SFD (9703-012)LICENSED CONTRACTOR DECLARATION
11 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
.3498 1
J.
/ate/ l / Signature of Contractol
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).
( ) 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.
KI 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:
r;arTier Policy No.
001.fVIN EAUX 114`5. Id'r<'i:11118I ;tAl
(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 becom" e"r
subject to the workers' compensation provisions of Section 3700 of the Labor
/Code. -II, h I�fort Wit? comply`withihose6rovisions v L
/ Date, �/ Applicant �� !�`+1,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 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/Ageht) r %�' a 7 .� ate
BUILDING PERMIT PERMIT# CONTROL#
9703-012 4827
DATE VALUATION ,*92" 4LOT . 1 TRACT 8929 1 } I /Sr i
ADDRESS 5L-.+1." A'E`A.N10A 1VAVARRO JOB SITE
APN 773-23."10
OWNER
CONTRACTOR / DESIGNER / ENGINEER,
ESIEQUII I. I"t)RONR
CORONET, E."<)NSM K,11110pl
P0. BOX 389
515401VISEN1 t)WEK OR
LA (,ilAWI-A CA, 92�5A
LA QUINT'A VA W2:;3
(t�i�TT3(i4tsp4 (''BT,# 2201
USE OF PERMIT
�kj) - )'l. Obit d• AJC *.lt;i Ni,) r ft.'LI4k,* mAJo:.'ls. WALLS Ok lryt Ak
THAQ'T CONSTRI K.71014 1,4%) W) SF
tK fRo 1WJA) Il 1 U11,00 .i{"
0Al4A0I;A'A1CN*T 304A0 SF
4hv,r W0(30r.R.MV,, NAIAH) U.,
EST 1MIr'I,T ED 1.'O`itT L)F CON,STR1lCF10N
92.x&4.40
1'"I�:ACiT k`lSti:'jliMl!'iriitl
/'tiN*41!"i:tR111It.)NFFE 101-000-41949t)i) stn3.f1E1
Pf,ANf7fIFt:'k F!i"P
i'TiL'. DEPOSIT SIT •• .$250.00
' N1.1- fJANWAI . kllRd 101-000--1,'..I-(A)0 35180
14M(:"FRA'AI. R*% , 101-dtW-420-000 $125.73
PI 1)A4R1N0 F f IM -W-11194" $ I11.75
51110NO MOTION 101-000-241 •000 1;9152
(JUAI)I4K1 tGt,es3f)•433-t1t}t) lt. )
1'N•+ RJk11STRiFC"}"(QI`? PY11•; 223.OW-44:I-342 S2,i)�f2.b7
1121.('f q Iii A
`a►�� O,�
tit ttY , )NS7AU K' 110N";+SND PLAN C1ar�('K
�•' LESS PREA"'Ai11 FEES
-$2'50.1X1
,
•
TOTAL PERMIT M1;,S 011E NOW
53,278.41
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
Al.
14
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
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 - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
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
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
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)
Building/QO
Address
Owner
•4 u�!'Gv c� 3 - o ► 2,
ESTADO
vlk""J
P.O. BOX•1504 APPLICATION ONLY
UINTA,05 CALIFORNIAS
LA QUINTA, AORNIA 92253
C_
Mailing
Address
Cit G,(,IWW,Zi`p'722,S-3 Tel S Gtel— L/161
/
Contractor .
C 6) (ZO ( G� f y cl l 61 i
Addr ss
CityTel.
1ZiP?-ZZ,5
3
State Lic. v City
& Classif. �/�� Lic. # Z (o
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hey affirm that I am licensed under provisio �kChapter 9 (commencing with Section
7D00) of Divisi n
SIGNAT3 of the Business Pro'fessi ns Code, and my li a se i�� fu9l forcaand
eft�f)
URE ��DATE
I OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031 .5, Busin ss and Professions Code: Any city or county which requires a
permit to construct, alter, i rove, demolish, or repair any structure, prior to its issuance also
requires the applicant for s h 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).
Fj 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 suchimprovements 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.)
II
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.)
