0206-141 (SFD)C. 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 /r Exp. Date
634981 i ( M%J'1tIZI
Date `?- � t, `•'t'• Signature of Contractor-� ��-' '`ti- 'L -•-f
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 E FUND Policy No. 154393"-01
(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 thWif I should become
subject to the workers' compensation provisions of Section 37,00 of the Labor
Code, I shall forthwith comply with 4hose provisions.
Date: "1 E t •Wim- Applicant-,
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to}
any permit issued as a result of this applicaton agrees to, & shall, ihdemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) �_�� -� Date -_2 - L i 't
BUILDING PERMIT PERMIT#
O20fd-:IdA -
DATE VALUATION .� LOT 1� TRACT
fi
F
JOB SITE
ADDRESS SF NWSS &1-7 AYF1C/•M.i�.K7A
APN N -275-010t
OWNERS
CONTRACTOR nFq`IG■KER/EN IIINNF]E'fR
i�j {
C0:R.0.I,'QH.{.1.4..i•� E1AZ1j(•1MW K$
�/t
f�
(YjiZ`.dAV.11.�4 C�SRfa� RUCI.71011T
PO BWX 389
78-•1501: ALLBET,: W1 W:1Z'. c,R-230
LA QU7Yto A. 922S3
a,A. Q=4T . CA, 92253
(760)564-46134 MVS y'61
USE OF PERMIT
SFU - WT 13, M.AiJr9 MAS` K.R. PERMIT DOFW NtYr 1.NCLUI,?F: BLOC:
WAV, POOL SPA eJRDIM lWAY APt'RC' ACH, ';% PY.A9 04HCL FER
R.E.1)UMON RZTeLECr1140 MUT14PL , ISSLI.ANCE OF&*,MK P1,AN1 `'C`1'P.ta
TRACT CONSTRUCTION ION t3F'
Ea:AakAGFrX�AI P0JRT 50-4.00 SNS
:.RT, WOOD MICE 200,001Y
ESTMAM %{7W OF CO:NURUCT 100
3 .A.I1"16120
T i�+.•��jBytlA.RY
P�rot
q��?O[[�i T�j:E�ry ��S'yy'���,••�i
101-000-418-1000 y � {� { } y� {q�ry p A
CONZi�fa�a4��CTION FEE 101-004+'^f 18.1000
PLA14 CHW K FEE 101 �i3f�Ii � 3 ��3 T � 5.14it.'77
FEE DIRPOSIT 4256.00
f4E1:I•I.A193t:'AL YER 101-000421-000 $62.00
ELECTRICAL FER 101-000-420-000
PLid:A.'f DIGPEE 101 000.4131-000
OT11,090,1MOTION FKF - JUSID 101--000.241.000 '3111113
CSIrADIND FEE 101-000-423-000 M00
DEVE60k'1✓It IMPACf ME S2,405,00
PPIEC1SF. Y*I d�PI 101 �t1�St1-�14 k 344 5100.®t1
t g Alf ..'.1;C1'" . i, c ilk`TidU(:'1 T01a7 P.Yuix27�c:?PLAN Ct:141L
', t3,,66p1.64
f �PI�C �t e7' �y
As,R'.0s XrrA��.d�°1J�eC;eisd Z°�IES
- `i�250-W
I,1PF.TaU `lr:' M DUF HOW
Zell3..64
WR
CITY OF LA QUINTA
FINANCEDEPT.
RECEIPT
DATE
By
DATE FINALED
INSPEC OR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
I
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
O2_
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
(J , �_ (J�
Compressor
Insulation=�Z
U
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 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
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
_� G
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_ Z T/
Encapsulation
Gas Piping
Gas Test
Appliances
Q3G
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 X03orY
Utility Notice (Perm) •d Z
COMMENTS:
Buildingcz�1 ; _
Address �t
c&ty/ 4 4 Qufk& \
P.O. BOX 1504 APPLICATION ONLY
78-495 CALLE TAMPICO n�
C C LA QUINTA, CALIFORNIA 92253 ^rj�
O
Mailing
Address _G (7,1� �,C�
City Zip Tel.
BUILDING: TYPE•CONST. OCC. GRP.
