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SFD (9612-102)LICENSED CONTRACTOR DECLARATION U), I hereby affirm under penalty of perjury that I am licensed under provisions of 1-- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and CV W 'Professionals Code, and my License is in full force and effect. Z) cD License # LIC. Class Exp. Date r-_ 0 LO 69. t=Ld�cY :Y 1 it )�fC1av� � Z r1_ Dahl % Signature of Contracto ,�'+�....- O� U rn OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's ~ Il 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). ( ) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). - ce) () I am exempt under Section , B&P.C. for this reason O N Date Signature of Owner rn 2< WORKER'S COMPENSATION DECLARATION p 2 Z I hereby affirm under penalty of perjury one of the following declarations: O () 1 have and will maintain a certificate of consent to self -insure for workers' X w tL compensation, as provided for by Section 3700 of the Labor Code, for the m� Q performance of the work for which this permit is issued. Q U I have and will maintain workers' compensation insurance, as required by OU . Section 3700 of the Labor Code, for the performance of the work for which this a � Z permit is issued. My workers' compensation insurance carrier & policy no. are: Cartier Policy No. co 5>�1'r�`+` t 1)177 i�"a E `•1�, r` d J (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 jhIs permit is issued, I shall not employ any person in any manner so as to b6come subject to the workers' compensation laws of Caa ornia, and agree,Aat if I should become 1 subject to the workers' compensaf , n provisions of ection 3700 of the -Labor ++ode% s all f rth1h�comply�wft those pr �sions. t/ DateY �"X�K 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,cancellatidh. 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 au i orize representatives of this City to enter upon the above-mentioned propeM for inspection purpose. Signature (Owner/Agent) _ 14 PERMIT # CONTROL # BUILDING PERMIT 4533 DATE�6�h�v"�� VALUATIONEj+ LOT TRACT ADDRESS 3. 4?�) 5 t�t �:1�d��:�:ll. '�lt' °tl t'i..� APN '%7a{f.,.131-014 OWNER CONTRACTOR / DESIGNER / ENGINEER 0 414 I,AQt91yt';TA tA 4!l,"54 IAQIa1h9fA (*A 012si USE OF PERMIT 1h it ?t. tfF�►f�41[l+c'f�tik�i�ttl' �tW tCt} �� 6 VT 00 L f°ON`;avw3.1Cfo 13i. lair"til<d'►;14.17 101 -(01? -130--1.9 19i;fA.i� t'1'11�.4 `t'i f�i•.f'CSi�2� =�'U`it¢.�it ,fVP,f1Oti�J1/'Af.I[!:`i 1U1�1)tYii �l�ts G �,4+si1 101.000.420-f1t)0 1K7A pf.tlhtlltNi111441,`i 1014?011=4'110.0110 tw.ttC.AiiYN,�tlr ' 1©r-ft(?1?-�1.;-t/t!U 5�.tt,tr�v INFRANf9.i,"ftfR ; T' rCV_1S :: Pf r A f Al 1��i - ,a = ,�s �� tJ4� p,�� Q�rtft'C'i{1I J (��r ('12C?'xifAi� ANY) P1 -AN ilf'l`i+ - S3,W11 -IA O r.aS,src, TAlD r t,i4(, 4 ����t11.�.att�� `. O ��� ka due. ��>7I,w'•�{�Y��,1G,t,?».�4 RECEIPT DATE BY % "" -` DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings 1 124 Ducts Slab Grade 4 L7 Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K to Wrap F.A.U. Framing 4Z4 Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wail 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 Pibg. 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 OX for Finish Plaster Sewer Lateral 3/ Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final Final t" Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole G 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) if COMMENTS: Building ^ S�6 Address Ownerl % /1- i 4 P.O. BOX 1504 -APPLICATION ONLY x 78-105 CALLE ESTADO v D07 -IR LA QUINTA, CALIFORNIA 92253 Mailing U /� Address D 0 k 3�Ll City Zip ITel. L/ ( a, Contractor / a ADaress City ZiP��d�3 ��`I State Lic. City & Classif. Lic. # Designer I I Address Tel. City I Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm 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 o/ the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 0/ the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation o/ Section 7031.5 by 'any applicant /or a permit subjects the applicant to a civil penalty of not more than live hundred dollars ($500). l-! 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 /or sale. If, however, the building or improvement is sold within one year o/ completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose o/ sale.) III, 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 /or such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) i 7 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 0 Copy is filed with the city. ❑Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed i/ 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: 11, after making this Certificate o/ Exemption you should become subject to the Workers' Compensation provisions o/ the Labor Code, you must fort hwith 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 sof this city to enter the above- mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip BUILDING DIVISION JILDING: TYPE CONSTj.