0108-180 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
AtChapter 9 (commencing with Section 7000) of Division 3 of the Business and
CN W Professionals Code, and my License is in full force and effect.
O =) cM! License # Lic. Class Exp. Date/1
Q' l y 634981 B i f i511J.2�
r` Z r,_ + Date 91 • I,'-� •' c.1 Signature of Contractors
0 ♦`
J U - •• - OVUNER=BUILDER DECLARATION
WLU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z_ ( ) 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).
c?) () I am exempt under Section , B&P.C. for this reason
U')
N 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-insurb 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:
Cartier Policy No.
STAT 9 P JIM D AIA3437-0
(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' compensbteion provisions/ Sectio 300 of the Labor
Code, -I shall forthwith comply wlth,those lfrovls/ ns. /
Date: 't t "3 ° t Applicant
-"Waning: 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 per
whose request and for whose benefit work is performed under or pursu
any permit issued as a result of this applicaton agrees to, & shall, inclkoidf
& hold harmless the City of La Quinta, its officers, agents and empl2. Any permit issued as a result of this application becomes null and work is not commenced within 180 days from date of issuance of
permit, or cessation of work for 180 days will subject permit to cancel) tion.
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)- ` - ��. '- -s' Date
'BUILDING PERMIT PERMIT#
DATE VALUATION LOT aj TRACT.
�t?- .9.26.20 1 :�.--_T1'3 ,1 ] 71
JOB SITE APN
ADDRESS
OWNER CONTRACTOR / DESIGNER / EN INEER
' ' ,I •, 4
Imo' t t+IWJE° Imo' i CORONTI-31 CC)Mk"li.U'CT(ON
;Pop -ox Sag 78.150 CAL,I.? 1PATPIC;U SUMW2,30
L, UMA CA 92253 Lt.QT13A1TA CA 92233
('760)564-A•604 CM.4 2261
iE'OF PERMIT V
VID . 1+U.A IT D0110 kN01 1%iC.L.UL'K 3L,OCK 96'.AIs.1./I►001.OR DRIVKWAY
.APPRO.A.CH, 90 M.F` STIN. Y3?
TR&M. CONSTRUCTION 1,499,00 3F
PORCCrlIP TIO 203.00 Ste
0ARA.GMARFORT 458.00 0317
5 M.. wocih MCI, 100.00 LIF
,LAS' WA ED CWT OF C'.ONff�'7l:�UCUOR
Fir FZa SUMN ?V
CyOP1 T RUCT1ON KIE
101-000-418-000
�61a0,GG
PLAN C1:1WX FEE,
101-000-439-318
$511.30
M CHA91CAL FEE
101-0(1", -421-000
$60.00
1?_1XCTRIrA1..1g?
101-0004210-000
$129.94
PLUMBINO Fa
101.000-419.000
51161175
5`9'i'd,ONC# IMOTION FZ9 MID
101 -000 -241 -OW
$9.29
GRAD11?• O ME
PT'.I;'C RE .P A14 ;1
101.000-441-345
�16D.t39
M39 4!LZSI T
101-000-439-310
4250.00
SEP 17 2001
ITII OF LA QUINTA
FINANCE DEPT.
RECEIPT
TX,33 PIRE-PAID rl•"s?k::3
'IYY.rAL PERAUT FM DUE NOW
R
DATE? BY DATE FINALED
r,
4+2y50,00
f
JSP ECTOR +
INSPECTION RECORD
OPERATION
DATE,
INSPECTOR
OPERATION.'
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs I
Underground Ducts
Forms & Footings I
Ducts
Slab Grade I
Return Air
Steel i
Combustion Air
Roof Deck
O.K. to Wrap I
Framing I
Insulation I
_ _
_Z _ ��
_Z �( /
/
Exhaust Fans
F.A.U.
Compressor
Vents
Fireplace P.L.
