0204-087 (SFD)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. or
License # Lic. Class Exp. Date
634981 B 0 1.13 11 P11
"'DateU a ? 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:
( ) 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:
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 ST 'fE}�tj)ff) Policy No. 1542437-01
(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.,,n any manner so as to. become subject to the
workers' compensation laws
(of%Calif ornia, and agree that if'l should become
subject to the workers' compensation provisions of Sectionv37,0) of the Labor
Code, I shall forthwith comply with those provisions.
Date:,. 7 Applicant?r',✓v ----�
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 pe.rson 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 i
correct. I agree to comply with all City, and Statelaws 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) t �'" �• Date 1,
BUILDING PERMIT PERMIT#
�2>;d••f3f3'l
DATE VALUATION a4 �V irS 7D LOT 71 TRACT 13LK a 6�i U24
73�
JOB SITE
ADDRESS M-320 ANEMA RIDWO
APN 774^2•RS—MI.
OWNER
CONTRACTOR/DESIGNER/EN (NEER
Cokow� ENTERPI-01as
(410,110MMI, CIONS U ICY9
PO BOX 369
7 8- 15 0 CKLE TAW= SUrrE0230
LA QT)IN'fA. CA 931253
LA Q)EYNTA CA 12253
()G0)I564• ,1504 CBT -6 2261
USE OF PERMIT
WNixLE;?�nh�S �L 4" 11"JV1;iiC4
l•
SPID • PIUMT ,OOA.,S i+lf3"T INC"LUVE 13t.00K WA3..4 P-001>, t?:k JDRi►i'Ar YAY
APPROACH. 9s"TA00, MASTER (1739 SY)
TRACT CONSTRUCTION 11733.00 3F
POR.CHIRA.TIO 56.60 Sid
OARA.M C':ARPORT X9 .00 SF
11li F%Z .suhurA"Y
00YISTRVICTION FFR 103-000-418-000 $67.00
PLAN CHECK fi'EE '101-000-439-318 .1563.33
F&F+ Dr, POSIT 101—OW-439.1318 X54.00
&1FrL"HA:4'lk'CA*L TiTZf 101 w000-421-000 Ir73.OJ
F.1,9C.TRICA,1, FEZ 101.000.420.000
PF iDA401'NO YVE :101.000.419-000
ST11101140 MOTION FEK- R ID 101-000-241-000
ORADINO J?E- • 103-000.42:3-000 f3.0t3
I•?WELOPER IMPACT FLEE $1,307.90
PRECISE PLAN 101•-000-441-345 �t0i�.i!ti
r
- --- ``K0 AL CONS'1i2tJMC3:1�a" ANWPLI, N CHWX
x;3,552.1 's
d I LEES IIRE:«PA►L`I1EES
a
4250.00
APR 51001 O'TA mzwll:�`�.Y�� r�u ya. r�0W
iis:�,��a.�. r
t
COYOFIAft
.RECEIPT44-
DATES"` ` ff
C Felt 7R
By i
DATE FINALED
'7-'3o -ez,/
3o-ez/
INSPECTOR
INSPECTION RECORD
OPERATION
SATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
a aUnderground
Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
F.A.U.
_ _
O.K. to Wrap
Framing
.. , 2�
Compressor
Insulation
?^a Z
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
i -os.—
Drywall - Int. Lath
Final
Final
=
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Footings
�r
L `
Electric Bond
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
O?/
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
6
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas) ('
ELECTRICAL APPROVALS
Temp. Power Pole -oz--
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) D U
Building s\ t
Address `"\
Owner ,- I- .
CUl'l�
T-itit 4 4 Q"
P.O. BOX 1504 APPLICATION ONLY
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 Rbb%1;5S
mailing
Address V
City Zip \ Tel.
Qs, „\ 1, so -k -,--k h��l
Contractor -- -1 1 -
13, y b,C)
State Lic. / u City
& Classif. "W Q \ P,::," Lic. N��
Arcn., tngr.,
Designer
Address I Tel.
City IZIp I LState
ic. #
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 force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
Ihereby 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
lot 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 (E500).
F.! 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 or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered tot 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 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
doesnot apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a confractor(s) licensed pursuant to the Contractor's License Law.)
-) I am exempt under Sec. B. S 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
f7 Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COM PENSATIONINSURANCE
(This section need not be completed it the permit is for one hundred dollars ($100) valuation
Of less.)
I 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.
Date Owner
NOTICE TO APPLICANT: ff, 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 property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip _
BUILDING: TYYPE'CONST. 7� OC`C,. GR/P.
A.P. Number --1:1q— - 0O
Legal Description--
Project Description •� •�/4Y7
Sq. Ft. \
Size I
New ❑
imated
No.
Stories
Add ❑ Alter ❑
No. Dw. 1
Units `
Repair ❑ Demolition ❑
PERMIT AMOUNT
Plan Chk. Dep. 'Z o
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 from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by: Date Permit
Validated bv:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 4/26/02 APN# 774-235-004
No. 23174 Jurisdiction La Quinta
Owner NameCoronel Enterprises Permit # 0204-087
No. 54320 Street Avenida Rubio Log #
City La Quinta Zip 92253 Study Area
Tract # BLK264U24 Lot # 21 Square Footage 1738
Type of Development Single Family Residence No. of Units 1
Comments
Construction - 1738 sq. ft.
