9902-013 (SFD)LICENSED CONTRACTOR DECLARATION
` 1 Woe bby 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
#534981 �,'" 1131100
vbate2-' Signature of Contractor 4 -f ,.L,
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 licerised
contractorsto construct the project (Sec. 7044, Business & Professionals
Code):
( ); I;am exempC under Section B&P.C. for this reason
Date Signature of Owner
'WORKER'S COMPENSATION DECLARATION
I keret 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 1 AGLE' INS. NINC482960-02
I (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. riot.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.Sectione3700 of the Labor
Code,, ;shall fo):thwith comply withahose,provisionsy
Date: 1-1 y Y Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,0001 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. Anypermit 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 workfor 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 representati es of this City to enter upon n
the -above-mentioned property for inspection-purpose"s�
Signature (Owner/Agent);! 1.40,' r. ? ``' Date -?
5
PERMT#•
BUILDING PERMIT'" Iq!AJ2-0,13
DATE VALUATIONg�e{,01 LOT 17 TRACT Bp L11Iry
l
ADDRESS .��3 .i<:4 ��� R1 f.11iCD
APN� , w
OWNER
CONTRACTOR / DESIGNER / ENGINEER
cokONE1. CONIS RUM110N,
CO.RONrrt, CONSTRUCTIOM
41-`4440 i11SEN;✓iC11 EP, DR,
51-540 MSENHC)tt/':EK OR- ' ,..
LA. QU1:M"CA CA 92253
Ltd ('!L1INTA.. CA 92253
(760)56-1-4604 C8L# 7.261 I
'
USE OF PERMIT
SiNGU .1Rii.1 ILY D4U1:1,UNc
4
SIU - PaWIT DUBS NOT INCLUDE, .BLOCK WALLS "vi2.POOL
T RAcr cos cx;, tori 1.489.50 3F
N5RCWPxr1c') • • 253.00 3F
tJAAAQ'&C APJ1 )tt'E' 464.00 SE
6.1-Y WOOD 141NCEE. 200. (if) LF
IrS'n.: rI:' TED COST OF CONNSTRd.lC 90.1
95.01.2.00
GOMWRLIC'r ION FCS. 101-000-4115-000 $621.50
PLAIN ('WrIs t"EE If?I-000-4-11.� 131
1? IECEIAI"`titiCAL FEE 101-000-4211-0050 �43.5v
1a'LECi"[t1:i. AL ITI 101 -000 -420 -OW 1130.90
,
PIIUN1141NO"1°'�`I: 101-000-419-000 $139.50
'3iRtt7h3�t?NF-RiJ 10!-(' XI -241-000 X550
1
c112.rV:jING F.I33 101-000423-000 �ro.0o
tAfk"RAS'fRUC;TrtM FEE 225-000-443-342
PRECISE PLAN 101-01�'i-44t_34g 51)ts3.iffi
nm nyntlosr ' 4250.00
Cr 113-1Y)TA1_ t'(lN�°Z'It�(�"iiC1N AND PLAN CHECK
Y.
$3,624.(K '
LESS PRE-T'K' PP 1° EFS
.
42-50.0p..
TOTAL PERMIT 1N'ZES DUE NOW
$3,374.06
REC IPTj_ V � �{ "\
\ 1�
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
_ _ _ Q (_
Exhaust Fans
O.K. to Wrap
..Z/—
F.A.U.
Framing
5 T_ -Compressor
_
Insulation
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 Z
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
_I Q . Q q
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
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 APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
.: Smoke Detectors
7Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
-;:ru:�'�T�t:�ti.,':ayw.:i,�5n:i��'i!t'3ii lhri��le�,=:�`^.'''ti):-:.°',�..?y,i�`'"''_.,*.e.•r"r:,a„+��•rri•,v'n�'�'F'7�-��.g�s°S[�•, l y� �i
9102-ot3 '
f�U',N,icv h
P.O. BOX 1504 APPLICATION ONLY
Buildingc k 78-495 CALLE TAMPICO
Address ) ' �:': I 1 � A i r'� LA QUINTA, CALIFORNIA 92253
uwner _ �?
,� BUILDING: TYPE'CONST. OCC. GRP.
Mailing �( / /
Address - (�- 6nx J[) A.P. Number—7
1 y ! -' 0, 1 '!_)Q 73
Cit Zi �
tra
Conctor '
J d'606161
6 J (,j�A t U ? , !�, T n� Project DescriptionAaaress_ 21
el..
State Lic.///��, City
& Classif. 4, �i iJO re/ i Lic. #
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70001
of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
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, after, 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
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 live hundred dollars ($500).
I'll 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, Bulsness 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
orimprovement 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 I, 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. 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
r.7 Copy is filed with the city. O 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 (E100)- 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.
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.
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
ame 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 property for inspection purposes.
