9706-018 (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
634A1 B it31/S+b: j"
)Date ///1 /r^ "t- Signature of Contractor w• f ; - ^�
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_oIf perjury one,of:,.tke 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) 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.IN
t3v1 tLslV �7?�Y.ILV 1. FJ %i�4 :Y4LVf%Lll�l
(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
wofkers' compensation laws of California, and agree that if I should become
subject to the. workers' compensation provisions of Section 3700 of the Labor
ode, I shall forthwith comply with those provisions. 4 i'_.)
Date: '7 /-+ A7 Applicant / !�
✓ i _ Ft_
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 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
t4above-mentioned property for inspection purposes /
�gnature (Owner/Agent)
L�
Date 7/'
BUILDINGPERMIT PERMIT# CONTROL#
9706-018 5 3 � 0 '
DATE �' VALUATION LOT TRACT,
�6#97.7F3 i 1 R73. V.t::t?'s
?�:?,,
JOB SITE/ 1 1
DDRESS' S'R-22S.AVL+1NIDA RAI3��.@` EZ
APN
773-11161-022)
OWNER
CONTRACTOR/DESIGNER/ENGINEER
ESEOUIEL M. COR-ONE1, +
:70K.c NT',".. Ct:;PMrP1' C 110N
P.O. BOX 389
VO. BOX :389
I OUT ln'A CA 922-53
LA. QERT`fA CA 92153
(761VIIR 24604 CBL# 2:261
USE OF PERMIT ..
Sri) - t'l:f:ibLlT ,i`.OBS N(YX 1.N0.0D13' BLOCK WALLS +:)i2 POOL..
'rtucr CO, 4.sr. uc r lO,s 1,485.00 SF
fa :�td.Oki� ��a`t IU 36.00 &F
t, MLAOrYCAttP()i2.I 504.00 ;;F
6V T°. WOOD F-ENCh 190.00 L
HILIVI'll':D MST € F CONISTRUCfI€.�N
-j,
. 92,,607.7#0
j� y, j}�,{j�j(� I{ yLp�fi�j`
yy�q. g�gga PEC
it K✓,�i.tWOI 0.���IiItNL7YJIF'!i�'N.H.R'
(70Nr1RCU:•'1110NF iC14 0f}-15 -(►fj0 $t,�t.►f;,(tt)
1'1:.:,lN01pFM f FIF-1 10140-•439-3t?,
tv1lsCHAFa CAf.FRis Ifil-606-4'21-0W
t..iwL.l:,f'?LI('Ai.. F't:F. If71,-tfr#1-•430-0{ftl $1.'S ��
.:
aal.tigpjt(iJtl�14� i()t-(;tf)(?-.9tQ•i)t)fl $i„^..`+�.rS
1'1:1: - 10`811.) 101 -OW -241
c:tf;s�i>►t :; T 1 1i11-u{?U-!121-i ► $20.00
itua`to.rtN'Fieoic""t"URE Vr:E: 22,541100.443-342
F'T�ijt'it3f ANi 1014M-441-345 $2�.11ii
til B-:'rCYTA_L, CONSIR1.911CN AND MAN C14FCk
S-1,510.83
LESS PRE-F'AID FEES
4250.00
TOTAL PERMITFET48 011F, N0%V
$3,260.80
RECEIPT
h
DATEBY
1
/ ;
DATE FINALED
INSPECTOR
�,•
sl
1. __>[
INSPECTION RECORD
• OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR -
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL P ROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPRCYVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral 4
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Building 2--
Address J l — 2
Owner
," M".+�;r R7ir"�^.,yW�l'+r'`!K`i-TurA.ids:l4Y'P':A'We=4':vw�.L„”-f(•'v�riPry�.Y�r'"�YV�'A'F"�$ T'�.'�#J+,r`'4Si�w�J�'".s.�`'Yr"i��5i:v".,L�i'ir'.��:Cv"'+iaM i'�^W�
P.O. BOX 1504 APPLICATION ONLY
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
mailing
Address
Ci y
/f r! l.(1Zip'_'2/_5>_S Tel.5c-: -Z/(. 8/(
Contrp=r 1
Add�sb t>U D c
Ci y / zip .7 Tel
State Lic. j City
& Classif. �� !� j� /� / Lic. # %
Arch., Engr.,
Designer
Address Tel.
City( Zip ( State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
atI am licensed under provis' of Chapter 9 (commencing with Section
of the Business and Profess ons Code, and my licenpe is jnjfulVorcejand
f. 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, alter, 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).
f: 1, 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 Contiactor'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 -budder will have the burden
of proving that he did not build or improve for the purpose of sale.)
11 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
Coes not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
i7 I am exempt under Sec. B. & 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' COMPENSATION INSURANCE
(This section need not be completed i1 the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg workfor 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, alter making this Cenificate 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 aQplicant Date
Mailing Address
City, State, Zip '
BUILDING: TYPE'C�IONST. / OCC. GRP.
A.P. Number J V 1- 0 tD I — E
Legal Description ` �( �� Ik-' -73 � l)
r'
Project Description ✓- P' 6
Sq. Ft.
Size 1/ r
New LR
j/ �., No. "� No. Dw.
Ca , Stories Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
L
PERMIT
AMOUNT
Plan Chk. Dep.
