n Copy is filed with the city. 0 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the Permit is lot one hundred dollars ($100) valuation
or less.) .
I certify that in the performance of thp work- for which this permit is issued, I shall not
am ploy 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. 309 7. 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 slate laws, relating to building
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of aOplicant —Date
Mailing Address
Ply, State, Zip
ILDING: TYPE'CONST.-OCC. GRP.
_1717,11-1 1 131P
Number ;;.1 ry)
)al Description
iject Description
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
I 4.1r koe It
Sq. Ft.
Size
No. o. Dw.
N
Stories Units
New 0 Add 0
Alter 0 Repair 0 Demolition 0
�&,NV
'noA
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
C50
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
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 11/29/99
I APN # 774-133-001
No. 19672 Jurisdiction La Quinta
Owner NameCoronel Construction
No. 53-520 Street Avenida Mendoza
City La Quinta
zip 92253
Permit#9911-176
Log #
Study Area
Tract# BLK243U23 Lot # 24 Square Footage 1461
Type of Development Single Family Residence No. of Units I
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 determ.ined 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,
1.93 X 1,461 or$ 2,819.73 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed projeciiin'4y r�vbe issued >�
Fees Paid By cash/Coronel Construction ;w' i�� te I e p h-6 n e' 5 -64 -4604 -
et,
Name on the check
By Dr. Doris Wilson
V, -
SuperintefidenV
Fee collected /exempted by Juanita Green Payment Received $2,819.73
Check No. Cash
Signature
N0110E: ,Pursuant ot*embly 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
abovewi begin to run ffbm the date on which the b�ilding 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 D!Mct('s)(s') behalf, whichever is earlier. I
Collector: Attach a copy of county or city,,Pkqp check application form to district copy for all waivers.
Embossed Original- Building Dept./Applic,ant Copy - Applicant/Receipt Copy- Accounting
d Title Compan
-uite AS
S
CA 92260
u re
`9 Sim
1:.ement m- en, t.
E- 99.9173KC
B'- ... ...... . CORONEL EN PRISES, INC., A CALIFORNIA CORPORATION
APN 774-133-001 02 & 646-311-028, LA QUINTA, CALIFORNI
A 922,511611",
er
092099
DEBIT
AN%1DERjATI
ON
$39,000.00
"by
`.�:,,8uye r
P
�i4"::PRAR' �A
%UONSWADJUSTMENTS
.................. 99.10 07/01/99
09/20/99
COUNTY" T
79 days @.55055 per them
c,ow ................... 107.48 07/01/99 09/20/99
40.
79 days' @.59711 per them
................... 107.48 07/01/99 09/20/99
79 days @.59711 per them
%N� R C WW G E -S-,,
AP
#qt plication'Fee,
CHARGES
225.00
25.00
FEES -25.00
T R -A
E S,,,! T _NSFER TAXES
Dee
6.00
P W N Q U -BUYER 206.83
W54 E`�
$39,437.8-1
_Z LIAJ k1jov.
f
c
33
1,
2_3 �)k.
3 z3
j
OA\
RC DWrict - PlannhV_Review Forin
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 applicabilit of compatibility issues -6r i1eed
Y
'to require the filing of Master Design Guidelines by the applicant. It shall be transmitte,d'te-.
Building & Safety as your correction' list.'Please attach additional explanations as necessary.
APPLICANT: ..CORONEL CONSTRUCTION
PROJECT
ADDRESS: 53-520 Avenida Mendoza
774-133-0*01
APN:.
LEGAL: LOT' 24 BLOCK 243 UNIT 23. S.C. @V.L.Q.
CK'D BY:* Greg Trousdell-
CASE NO. 99-141 ..CHECK -DATE:
BIN NO:.
Inform- . t . he assigned Build -Ing plan check6r upori.your..assignment to this case. The CDD
Exec'utive Secretary maintains a log book to track-6ppl�ications and assign case numbers.
REOUIRED ITEM
., . I Y I N I - COMMENT/_WRRECTION
rCase logged and number assigned
ON6
yeriiy:lebal and APN information
g
C Co sist t
onsistent With MDG on file las applicable)
MDG filing required 15+ filings� since 9/3/98)
%,tjl IZ11 DLV- -� 7
Colors
Materials
Architecture
X,
OTHER REQUIREMENTS:'
- ----------
The z oning code, architectural andlandscaping manuals, and/aassigned inspector should.
be . consulted where 'uncertainties arise.'The completed checklist shall be -maintained-in the
Building.& Safety address file.
�Nm
v
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements'of Section 109 of the Unifo
nn Building Code,
certifying that, at the time of issuance, this structure was in compliance with the vadous'ordinances.
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: .53-520 AVENIDA MENDOZA
Use Classification:' SFD Bldg. Permit No.: 9911-176
Occupancy Group. R 3 Type �of Construction: VNN 'Land Use Znnpm Rr
Owner of Building: CORONEL ENTERPRISES, INC
Address: 51-540 EISENHOWER DRIVE
City: LA QUINTA, -CA 92253
By: STEVE TRAXEL
Date: 04-26-00
Building Official
POST IN A CONSPICUOUS PLACE