A.P. Number�71 4 - �� S _--() \ b
Legal Description\—o,)�, -7
Project Description ) -
Address q
CityZip
Tel.
State Lic. �, tT
& Classif. - " `
City
Lic. # l
Sq. Ft.
Y
No. ` No. Dw.
Size
Stories \ Units
Arch., Engr.,
Designer
New p Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRA OR'S DEC
I here affirm that Item licens ntle D v(Sions o Chapter 9 (Com encing51"
000) ivisio of the Bus' ss o essla Cotle, a d my licen is In c
e
SIGNATUREDATE
WNER-BUILDER DECLARATIONEstimated
I hereby affir xempt from the Contractor's License Law for the followingreason:
VtRatl,,a
Valuation
ISec. 703 and Professions Code: Any city or county which requires a
PERMIT
AMOUNT
permit to construct,ve, 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
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
Plan Chk. Dep.
?�
subjects the applicant to a civil penalty of not mote than live hundred dollars (8500).
l: 1, as owner of the property, or my employees with wages as their sole compensation, will
Plan Chk. Bal.
Const.
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
Mech.
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
Electrical
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.) ,
Plumbing
I i I, as owner of the property, am exclusively contracting with licensed contractors to con"
struct the proiect. (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
S. 1.
'
such projects with a contractoi(s) licensed pursuant to the Contractor's License Law.)
i? I am exempt under Sec. B. 8 P.C. for this reason
Grading
Driveway Enc.
Data owner
Infrastructure
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
(l Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(This section need not be completed If the permit is for one hundred dollars ($100) valuation
Or less.)
1 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.
Dale_ Owner
NOTICE To APPLICANT., If, after making this Certificate of Exemption you should become
th
subject to e Workers' Compensation provisions OI the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Side Setback from Property Line
Lender's Name
FINAL DATE
INSPECTOR
-
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 slate laws relating to building
construction, and .hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Issued by:
Validated by:
Date Permit
Signature of applicant Date
Mailing Address
Validation:
APPLICANT PINK = BUILDING DIVISION
City, State, Zip
WHITE = FINANCE YELLOW =
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 16 54680 Avenida Carranza 1846
Unit 6
CERTIFICATE OF COMPLIANCE
Unit 7
Unit 3
Unit 8
Desert Sands Unified School District
4$0
Unit 5
Unit 10
47950 Dune Palms Road:
4�
o
Q BERMUDA DUNES C
Date
7/16/02
La Quinta, CA 92253
rn RANCHO MIRAGE d
No.
23378
(760) 771-8515
�� INDIAN WELLS
LM DESERT
PADESERT
LA IO Ty
INDIt^�
Owner
Coronel Enterprises
APN #
774-275-009 & 010
Address
PO Box 389
Jurisdiction
La Quinta
City
La Quinta Zip 92253
Permit #
Tract #
BLK 307
Study Area
Type
Single Family Residence
No. of Units
2
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 16 54680 Avenida Carranza 1846
Unit 6
Unit 2 15 54700 Avenida Carranza 1846
Unit 7
Unit 3
Unit 8
Unit 4
Unit 9
Unit 5
Unit 10
Comments Two Cashiers Checks: $3950.44 - 26480 and $3950.44 - #264839
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 50
square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile home
It has been determined that 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
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.14 X 3,692 S.F. or $7,900.88 have been paid for 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 CC VIB - Ish Coronel Check No. see above
Name on ine cnecK Telephone
]Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Crystal Scott $7,900.88
Payment Recd Over/Under
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1), 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 issued, or from the date on which thos
amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
1
RC DIS".- CT
- PLANNING REVIEW FORM
This form is to be used by CDD staff for review of single family dwellings in the RC (Cove
Residential) District per Section 9.50.090 of the Zoning Code. Its purpose is to determine:
1) that the proposed house design does not duplicate the same architectural style of any
house within 200 feet of the applicant, and/or 2) if there is a need for the applicant to file for
Master Design Guidelines. If the applicant does need to file a Master Design Guideline, please
transmitted this information to the Building and Safety Department as part of your correction
list. Please attach additional explanations as necessary.
APPLICANT
SITE ADDRESS
Coronel Ent.
