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9604-035 (SFD)�y ALC M 9 - LICENSED CONTRACTOR DECLARATION Ihereby affirm that I am licensed under provisions of Chapter 9 (commencing with DATE .51101% Section 7000) of Division 3 of the Business and Professionals Code, and my License isein full force and effect. _ JOB -SITE ADDRESS License I0. t, 61 UC..I Exp. P ' li t i %9L+ OWNER Date I natureof Contracto , (Y „ , e OWNER -BUILDER DECLARATION . I hereby affirm 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: Carrier Policy No. (This sectibAEA"dtrlo Elie completed if the permit valuatioMsr'f6e'ViW..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 ;.Section 37 0 of the Labor Code, 1 s� l forth�wcomply w' `thoo�sse��e provisions. ApplicanV"`�', gL'.t / 4o'– Y 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 application agrees to, & shall, indemnify & hold harmless the City of Indian Wells, its officers, agents and employees. s 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. �C:�ON1; L CONS')"'+:' 1CIMIN 77836 AVENI`DA i0N'1'EZ►.11l1A 8 (6140564-4604 USE OF PERMIT ERMIT;iI o. -Is PE' 23 1 TRACT Z� APN 778M.t VENIDA t%40N'1U-ZU11 A # DESIGNE..i.7N9 =+ER604 i:RIA 2261 m12i14:[`r DOES Nat INC LL1DE ,MOC WALLS OR, POOL; 'l7.LA.0 i CONS AWLJC'TM—N' 1,530,00 SF PCI)RCH/1-1XV10 45,00 SF GARA.GEICARPO.IZ1, 1W.00 St." rsx ivu. 'rEo con or c®Ns`niucrioN 95180.50 t'I~ kN18T .il *,IH:: S1r1i69MAR s C '6DEPOSIT 4250,00 CONSTTI'iCICTION FEE 101.000-IM001 $62:1.s0 - I r13+1 CHI EXI I,tb.1 101,000-433-3111+ $522.04 I , CiiAAifCA.t, C,i ld 101-{)t)0421-000 .11.1+;C`t'I21CAL. FIEF 101-fM-420.000 $1.23.40 PLLrPa B NO FEE $128.75 TONNG N110-111(YJ %FE .Ii1u; Tir i.Q D:-il()0-241-OOtj a�.S Q-RADINCr FRP 101-fIc10.423 (rt)0 $ro.CsO iNFkAS'PRUC'.Ci,)'RE F66 225-000443-342 $2,.142.05 !"lt fi':kS,4 i'1:r,Jq 101=W-441-345 $25,00 IN `. CN AND i4wiLMrQTAL CONSTU $-1 _V,n r..- a LESS ;RKE-PAID F'F.ES -$2.50:00 • f. T0TAE_P14 ;RillZ. 1( .F ;F,3 DUE NONNY $3,44)"1.82 I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and States relating to the building construction, and hereby authorize representative of this City to enter upon the move -mentioned proper,for inspection Signature (Owner//1 Data-✓�(�7 RECEIPT O 0 DATE I BY - .• I 1 (DATE FINALED . I INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs ZTi ` Underground Ducts Forms & Footings Z 4 Ducts Slab Grade Steel Return Air Combustion Air Roof Deck h Exhaust Fans O. K. to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall -lnt. Lath Final Final POOLS - SPAS BLOCKWALL APPROV S steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover 316!7x Z D. Equipment Location Underground Electric Underground Plbg. 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 O.K for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping 14 Gas Test % (e Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Vottage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) / Q/� 1/04 �P P.O. BOX 1504 APPLICATION ONLY BuildinAddrres� s l CJ Owner Mailing C) - :� CSX 78-105 CALLE ESTADO _. QUINTA, CALIFORNIA 92253 Cit�yfj -YV��i T_ipq2z ; * TeL561`,�, Contractor / //-- r'" ! �� Address t'c).X�`a�l �!�r✓I Zip,7Zs{'Tel.516C!_ State Lic. ��rY City &Classif.�311y' (aLic.# ?� J Arch., Engr., .z r Designer Address Tel. CityI Zip I State Lic. # affirm hat I am JJrcensed under provi tons of Chapter 9 (commencing with Sect ivlsl,c � �f th�8usiness and Profession Co e, and my licen ��n tut =rCE; OWNER -BUILDER DECLARATION 1 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 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). 1: 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.) 1. 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. 