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9710-175 (SFD)LICENSED CONTRACTOR DECLARATION I herQby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is iri full force and effect.. . License # Lia Class Exp. Date Pate f ^'" 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: ( )- 1, as owner of the property, or my employees with.wages as,their sole compensation, will do the work, and the structure is not intended orIoffered.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•ttie 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 Policy No. Cft' LD.1 N 1I.W33,13 r3JS, N'iii'("'I1161f^u"J0 (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 La6o' r Code; I shall forthwith comply with those provisions. Date: f 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 Applicationis hereby made to the Director of Building and Safety for •a permit subject to the conditions and restrictions set forth on -his „application. K.: 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. fSignature (Owner/Agent)-^r*— Date BUILDING PERMIT . PERMIT# °°NTR°`# sir#I•U7�i DATE , VALUATION•.�.,�u LOT; 1 TRACT S,y��9,,f5 tJ T V .- JOB ADDRESS ':.1-51t�X•�..�VOIm ta�noo APN :773-12.•,•003 ' OWNER t CONTRACTOR/DESIGNER/ENGINEER I ; ;;I'QU1.11 COM, 1!I',• �.;.►,130X 34W, p.o. WX 9 1.A QUNIA. �� t,.A 9229 LA t,?Li11`!•1'A. CA �Y*`.'53 , - �'�€�L33.Sf►rk«zfc�?� £�'d3i.,� ^�+�t USE OF PERMIT ERR) , XRW'l DOEIS NOT W+.:C.UD UOCK 14"ALL S 0A POOL. P140 TTM—S . TRACT CM74.371MUOTION IN -17111'"ATIO F ' f_°rirARAG*W(1 il2]k: XT roi5mij 13t' +moi F�r!'' lK.'aS OF CXkll'YSV.�.�t'w.°'i'Ay C0N.S`TR*0C"rfQN FFS,, 1011400418-000 S500) . fl1,A1Z t;=str.�g;1,1� w}; a(3F_(�l0- i3�aa3IH �.tvc,,;t� L ' Mf1;�:liAihl`it:tii, •t:f: _ 3f7i.-fltit�-�2f••E3i7fi �!i3.:'sE1 I LF-C-11tIC;A1 flit~ SM01 f+f,T M)ItINGFFJ-i, $121.75 {, ."3'0)NG Nti:3':€' ON V013 - RtSi3) MU -000-241-0M : at:.1 k ilR.r1f;>I�t.P t�ni: Cit-nisi)-��3 %ru srtt.a+ti ItdFit/!:_+"L`RLIC rF.YfLV f+'1; '225 -(M -443-34Z CY) ss41;cf,411 1V?!,AK it) 140,11-441-345 LESS #3ti 't'AlD:PEI, S rcr3�a,rs�.taiw�.r< 0JJPIN 0uv RECEIPT DATE 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 Exhaust Fans O.K. to Wrap - F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wali Insulation Condensate Lines Party Wali Firewall Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL APPROV LS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I I Gas Piping PLUMBING APPR VALS 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 APP O ALS Temp. Power Pole .4 W17 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: ' Building • �/I 1 4 4 Q P.O. BOX 1504 W { 78-495 CALLE TAMPICO able LA QUINTA, CALIFORNIA 92253 Mailing I Address ®0 6 3ef City /°l, ZIp�� Contractor (/ Address?U 'City/ - 0 Zip��' g 3 Tel.. /_ State Lic. ,_,(�J' City C/7 & Classif. °7 Lic. # Z2.� Arch., Engr., Designer Address al Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full forte an effect.p. ��,� ,,SIGNATURE - DATE .tom OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business 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 th 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 (8500). [] 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 ort! roves 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 1, 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 contractor(s) licensed pursuant to the Contractor's License Law.) 17 I am exempt under Sec. B. & 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 lhp work -for which this permit is iss ed, 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 to the Workers' Compensation provisions of the Labor Code• you must forthwith comply with such provisions or this permit shall be deemed revoked. r 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 if work thereunder is suspended for 180 days. 1 certify that I have read this application and state that the above information is correct. 1 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 adplicant —Date— Mailing ateMailing Address City, State, Zip i _ G,r 9_710 — 1 TI APPLICATION ONLY .DING: TYPE"CONST. OCC. GRP. �+ Number -7% 3 — 1 3— 1 I Description L_ o+- 1k \U mt Description S - r-" • ILN r Sq. Ft. n 'l No. No. Dw. Size Stories Z Units New t7'� Add O Alter 0 Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. J Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL _%J. 00 REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line YA Rear Setback from Rear Prop. Line t; n Side Street Setback from Center Line 0 Side Setback from Property Line FINAL DATE - INSPECTOR Is s u eby: to Permit Valid'ateby: 1 WHITE = FINANCE YELLOW = APPLICANT f PINK = BUILDING DIVISION Desert Sands Unified School District Notice: 82-879 Highway 111 Document Cannot Be Duplicated Indio, CA 92201619-775-3500 CERTIFICATE OF COMPLIANCE Date 11/3/97 No. 16220 Jurisdiction La Quinta Owner Name Esequiel Coronel No. 51-590 Street Avenida Rubio APN # 773-122-003 City La Quinta Permit # Log # Zip 92253 Study Area Tract # Lot # 10 Square Footage 1290 Type of Development Single Family Residence Comments No. of Units 1 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 1.84 X 1,290 or $ 2,373.60 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 ccNalley Independent Bank/Coronel Construction �.a��Telep7h''one �5f644 60 Name on the check F *- w By Dr. Doris Wilson Superintendent Fee collected /exempted by Pauline Pearson Payment Received $2,373.60 Signature e Check No. 151727 IOTICE: 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 Allect 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 - Commonwealth Land Title Company 72855 Fred Waring Dr.. Suite A5. Palm Desert. CA 92260 Buyer's Settlement Statement Escrow -No.: 97.6922KC Buyer: ESEQUIEL M. CORONEL, Property.: APN 773-122-003-9, LA QUINTA, CALIFORNIA 92253 Escrow Officer: Kelly Collier Date: October 21,-1997 TOTAL CONSIDERATION Deposits by Buyer PRORATIONS. COUNTY TAXES BROKER'S COMMISSION LENDER CHARGES RESERVES ESCROW FEES, TITLE CHARGES Settlement Charge RECORDING FEES, TRANSFER TAXES Record Grant Deed ADDITIONAL,CHARGES REFUND DUE BUYER DEBIT CREDIT $?2.000.00 12,300.00 From 07/01/97 To 10/21/97. 73.85 d 150.00 6.00 217.85 $12,373.85 $12,373.85