0012-147 (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
634.981 B U1/31/2t.
DateSignature 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).
() !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
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 A policy no. are:
Cartier STATE FUND Policy No.
(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 provisions.
Date: ADDlicant
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 c'
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
the above-mentioned property for inspection purposes.
Signature (Owner/Agent)
Date
BUILDING PERMIT PERMIT#
DATE / VALUATION LOT' 601.2-4 TRACT
f
JOB SITE
APN
ADDRESS 51..-71.5 ,AW114ltY3ARAM
7'1;5-82 ,8
OWNER
CONTRACTOR / DESIGNER / ENGINEER
COR.09M COA STRT)-110.N
a o—R.i i2Yn e:^.C92.1e'1,a. 7 ON
78-150 CAfhr.,a' 3AW.l O Si.tI'M0250
78.150 ==..',,Chili PTICO r .. _' E #230
L„ , Qi.T1`krrA CA 92253
LA QIS.41+lT& CA 92 '
('160)5CA,4604 t;A1rFd 21tz�.
USE OF PERMIT
SN03.A1«• RAWLY DWEL11140
SF9]-PWZM1 T D09S'N0T INCI,U)3 a1, x.6Sb'3E9.I�LSfi ciCl7Jl�12'iti�4tji :i'
APPROACH
TRACT CONSTRUCTION :. 1,421,110 SP
PORC.WFALTIO 2.W SY
OA.RAOIU eAX POWt (OF) 91496,40
5 FT. WOOD PENCE :100.00 ly
STAMAA&i.Ra� COW Oil 'i..ti.+*dVLZ 6+L+8SW.1.7
�y�'p+yy�.,f,(��p y�y�• �y[�.���q�q„y
Ti Ns'64lfttK].' RT, �A�I.fAV.LLR'JARY .
CONSTRUCTION 1+F% 101.000.41 18-0013
PLAN CHECK" FSE 1b31'-000-:4•33-318 3�f1a.1�
i :(:liA1�1TC11L t� 101.000421-000
21,31 CTRICAi, rel?, 101-OO.&4MOOU
PLllMBrOG FRE 101 -000 -413 -OW $110,75
a T.iaONO A UfJON FRE • 1tY? x11:7 101-000-241-000 $8.93
ORrl INO FFR 101-000-423-0.00 . .120,00
DL�N 3DPZ'R IMPACT IFEL $1,90.00
e.
PREC18IZ? PLAN 101.000-4-41.345 $100.00 .
FEE DEPOSIT109 -000-4.:33'-318
a.
fftT8-'Mi'AL 0098!"K1Jf 1'101T AND N (1-MCK
�3��yy;�,4pp3p�i.�7yyr//b��
yy.e��?��gqLrr��.et
ry-�ppyy��
�.M 9 i�.ElG"d"/'ID IMF.
"�Y 2r*0,00,
JAN 03 2001 l
oil 0
RECEIPT "
DATE ;+ f
BY j} .
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
-O/
Exhaust Fans
O.K. to Wrap
- - GY
F.A.U.
Compressor
Framing -� , p(
Insulation
-/ .O(
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans &' Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath,
i
Drywall - Int. Lath
Final •
Final'
POOLS - SPAS
BLOCKWALL
A PROVALS
Steel
Set Hacks
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
/J
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
1 - t2 -off i
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole - - p
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) .�(
1-� y. •a. -•,.e. �<:.,. �,,..,,e..•-.n+ast+K i"- •±k....� r -x -.A a,:.y-�„^..r'aL" .._5+ �.-. _...;s."'""t}S. -.u..►+►•� �..c:,...- ,^...-..,,,�. w`w`..�.n.�`p�.
Zit
vox t Y` -:..�• ?•. '�'�' ��� tit' t ri r., , y 1'tO•� I_• �
s� ..:..i•4•.-..1=.. r!``:+„P e... *b • � _ Y``�, te. ��'1����� re. Vy ` � �
•�"'PO.'BOx1504' -. APPLICATION ONLY -
Building 78-495 CALLETAMPICO _.
Address - r'� Z LA OUINTA, CALIFORNIA 9225.9
Owner
V BUILDING:�TYPE•CONST.' r ' •' _
Mailing , OOC. GRP
_
y A.P. Number 't]Zn" �113 IF\_P'R6L ,mo*ai'°4,Address
city-
z,ip Tel. Legal Descr'
ptionv `
" 'Contractor - Project Description _S. 1 • �, spa
ddre Ir
ry 1' t
City ` _ Zip - Tel ,r,
,�� Baa y Ckll
_ State Lica City • s y �. _ M -
8 Classif. / Cw - Lia 8^� � � x ,t -. -
O -1 I dL Sq. Ft - No.. No.
s
Size _ Stodi s "'a
Arch., Engr., - _ - � Units ....._ -
Designer ; New $0 Add ❑Iter O Repair 0 ` `'Demolitlon f7-
Address , Tel. '
4-2—
City.
