9808-071 (SFD)1� 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 E Date
r93�19i31 Ei j 1/31;00
Date' / 4 ' f3Signature of Contractor 7 7: ' '� '1��� ✓
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 Policy No.
GOLDEN EAGLE INS. NW0421W200
(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 m nner so as to become subject -to -the _
workers' compensation laws of Calif9r la, and agree that if I should become
subject to the workers' compensati6 .provisions ofSef�tion 3700 of the Labor
Code, I shall forthwith comply with'tl7ose provisions.
✓Date: Y ... /I /O APPlicant/ i /.-'Y///� /.1 /l
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. r
-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
r 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.witti all City, and/State laws relating to the building
C and hereby'authorize ,representatives of,th'is City to enter upon
i-tthe,above-mentioned'property for in'specti'on purposes.
ASignature (Owner/Agent) % Date��y P
PERMIQ84.19- 7 . CONTROpL#•,
BUILDING PERMIT
DATE VALUATION �gZQD ± LOT f TRACT �Y�Jy�p 7A"9
JOB SITE ADDRESS ": r3i1��'1 NIDA3t8 BIO
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CORONET„ C0N.,'7RUC't I0N
CO RONEL COPTSTRUC1,11 N
51-540 EISEN'r140VVE.R DR.,
51-590 EISENFLOWER DR.
LA t7UIN1-A. CA 92253
L i ,'�U:iN"rA (`,A. 912.53
( Iti01564-41904 C13i.-4 2261
USE OF PERMIT
SINGLRNFA.MiLY DWELLING
S D - i'FT2MfF .DOES NOT fNCLUDF. BLOCK WALL OR fK)0L, COzRON'(,:2'..
INIA817.-dt #/3 SUSMIT17AL.
1RACT C OPd:3'PkiSC'iION 1,485.00 Sr
AORCHIPA7'.10 30.00 wI:
0ARACO&CARPDXT 504.00 Sq'
F FT. WOOD FF.NCF 203.00 Lf~
MI FED COST OF CONMM° ON
P.ERNH a F ER SUMMA R
CON37141RC'1 ION FEE 101-000-415-000 �cOB.Otf
P1,A3N CIMCK .F:E . 101-OW439-313 S5.1 L24
NiEC�tFlI�11C.i1L :*FE 101-000-J21-000 $53.5:1
ELECTRICAL FFE 101-WO-,40-00iq
�f NLUN4,13117NO FEE 101-004-419-000 $127.50
STRONG iM.O 1' ON FEL - R SIJ 101-000-741-000 $9.26
ORADING FEE .101.-000-42.3-000 z0.r?OP
r
INFRAS'MUC'T`UWC FS.0 225-000-443-342
Pitr..c`.E P1Lt N 101-000-441-345 $25.00
S`EE DP-PbsiT 101-000-439-318 _ra56 00
t.
%SAJ8-11 YTAf_ C_ONb"VRUC-[ 1.CYN AND PLAN CHECK
P. .
LESS PRE-PME) rEL s
AUG 17 1998 '1-�)TAL PERMIT s+'3I N DUE NOW
•
,�,,1 l
RECEIPT
DATE J
BY
DATE FINALED
INSPECTOR
• r 7 i::
� � r
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
hIV
Steel r
Combustion Air
_
Roof Deck
Exhaust Fans
O.K. to Wrap
Framing�j7
Insulation
F.A.U.
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final P
POOLS - SPAS
BLOCKWALL APPROVALS
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
Waste Lines -�
Gas Test
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral /J
Sewer Connection r �f/
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
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
I
Final
UN4 Notice (Perm)
Notice:
Dociiment Cannot Be Duplicated
Desert Sands Unified S.chool.District
47-950 Dune Palms Road
La QuintaCA-92253
760-771-85115..,
CERTIFICATE OF COMPLIANCE
Date 8/17/98 APN # 774-043-009'
No. 17551-- Jurisdiction La Quints
Owner NameCoronel!,Construct-ion Permit #
No., 53-. 80
Street Avenida Rubio.
-
City L4 Quints : zip - 92253
Tract # Lot # Square Footage
Type of Development': Single Family Residence',
Comments
Log #
Study Area
1,485
No. of Units 1
At the present time; the Desert ' Sands Unified- School District does not collect fees 'on garages/carports, covered
patios/walkwdys, residential - -additions under 500'square -feete I, dfi I ic. .hed...,accessory structures or replace mient mobilehomes.