17 1 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
0 Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(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 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, 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 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 Address
City, Stele, Zip
BUILDING DIVISION
BUILDING: TYPE CONST. OCC. GRP:
A.P. Number -77-3 _ Z J 5— t 7 p
Legal Description A, J7
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:
Sq. Ft./ L No.
Size Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑
Repair ❑ Demolition ❑
L
r
r
' f
Estimated Valuation
;
PERMIT
AMOUNT
Plan Chk. Dep.
00
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
00
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:
,1.
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING 1F
1ST FL. SO. FT. $
2ND FL. SQ. FT. @
POR. SO. FT. @
GAR. SO. FT. ng
CARP. SQ. FT. @
WALL SQ. FT.
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION $
UNITS/
MOBILEHOME SVC.
POWER OUTLET
1
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ c
BATH TUB
SQ. FT. p c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID Q 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
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 & 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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCG
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 3/19/97
No. 15354
APN # 773-235-010
Jurisdiction La Quinta
Owner Name Esequiel Coronel
No. 52190 Street Avenida Navarro
City La Quinta zip 92253
Tract # Lot #
Type of Development Single Family Residence
Comments
Permit #
Log #
Study Area 112
Square Footage 1490
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
1.84 X 1,490 or $ 2,741.60 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project rnaynow1be issued
4Q*11 " • "
Fees Paid By ccNalley Independent Bank/Coronel Enterprises Inc. y Telephone. 564;604
Name on the check ; �^• �_N
By Dr. Carol McGrew r
r
�.
Administrator in Charge
Fee collected /exempted by Pauline Pearson Payment Received �'"x $2.741.60
Check No. 134733
Signatureirn 0
e ,.
40TICE: 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 permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
;ollect them on the District('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
Mar, 14. 1997 9: 06ANi' TEL 'No.
•R.ICOROZNG REEQUSSTED BX:
ORANGE COAST TITLE COMPACOMPANY
97.6431KC R.155942-1
W"SSOOWIESDW,D
VVIUTHELSHOWNBELOW,
NAIL TAR sTATEMENTS T0:
ESSQUIEL K, CORONEL
51.540 EISENHOWER DRIVE
LA QUINTA, CALIFORNIA 92253
714 370 3332 Mar 13No, !444);2P..9/301
1-4, ,R�i /P .,� .,.,.5 ..,.
.Mai' i.
.� .3 .tg9�a�� tom, tPRocardar
p MJFMIA
.-..v..�,e�,..�I-:w�wf�Y�, 1BfR.1Na+P•1'r..W�•.
SPACE ABOVE THIS LINE FOR RECORDEat'S USE
G,r DEED APF: 773-235-010
The undersigned grantor(& declare(s): ,
Documentary transfer tax is $8.25
(XXX) Computed on full value of property conveyed or
(( )) Computed on full value less liens and encumtrances remaining at time of sale,
Unincorporated area: ( ) City of and
-~. FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
KARL F. GANTIRT and FANCY F. GAOTERT, husband and wife as joint tenants
hereby CRANT(S) to
ESEQUIEL M. COROWEL, A SINGLE MAN
the reed. property in .the City of LA QUINTA, County of Riverside, State of California,
deser1bed as: /
LOT 13 OF BLOCK 9Z, S ?A CARMELITA AT VALE LA QUINTA, UNIT N0. 11, AS PER MAI'
RECORDED IN BOOK 1 PAGE 75 OF !SAPS, RECORDS OF RIVERSIDE COUNTY, CALIFORNIA
Dated February 12, 1997
Stena of Califarr�ia r' '
County of Nevada 1 S.S. KARL F.
On vm
before me, N• P
Per
sonally appea ed NANCY F.
Gare r. Cantert
per abna y known to ms (or proved to me , bn •'''�•. -
thebao s~®b• se.tisfogptY•-evidenoe)''to be
the pars n(s) whose name(s) is/are subscribed
to the withip.instrument and acknowledged to
me that he/she/they executed .the same in
his/her/their-authorized cepacity(ies), and fit:
that by his/her/their signature(s) or the
instrument the person(s), or the entity upon
behalf of Which the persons) acted, executed
Lila instrument.