54-700 Carranza
APN 774 - 275 - 010
LEGAL: LOT 15
CHECK AND APPROVED BY:
CASE NO.: 2002-663
BLOCK 307 UNIT
Greg Trousdell
DATE:
S.C.@V.L.Q.
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
Verify legal and APN information
Consistent with MDG on file (as
applicable
MDG filing required (5 filings since
e
9/3/98)
Architectural variety within 200 feet of
X55\Of%
the surrounding area:
Colo
t �
Pray
o
t eP jOyc
I -A 01I/N7.
° m RECD
Materials
EXr
101,
b`l
ond���o °• �`' Sys T
Architectural design features
Other Requirements:
Liy�r �W
-
RECORDING RECUESTED BY:
ANO WHEN RECORORD MAI_ THIS DEEC ANC,
UNI-P.S5 OTHERWISE 6F OWN 5ELOW,
-M;klL TAX 8TAT EMENITS T0:
"EX" CORONE–L
D 10 -� S4 - loo Av6
'—� t3 V Cc, r r 0.. r-. Z -.,-
3PA:;G AaOV THIS LINE, KCR rsKCOP.]r;'S t)gg
The undersigned grmntor(s) declar:st;s):
Grant Deed .A.P,N, 774-275-0'09/010
Documentary tre,'lsfsr tax is S
( ;cx) computed on NO va(us Of prsperty convaypd, Or
(. ) computed on `ull vslue less value of Pens and encumbrancas rams)ning at ;Ime of sale,
Unlncorperetad area. ( ) City of
FOR A VALUABLE CONSIDERAMN, receipt of wh;Qn, is h9rsby ackncwleoged,
CFARLES HOPGAARDEN
hereby GRANTS) to DAJ.D BOSS ML --ER, a cArrtrd Mar- as hid -scla and separate property
ih9 ,rW rrcpvrt' il^ Che City of ia
C,u�nca
Slate of Cylifornia, desiv ced as
CJUr1:j oP �iVA�B��C
rnd
Lot c- Black 307 Utit "N _ , Sante Carmalita at VAI S LA Qulrta,,
as pet, _ecotdS6 i -a Boob -ages ^, d: spy, Racozda of S.Ivereide County,
Cn.';1.Aorn.a
Caiad April 18r 2002 Signature ofGrssnlor
sista of Catircrnis ) ,
County of
On befcr,s me, —
CHARLES HOFGAARDEN
ptr.ao-.raily eecbe(ad -- --_ —
C.HaRLES i3QFC�r��RDEN
pars: natty known w me (or proved to me on the Dash of eattsfacto; y
avldence) ;o be the parsons) whose namt:(s) isiere subsc 'bed la the
wtt:^,:, ;net ar,,rr., and ae}�,nowlaegrd to me Inst telatltAhey axecu;ed
:na name in h ahvr+l air autncrlyad capaclty(ies'), and that by _ —
hisrher'theIr si;nature(i) on >re ina:rvmant iha aanon(s), or the onety
upon bahalf of whlch the cerson(s) Acied, executed the irstrurr,ent.
WITNESS r -.y hsna and af{cla! seal.
Sldn9cufa
NIHIL TAA STATEMENT6 TO
I
,
LFi11'0N
S,fli A2 83N,Gjj INVEZ:l Ui) '8l'ae'b'
I
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: 54-700 AVENIDA CARRANZA
Use Classification: SFD Bldg. Permit No.: 0206-141.
Occupancy Group:.. R3 Type of Construction: VN Land Use Zone: RC
Owner of Building: CORONEL ENTERPRISES
Address: 78-150 CALLE TAMPICO STE 230
City: LA QUINTA CA 92253
By: KIRK KIRKLAND
fd Date: 1-24-03
Building Official
POST IN A CONSPICUOUS PLACE
r cow
INSTALLATION CERTIFICATE CF -6R
Site Address Permlt umber
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE REDUCTION
Pressurization Test Results (CFM @ 25 PA)
Test Leakage (CFM)
Fan Flow
11' Fan Flow is Calculated as 400 cfm/ton x number of tons, or as 21.7 x Heating Capacity
in Thousands of Btu/hr, enter calculated value here l,�c.•
If fan flow is measured, enter measured value here
Leakage Fraction = Test Leakage/(Measured or Calculated Fan Flow) - ?
