9912-153 (SFD)LICENSED CONTRACTOR DECLARATION' -
I affirm under penalty.of perjury that 1'am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04,Uj Professionals Code, and my License is in full force and effect.
O =) ch -License # Lic. Class Exp. Date
C fij<I bI Ii j'� 1
�1i...r ).
I LU
oZ r- D�te� �-' r �a�Signature of Contractor
m p
J U C:) OWNER -BUILDER DECLARATION
HLULU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
Z_ ( ) 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
C; 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.
C::0,iD01413Ar3L1'*_ 1"NS, Fr WC,st3r- 160-v.
(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 become subject to the
workers' compensation laws of California, and agree that if I should become`
subject to the workers' compensation provisions.,of..Section 3700 of the Labor
Code, I shall forthwith comply with those-prov`isions�, fr
Da�'- Applicant -.^.--- -�•
Warning: Failure to secure Workers' CoT
Warning: 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, indemnity
& 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, Iand hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection'purposes.
Signature (Ovine"r/Agent) ti c -Date
PERMIT #
BUILDING PERMIT,��,:�
DATE VALUATION '992,93-7.40 LOT 1S TRACT ti 1,K 551,15
ADDRESS i.1!-C+{1.�+I�i�rI�S'��A�F� R AkE' SRUZ�
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
�, -r.. �.,.a ♦...
.� a mow. ti
.'. I., Ct.?NISTP1111., tGNI
5I • iG EIZ13U, HO WE it lilt.
51-540 EISENHOWER. DR..
I,.A+;)LilNTA C'..A 92253
LA QUI,N'I"A 4_'A. 922 53
(760064-4604
USE OF PERMIT
NO
6i:4) - ITt:CtlinH' I.iO S N01' 24CXUDU BLOCK. WALLS OR flo," .
7': �C'T C014STRUCTION j,49100 F;
i'ORCIPPATIO 90.00 SF
Crr1.({A.E31~lt rlKi'L)it`t' 46:3.0) Sf:
5 F`4'. WCKA) FENCE 200.00 L
y�['� p^ ('�/ /�p� /^t B e�p�
p� ('y p'pp MUD
ESTM F. ALrLP �. 05" �3'kj �.�ii'1. S A IRMIi..•�E'A'Lil'1
'� '•.3 1�d:1✓�ay�% .�i?iY
1r E.RN411, FEE SU1MMfLic+ V
CONSTRUC'110T6kki7 101-M)-418-000
P1. AN (-t-fFiyl;_ t r: 1Q@.-()[1(1-43 -3ER $4118,`+3
�� r ► e
MF:'c_1'I1Z&RCCij. I'1.:4: 101,"000-e21'000 S53.50
L,
�
ELL I)iiC AL Fi ii Ii)I liGti-a G-Oitt) �! �ti.y�
r i `
K.U;44HINO .FFE I t)I -fN)4) d! u tIGl1 S110.75
_ ? r
S'!'4?4?NC:MOTrc»v t;F•::€.?, RFRTO 101-000-24141M 39_40
:;fL.�L►l;JCi 4 i f.s 101 -OW -423-000
DEVE14.)PEREMPACT FEE
It
PREC:ISE_VLAN J01-000-441-345 y,tEzi�.t3{J
-
FRF 01?vnSrT 101400-439-318 .4250.00
Sf.fFt-i'(7'I'�.1, (''f'►Ai`` t'o21 Tf'"f'1(t�t AiJ1� T3i.,d�A1' 0-'141
. s iv r
I.X'S'S VRT--.p ltr, N'Ir'tJ5
,.. ;.
'FdYi•r L a'ERIVII[T Ff.'VS D)iJFN(i'1Ai/
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
f
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
3��O
F.A.U.
Framing
,3—a Oa
Compressor
Insulation
3 � 3p
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
t(— 7 --aa
Drywall - Int. Lath
y— . o0
Final
Final ov
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
o� 5�
���
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
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole Coe:)
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Q
Final
Utility Notice (Perm)
COMMENTS:
.,
P.O 80X 1504 — i
Pu
Building 78-495 CALLS TAMPI00
l
Address �/ " LA QUINTA, CALIFORNIA 92253
OW i r- t teneome L,
om/
BUILDING: TYPE'CONST. OCC. GR -779
P. k
'• Mailing
A.P_Numtier•„'�lr'w(Jf.',?