It has been determined thel.:A-bove-named'dwner is exempt from paying scho6l'fees at this time due to the following
reason:
EXEMPTION .NOT APPLICABLE
to Government Code -53080 in the amount of
This certifies that school fatility-fees impose pursuant
1.93 X 1,485 or $.1;866 O5
thepop ilisteddn
'above dthat building
permits and/or Certificates opiccupancy*0-this square footage in this proposed proj6ct!may ndy; beissued
Fees Paid By _CCNalley Independent Bank/Coronel. Construction,
Name on the check
By Dr. Doris Wilson
Superintendent,
Fee collected /exempted by Juahita Green Payment Received '$2,866.05
Check No. 173876
Signature
NOTICE Pursuant AAmbly Bill 3081 (CHAP - -549, STATS. 11996) this . will]`sbrv6'to n(;tify,j66'tkat the 90 1 -day approval period in which you may protest the fees or other payment idented
OT"
sib ct or on which they are paid to the Distri (a) or to another public entity authorized to
above will begin to run filArn the date which the or installation p6 is sisued ct
rinit for this proj6
Ila. �rf t'.
collect themonthe Dititrict('s)(s') behalf, whichever is ea ter.
F
Collector: Attach a-cbpy..:of_ county or cityplancheck-application form::to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy= Applicant/Receipt* Copy - Accounting
IF
03/15/1994 16:35 6195644202
�• DEC. SB.199a . 9:* --4 rt CTC SI WIVISION tW
��iquettt.d fay.
CMAD MT'f�EICOMPAN,
me019011o1pi twig: M,
CQzW4&2 tttMvrieee, Inc.
Le *%Leas, CA 92253
CORONEL CONSTRUCTION
�F s y 140.542
CQ,��qq ` of oacat tent Aecardod
H85'. not bean iaft red`with original_
ej�U 1TY. CAUFORNIA
°.2
PAGE 02
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TAXIS;
TRU i it_ee Counh' 3 CRY
t Na: xti� • -a oa AN— eoft*UW on!h0 U valuu -2 the 10im t of prop" conveyed, or
�� eompWad on the tN value (e+aa the valtle d flanmtx
s or enouances
QT -DE A./ r _._. C niialhiAr W EXB4FT or�stax tar the.fogowhg reason: �
FOR A VAS C0N89XrRATi0W,. recgo 0fwNCh IB hMbv ackn000dgb;
Henry C. , addend, a tsystse o1: 'tho $ensy.'azis�rold LiV114 Trust eveobliehed pursuant co
, that a -warm ",ik, eat 'eAttltled :pDaclAritLea:;' t *iU§z■ dated June 19, 1995 end a=ured by
hweby GRAWN 10; HWY &L OrjjftWd W %meter end *trtiev
Casamal fmtezrAfod. =ao- a Calitem a Corposltien
d do fflawwrolt •shdin*a City oT ZA.Quint�
G0181ht� >ii i-oi.QgtFotflfa; dwadbw aa_
LOTS li fir nock 17i Or �I
cJ4:i1'A;. AT VAU LAQUIHTA INXT NO. 19 AS SHOW BY KAP
Olt T"S W nWa if VMW 3108 MiRD, OSP RZ433WIUB CMAU, CAL2➢MWZA
Dabd Poe1Me 00, . 1998
STATE OR f
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J
FACSIMILE
To: Esequiel Coronel
Of: - Coronel Construction
Fax: 564-4202
Phone: 564-4604
Pages: 1, including this cover sheet.
Date: December 8, 1998
Dear Zeke,
Regarding the address changes needed on Avenida Rubio, I spoke to Mark this afternoon.
Once you close escrow on the third lot, get a copy of the grant deed to me. Then, I'll be
able to change all three at once.
As we guessed,.the addresses will be 53-110, 53-130, and 53-150 Avenida Rubio, for
Lots 19,.18, and 17, respectively.
Call me if you have other questions,
Greg
AXE
From the desk of...
Greg Butler
Counter Technician
City of La Quinta Building Department
PO Box 1504
78-495 Calle Tampico
La Quinta, CA 92253
760-777-7012
Fax: 760-777-7011