Pass if leakage fraction <_ 0.06 ❑
Pass Fail
❑ For AEROSOL TYPE SEALANTS ONLY - The following diagnostic testing was completed:
Duct Fan Pressurization at rough -in measured leakage (CFM)
CHECK AFTER FINISHING WALL:
❑ Yes ❑ No ❑ Pressure pan test or House pressurization test
❑ Yes ❑ No ❑ Visual Inspection of Duct Connections /�/ / ® ❑
Pass Fail
U�THERMOSTATIC EXPANSION VALVE (TXV)
Yes ❑ No Thermostatic Expansion Valve (or Commission approved ❑
equivalent) is installed and Access is provided for inspection
Yes is a pass Pass Fail
❑ DUCT DESIGN
❑ Yes ❑ No ACCA Manual D Design calculations have been completed,
Duct Design is on the plans and duct installation matches
plans.
2.Yes Nv
TXV is installed or Fan flow has been verified. if no TXV,
❑ ❑
verified fan flow matches design from CF -1R.
Measured Fan Flow =
❑ ❑
Yes for both 1 and 2 is a Pass Pass Fail
Ef I, the undersigned, verify that the above diagnostic test results and the work I performed associated with the test(s) is in
conformance with the requirements for compliance credit. (The builder shall provide the HERS provider a copy of the CF -6R
signed by the builder employees or sub -contractors certifying that diagnostic testing and installation meet the requirements for
compliance credit.)
r
l � �-� / I7 a3 �D� �s •
"rests Signature, Date nstalling Subcontr for (Co. Name) OR
Performed General Contractor (Co, Name)
COPY TO: Building Department
HERS Provider (if applicable)
Building Owner at occupancy
HUU 14 '02 1'(: 54 FK
REPORT OF FIELD COMPACTION TESTS
TO 95644202 P.01i01
cv : r.Lvovr NO.:
0 - : E: g - +- •
C41fx r;
onOiE67[f_
c o ct. � t�� � t,.,. _
CAVCE IN3o0.�-aA Tlp�+ +n0
.mCiS-Un¢ c
I 0111• Sr+wG+Ap �a110 q;•;IpN nVMOfaf
:.0.1 a. r10 •+. EAC In T, _,
C.tVCL 101V S�r.I (rl :' N vaRl_;Ipw
-..udAa fiO r'
_
�CUwr$ taOnl iaaE�S I
,.A:.1
i1(
_•1 U - ]. �.1
I .1 �'11_il��l/��,VV1.
USE
�> C
i Cl'0 rl �.v ! SOO,I jr 1
='.: ��: �1�:1 j
.ao1StUAE:
I Z_. - -
10.:0.
'
-�
.. ',0 _. 1p.. O'er. �•�
I 'Ell S:rY:^Ei1SCr�•: ;
_. 51 1':
iw i
—
I-
i
`/:SUS. _i_:,SSIF:C=,-ION C: !OIL
:A:.X. �]R`,' p��ISI-Y.
I
��? I op -.I um .:.C:S Ung.'•
VWT
I
'i'Mv\vt(A
L
�
' �
9 5
Q),7 G`
-= :.1?.... -:0 •+
.mCiS-Un¢ c
:a7%..I'^,
J�
•J
�
,.A:.1
_•1 U - ]. �.1
I .1 �'11_il��l/��,VV1.
�> C
i Cl'0 rl �.v ! SOO,I jr 1
='.: ��: �1�:1 j
..:CIS L;AZ 1 =ir..- I�
I Z_. - -
10.:0.
;n.. i .::IS
Z
1
I
i
�
•61
I�Z� 3
L
�
' �
9 5
Q),7 G`
j N1
•�C�1��ICIaN
1LE7"'a u�
]A<t Flt:. a -ot inC--ap
, - IAJc COVtiE C - 4t'rc-�QG I
• �n.. rte.-�,rr e _ .. n. •n ,..� .
I � 1
1
• j i
i
1 i
C es..Or COr wffx S o'E C IF.C•a 110• i
V'.
CS OF tFICAT1Qns
** TOTAL PAGE.01 **