-City.Zip State, Y�
Lic. p
LICENSED CONTRACTOR DECLARATION
1 ebY affirm that I am licensed urlde Drov I sof Chapter t! (comma Ing with Section -•+.
• Division 3 of the Byah��g�n� fOfe$�1 a Cade, and tint license Is 11 f a
eft d'Y / l l A • A ie i . /t pJ�!_..M -i. -
OWNER•BUILDER DECLARATION
I hereby affirm hat 41- exempt from the Contractors L1 all Law for the following
reason: -(Sec. 7031- ass and Professions Code: Any city or county which requires a
gem* to construct, ager, Improve, demoish, or repair any structure, prior to , to issuance afro
requires the applicant for such perms to lie a signed statement that he Is licensed pursuant to
the provisions of the Confrocrors tkense Law, Chapter9 (commencing with Section 7000) of
Division 3 of the Bus -mess 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 penahy of not more than five h0ndred dotlam ($500).
1-: 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 Contractor's License Lew does not apply to an owner of property who
builds or improves thereon and who does such work hinseff or through his own empioyees,
provided that such improvements are not intended or offered for sale. N, however, the building .
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he dight build or Inprove for the purpose of sale.) -
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 wit a contractor(s) licensed pursuant to the Contractor's License Law.)
1-1 1 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. 3600, Labor Code.)
Policy No. Company
r) 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 6 the permit Is for one hundred dofam (f 100) valuation
or fess.)
1 certify that in the performance of th0 work. for which this permit Is Issued, I shall not
employ any parson in any manner so as to become subject to the Workers' Compensation -
Laws of California.
Date Owner
NOTfCE TO APPLICANT: N. after making this CertMcate of Exemption you should become
subject to the Nbrkers' 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, Ctv6 Code.)
Lender's Name -
Lender's Address `y
This Is abuilding-permit when properly filled out, signed and validated, and Is subject to
expiration if work thereunder is suspended for 180 days.
1 certify that 1 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 aOplicanl Date
IAailing Address -
City, State, ZIP
WHITE a FINANCE YELLOW ms
Itimated Valuation -
PERMIT
Plan Chk. Dep. 7 2f
Plan Chk. Bal.
Const. a/OF 1 1_7
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL'
REMARKS
I T 1 /I44oe�
,,. � •y.
ZONE:�,-
"
BY:
Minimum Setback Distances:
M
" Front Setback from Center Line
- F
Rear Setback from Rear Prop: Line
-
•
Side Street Setback from Center Line - F` T
. r
Side Setback from Property Line
1
r;`4I
,�•
P NAL DATE
jIssued
_INSPECTOR- '
- - , a- a
by:
Date Permit
R
Validated by:
r `z
Validation
iiE
APPLICANT
PINK BUILDING DIVISION
f
Desert •Sands,Unified &hoof istrict` '
47 1950. Dune Palms Road
' - Notice:,
La-Qutnta,•CA 92253, -,
Document Cannot Be`Duplicated.. "•.,, 760 771 8515.
CERTIFICATE OF COMPLIANCE
Date y 12/28/00 M `'FAPN # 773-125-022
No. 21420 'Jurisdiction La. Quinta
Ail -
Owner NameCOroilel ConstructionPermit #
0012=147
No. 51-715 Street Avenida, Ramirez Log#
City La Quinta zip 92253 Study Area
q g -
Tract # - Lot # .Square Footage 1421
Type of•Development Single Family Residence No. of Units 1
`Comments "
At the present' time, the Desert Sand§ Unified"School District `does ;not collect .fees on garages/carports, covered
patios/walkways, residential addiiions'under 500'square feet, detached accessory structures or replacement mobilehomes. It
has `been determined the. above-named owner is exemptfrompaymg•schoo- Cfees at this time due to the following reason:
EXEMPTION NO.T APPLICABLE
This certifies that school- facility fees imposed pursuant to Government Code 53080 in the amount of
2.05 X 1;421 "or $ 2,91-16 MF the property;listed above and that building
permits and/or.Certificates :of Occupancyz.forthis square footage m this proposed project maX'now be -issued
Fees paid. By CC /1 st Bank - Ismael Coib'el y Telephone? 760=564-4604
Nameon the check
By Dr.:DoriS Wilson
Superintendent '
Fee collected /exem ted by Annette Barlow ' Payment Received $2,9131.05
_ r Check No:' 57262
:.
NOTICE: Pursuant of Assembly Bill 3081 (CHAP`549 STATS. 1996) this will serve to notify you this the 901y approval period in which you may, protest the fees or other payment identified...
above will begin to run from the date on which the building or installation pe" it for this. projectis sssued or on which they are'.paid to the District(s) or to another public entity authorl tom Y•.
collect them on the Distrlctt('s)(s') behalf, whichever is earlier. - 4r
Collector:. 'Attach a copy ofcounty or city plan check_ application form to.district copy for all waivers.
i
Embossed Original- Building Dept:/Applicant Copy - Applicant/ReceiptsrCgo�py '`Accounting
`571, cS -v .Z.,
SALE ESCROW. INSTRUCTIONS.
