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SFD (9911-063)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 fi3d98I_ 112011Date /�' //" JSignature of Contrro_�__•a r -��`� OWNER -BUILDER DECL `RATION I hereby affirm under penalty of perjury that I am em5mpt 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 urider 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 Policy No. a".=f.1�a'ac,tN E.114XV, livS (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' compensatlon provisions O�f4Section 3 00 of the Labor Code, I all forth ith comply'withithose.provision' ��cW Date: _e✓rApplicant— e .ir,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. 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 (Own r@ /Agent) Y_ ' t -�" f � r Date r / r` r BUILDING PERMIT PERMIT# ��� DAT VALUATIONy�w LOT 23 TRACT. lik-W U13 ADDR�Ss 53-50 AVEN119A MLNWZA APN 77'4-133-"2 OWNER" .�....— CONTRACTOR / DESIGNER / ENGINEER f RNy; d r !! {( / ,fir q? / N 3f. F:ISE1�tiUWi bi Et. 31.-510 EISE:N,14O"WER.DIL LA QLANIITA CA, 92253 LA. 6, UIN"FA CA 'W253 (7M)'564.4604 CRLN 2261 USE OF PERMIT 5(!f;. U' 1 AEv8tLY t;04-' SF0 - PIi1 WT DoL�i N()T Il+0,VOl;.ist ice; WALL 0R P004- RAC i 1.421.00 SF TRACT I'OkC''HWATtO 36.0 3 WE, W,:Jol.) �Fr.t.K% 140.w t.t>° .lc3'F111X1 E13 i"09f OF MNS" R.UICTION 39,335.10 FERN'ifT FCC r4<)Al:S'f'1Z?ti"f'1U1`a1i'1k., 1014K)0 -41.19-€>M $394.Ott P1. AMt"F('iCF'f`. f01-i)6k?-•W, _'fit18 Sim I? NVWY* I I A:NIC'A.L !"EV 10a MI. U0.W )1t1i �►1..1 f:.+`s 3 ti 11(KX)_4_ "_.(i 7 319.44 tat, M1;i114t 11,111 ;' 101-000-M4 40) $110.75 gi�'teryrsa l AfOT(f tri rrr - RF -Rin 1014W-741-f1f141 t 9 (; R,V` N11 FUL 101 W4 23 d.1(1i} 1;2it.Gtt 1fv1:f A%'F' V1tE 51,907.00 tbR ,('ISts W.A1i`f 1tt1-4iEi>1-X41-:LAS $100A) t f 5+ t)t»F�i ;•;t 1 1r1i•!1<1t? ':i1R .1230 no -1111-11-R-Af, ("( )?dM`Rl.fd''T"f01K AND PLAN C'1JF(.7lK S3,4V 7 x LEW PRE -PM) FEES 4250M RECEIPT lb DATE BYE DATE FINALED INSPECTOR 3 INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings ? Ducts Slab Grade ! 2� Return Air Steel Combustion Air Roof Deck a -/ - O� j -� Exhaust Fans O.K. to Wrap 57 F.A.U. Framing -/5=0p 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 POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs f g , Footings C Electric Bond Main Drain Bond Beam 2- _ y s Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Ir f - 2-V - C1.1i 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 57 Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) l( - >-9 - ao 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 Final Utility Notice (Perm) � r•"` --. tir s mow' � .-»-•�'�v= �-,ti„r �`�. Y::�. Building Address - -Lc,_f-^ Mailing. -1 Address , C., r wit4t " P.O. BOX 1504 J 78-495 CALLE TAMPICO co( LAQUINTA, CALIFORNIA 92253 Zipr,�171 Tel. ((Contractortri F ( C...0 nc_' Address r).0 1l:- `(_,�L` " State Lic. /� City & Classif. op" ) tom^ �lrg r Lic. # Arcn., tngr., Designer Address Tel. CityI Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under pproovls ons of gJapfe (commencing with Section 1090) of Division 3 of the�sf e s an P 3fesslons Code, and m Iicen e� II jd7Jand effeco .''7 SIQNATIJRE I V1 liv DATE OWNER -BU CD R DECLARATION I hereby a fir ,that 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 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). 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, 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'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.) I'] I 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 it the permit is for one hundred dollars ($100) 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, alter 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 ateMailing Address City, State, Zip APPLICATION ONLY C51— BUILDING: 51 BUILDING: TYPE'CONStT. OCC. GRP. A.P. Number W -- F5? — C07— Legal 07—Legal Description b 04- 7_5 Olt. 21PS Project Description 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 Sq. Ft.L Size ` _,/ �' No. Stories „+-- No. Dw. /1 Units New Add ❑ Alter ❑ Repair ❑ Demolition ❑ �,. a� Ott SEP 2 _ �', •, , a .