Zf T 1.0 `
DeacErIpt
Co Tactor ! Pro�ecl Descriptkin _
t
13C X 15.K-1
AtZ
State Uc. City
S Classif. Uc. 11 Sit. " �j7 Ido. No. Dw. +:
Stories ' Units -
Arch., Engr.,
Designer New Add;Q tAlterl7 Repairer Demolition'O
Address Tel.
y
City _ Zip State
Lic. p
LLCE M CONTRACTORS DECLARATION -
f affirm that I am under of mencing with Section
: ion 3 of as and ns arM my If ae 13;Tf - - .• ' -
N
\ owNER6uILDER LAa►TiON Estimated Valuation' -
I he, afflcm, if
am exempt from the Contractors License Law for the following _• rt +
reason: (sec. .5.BusMss and PrWesslaa Code: Any city or county which requires a -
pwrf* to construct altar. Iprove, denwYalr, or repair any structs. prior rota �§eurnes oho ..
reptrWat_ rep, apparard ror ouch pamdt ro rsa a agnea awemsm riot ne n xaneed parswnt ro PERMIT - AMOUNT -
fha Drgr6%nYroPMe Conhacfwb Licernaa Caw. Carpier a (ea+mtenNip with Section 7000) of-
GMbrn 3 of the Business and Amressbns Code. or that, he le axenpt durehorrn, and the Dads
for Me aaeged exemption,Any violation of SoCfbn 7031.5 by 'any apprcam for a permits Plan Chk. "Dep.
ausiWis the tpp`canf to a chs penaay of not mon than Bre hundred dons (8500). Plan Chi:. Bal: - -
1 I, as owner of the property, or my emPloyeeswith wages as their sole compensation, will
do the wont, and the structure Is not intended or offered for sale. (Sac. 7011, Bulsnass and Const.
Professions Code: The Convector's License Car' does not apply to an owner of property who
•(.britds'or improves thereon and who does such'work himself or through hill own employees, Mach. ` _ 'ti _
provided that such srprovements are not Mended or offered for aale. M, however, the &Adsng
or improvement is sold within one year of comple0on, the owner•buadair w0 hem rhe burden Electrical -
t of proving; that he did not Dune or improve for the purpose of sale.) -
t'I 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing - - -
• sttjnct the project. (Sec. 7011, Busknesa and Prolessbns .Coda: The Compactor's License law
cities Trot apply to- an owner of property who bunds or bpnves thenen. and who conhacts for S.M.I. "
such projects wish a contractor(s) scowed Pursuent to the Cnrractors Lkenn Low.) Grading
1-1 1 am exempt under Sec 1t a P.C. fa this reason _
Driveway Enc.
Bate � owner r Infrastructure _ —,o
_ WORKERS' COMPENSATION DECLARATION
1 hereby affirm that 1 have a certificate of consent to sell -insure, or a certificate of
-
Workers Compensation Insurance, or a certified copy thereof. (Sae. 3800. Labor Code.)
z" Policy No Company
+>
O Copy is filed with the city. -'O Certified copy is hereby furnished
TOTAL
-
CERTIFICATE OF EXEMPTION FROM
REMARKS'
WORKEFtWCOMPENSATION INSURANCE
(This section need not be completed It tha Pemrt Lr for one hundred. dollars (t 100) miustbn
or less.)
ce"ity that,in the pedormancdiof thpwork. for- which this permit is Issued; I shall not
4 ,+'e _ «
employ any ppeerson In any manner so as to become subject to the Workers' Compensation
Laws o} Celilomla
•
Date—Owner
_
TO APPLICANT. NOI, after making ^ails CorMde of Exemption you should eaconna
ZONE:
subject'ro the ww"fit. Compansawn provisions of the Labor Cods, you must brfhwe
'
Minimum Setback Distances: - -- ,•
corripll' wBh such provts(ors or era Permit shag m
De deemed revoked.
_
- Front Setback from Center Line
Rear Set;ck from Rear Prop. Line =
CONSTRUCTION LENDING AGENCY
'Side Street Setback from Center. Line ' �-
1 hereby affirm that there Is a construction lending agency for the pert ce of the
' work'lor which this permit is issued. (Sec. 3097• Ch9_Code.)