Signature of a0pl
Mailing Address -
City, State, Zip -
j 4 //diel/ J,-_-,
Sq. Ft. /Y= No. / No. Dw.
Size / J Stories Units
New/ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
ZONE: BY: h
Minimum Setback Distances:
Front Setback from Center Line
Rear -Setback from Rear Prop. Line
tem'• �'Sif:! Leet Setback from Center Line
d vim'
d Side SetgaeJc from Property Line
YFINAL DATE C O ��E*
aNSPECTOR
Issued by: _ r"n. e,, Permit
Validated,,.:
Validation:
WHITE = FINANCE YELLOW = APPLICANT
PINK = BUILDING DIVISION
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School.Distrct
47-950Dune: Palms Road:
La Quetta, CA 92253.
760;-771;851'5
CERTIFICATE'OF COMPLIANCE
Date 3/2/99 APIC# 774-043-008
No. 18407 - Jurisdiction''.• LaQuinta
Owner NameCoronel Construction > Permit .#
No. 53150: Street n Avenida Rubio Log #
City La Quinta tiip."'92253
Tract # Lot # Square Footage
Type of Development. . Single Family Residence
Comments
Study Area
1.,489
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 ac'ce'ssory structures or replacement mobilehomes.
It has been determined the above-named owner is exempt 'from paym&.§6hool fees at this time due to the 'following
reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imp osed.pursuant'to Government Code 53080. in the amount of
1.93 X 1,48914 or $.2,873:77the property listed'above and that building
permits and/or Certificates of Occupancy for this sq'u'are' age in this proposed project may now be issued
Fees Paid By ccNalley Ind. Bank/Zicke Coronel Telephone
Name on'the check
By Dr: Doris Wilson
Superintendent
Fee collected /exempted by •Adriana Gauto
Signature
Payment'Received
Check No.
188284.
$2;873.77
U
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90=day approval period it 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 which they are paid to the District(s) or to another public authorized to
collect 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 allswaivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
1 � Y
t i
RG Districts = P/anh Mai�-Review Form
This form•.is to' be used,by.CDPD'staff -for review of single Jamily.-dwellings in the RC (Cove
Residential) District; in order to determmeAfh*e , plicabil�,ty,.of compatibility issues or need
to require the filing 6tWaster .Design Guidelines-_by7the a00licant.1t shall be transmitted to
Building & Safety` as your correction* list Please attac . , additional: explanations as necessary.
APPLICANT: • �RO�' CONSTRUCTION
PROJECT S3,
ADDRESS: ,�5-, 150 Avenida Rubio :r
APN:
>774-043-008
17 176'' 18
LEGAL: - LOT- ,.BLO.p-,K UNIT ,. S.C. @ V:L.Q.
CVD D B Y : . LESLIE MOURIQUAND
BIN N0: 4B CASE NO`. 99-41 CHECK DATE:
Inform the assigned Building. plan checker upon..;your- assignment to this case. The CDD
Executive Secretary maintains a long bo;ok.to track applicatiops;and assign case: numbers.
REQUIREfD::ITEM; ' Y •,-CO.MMENT/CORRECTION
Case. logged and number assigned
Verify legal and APN information
Consistent ,with MDG. on file. (as -applicable) .
MDG filing required (.5+ filings'since 9/3/9.8);
— - -Gonsistency-with-street/surrounding-area: -------
Colors
_--- Colors` -
Materials
Architecture ..
OTHER- REQUIREMENTS:
The zoning code, architectural and I'andscaping. manuals;, and/or assigned inspector .should
Few. .,
be consulted where°uncertainties arise The corimpleted.checklist shall be maintained in the
Building & Safety address:'file.
r• ..
78-495. CALLE TAMPICO`_ — LA'QUINTA, .CALIFORNIA') 92253 – (760) 777-7000
FAX (760).777-7101
TDD (760) 777-1227
December 17, 1998
To Whom It May,:Concern:
This letter is to confirm:the following addresses and .legal descriptions. All these
addresses are within the. City of:La Quinta, CA 92253:
APN
Legal' Description
Street Address
774-043-006
Lot 19, --Block 176- � Santa
53-110 Avenida Rubio
Carmelita.at Vale La Quinta,
Unit 18
774-043-007Lot'
18, Block 176, Santa
58-130 Avenida Rubio
Carmelita ;at Vale La Quinta,
Unit 18
774-043-008
Lot 17, Blo& 1.76, Santa
53-150 Avenida Rubio
Carmeliita,-at'Vale La`Quinta,
'Unit 1'8
If you have any questions,regarding-this matteri please contact me.directly at (760)777-
7012. Thank yo&Jor you cooperation.
Sincerely,
Greg Butler.
Counter,'Technician
Building -4 --Safety Department -
MAILING :ADDRESS = P.O.: BOX 1504 - LA QUINTA, CALIFORNIA 92253