9905-070 (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. Date
�'63a81 13E/31/2U;
Ddb Signature of Contracto�XC 17"�-t •-_
OWNER -BUILDER DECLARATION
1 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 contracts�ig" ith licensed
contractors to construct the project (Sec. 7044,• Businessrofessionals
Code): r
() I am exempt under Section B&P.C. for this rear
Date Signature of Owner �t
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty ,of perjury one of the following declaratiw.fI`s
() I have and will maintairi a certificate of consent to self-irlsu a for workers'
compensation,.as provided'for-by Section 3700 of the LabgV-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:
Cartier Policy No.
C3O;LD'EN EAG1E, fS> NWC-I1=60-02
(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,l should become
subject to the workers' compensation provisions -of Sectio, 7'3700 of the Labor"--
Cod'e I shall forthwith comply with those provisions'
Date:�� r! , • `1 �APPlicant r
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.
A. 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. 1
/Signature (Owner/Agent)~. 4 A Date"54 t'
BUILDING PERMIT PERMIT#
"'199135-07()
DATE VALUATIONLOT TRACT
45!(3ti11 °�9 S92,163.9_ 45 15 1155, U5
JOB SITE
"ADDRESS 51_700 AwIEWDA CA�lt�%NZA
APN '
773-125-1110
OWNER CONTRACTOR/DESIGNER/ENGINEER
C,I)R.0NN1-L r_";rl'ERPR.tfil:S' CtaRONEIt, C0N.';31WCT[0N1
51-540 EISENHOWER DR. 51-540 EISENHOWER D.R.
L.A QUIVrA CA 92213 LA QtI.HM"PA, CA 91213
(7650)564-4604 CIALIt 2261
USE OF PERMIT "
�`.'
.SFD - i?iMMiT D iSNN. T E BLOCK . OR T'WL (MASTEM 64
e
GAWWCIWCARPOW/,� 504.00 -3F
PUIbUti:<1a"'1'YO 3,i,00 sw
'I;RACTCOWI'6CI'MION 1,2900) S
5f7. WALL 1y.00,t-
5 Ff. WOOD FENCE 150,00 LF
EXHAIATE, D COST OF CONSTRUCTION
921363195
PERAUT FEE SUMMARY
FEW UI i>e 8rF 101-000-439-3.18 4,250,00
PLA8+1 CHECK FIVE W -WO-439- 318 $51 ! ?8
CONSTRUCTION PTIE 101-000 4:i �t-�)VO $608.00
NIECHiVNi.CAL• IFM; iGA-t'30(}42I- ko $47.0)
_• f:I.E 3'I;iCAL: IER 10!-0130-420-000 S121N.71
R.1WMNGF-fir; 7 t-flt •43.9-t3t10 ►� s'►
STRONG MOTION F66 - WiSrIID ,! 01-000-241-000 39.219
ORAD:fIvN0 I lrts 101-000-423-1100 520.00
INF-RAS'I" UCIII ftEFRE 225.0(11? -443-342 S2,042.67
PREC TSE PLAN if)1-000-441-�fd5 1:'31{{0:00
S nYD 3'1'Ai, i )I�S"!'►t(.TC"3'1C�te( ��NCJ .qN t"ktt,;C;
gV07 a7
i,S �'!'.1~-p.A.l'F� F13ti
-$2`Q.JO
TO'fflL P ERMff II'EES .fM E N,<<}W
$3.347.47
ECEIPT \� f
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION 7F77DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forts & Footings
fix
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
—
Exhaust Fans
O.K. to Wrap
1.1—M — f
F.A.U.
Framing
Q — —
Compressor
Insulation
Q
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
o -�
Drywall - Int. Lath
S
ae,,
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
d• 7
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lin esHeater
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)
...ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring ;
Low Voftage Wiring
Fixtures. t .
Main"Service.
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors:
Temp. Use of Power -
Final
Utility. Notice (Perm) . ' . .
gad -070
P.O. BOX 1504 APPLIC T N ONLY
Building ! C( Y YCA V 76-495 CALLE O �S
Address LA QUINTA, CALIFORNIARNIA 92253
1-1
Owne �
CNil��� I
C I
Minimum Setback Distances:
Front Setback from Center Line
Mailing
Address
CityZip
(_ X ( 1,VI
C1 3
Tel
CC 3 nStK-�1 P ` l C, ,, tS y(� G (, U-1
r
Address r�
Date Permit
Iti/" �l�1 t >L
Validated bv:
Zip,.22 �i j
Tell,.` 1I _
State Lic. �,
& Classif.
i / 1 I
City
Lic. # 22 6
Arch., Engr.,
Designer
Address
Tel.