- -
�� Side Setback from Property Line
�- Lenders Name
\ Lenders ,Cddress
FINAL DATE
INSPECTOR
This is a building permit tw III out signed and validated, and Is subject to
_
expiration if work thereunder days. • : -- - •
I certify, that I have read this application and state that the�above Information is correct
Issued by:
.. -
Date Permit
I agree to comply with all city and county ordinances end state laws relating to building
construction, and her z Ives of this city to enter the above.
mentioned properly fordo '• .
Validated by'
-
Signature of applicant Date
4
' Mailing Address
,Validation;
City. State. 31V.,IA I — IMV 1
. _
A.
WHiTE..FINANCE YELLOW APPLICANT
PINK. BUILDING DMSION ;r
;+
. R Dis r - `Pl�ni F, vi F6-
This form is to be-,Used.rby CDD staff for review of single family" 6vellings in the RC (Cove
Residential):4,District, i.n odder -to deterrri,ine ty a applicability .of compatibility issues or need
to`require the filing of: Master Design Guidelines. by -the applicant. It'`shall be transmitted to .
Building &.Safety as your correction list.:VPlease attach additional explanations. as necessary.
APPLICANT coRONEL:°CONSTRUCTLONc
PROJECT r:
ADDRESS:
51-605 Avenida'Ram'`re
r
PN: 773-125-018
A r.
LEGAL: LOT 6' , BLOCK = '"' 5:5 UNIT 5 . S. C, @ V.L.Q.
t.
CK'D `BY: Freda Baker k
s
BIN NO:
CASE NO:' -99 168. CHECK -DATE:
Inform the assigned -Building p1" 1 checker` vpon. your._assignment to this, case. The, CDD
Executive" Secretary maintains'a log book MArack applications a"nd" assign case'numbers.
.xt,. ri
The zoning code, architectural :and landscaping,"manuals, and/or_.assigned inspector should.
be consulted where 'uncertainties arise.. The completed checklist shall -be maintained in the
Building &Safety add�essr file.
P777-
Notice:La Quetta; CA�92253 '
Document Cannot'Be Duplicated760,47:1-5515
CERTIFICATE OF .COMPLIANCE
Desert Sands:Unified School District
49 950''Dune'Pa1ms Road
Date 1/20/00
No. 19940 Jurisdiction
Owner NameEsequieh Coronel
No. 51-605 _.:'Street Avenida;Rarhkez
City La Ouintazip 92253
XPN # 773-125-018
p
N ..
La Q*ta
Tract # Lot # ,- . Square Footage
Type of Development. 'Single.Fai* Residence
Comments
Permit #
Log #
Study .Area
1492
No. of Units A
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 or4replacement mobilehomes. It
t
has been determined fhe above-named owner is exempt,from payfrig school fees at this time due.to the following reason:
EXEMPTION NOT.APPLICABLE
This certifies that school facility fee's imposed •p'ursuantto Government Code 53080 in the amount of
1.93 X 1,492 or $. 2,879:56 the property listed above and that lisuiading4
permits and/or' Certificates of�Occupancy for this square 'footage in this proposed project ma ',now behssued
7.
Fees Paid By CC/Valley Independent Bank/Esequiel,;Coronel act hone;` 760 564-4604
M ine.on the check s
�•-
By Dr. Dons Wilson
Superintendent -
Fee collected /exempted by Olivia.Aguirre. Payment Received $2,879.56
Check No. 209578
Signature
NOTICE:. Pursuent:ot Ass mbly Bill 308flM71AP549'BTA7*. 1996) this will serve to notify you: that the, 90 -day appioval period in which you may protest the fees or other payment idenCdied
above will begin to�run from the date on whioh'the building or installation permit for this'project js sssued or on which theyare paid to the District(s) or to another public entity authorized to
collect them on ttie.District('s)(s') behalf, which6veris earlier.,
2.
Collector: Attach a copy of county or city plan .check application. form; to district copy for all'waivers. .
.
Embossed Original- Building Dept./Applicant Copyr- Applicant/Receipt Copy. Accounting
DEC. 7. 1399 12.08PM CTC SuDDIVismri FIND Pal'nF'r 8 ND, 854 P. 1
RECORDING P54ili:STE0 ay: I
6,; ' 7 1 ��
ANO UVmvj ,4oaDED, I AIL TtC�
i
i
Caronel Wtterpri.seo,.Inc.
