9903-104 (SFD)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. Dater
6N98Z 13 ft`3t/Ute
Date? ZSignature of Contract
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.
u) 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:
Cattier Policy No.
(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, anisagree that if I should become
subject to the workers' compensation, provisions of Section 3700 of °tWe Labor
Code,.;shall forthwith comply withlthse provisi`ons�� f
Date: %- Y �? r%''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 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
Si�nature (Owner/Age )
BUILDING PERMIT PERMIT#
DATE VALUATION Sg(It)"96280 LOT TRACT
ADD ESSOB SITE ;1Jj+• 1t 11 STV A't�t1'13k� Hyl li�lil�t
APN 71.9425-016
O.
OWAE,RR
CONTRACTOR / DESIGNER / ENGINEER
' FSEQVTE1, CC`.i ONTEL
f;OMONE+L, CO'ISS'1'Ri:K•"r ION
5t -S40 EISENHOWER MI
51-540 r0SENI-11GW.i t2 DR.
LA QUINTA CA 5.2253
LA 47UIN I'A CA 92153
(760-564-4604 CB114. 276).
USE OF PERMIT
SINGLEFAMILY 17WELLL'NG
Sti'il - PERMIT T ois war INCLUDE RLOCK WALLS OR POOL...
i"ItttC T %Crit;S F'i�UCTi:�l i 1,4545.00
PORCOVIA.T10 65.00 SF
0AliAOUCAR'OWl' 463,611 Sl,,,
6 F T. 'WOOD'F6NO3 200.00 LF
PEAMIT FU SUMAIAM
CGINS'1RUC71ONFEE 1431-1000-41-R-wo $643.00
t±1 1�N4`fTf£°i<.F'► Stlt_4)(lt►.tldc) 31,R $54;t•RR
ME,C-1fAXI C 4'IiL FIX tot _Mt ?.1-000 $66.5
fs3. CEIZ,ICAL P.ls13 $139.34
-...-):'PLL+Wt8T4G PEE itil-(?()4 115 -ll4fJ 39'l.se
;'(i2,f)T�ttiV(tytdRfS�F >c7FCii) 1!)1 l'Nli}-;_�ti4t(1,ttl
t RADS NG FEC ifli •: (} 3ry 9M_` 0l:}t1 3211.04
W- RA,`3`!.`it016;IURE RED., 225-600••443-:342 512112 x.96
.PRFXtSE PLAN 101-000441- 45 $25.0io
ARTVN 70i••00n-'1S5-{1011 52.41
1011-0100A39.318 42-SO.40
tit, B -110TH!, CONS"€' UCT }'Ifr N AND PL,ikW CHECK
53,740.x9
LESS i'ttT'-PAD FEES
4250.00
TOTAL PEMMIT FV,'E 'DUIQ NOW
�1
s3'5-411.89
IT,Y(I ' •
DATE
BY +(
DATE FINALED
INSPECTOR
F \ `
rEq_
\It>LU
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
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings - Z —
Main Drain
Bond Beam
Approval to Cover
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
Gas Test
Appliances
Final
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)
COMMENTS:
i
1- 7 of _/ 0 5�__,
Building S _7o 0 f
Address
City
-►
T
State Lic. City
& Classif. io 3q` 11k !
Arch., Engr.,
Designer
Address Tel.
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
i
City I Zip I State I
' Lic. #
that I am licensed/under provisions of Chapter<9 (commencing with Section
3 otlhe Btisi'hess�and Professions Code, and m)g, licensers in full force and
OWNER -BUILDER DECLARATION
I hereby affi m that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8usiness: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 rile 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).
f: 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 I 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 contractors) licensed pursuant to the Contractor's License Law.)
I-! 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
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 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 fo the Workers' Compensation provisions of the Labor Code, you must forthwith
Comply with such provisions or this permit shall be deemed revoked.
X
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
ame 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.
Signature of aliplicant Date
Mailing Address
City, State, Zip
WHITE = FINANCE
I,1�11�
?LICATION O LY
BUILDING: TYP`! /E'C�O�'7-3
N�ST. "'� OCC. GRP.
