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0204-025 (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. License # Lic. Class Exp. Date 04"113 �� � � 0IM12C 9 Date o C-? 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: ( ) 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 pert rmance 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 S'.iAiWtUWD Policy No. 11029V,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 in any manner so as to becomefsubject to the workers' compensation laws'bf California, and -agree tha)fif l,should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. t� Date:/ . , l t .)l , Applicant -Al I Warning: Failure to secure Workers' Compensation coverage is unlawful and sliall 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 a0d 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. 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 e above-mentioned propeeny.for:rnspection purposes. -,4 Signature (Owner/Agent) Date BUILDING PERMIT PERMIT# t 0203.-02s DATE. ( '� ©� VALUATION � py®r ed LOT 20 TRACT 43LX 2154 U 224 JOB SITE ADDRESS '-3G AV1TT+1 A RV1310 APN OWNER CONTRACTOR/DESIGNER/EN (NEER CORONET, t:'ONSI2MarlQN C()1 C)1;dRL. C 01<MYRUCZ ON 78.150 CALL1i' ICO c►1ni #2;30 78.1.50 CATS TAW. WO SUrl"W230 lJk(;�€�`IATA.A>,. CA 92253 T A0Q;1T LA CA 92233 (761D)564.4604 MVM 2261 USE OF PERMIT 819C31;:1 RAWMY DIWE UNQ SF17 - i rLP.MI T CJOEASi NOT 111ICIA)OE BLOCK WALL, POOL OR. a RfVL?, .KY A1'1`.f1;OACH, 99 CODE, T ted C Ir'ONN A t9 UCTI.ON deM9190 1 I.I' CdltRAOMr1RPORT 449.00 81F l g FT. WOOD .G1 NCE 210100 V, :i urn"WD Mir (W CC3Ti%.1”, UM014 YEWLT Ys ER fit YMA1. T CONSTRUCTION %'I`3, 101-000-418-000 $671.00 PLAN CHECK FEY, 101-000-439-318 0111a.9S FET'* D PO 1131-000-439-318. 4250.00 ts3 11ATYIt a�Y. I s. 1011-000-421--000 $7.1.011 101.000.4.2.0-000 4121,10 PL[4MI'I O FZ9 1 fr1-000-41 -CJ0lJ i 16.75 5, TIR01443btiO 1014 FEE; I. ID 101-0,00-241-000 t�9d,83 CfRADI'NO 1W, 101-000-423-000 1120. W DEVELOPER IMPhC"J FEE51,90,7,00 �Y PLAINPRECISE PLA�1 •-CK3G-4�1-�4 �5 $1530.00 .4 T313-1 i3'1 Al f:' T,�E3't';' 101`1' AM PLfi.1`t• CEWK LESS f1'vZ-FAii3FIMS 4256,00 JUN 2 1 1002 CITY OF LA QUINTA RECEIPT BY DATFI*LP INSPECTOR �� � y- 0 2;. tea• P • -l/2_ k 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 _p Exhaust Fans O.K to Wrap T%Z F.A.U. - Framing / Z fiC_ Compressor Insulation Z Q 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 G '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 Gas Test Electric Final Waste Lines _ Water Piping 7 Heater Final Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Ole Gas Test -. (j. Q Appliances Final COMMENTS: Final /� v 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 Final Utility Notice (Perm) Building Address Owner .Mailing Address City Zip Tel. Contractor� Address City r Zip Tel Ale-) �IGI rf'I�ICII TAM IF1 P.O. BOX APPLICATION ONLY 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 J BUILDING: TYPE'CONST..- OCC. GRP. �~ A.P. Number ,7_1t4-� 1�5– y ( ^� Legal Description–. Pr�1o"J' ct Description s,•A�' a \• ` t y w 1�. c T 4 _ c • �\� . C� b'a` ti Imo. State Lic. City 8 Classif. �� ci 9� ` es, ' Lic. # � � � � Sq. Ft. Arch., Engr., Size Designer New p Address Tel. ,, :foN City Zip State Lic. # s LICENSED CONTRACTOR'S DECLARATION;:: � I hereby affirm that I am license5,unnder provisio P. of Chapter 9 (comment 300) of Division 3 of the Business and Profes3io "Code, and my license is OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,13us)nes and Professions Code: Any city or county which requires a permit to construct, atter, 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 five hundred dollars ($500). lJ 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 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, 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.) I-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. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE (This section need not be completed it the permit is for one hundred dollars ($100) vaivalion or 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: If, after making this Certificate or Exemption you should become subject to theWorkers' 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 g q No. ! 