�'• i • ir1 J Estimated Valuation PERMIT AMOUNT Plan Chk. Dep.s0 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 Notice: Document Cannot Be Duplicated Date 11/24/99 No. 19664 Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE Owner NameCoronel Enterprises, Inc. No. 53-540 Street Avenida Mendoza APN # 774-133-002 Jurisdiction La Quinta city La Quinta zip 92253 Permit # 9911-063 Log # Study Area Tract # BLK243U23 Lot # 23 Square Footage 1421 Type of Development Single Family Residence Comments No. of Units I 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 1.93 X 1,421 or $ 2,742.53 the property listed above and that buildi&. permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued 00 Fees Paid By ccNIB/Coronel Enterprises, Inc. Telepho e ,564;-4604 Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Juanita Green Payment Received $2,742.53 Check No. 202590 Signature NOTICE: Pursuant of As mbly 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 run frphn 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 tolled them on the Dis ('s)(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 ^4 L 1 n"weahth�L and Title Companyy ?ir`ti�rartl. , S:uite A5, PaDesert, CA 92260 rs�Spettlement' Statement r, yscrow-"No' 99.9173'KC yg t CORON NTERPRISES, INC., A CALIFORNIA CORPORATION aN1�s�U tyr APN 774-133 O1/ 0 & 646-311-028, LA QUINTA, CALIFORNIA 92253�,i;' �F ic'eir : Kelly '1 i.er ..F - _ y r 1 092099 MI i:4 frit s F°` DEBIT 'CREDrIT�: rt; ONgIDERAT.ION $39.000.00 }, is F by ?Buyer 39A 3rppYpa' [;ONSYyA©Jl"1STMENTS Sal„kt{e. FzTAXES' ,. ...... 99.10 07/.01/99 09/20/99'9 79' , days @.55055 per diem n kl ;T'AIXES..................... 107.48 -07/01/99 .09/20/99 79 days @.59711 per diem TAXES , .. ... 107.48 . 07/01/99 09/20/99 ........... 79 days @.59711 per diem ,. `a k es` Application Fee Atr lar 1 s N FEES ,. TITLE . CHARGES, , t, enit, C.;ha r: ge 225.00 s, ' z 25.00 WAIU!ED FEES -25.00 �NGis FEES,, . TRANSFER TAXES z4" Grant" Deed 6.00 ` s' r s fiDUE BUYER 206.83 Mfr"a7�` jr $39,437.8 $39'4N,,' 83T: -:tr k g5 s {" �L( 3 ! x _z tb" 4`� �S'4+'Z" 111111!�"" 71., � ar I -)C> PL RC Di ri - Pl nni vi F IlFe0 family dwellings in e�RC Cove This form is to be used by CDD staff for review of single a y g l� 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 fist. Please attach additional explanations as necessary. Building & Safety as your correction'. APPLICANT: CORONEL CONSTRUCTION PROJECT ADDRESS: APN: . LEGAL: CK'D BY: BIN NO: . 53-540 Avenida Mendoza 774-133-002 LOT 23 BLOCK 243 , UNIT 23 , S.C. @ V.L.Q. Greg Trousdell CASE NO. 99-140 CHECK -DATE: Inform the assigned Building plan checker upod..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 .......... ........ .. \,..,..... ....... ..... .na..n .....aa .�. �::. .n a .a.....a.\. va:: `:::.a:.::.:a� \a ?� \ 7 mom Case logged and number assigned Verify legal and APN information Consistent with MDG on file las applicable) QQ�� MDG filing required 15+ filings since 9/3/98) Consistericy -with -street/surrounding area:.ONE OT Materials �} 'ti��/? 1� ,514 Architecture 00 OTHER REQUIREMENTS: The zoning code, architectural and landscaping manuals., and/or assigned inspector should be consulted where 'uncertainties arise. The completed checklist shall be maintained -in the Building '& Safety address file. ' 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: 53-540 AVENIDA MENDOZA Use Classification: SFD Bldg. Permit No.: 9911-063 Occupancy Group: R 3 Type.of Construction: VN Land Use Zone: RC Owner of Building: CORONEL ENT. INC Building Official Address: 51-540 EISENHOWER DR. City: LA QUINTA, CA 92253 By: STEVE TRAXEL Date: 04-28-00 POST IN A CONSPICUOUS PLACE I