0309-112 (SFD)U)
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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
61/31/2(
6 -Date Signature of Contractor:
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.
( ) 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 STATE FUND Policy No. 154,207-03
(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 (&California, and agre that if I should become
subject to the workers' compensationitpro visions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
,Date: -A Applicanta_-k A- }
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1: Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby'authorize representatives of this City to enter upon
the above-mentioned property for, insp inspection purposes.
SSignature (Owner/Agentled,. \ I-- Date"(-
BUILDING PERMIT PERMITk
0309-112TRACT
DATE VALUATION LOT
619,i�38d ti 21d3 2 EILK 234
JOB SITE
APN
ADDRESS 1 �pry{
OWNER
CONTRACTOR/DESIGNER/ENGINEER
C<'1>20k1M1 NMRPIMSE3
CCS,RIONEL C140M "TI.Z•f:1'4 ."3ION!
PO BOX 389
5'1.103 AVENMA VILLA 4101
'C.A Q13MI-A, C -,k 92253
I -A Q'UTAfA CA : 2253
(760564-46D4 CB110 2261
USE OF PERMIT
..WGI —.
1048 S.F. SFD PERMIT DOES 140- INCILUDE WA:3ta£CWALL, POOf.JSE A
OR i:ltlVRWAY APPROACH
TRACT f:"3'1RUCTION 1,948,00 OF
PORCH/PATIO 36.00 S1?
0ARA.cIIJCr'� W1T'3RT 693.00 8F
F' TR"TM COQ➢,' OF C'`Q NSTRUCI-)IONS.M,
PZR1 C,r 1t•`�$' : SUMbWZY
CONSTRUCTION FEE 101.000.418.000 M9.50
PLAN C'1s1Lrl:1C FEE 1101-000-4.39-318 $95.69
FEE DU1031T 101-000-439-318 W9100
AAZCHAN1CA1, FEE .101 -OW -421-M.) gS9.00
KLECrTRICAL 1HE 101-000-420-000 �19.St,.xQ
PLUPABIN10FFS 101-000-419-0100 S12A.00
STRONG MOTION FRE - &VISM 101.000441-000
GWINO FEE ...1,01-000-423-000 X15>00
DEtC1NWPER IMPACT FEE $2,405 Ott
PRECISE PIAN 101 -000-441,-34.5 �i043.00
RUr110N' AND LCL" CHC.,C°IC
p UU LES3 PRE -PAM PIES
4250.00
S EP 2 3 2003 °1 °y. BTU 3?' Mfg DUN AOA
$ 3,ft.go
p•U1NTp'
�
c, F ANCE pEPT.
.
RECEIPT
DATE//fir ! %
BY(j
D I F%NALE
INSPE
Nyy
INSPECTION RECORD
i.
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
1
Return Air
Steel
T
Combustion Air
Roof Deck
o3
Exhaust Fans
O.K to Wrap
F.A.U.
Framing ,Q
Compressor
Insulation
G
Vents
Fireplace P.L.
l:
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
j "
Drywall - Int. Lath
Ir
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
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:
MAY -25-2004 TUE 11:48 AM
Coronet Construction
FAX No- 160 564 4202
N. u
I
CI1'� QUINTA ti
DEPARTMENT s
77012
EQUEST LINE a
777.7153 ;
Owner 'k-LIJKuivi+`.L LNTERPRISES }
Contractor=CORONEL CONSTRUCTION
Permit Number 0309-112
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 53-975 AVE. CARRANZA
1948 S.F. SFD, PERMIT DOES NOT INCLUDE BLOC
WALL, POOL/SPA OR DRIVEWAY APPROACH .
TYPE OF INSPECTION DA -M INSP.
{
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO '
I TURN ON UTILITIES OR OCCUPY Bl III n'ern .
Certificate of Occupancy
Building & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
Use classification: SFD
Occupancy Group: R3
BUILDING ADDRESS- 53-975 CARRANZA
Type of Construction: VN
Owner of Building: CORONEL CONSTRUCTION
Building Official
POST IN A CONSPICUOUS
Building Permit No.: 0309-112
Land Use Zone RC
Address: 51-105 AVENIDA VILLA
City, ST, ZIP: LA QUINTA CA 92253
By: KIRK KIRKLAND
Date: 5-25-04