1 Stories Add ❑ Alter ❑ GZ& 14 D� Estimated valuation,, PERMIT Plan Chk. Dep, Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL No. Dw. ` Units Repair ❑ Demolition ❑ 77/-6 25 ale- �s- C v�2�n.EL AMOUNT fJ REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Rear Setback from SideaStreet SetbacN iK—_ Side Setback f roimmP FINAL DATE ' INS.I 1• Issued by: ,r- IDaf. v Validated bv:\ r Validation; r% WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION ter Line Prop. Line k n Center Line rmit Desert Sands Unified School District �lEDsc 47-950 Dune Palms Road Notice: La Quinta, CA 92253 ?% '>'<>><>»>..>{<- o Q BERMUDA DUNES r Document Cannot Be Duplicated 760-771-8515 V) RANCHO MIRAGE b INDIAN WELLS PALM DESERT CERTIFICATE OF COMPLIANCE LA INnU�7 D1O O o- .t/' Date 6/21/02 APN# 774-235-005 No. 23322 Jurisdiction La Quinta Owner NameCoronel Construction No. 54350 Street Avenida Rubio City La Quinta Permit # 0204-025 Log # Zip 92253 - Study Area Tract # BLK264U24 Lot # 20 Square Footage 1789 Type of Development . Single Family Residence No. of Units 1 Comments 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 1,789 or $ 3,828.46 the property listed above and thit building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued Fees Paid By CC VIB - Ish Coronel Telephone Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Crystal Scott Payment Received' .$3,828.46 Check No. 264800 Signature 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 i Certificate of-Oc'cupancy City of La Quinta Building and Safety Department 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 54-350 AVENIDA RUBIO Occupancy Group: R-3 Type of Construction vni Bldg. Permit No.: 0204-025 Land Use Zone: RC Owner of Building: CORONEL CONSTRUCTION Address: P.O. BOX 389 Building Official s City: LA QUINTA, CA 92253 By: KIRK KIRKLAND Date:. OCTOBER 28. 2002 POST IN A CONSPICUOUS PLACE OCT -24-2002 08=57 PM P.02 1NSTAI.L,AT10N CERTIFICATE I CF -6'R 54 � 3�0 �h,�.� k'���o G 1 tint Ycrn tltlrc,.ss llt Number DUCT LEAKAGE AND DESIGN DIAGNOSTICS UCT LEAKAGE REDUCTION _ } t >>t;riz tic�n'i'esi IZe1'011S (CFM @ 25 PA) Test Leakage (CFM) / f -.m uitm j!'j-.111 f :nit t.j (",11culatcd as 400 cfnUton x number of tons, or as 21.7 x Heating Capacity in Thousands of Btu/hr, enter calculated value here _ If fan flow is measured, enter measured value here _ Lcakage Fraction ='fest Leakage/(Measured or Calculated Fan Flow) Pass if leakage fraction 5 0.06 ❑ Fur-%,1.R0S0L'i'YPE SEALANTS ONLY -The following diagnostic testing was completed: Duct Fan Pressurization at rough -in measured leakage (CFM) CHECK AF"1 F!: FINIS14ING WALL: ❑ )'Cs ❑ No ❑ Pressure pan test or House pressurization test ❑ Yes ' ❑ No ❑ visual Inspection of Duct Connections THERMOSTATIC EXPANSION VALVE (TXV) 0 No Thermostatic Expansion valve (or Commission approve etluivalcnt) is insti llcd and Access is provided for inspection Yes is a pass ❑ DUCT DESIGN ❑ Yc, ❑ bio ACOA Manual D Design calculations have been completed. Duct Design is on the plans and duct installation matches plans. TXv is installed or Part flow has been verified. If no TXV, / vcrified Can flow matches design front CF -IR; Measured Fan Flow Yes for both I and 2 is a Pass Pass 1:30 Pass Dt 1 2r ❑ Pass Fall ❑ - ❑ Pass Fail �- I. titr antler>ttnrd, �crtfy,that the above diagnostic test results and the work [ performed associated with the test(s) is in :tm!'tt:•ntafit: e with 'he retluirenutits for cotrtpliance credit. (The builder shall provide the HF•.RS provider a copy of the (•F-611 st_tucil int' Ox hutldrr employees or sub -contractors certifying that diagnostic testing and installation meet the reyu!remci% for ,r ntltlt:uk:: crcc:itt - --.............. --- < igmii.trv, D -tie �. installing Subcontractrtr (Cu. Manic) UR I' ;io(!:IC,I General Contractor (Co. Name) t'0!'l 1 O litliidIng Oepannwnt I Il:la Provider (if applicable) ''icl_act tDwner ac ,Occupancy r