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
2.14 X 1,738 or $ 3,719.32 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 VIP Bank - Ish Coronel Telephone
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Crystal Scott
Signature
Payment Received J . $3,719.32
Check No. 267020
NOTICE: Pursuant to Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
collect them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant. Copy - Applicant/Receipt Copy - Accounting
IEB-Aur•15- 2002 8 : 5 6AMJ'th I and tItIgrNo.1663
FP. 1'
000 783 3343 T-166
r.ua3/0114 F•-122
F&CORDtNO REQUBSTEp By:
OFDOGUMENTRECORDED
SoLdhiand Title .Inland Emplm
�A3 N0.
AND WREN RECDRDED MAIL To,
LON�
N CpMFaRED yy�}{ ORIGINAI.CDi20N�LRN7ERPRtSES,IIVC_
"���
��DECOtIEVYYAE!GORpEA
Pb Box aes
LA QVINTA, cA gzzsa
A.P.N.:77413-00 u0s•7
Order Ne.c
k s u wte a MAkacaa .R i aac
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' GRANT DEE'
C�
THE UND] RSIGNEsD GRANTOR($) DECLAR
(S)
DOCUMENTARY TRANSFER TAX IS $70.40
PV Computed on foil value of prop rty conveyed, or
() Computed on full value less va
a of liens or encumbrances remaining at time of sale
() Unincorporated area: pQ C'
of LA QUINTA
FOR A VALUABLE CONSIDERATION, receipt
4111th is hereby acknowiedged
MICHELLE >E;ICHSTEeDT, a single woman
`
,
04
hereby GRANT($) to
1
ti
CORONEL ENTERPRISE -S, INC., a Callfomia corvoration
the following described property, In the County If
Riverside, State of California.
LOTS 20 AN .2, F 5LOCK 254, SANTA CA
RECORDED IN BOOK 18, PAGES 44 AND 45
ELITA AT VALE LA QUINTA, UNIT NO. 24, AS PER MAP
F MAPS,
RECORDS QF RIVERSIDE COUNTY, CALIFORNIA
Dated: January E, 2002
STATE DF CALIFORNIA
I
COUNTY OF t
On UPc moo?- befo
me
a Notary Public in and.for said County qnd State, pe
Wally
appeared
� ��
;r vJ�p ��r✓k S �df-
_ M(CHELLE HSTEDT
personally known to me
� 5+-�fdert�}to be the person(*) 402e n e(s) ti-<�.,..,a...�.., .• .
subscribed to the within Instrument and ackno
„•M
edged
to ma that -he/sh e/the'y sucecutQd the same in-hidh
r KELLY COLLIER
�r/the+F �y
authodzed caps y(146) and that by hfa
signature(a) on tna (nattllment the
/ coM�+-a+�atze
a H}gru2rPU�LIc•cwFvRNIA
permn(s) or th .entity
upon behwit of wh h the person(s), noted, exeCut a the WYE�W. J NE 6, 2 0
rte.. �uNe s, soon
instrument.
W ITN n a • o al s
FNs Aron far Natory5rt■I only)
5ignat
,
t ri o
MAIL TAX
EMENTS AS DIRECTED ABOVF-
a,
V �
:5w TAiY1
Building afety Department
OF Plan Review Correction List
Date: 4/11/02 4'
Project Address: 54-320 Avenida Rubio��
Project Description:' Single Family Dwelling, "TAGS" 98' Master
Status: First Plan Review
Contractor/Applicant: Coronel Ent. / Mr. Coronel 564-4604
Plan Review by: Daniel P. Crawford Jr.
Building Inspector II
(760) 777-7027
APPLICANT:
The following items are being returned
to you for correction:
1. One (1) Red -lined Plan Set
2. One (1) Red -lined Title 24
3. Plan Review Correction List
Dear Mr. Coronel,
COP' Y'
Permit # 0204-087
BUILDING DEPARTMENT STAFF:
DO NOT accept any resubmittal unless
ALL of the following items are included:
1. One (1) Complete Plan Set
2. One (1) Title 24
3. Plan Review Correction List
4. Assessor Site and Floor Plan
The following instructions are provided to expedite your plan review for approval:
1. Please identify on the Framing and Foundation Plan the location, extent and materials for all
interior brace wall lines.
2. Please reconcile Foundation Plan for required interior footing at all interior BW locations,
thank you.
3. Plans prepared do not reflect the Title 24 submitted. Please revise submitted Title 24 to reflect
U -factors on plan or reconcile plan U -factors to submitted Title 24.
4. Please provide School Fee letter, thank you.
Please. revise plans and/or calculations as necessary, reprint and resubmit one complete set of
plans and/or calculations, stamped and wet -signed by the professionals who prepared them. As
further information is provided and reviewed, additional corrections may be required. Please call
if I may be of any further assistance, Thank you.
Sinc rely /
a o
1
Building Inspector II
RC DISTRICT 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 Construction
54-320 Avenida Rubio
APN 235
LEGAL: LOT 21
CHECK AND APPROVED BY:
CASE NO.: 2009 -616
BLOCK 264
Martin Magana
UNIT 24
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.
REOUIRED ITEM
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)
Architectural variety within 200 feet.of
the surrounding area:
Colors
Materials
r
ex
Architectural design features
O Flanning
Commission
Other Requirements:
initi
ommunity Dev. Dept, 2i oZ
9 No. �2- Oki
Cas
Exh.
bit
E3
ith Conditions
Certificate of Occupancy
City of La Quinta
Building -and Safety Department OFnE°°"
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:
Use Classification: SINGLE FAMILY DWELLING
54-320 AVENIDA RUBIO
Bldg. Permit No.: 0204-087
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC
Owner of Building: CORONEL ENTERPRISES
_rd4_V
Building Official
Address: P.O. BOX 389
City: LA QUINTA, CA 92253
By: RICHARD KIRKLAND
Date: 07-30-02
POST IN A CONSPICUOUS PLACE