_
Grills
Fireplace T.O. I
Fans & Controls
Party Wall Insulation)
Condensate Lines
Party Wall Firewall I
Exterior Lath 1
Drywall - Int. Lath 1
1 -
Final
Final 1
BLOCKWALCAPPROVALS' •
POOLS - SPAS
Steel
Set Backs }
Electric Bond
Footings
Main Drain
Bond Beam i
Approval to Cover
I
Equipment Location
i
Underground Electric
i
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines I
/� _ _ 7
`
Heater Final
Water Piping i
Plumbing Final
Plumbing Top Out )
Equipment Enclosure
Shower Pans {
O.K. for Finish Plaster
Sewer Lateral i
Pool Cover
Sewer Connection }
(p O
Encapsulation
Gas Piping I
Gas Test
Appliances I
1
Final
i
COMMENTS:
Utility Notice (Gas) I
ELECTRICAL PPROVALS
Temp. Power Pole 1 o
Underground Conduit
Low Voltage Wiring I
Fixtures I
Main Service i
Sub Panels }
Exterior Receptacles'
G.F.I.-
Smoke Detectors I
—Temp. 'use of Power,
Final i
Utility Notice (Perm) )
r
Auilding
Address'S��-\�
q+s'-.e:�.�� fi-r��srw;vas..;�,�'�'. ��:!i��Y ; r ::•r �'-.,--�'„ti
P.O. BOX 1504 APPLICATION ONLY
78-495 CALLE TAMPICO
V LA QUINTA, CALIFORNIA 92253
Mailing
Addressp U -3 19,
U ,c
City Zip Tel.
CityZip Tel.
State Lic.„ City
& Classif. �� \t Gf i 13 Lic. #
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRA T R'S DECLARATION
I he �y'affirm that I am licen�d~u�nder pr 1 tons of Chapter 9 (commencing with Seg Ion
000) of Divisio i' of the Busipess and'Profiss ions Code, and my license is in full for=nd
"OWNER -BUILDER DECLARATION :.
I hereby affirm that I am exempt from the Co tracitr'seL"icense Law for the following
reason: (Sec. 7031. Businese'and Professions Cod--JAny,city or county which requires a
permit to construct alt r.Jmprove, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed state/r7ent 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 thaf. Ae, is: exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 703'1§`5:•_by any applicant for a permit
subjects the applicant to a civil penalty of not more than lie hundred dollars (5500).
I: 1, as owner of the property, or my employees with wages asjtheir 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 owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
I'1 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.)
1-1 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.
4.1
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. r
Date Owner
NOTICE TO APPLICANT: IL 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.
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.
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 properly for inspection purposes.-•
signature of a0plicant -Date-
Mailing
ateMailing Address
City, State, Zip
01
BUILDING: TYPE'CtONST. OCC. GRP.
A.P. Number
Legal Description u\
Project Description
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback froln Rear"Prop. Line
_
Side ,Stree-Setback from Center Line
SideSetbackfrom Property Line
FINAL DATE_
Issued by: Date
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT
I CRY OF LA QUINTA J
1 FINANCE DEPT.
1
PINK,!: ;BUILDING,DIVISION
Sq. Ft: -,No.
No. Dw.
Size •�\1 �,S
Stories
Units
New ❑' Add ❑
Alter ❑
Repair ❑ Demolition ❑
M
Y5 2 it
�
Estimated Valuation;
PERMIT
s
AMOUNT ”
ni
Plan Chk. Dep.
2,jn V
Plan Chk. Bal.
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 froln Rear"Prop. Line
_
Side ,Stree-Setback from Center Line
SideSetbackfrom Property Line
FINAL DATE_
Issued by: Date
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT
I CRY OF LA QUINTA J
1 FINANCE DEPT.
1
PINK,!: ;BUILDING,DIVISION
DeseefSands;Unified School District
47-956.Da e:Patms Road
Notice: La Quinta;,CA 92253
Document Cannot Be Duplicated 760=771-8515
CERTIFICATE OF -,COMPLIANCE
Date 9/17/01 APN# 773-3137013
No. 22510 Jurisdiction La Quints
Owner NameCoronel Enterprises Permit # 0108-180
No. 52-990 Street Avenida, Rubio . ' Log #
city La Quinta zip 9225.3 Study.Area
Tract # BLK 171 Lot, # 14 " . Square Footage 1465
Type of Development Single Family Residence No. of Units I
Comments
a cashier's..check.in the amount of $6,480.05 for (2) SFD:
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, deiached 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 1,465 or $ 3,003:25 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 / VAlleyTndependent Banke.- Ish:Coronel Telephone .
Name on the. check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Annette Barlow Payment Received $6,480.05
` Check•No. 253860
Signature
IOTICE: Pursuant of Assembly Bill 3081 (CHAP 549; STATS. 1996) this will serve to notify you that the 90 -day epProval.period in which you may protest the fees or other payment identified
bove will begin tonin from the date on which the building or installation permit for this project is issued or.on•'Whii:Fi they, are paid to the'District(s) or -to another public entity authorized to
ollect them on the DistrictCs)(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
I
`:RC 'D:ISTRICT - PLANNING REVIEW FORM..
