0012-237 (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�
h
63.4981 r
Datek. r' Signature of Contract otr-• ` ( ( Jr
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 ofthe work for which this
permit is issued. My workers"compensation insurance carrier & policy no. are:
Carrier 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, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions. I j
Date:; ., t Applicant ; :, I i. �
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 `aIuthorize representatives, of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) = f' Date S
BUILDING PERMIT PERMIT#
DATE t VALUATION LOT •" % TRACT
�
! !f i $592NMO SM288 U2,5
JOB SITE;
APN
ADDRESS
A -:fib A VE�IDA CARRANTZ.A.
774 -241k -M
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CcaROW L `ate'.
COR013rIL C101413MU(.1:3ow
?8,1'SEy+W�):.�'t'��+33i�[C;�;��3:i'f23�
'1�P75'fit.f��1':�•Ti,At�'i'fC�;3rlx"f'k�?':t7
LAAQU;11.TA 0.A 9 253
LAQTT'aTTA CA 9212S3
(760)36446(94 CMIX 2261
\
USE OFFPERMIT
ORVLE, F$iY WN
G-,
Sri) I .FJJ rKA.S' P41- PERMIT DOPS, N''0T dNC LU,99 8L0CK'et At.4 PDOL
SP.A, OR D.'R-iSi 21 W.ttY AP1'!t(?AC,'g{. W MAv'd`.UR "t3 -V
f
TRACT CaN=, RUCTION 1,402.00 SP
IrtJ[,'.L'F1/PATIO MAIO SF
C3}9.:fi: UDICmARPOR i ill) swN.9+1
5 FT. WOOD VEk CY, 300.00 J_F
it srzwATzD cogr we co.,Nsr ,iwc no.,N
7 i
PERM, rW Im W%MARY
CONSTRUCTION FEE 101 _0004) 8_000 $601104
PLAN C11ECK FEE $50&53
MECHANICAL Wlso
1r�L�s�t TRIC A.L 1 13 1017000-420-000 $130.08
1'I.,jUMBIWI 4 T`EE • 101000.419.000 6r1101W
S"i' uma m rioN nn?. - rasm 1 of -1+W-2.41-000 $9.:10
OI:" Z), 0PFR rTti9}?AC: M2, 1"907. (to
1'a4:.0 nPa Ax 1€11••000-441'•343 If1fr.A4
FZIV DEPOSIT
f
f.
SUB - TOTAL fplo 'slvoi",:CS'w AM JK;t M-4 CHEM'
$3,440.09.3,
-
NP
00 Y
17
11
o�B�il
{
RECEI -
DA'7 f
BY /
DATE FINALED
INSPECTOR
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
- C%lT
Exhaust Fans
O.K to Wrap
2 O 1 Sr
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
f_
Drywall - Int. Lath
Final
GG
BLOCKWALL APPROVALS
Final
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 Linest
Water Piping
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
- p ( (
Encapsulation
Gas Piping
Gas Test
8
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:
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 the Building and Safety Department as your
correction list. Please attach additional explanations as necessary.
APPLICANT CORONELI' CONSTRUCTTONnLa
SITE ADDRESS 54-3.0.0- Avenida Carranza
APN 774 - 243 - 002 BINNO.: CASE NO.: 2000-368.
LEGAL: LOT 22 BLOCK 288 UNIT 26 S.C.@V.L.Q.
CHECKED BY: Crpq Trmi,gdpl 1 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
N
COMMENT/CORRECTION
Compatibility Review
Case logged and number assigned
/
Verify legal and APN information'
Consistent with MDG on file (as.applicable
ti 1,
MDG filing required (5 filings since 9/3/98)
�0
Consistency with street/surrounding area: 41,104
����`
o�
y•
Colo>�
o
�v
P,.A-,P
Materials
Architecture
•�
Other Requirements:
b-13
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 1/2/01
No. 21429
Owner NameCoronel Ent.
No. 54-300 Street Avenida Carranza
city La Quinta
Tract #
Lot #
APN # 774-243-002
Jurisdiction La Ouinta
Permit #
Log #
Zip 92253 Study Area
Square Footage 1492
Type of Development Single Family Residence No. of Units 1
Comments
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
2.05 X 1,492 or $ 3,058.60 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 By CCNaffey Independent Bank - Ismael Telephone
Name on the check `t
e
By Dr. Doris Wilson,
Superintendent
Fee collected /exempted by Ellen Patino Payment Received $3;058!60
/{ Check No. 235139/235120
Signature
JOTICE: 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 thedate 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
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to. the requirements .of Section 109 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:
Use Classification: SFD
Occupancy Group: R 3
54-300 AVENIDA CARRANZA
Type of Construction: VN
Owner of Building: CORONEL ENT.
Building Official
Bldg. Permit No.: 0012-237
Land Use Zone: RC
Address: 78-150 CALLE TAMPICO #230
City: LA QUINTA, CA. 92253
By: STEVE TRAXEL
Date: 05-02-01
POST IN A CONSPICUOUS PLACE