WITNESS my hand and offs 1 seal.•
Signature
MAIL TAX STAT n
. SAME AS ABOVE
,
(This area for official notarial seal)
i;�K ,
,,04103/1997 12: 27 6195644202' r;Y> a r CORONEL'
,CONSTRUCTION 1 PAGE 02
Fit
GoQis�Hln
I
f onsufthis •116"gfnaslOn�,�
v� t.
-
REFORT `OFt, FIELD COMPACTION TESTS
ESTED FOR; CORONEL CONSTRUCTION.- PROJECT, 52-190 AV NIDA N11VARO
< !' P.01. BOX 389.^~ LA QUII:T.A
�j LA QUINTA ;','CA 92253
)ATE: I March 28, 1997 OUR REPORT NO.: 0737005.7-2
'EST DATA: (1) Fine silty sand OFT: -MOIST. 12,OW
_......................._....................:..........
MAXIMUM I COMMENTS"
TEST 'TEST SOIL ID LAE GRY w WATER ` WET DRY' PF,R(,i .NT $
Spec; 90 Min
NO. DEPTH ELEVATION NUMBER 0 NSITY i GQNTENT I DENSITY DENSITY CUMI'raCTION i Sp .
.
1 811 F;G. * 1. 11.5,0 11_6 115.5„ 103.8 90,3
2 I 80• G. * 1' 115.0 14.1 118,8 1,04. 1 9Q.5 1 - A
-- .......:... _..... ... ....... .... ..._..... _..._.._..._ ...._....... .',
3 e" b'.G. * 1 115.0 12.1• 116.2 103.7 I 510.2 11 - 'A
4 8" F.G. * 1. 11.5.0 1?.2 116 ' 104..0 I 90-4. 1 - A
................ I
i .
"EST LOCATION:
House Pad
1
North
west ' -corner
.of
house.
pact
2
_ .............
North
.................._......
east corner
_........ w... , ..... _..........
of
house.
......,.... ,.........
pad
..... .. .
3
South
east'corner
of
housci
pad
4
South-west
...
corner
.... ........ ....
of
house
_........ ......
pad i
-........ ................._.._.........._........ _.
TOTES: TESTS
PE FORRMED PER er cubic foot -91 8 ASTM D3017-88(93) *COMMENTS: 1 FILLIRACMAT RIAL A..PEST RE COMP COMPLY
WT $ NOT C CATIIONS
WAT R CONT SHON b cer� of drY wei0nt 3. BA COURSE WITH SPECIFICATIONS
POR EN'Y (Q crTbN: used on Ma'lmUm dry 4. g BEAgE C. RETEST OF PREVIOUS TEST
density o t Ined on sample imitated by 5. S8IL CEMENT" U. MOISTURE IN EXCESS OF SPFECIFICATIONS
soil ID number, 6. OTHER E. MOISTURE 9Et.Ow5PFCIFICATIQN$
* (1) ASTM.D-1557, Procedure A
-ESTINSTRUMENT: Troxler., 3411-8, 1.3099 STANDARDCOtJN1- M: D:
1EMARKS: PSI DID Z40T MONITOR TKE .FILL, PLACEMENT. ADJUSTMENTDATA M: 00 D: 00
**F.G.= Finish grade**
Respectfully Submitted,
TECHNICIAN; Juan Nunez Professional Service Industries, Inc.
HESE TEST RESULTS APPLY ONLY TO THIS SP1$CIFIC LOCATIONS NOTCD AND MAY NOT A&II I!SENt ANY OnaCQ LOCATIONS OR ELEVATIONy,
EPORTS MAY NOT BE REPRODUCEC, EXCEPT IN FULL,, WITHOUT WRITTEN PERMISSION BY PROFF8310NAL SeRVICE WO+I$TRIE`i. INC.
s1 a..+oo.2 (8)F PSI •-42-240 Green Way, Sulto C • Polm pogort, CA 92211 • PhOna 619/341 579D +Fax 819/341.5794
r