This form is to -be used by CDD staff for revie.w.of. single family, dwellings in the RC (Cove
Residential) District per Sectio 6-` 9.'50.090..6f the Zoning Code.. Its purpose is to determine:
1) that the proposed house design does not •duplicate the same architectural style of any
house wiihin_ZG0_feet of the applicant -and/ora2) if -there -
is a need for.the-applicant to file for
Master Design Guidelines. It -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.
. Y
APPLICANT CORONEL EN.TERPRISES
SITE ADDRESS 5.2.-990 Avenida Rubio
APN 773 _ 313 - 013. 'CASE -NO.:. 2001-539
LEGAL: LOT 14 BLOCK" 17:1 UNIT. 17� S.C.@V.L.Q.
-
CHECK AND APPROVED BY: Mich ele Rambo DATE:lot'
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 AY
Y
N .•
COMMENT%CORRECTION
Verify legal and APN.information
Consistent. with MDG on file"(as
applicable
MDG filing required (5 filings _since
9/3/98)
X
x
F,�, y''• , GFD�k
N4 T G2/ly
Architectural variety within 200 feet of
the surrounding area: ::
Colors
Colo r
I
Materials
Architectural design features '..
Nl
0, -
o
p<
Other Requirements:
Jao,23. 2002 425P No•9596 P- 1
UA
=CITY OF`j
BUILD NG 7Si41F'E""' TMENT •
or
..INSPECTION Rl=QUEST'LINE .
777-7163
owner CORONELFNT,
Contractor. CORONEL CONST`'
Number 01.08-180
Permit
�POST,ON JOB'IN,-,,CONSPICUOUS.,KACE'r
INSPECTOR MUST:SIGNALL APPI'ICABLE'SPACES
,J08 AdORESS v52-990 AVkNIDAA RUBIO 'R
X.
SFD - PE T DOES N,OT INCLUDE: BLOCK
•,, ,.. • ,
` «ALz,%POUL` Q�'. DR�'WAY'APPROACJ3.''
98 MASTER ,' ,
TYPE OFINSPf�: - •:NV . DATEINSP:R'
F. UNOATION $ $F,;•"�fiCK '' •�-�
FOOTING STEEL _ r
MAIN GROUN5 EM;
GROUND PLU?yiiI G
PRE-GUNITE r
00 NOT PG 'CONCRETE`UNTILALIA 6VE• AS;BEEN SIGNED
JOISTS & GIRDERS ;, r'
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE_ HAS BEEN SIGNED
ROUGH ELECTRIC ,. ~..
ROUGH PLUMBING
ROUGH GAS 8,GAS EE6T z►
H.EATINGA VENT,-. A/C'
FIREPLACE'
ti-
ND'SEAM,
g;
r :K'TO WRAP
AMING
ULATION
R ..E=ROOF..
COVER NO WORK UNTIlrA80VE.;HAS BEEN SIGNED
t 4 . ALL INTERIQR•:, .,, •
E ERIOR;LATH.
L;PRE.PLASTER
L FENCE 8 GATE
S . ER SEPTIC TANK F�.� �• C... �•
FINALS'.: q
E ECTRICAL
_P .UMBING -
FN, IWGAS:TEST �+
H TING =
H USE NUMBERS,. }
J99 COMPLETED :
TEMP POWER '
ABOVE APPROVALS, DO,NOT INCirWt k RIGHT TO- ..
Certificate of'O.C.c.upancY,
�-
Citof L Quinia
Y.
Builqih gandty;
Safe.De ti
9! p. art: of
This Certificate issued pursuant to the requirements -of Section .109 of the ,Uniforii Bui/din :Code
certifying that, at the time of issuance, 9
of the Cit re u/atin building ..
this structure was in comp/lance with the.. various -ordinances•
. Y 9' g g construction or use: For the fo/%-wing: -
BUILDING ADDRESS: _52=990•AVENIDA .RUB.10
Use Classification: SINGLE FAMILY DWELLING `Bfdg. Permit No.: .0108-1`8*0
Occupancy Group: R3--. Type of Construction: VN Land Use Zone: RC
Owner of B°wilding: CORO.NEL ENTERPRISES
Building Officia
Address:
P.O. BOX 389
City:
LA QUINTAL CA 92253
By:
RICHARD KIRKLAND
Date:
JANUARY 22, 2002
POST IN A CONSPICUOUS PLACE