A.P. Number —)"�5-Qt0—4/
Legal Description�n 1 L; -,)Lx ) 0k) i
Project Description r I t
Sq. Ft.�� No. '� No. Dw.
Size„ I Stories Units
New Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated valuation
PERMIT AMOUNT
Plan Chk. Dep.-�
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: A1r1 LDate Permit
"
\.
Validated by:
ValidatioFEB 181999
3PITY OF LA, Q It
YELLOW !.APPLICANT PINK = BUILDING DIVISION
E ` �
SALE ESCROW INSTRUCTIONS
f
THIS DOCUMENT WILL AFFECT YOUR LEGAL RIGHTS - READ IT CAREFULLY!
TO: COMMONWEALTH LAND TITLE COMPANY Escrow No.: 99.8381KC
'72855.Fred Waring Dr. Date: 01/31/99
Suite A5 Page: 1
•Palm Desert, CA 92260
(760) 836-3726
Escrow Officer: Kelly Collier
THE ESCROW HOLDER IS COMMONWEALTH LAND TITLE COMPANY WHICH IS LICENSED
BY THE CALIFORNIA DEPARTMENT OF INSURANCE.
Buyer, or his agent, will hand you or cause to be handed you upon signing of
these instructions a deposit in the amount of.. .. .......... .........$ 500.00
Buyer will hand you additional funds prior to closing in the amount of .......... $ 11,500.00
TOTAL CONSIDERATION $ 12.000.00
and any additional funds and instruments required from me to enable you to comply with these
instructions, which you are to use on or before February 25, 1999, and when CHICAGO TITLE
COMPANY can issue a Standard Policy of Title Insurance Owners form, with liability of
$12,000.00, on real property in City of LA QUINTA, County of Riverside, State of CALIFORNIA viz:
Commonly known as: APN 773-125-010-4, LA QUINTA, CALIFORNIA 92253 ,
LOT 15, BLOCK 55, UNIT NO.'5, SANTA CARMELITA AT VALE LA QUINTA, AS
PER MAP RECORDED IN BOOK 18, PAGE 63 OF. MAPS, RECORDS OF RIVERSIDE
COUNTY, CALIFORNIA
Except any reservations of record of minerals, oil, gas, water, carbons and hydrocarbons.
Showing title vested in:
CORONEL ENTERPRISES, INC., A CALIFORNIA CORPORATION
Free from encumbrance except:
A. Current general and special taxes for the fiscal year in which this escrow closes, and
taxes for the ensuing year, if any, a lien not yet due or payable.
B. The lien of supplemental taxes, if any, assessed pursuant to the provisions' -of Chapter
3.5 (commencing with Section 75) of the Revenue and Taxation Code of the State of
California.
C. Special improvement assessments, if any.
D. Easements, rights, rights of way, covenants, conditions, restrictions and reservations of
record.
Seller
a
� ra.
•v .
Buyer
RC District - P/annina Review Form
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 applicability of compatibility issues or need
to require the filing of Master Design Guidelines by the applicant. It shall be transmitted to
Building & Safety as your correction list. Please attach additional explanations as necessary.
APPLICANT: CORONM CONSTRUCTION
PROJECT
ADDRESS:
APN:
LEGAL:
CK'D BY:
BIN NO:
Avenida Carranza
773-125-010
.LOT' 15 ,.BLOCK 55 , UNIT 5 ,. S.C. @ V.L.Q.
STAN SAWA
See Greg CASE NO. 99-43 . CHECK DATE: Gze --Vu &
Inform the assigned Building plan checker upon your assignment -to this case. The CDD
Executive Secretary maintains a. log book to track applications and assign case nombers.
REQUIRED ITEM Y N COMMENT/CORRECTION
Case logged and number assigned V
Verify legal and APN information
Consistent with MDG on file (as applicable)
MDG filing required (5+ filings since 9/3/98)
-
-Consistency-with-street/surrounding -*area:
Colors v
Materials v
Architecture
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.