8 P.C. for this reason Date Owner I" WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certi[icate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Cte.) , Policy No. Company 171 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 ($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, 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 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. r Signature of applicant Date Mailing Address City, State, Zip BUILDING DIVISION BUILDING: TYPE CONST. // OCC. GRP. -1-7-7-37 'j A.P. Number / � 3 — /52 06 Z Legal Description L- c? -.4- 2.1 2_5 Project Description REMARKS. ZONE:�� / BY: Minimum SefbatAibistances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Ce= e�r Line Side Setback from Properly Line^� FINAL DATE INS Issued by: - Date aJU A Validated by: Validation: Sq. Ft. �� r,?O Size U No. No. Dw. Stories Units New Add ❑ Alter ❑ Repair ❑ Demolition ❑ s Estimated Valuation r PERMIT �� l J AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const., Mech.' lectrical::' Plumbirig S.M,I:' Grading-, Driveway Infrastructure "' ,� •. TOTAL= it REMARKS. ZONE:�� / BY: Minimum SefbatAibistances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Ce= e�r Line Side Setback from Properly Line^� FINAL DATE INS Issued by: - Date aJU A Validated by: Validation: STRUCTURE PLUMBING ELECTRICAL HEATING R AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND CONSTRUCTION ESTIMATE NO, ELECTRICAL FEES NO. PLUMBING F BONDING HEATING (ROUGH) STORAGE TANK SES L IST FL. SO. FT. @ $ UNITS DUCT WORK ROCK STORAGE 2ND FL.SO. FT. GAS (ROUGH) YARD SPKLR SYSTEM HEATING (FINAL) POR. SO. FT. @ MOBILEHOME SVC. BAR SINK a GAR. SO. FT. @ POWER OUTLET ROOF DRAINS WATER HEATER CAR P. SO. FT. @ FINAL INSP. DRAINAGE PIPING BOND BEAM WALL SO. FT. @ DRINKING FOUNTAIN =$ SO. FT. @ URINAL FRAMING ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used is property tai valuation REMARKS: VENTILATION _ FLOOR DRAIN MECHANICAL FEES FIRE ZONE ROOFING WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) SPARK ARRESTOR APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY LATHING AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET INSULATIONISOUND COMPRESSOR HP POLE, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. @ c BATH TUB SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 11A c SEWAGE DISPOSAL GARDEN WALL FINAL SO.FT.GAR @ ?14c HOUSE SEWER GAS PIPING PERMIT FEE 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 R 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 APPJEOUIP. 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 Notice: Document Cannot Be Duplicated Date 5/3/96 No. 14432 Owner Name EsequielCoronel Desert Sands Unified School District 82-879 Highway 111 Indio, CA 92201 619-775-3500 CERTIFICATE OF COMPLIANCE Jurisdiction No 51780 Street Avenue Morales City La Quinta zip 92253 Tract # Lot # Type of Development Single Family Residence Comments APN # 773-152-002 La Quinta Permit # Log # Study Area 113 Square Footage 1580 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: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 1.72 x 1,580 or $ 2,717.60 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 '�.,_. Y Coronel Construction s �5 Telephow " 64-4604 Name on the check. 4* By Dolores A. Ballesteros_ Superintendent Fee collected /exempted by Pauline Pearson Payment Received $2,717.60 1238 Check No. Signature pg A��Q� oe 11: o .�.�/U�.�_ 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 OFFICE OF THE AGRICULTURAL COMMISSIONER CALVIN C. KAMINSKAS Asslstonf Corm loner P.O. BOX 1089 RIVERSIDE CA 92502-1089 DAN RILEY JAMES O. WALLACE PHONE (909) 2753000 Sealer, Welohts & Measure's Aorlcultural CommIuloner FAX (909) 275-3012 (909).276-3030. Director of Welohts & Measures FAX (909) 276.4728 83-612 Avenue 45 Suite 7 Indio, CA 9220.1 (619)863-8291 DATE '�l Y `1 4O CASE NO. �� G co 0 q -0-3 DEVELOPER'S NAME: ADDRESS: r TELEPHONE: v✓2 v ie S Dear Developer: After reviewing' your landscaping plans, all plant material listed 'is not in violation of quarantine laws governing the Coachella Valley. If substitutions do occur and they differ from plant material listed, this office must be notified immediately. Thank you for protecting and Preserving the Coachella Valley's pest -free environment. WricuYural Cominissioner's Office cc: Indio and Riverside Tt Of 14a utnta utlbtu aub �Sdfet 31tiliYeilon- This' Certificate issued pursuant to the requirements of Section 306 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 51-780 Avenida Morales Use Clossiticotion Single Family Dwelling Bldg. Permit No. 9604-035 Group R-3 Type Construction UN Fire Zone Use Zone SR Owner of Building 'Coronel Construction Address 77836 Avenida Montezuma La Quinta, CA., 92253 `city Daniel P.. Crawford Jr. 77�� ! Date; July 12, 1996.. Building Official POST IN A CONSPICUOUS PLACE