5(%, D 0
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 StreetSefback from Center Line #
Side Setback from Property Line
FINAL DATE INSPECTOR
it a IV
Issued by: Date Permaiit'
Validated by: JUN ® 4 1997
Validation: fl �Q �/{®r
QV INTA
ti; WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION,
Deseirt Sandsi::Unified� School District '
Notice: 82 `879 Highway 111,
Indio, CA -02201
Document Cannot Be'Duplicated. 619 775-3500
CERTIFICATE OF COMPLIANCE
Date 7/2/97 APP4# 773-061-022
No.,15757 Jurisdiction La Quinta
Owner Name Esequiel M Cororiel Permit #
No..51-22'5.'Street 'Avenida Ramirez Log #
City La Q.uinta Zip 02253 Study Area 113
Tract # M,vlg9' Lot # 11 Square Footage 1485
Type of -Development Single Family Residence No. of Units 1
Comments'.
At the present time, the Desert Sands Unified ' School' District does not collect feeson ' garages/carports, covered
patios/walkways, residential additions under 500 square feet;'detached•accessorystructures or replacement mobilehomes.
It has been determined the'above-namedowner 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
,,1.84 X 1,485 or $ 2,732.40 the property lsted'above and that, building
permits and/or Certificates of Occupancy for this square. footag'e n'this proposed proje .t'may now. be issued
Fees Paid By ccNalley Independent Bank/Coronel Enterprises Telephone' -564-46.04
Name on the check -
By Dr. Doris Wilson ' J
Superintendent _ r
Fee collected /exeri-p-i4by Pauline Pearson Payment.Received' $2,732.40
c� Che.ck No. 141574,
Signature
10TICE: Pursuant of Assertibly.Bill 3081 (CHAP 549 STATS. 1996) this will'serve to'nobfy you that tl4e 90-0ay approval period in which'you may; protest the fees or other payment identified
bove will begin to run from the date on which Alia building or installation permit for this project is`sssued'oron which'they are paid ;to theyDistiict(s)V to another public entity authorized to
ollect them on the District('s)(s') beheff,;whictte4er is earher''�
Collector: Attach a copy of county or city plan check 'apphcation `form to district copy for all waivers.
Embossed Original-' Building Dept./Applicant Copy - Applicant/Receipt ' Copy,- Accounting,
L+.
RECORDING REQUESTED BY;
CHICAGO TI'T'LE COMPANY COMPANY
97.6629KC 7720752
WILMOL'01HINNAP00"
ESEQUIEL M. CORONEL
51-540 EISENHOWER DRIVE
LA QUINTA, CALIFORNIA 92253
GRANT DEED
i
FOR RECORDER'
M--71
The undersigned grantor(s) declare(s):
Documentary transfer tax is $22.00
(XXX) Computed on full value of property conveyed, or
( ) Computed on full value less liens and encumbrances remaining at time of sale.
( ) Unincorporated area: ( ) City of _ and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
WILLIPA R. RILEY, TRUSTEE OF THE WILLIAM R. RILEY TRUST (1990)
hereby GMIT(S) to
ESEQUIEL M. CORONEL, A SINGLE Y"kN
the real property in'the City of LA QUINTA., County of Riverside, State of California,
described a►s;
LOT 11, BLOCK 73 OF SANTA CARMS.LITA AT 'WALE LA QUIN?A, UNIT NO. 9, AS PER MAP
RECORDED IN BOOK 18, PAGE 69 OF MAPS, RECORDS OF RIVERSIDE COUNTY, CALIFORNIA
Dated May 9, 1997
State of California
County of Riverside }.S.S..
On June_
before me, xlliez
personally appeared
williaRiley
personally known to me (or proved to me on
the basis of satisfactory evidence) to be
the person(s) whose names) is/are subscribed
to the within instrument and acknowledged to
me that he/she/they executed the same in
his/her/their authorized capacity(ies), and
that by hies/hex/their 9i.9nature(s) on the
instrument the �tpe
rson(s), or the entity upon
behalf of +�vhichr n s) acted, executed
the instrument/ -f
WITNES*,my rAnyl, 44d lofticiflM. lAeal.
Signature_
MAIL TAX 8TAT2MMM To: SAME AS ABOVE
2/2'd
df?
�Zj
WILLIAM. R. RILEY, TRUSTEE
2
(This area for official notarial seal)
0
3-1iIi Hi.103NWOWWOD Wd5b:20 L6. -�0 -inf
UP tWHIER
_
Comm. ►:1057217
WTA0 AIRM CAliORM
v
(�
Rlvsraids Coulty
*Comm- &ohs MW t8. IM .-i
(This area for official notarial seal)
0
3-1iIi Hi.103NWOWWOD Wd5b:20 L6. -�0 -inf
*' OFFICE OF. THE ;
AGRICULTURA .- COMMISSIONER CALVIN C. KAMINSKAS
Asslstont Convnlssloner
P.O BOX 1089
RIVERSIDE CA 925k1089 DAN RILEY
JAMES O. WALLACE PHONE (909):27b 3000 Seder, Weights & Measures
Agricuthual Comjv. brier FAX (90V) 27553012„ . (909) 2763030
Director of Welphfs &Measures FAX (909) 276-4728
46-209 OASIS `ST:REET; R'OOM`:14
INDIO', CA 92201:`-
iiICO� "863-8;91
DATE L�. 7� CASE NO:
DEVELOPER'S NAME.:.--
ADDRESS :
_c VN
TELEPHONE 60 S 7 610 ..7
Dear Developeri•':
After reviewing your landscaping plants,; 'all plant -material listed, is not in
violation of .,.quarantine laws _goirerning ' e Coach"el-la Ua11ey If substitutions
do occur and they, differ -from plant material listed, this office must.be
notified immediately.
Thank you for •pr.otecting •and .preserving`. _the' Coachella VaIley's.' pest -free
environment.
Ag cultua .ommissioner's Office..
cc: Indio and Riverside
r ,
.a