P.O. Box e9 `
La Quinta, CA 92aa3 }
ASSESSOR'S PARCEL NO,:
TITLE ORDEANo,;
a .of Docurnern Recorded
on as No. - 2dri I
Has eiot`lsesn cornpara+d with ori�ral.
GARY :. ORSO
Coua�'ry`Recarder
(�I1/EF'IS��ECs3t1I+iTY, �CAL9FOR%IP4 �
TMs
FOR MICOPMV use :.N r
The undars!grted Grantor(.-) dsctars(s) that the DOCUMENT TFIAN&FER
TAX IS:
County . S City
ESCROW NO.; . 192�00 a i xx 0o1711putsd On the fill value of the>Entsrcmt of property conveyed, or
-- cvrnpttte>d'on the full vslue less the value of Years or encumbrances
GRANT
rvrnalMng thereon at the time of sale
OR trarsf& is FXEP. PT from tax for the following reason:
IN;, i _
FOR A VALUjsBLE CONSIDERATION receipt of which is hereby ackmwl edged. - -
PN Henry c_ Q iswold, as trustge of the Henry Griswold L:ivzn3 Trust
s
hed that certain document or
"declarer-ion. of Trust dated June 199t199,pursuant to
� herebg GRAN.rr(S) ,olAg ry C. Gr.'suo a� .'Trustor and Trustee
and executed by
Coronel EA':exprisea; Xna.
Al I
® all that real,property situated In the j ity of La Quinta
y County of -t,, Riverside, . State of Califgmi& d6scribed ss:
LOSS 4 ANi) 6 r>� aLOC3C 55` OF 'SANTA CA MBLITA AT VALM LA Q�.2�M` s By MAA
�- i Q '° -A , iTD77'z NO , 5 .A� 5fi�W?d
Oil >;ILS U Soon is PAGSS 53! OF MAPS, ,RECORDS OF RZVZRSID3 COUtQTyt, CALIFORNIA
i
Dated_jejhember os, 19s� f
STATE OF CALIFORNIA,'� s� "^.xy �Gci-vwl�lcl,rus e �
COUNTY QF_. R1verside, SS.
On_ Dece., m _jr 21 1994 , 6e me Cindy_ $urs to
Notary -Public, personally appeared
__ Hesar. v G. �rie�.roid : thus ®e
personally knuwrt ,td me (or proved Oto me oh the basis of
satisfactory Veldence) to be the persons) whose name($) aPrdtsvr3URO1N
iS/ars sub3crlbed to the wlthsn instriimant and 4ckmawledoed Comm. #11 =93
to me that he
/fir executed th®:e�me In hlsjr NOTnwrrueLrcp„a
aurhorized capacky(ka), and that by" khs � ar�sroaoau.vr
Y /he iralr`signatt�re(a) ^ Car.e�r.00�rpZa z�px °'
on the Inarrurrlent the person(s), air t'. ,entity upon behsff of .
which the person(a) acts ,executed ttilnstrurr,®nt. .
WITLESS my Mend .a acts
,4,
Signature
MAIL TAX STE,TEMENTS T (Tnn.r.anvemol�rtsieyeea�
SMS AS ABOVE- !
NAME—
CfY. STATG d pip
7.40I�t TQViV1 1T *'1Gl AIAn oArt AA r
f.Certificate. of Occupancy
� City of Lai Quinta,
Bu�ld�ng and -Safetyep rf�rnentIF vf:a_
• • . .. is ...., • , - : rt.=� - � �. -
This Certificate issc ed pcirsuant�to the requirements of Section 1,09,of the Uniform Bui/_ding Code;
certifying that,. at,the: dMea;of issuance, this 'structure`was.�in comp/lance with the wanous ordinanc_ es .
of ahe. City regu/titing _bui/din'g consfructiori'or` use. Fo `thee fo/%wing:
BUILDING ADDRESS: 51.'605 AVENiDA: RAM.ER1'Z
Use Classification: SFD 3 s +4 Bld Permit No x '.9912 153
-> 9' . M
-'occu anc Grou R :3 Type of Construction: �/N' LandrUse" Zone. ` RC `
p=, Y p:
i