�•OCC. GRP. P. Number I v2) 4. Igal Description oject Description Sq. Ft. � No. No. Dw. Size % ,�) Stories Units New.l!!' Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT 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 Propert AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. FINAL DATE Infrastructure Issued by: Date Permit Validated by: i I 11C/ TOTAL y Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: e CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEE 1ST FL. SQ. FT. $ UNITS A _ ' ROUGH PLUMB. BONDING l 2ND FL. SQ. FT, t2 FORMS YARD SPKLR SYSTEM POR. SQ. FT. @ MOBILEHOME SVC. BAR SINK GAR. SQ. FT. @ POWER OUTLET ROOF DRAINS CAR P. I SQ. FT. @ OTHER APPJEQUIP. DRAINAGE PIPING WALL SO. FT. @, TEMP. POLE DRINKING FOUNTAIN SQ. FT. @ GROUT URINAL ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation WATER SYSTEM FLOOR DRAIN MECHANICAL FEES =$ WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE,TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. @ c BATH TUB SQ. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ IIA c SEWAGE DISPOSAL LATHING SO.FT.GAR @ ?44c HOUSE SEWER MESH GAS PIPING PERMIT FEE INSULATIONISOUND PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC, FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL Desert Sands Unified School District Notice: 82-879 Highway 111 Document Cannot Be Duplicated Indio, CA 92201619-775-3500 CERTIFICATE OF COMPLIANCE Date 12/26/96 No. 15112 Owner Name Esequiel Coronel APN # 774-132-014 Jurisdiction La Quinta No. 53-565 Street Avenida Mendoza City La Quinta zip 92253 Permit # Log # Study Area 111 Tract # Lot # Square Footage 1290 Type of Development Single Family Residence: l'' ' ``'` 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 1.84 X 1,290 or $ 2,373.60 Y„r 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 ccNalley Independent Bank/Coronel Enterprises Inc. Telephone 564-4604 Name on the check' r . � By Dr. Carol McGrew Administrator in Charge s Fee collected /exempted by Pauline Pearson Payment Received , 373f60 :..::Cfieck No. 126615 Signature NOTICE: Effective January 1, 1997, Pursuant of Assembly 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 from the date on which the building or installation pehnil 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 District('s)(s') behalf, whichever is earlier. 1 Collector: Attach a copy of county or city plan check :applicafidn form ==to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy''r Ajiplicant%Receipt Copy - Accounting Dec, 16. 1996 5.05PM No, 7875 P. 1/1 We hereby Cerllfy that this Is -11 trui and correct COPY of the original. ORANGE COAST TITLE COMPANY It 467755 _ f 4;ic , RecORDilib ARQt)iK1T)® BY: A ��ootrcio�t { R,' OF t1pA17pP, (10AST-rITLI); �rBR'AC4ttiTANY 9Gt31A9lUt R•LS;787.1 e L&�43 ��BtE��IIA37, VMS Dm AND, P A 1 OEC 11 198 � �y96 IIAI1. TAR BlAt ?R 70 DSC. ifArTO Tax 1t86QUYBG M. (1t1R0iP$r. F� Kms' `mom 3l•9A0 IiISSN11oY8k DAIvtC R"Nor LA CuIM, CALIFORNIA 42233 0 "�"�"�• STACE ABM 97t S I49 #O!DEEDcoMV9 vet - GRAN'P!DEEDfm 774-132-014 i+ pw C. The underai d ) gne B or tax doglaro((a , ; n / Do�en tory rronsY�sr tax i9. w11.00 (Hxx) Coapoto$ or fait value ge prgperty corlvayed� oc l( l) Connyyuuto oil i4►1 va tto loss ens ono oge:un reneet tomoining sr, ritaa of ogle• 1M11yeorPOZAted oroa'. (hk) City of , and FOR A VALUAMA CORSIDBRATIM, caoolpt of which ie hereby atkaow odsed, GREGORIAN UNIV8R3I7Y INUNDATION hereby CBAIFT(S) to ESEQg21Sl, N. =032L. A SINOLB VAN M the real property in the City of TA OVINTA, County of Rlveraide, state of cwli£ornia, h dewctlbed era: se IAT 3 IA :STACK 243 OF SANTA CAUBLITA AT VALE IA QUINTA, UNIT 21, As PER NAI RECORDED IN BOOK 20. PACE 25 OP MAPS, RBCoRDS 014 RIVERSIDE COUNTY• CALIFORNIA W84 November IS, 1996 state of C r LjU etV t;RBCORIAN UNIVERSITY AOUNDATIOS county of'u: " 1 S.S. - beYece me, T Owl parsons ly appeared BY v /SOF ww• VA14—, 69/041 Nama/' t e yeruonslly known to me (or proved to mean BY the baela Of eotWaCtety evidence) to be sae t e the pereorl(a) Whose Mmo(o) io/aro subscribed to the withfa inetswmeet god acknowledged to me that Ae/oho/dray executed tho Dome in his/her/their avtherisod aapaoiCYU03), and " that by his/her/their algnstvre(a) on the inatrument the person(o), or tto entity gpen behalf of wMch thn rnrenn(a) nor.rl, , .o.•,��d the instruiT&NTS YIITNRSS myo4 ici 1 goal. Signnc�re. nron ter offir-inl nn►nrinl nnnl•) MATL 1AX sTo; ,AMP. AN n1141 RA) knt r.UMe1T1eN - , IWAT Mal wh J m— Td !b, 11e0Ns1 Q�mn.s n ww, Order. 00000153787 TOF: 0001 RV 1996-467755 Page: 1 of 1 AMY nGPICULI UPAS CO'MMlssloN��� cnLvtN c, "IN P.O. DOX 1007 A►dolon) Cormita IIIVIiIl"Ibli CA 92602-1009 1 JAMES O. WALLACE bAN gILEI( /torlotAKpol Ctxtv..bt�oi��r PI 10"E (rp7) 7.76•:(K)O Soolnr, wnbhll L M� bheclat of webhb A MooeUlof rAX (-,W) 7.76.8017. ( J) 11b9oJd FAX (M7).216-41