THIS DOCUMENT WILL AFFECT YOUR LEGAL RIGHTS - READ IT CAREFULLY!
TO:. COMMONWEALTH LAND TITLE COMPANY Escrow No.: 10340KC
72855 Fred Waring Dr: Date: 09/01/00
Suite.AS Page: 1
Palm, Desert, CA 92260
(760) 836-3726
Escrow Officer: Kelly Col lier-
TIM ESCROW HOLDER ISC:ONIIVI,ONWEALTH LAND. TITLE .COMPANY WHICH IS LICENSED
BY THE CALIFORNIA DEPARTMENT' OF INSURANCE.
Buyer, or his agent, will Hand you or''cause to.be handed you upon signing of
these instructions a deposit in the amount`of............. .....':.1:.............$ 11000.00
Buyer will hand you additional funds prior to closing in the amount of .......... $ 20,000.00
TOTAL CONSIDERATION $ 21,000.00
and any additional funds and instruments -r..equi red.from.me.to-.enable you to comply with these
instructions, which you. are to us or be ore°,October 13, 2000,''and when OLD REPUBLIC TITLE
COMPANY can is"sue a Standard Policy of Title Insurance Owners form, with liability of
$21,000.00, on real property in C-ity of ,LA QUINTA,-County.aof'Riverside, State of CALIFORNIA viz:
Commonly known as: APN 773-125-022-5-(RAMIREZ)-,.LA QU-INTA, CALIFORNIA 92253
Lot 10, Block 55, Unit No.. 5, Tract Santa Car.mel:ita at Vale La Quinta, as per map recorded in
Book 18, Page(s) 63 inclusive of Miscel:l'aneous'`Maps,, in the office of the.County Recorder of
said county.
Except any reservations of record of. mineral s,. oil, gas, water, carbons and hydrocarbons.
Showing title vested in:
CORONEL ENTERPRISES, INC:.,:A CALIFORNIA CORPORATION
Free from encumbrance except: i
A. Current general and special taxes for"the fiscal year fn which this escrow closes, and
taxes for the ensuing year, if ank`. a `'lien not yet. due or 'payabl e .
B. The lien of supplemental taxes, if any- ,-assessed.pur:suant to the provisions of Chapter
3.5 (commencing with Section 75).,of.the, Revenue and'laxation Code of the State of
California:
C. Special improvement assessments, if`',any.
D. Easements, rights., rights of way, -covenants, conditions, restrictions and reservations of
record.
µ' l,, `5 000
RCDITS_TRICT- TLANNING�REVIEWTORM
This form is to•.be used by CDD staff fbr fev e`w of,single. family,,dwellings-in the RC (Cove Residential)
District; in.order t6 -.q ermine the applicability of compatibil'ity'issues orneed�to require the filing of Master
Design Guidelines by -the applicant: It shall be:'transmitted to,'the�Building.Ad Safety Department as your
correction list. Please attach additional explanations' as necessary
APPLICANT
SITE ADDRESS 51 715 Avenida Ramirez x
APN 773 . - -125_ 0122. BIN�NO . JPA �x CASE NO.: 2000-335
LEGAL: LOT l.t . BLOCKS : 5 5 .._.; UNIT "k5 S.C.@V.L.Q.
l
CHECKED BY: Wa11y.,Nesbit' ,.DATE: /L/? -I
Inform the assigned Building plan checker" upon your assignment to -.this case. The CDD Executive
Secretary maintains a log book' o track�applications`and assign case numbers.
REQUIRED ITEM-- `"
Y.
N }•
COMMENTICORRECTION
.Compatibility Review'
Nle
Case logged and- number assigned
Verify legal and APN information
4'r 1"' ^'""'E. °ice '•''0i'`y 44&K
N,0; i.'a Oi-tov� va' ow•�r ,aurxo�e�zos�w
Consistent with MDG on file (as. applicable
MDG filing required `(5 .filings since 9,/3/9,8)
,/
= 0^0 J f
Consistent with street/surroundm area-
Consistency g` ..
>�
Der,,-pu�'r
V.
,,kir- - use C W-fISM-Ir
Colors
Materials
Architecture„����,,r
C44✓0, T7 w- SRequ'
-
ramaAus?
-VL41.07 01.1A4ASkh P
F r
ved
` r
Commissw .,...._..,. .---
O PI
nein
,Ny co�o�ts 2b d'. s6D•
p:Ci
y Co
jhdf.�._._..
CIMMLImyr,►,..:.�..*
is 2zloo��,.�—.
L Car
xhibit ..:'.
nth' Conditlons.�c_._.....