City IZip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
affirm that I am licensed under provlsionssof=Ghapter-B•(commencing with Section
Ivision 3 of he BL in ss a Professions Code, antl my1 cen e s i I for a nd
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,13usiness 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
Diviston 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).
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+for sale. If, however, the building
or improvement is sold -within one year of,completion, the,eowner-builder will have the burden
of proving that he did not build or improve for the purpose of sale.) I
I 1 I, as owner of the property, am exclusively cvntractigljq with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions.Code: The Contractors License Law
doesnot 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 7 1 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. O 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: 0, after making this Certificate or 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.
Signature of applicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE"'"CONST. OCC. GRP._
`�j
A.P. Number r -� 3— 12 l ' C,
Legal Description
Project Description > �•��
t` �-
Sq. Ft. f1 ~No. `"1 No. Dw. '
Size Stories Units
New LRI✓ Add ❑ Alter ❑ Repair ❑ Demolition ❑
(PI.dGGii tfoV4c rhSyED2e, DG-n,u1r �n3-104-.
n
PERMIT AMOUNT
Plan Chk. Dep. / /
Plan Chk. Bal. , P/
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
r
FINAL DATEINSPEF
r
Issued by:
Date Permit
APR 15 1999
Validated bv:
Validation:
9
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
F
CORONEL.
CONSTRUCTION
( 760)564-4604
P.O. BOX 389 FAX (760) 564-4202
LA Ql11NTA, CA 92253 LIC.# 634981
April 14, 1999
City of La Quinta
Building and Safety
Dear Mark Harold;
We are requesting a plan change for 51-700 Ave Carranza due to -the homeowners request
for a different floor plan. We would like to transfer the fees we paid to the, new plan.
Sincerely,
Esequ el oronel
RC District - Planning 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: COROMM CONSTRUCTION
PROJECT
ADDRESS:
APN:
LEGAL:
CK'D BY:
BIN NO:.
51-700 Avenida Carranza
.773-125-010-4
LOT 15 , BLOCK 55 , UNIT , S.C. @ V.L.Q.
Fred Baker
CASE NO.
99-61
CHECK DATE:
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 numbers.
REQUIRED ITEM
Y I
N COMMENT/CORRECTION
}},.,\\:.}•::.`\::?^�:;}}}},?�.}:'?�i��ji':'.��i4�'ii:`:�i.:; ...�:.:•+:R `: •h•::.
.:....::..;+..\;....:..:'•`G:}:":...'i•S�{}�':\\:\•�.r:F^`Er
•.:T\}..\4:....: ..�.}:: t\•.::::.:.?>;: •.... `.:. q.;}:
EX}}};J
bM:p1?►13•[{r�[�\iv:....N.:':P�i}....�v:::t::�.::}:.:`�:•::::i}}.n?;•.\:.::::Q`v:n�.....:.
i:.:4}�\\.:.:}.......nn •:•i4i�:•:K:}�•;•:t :?iii{j:�.y;:\.:}vZ:'`.
Case logged and number assigned
Verify legal and APN information
Consistent with MDG on file (as applicable)vvrmrwf
E
U:
DA
MDG filing required (5+ filings -since 9/3/98)
Cbiitistericy with-street/surrounding area:. `
Colors
Materials a
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.
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
Date 3/24/99
No. 18490
Owner NameEsequiel Coronoel
CERTIFICATE OF COMPLIANCE
APN # 773-125-010
Jurisdiction La Quinta
No. 51700 Street Avenida Carranza
City La Quinta zip 92253
Tract #
Lot #
Type of Development Single Family Residence
Comments
Permit #
Log #
Study Area
Square Footage 1645
No. of Units 1
Cert. # 18474 issued for 4500.76, check was tor 4576.00 - there is a
;redit of $75.25 which is reflected in this certificate.
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.
11
It has been determined the above-named owner is exempt from paying school fees at this time due to the-foilowir_g'; ;
reason: -
EXEMPTION NOT APPLICABLE ,
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
1.93 X 1,645 or $ 3,174.85 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 Ind. Bank/Zeke Telephone
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Adriana Gauto
Signature
Payment Received $3,099.61
Check No. 183225
NOTICE: 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
collect 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