0108-179 (SFD)_ •LICENSED CONTRACTOR DECLARATION._,
I hereby affirm under penalty of perjury that I am licensed undeprovisions 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 s�
04981 01.T�1r E'
bate `s s 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 rhy 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 M
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.
MAT E M14)) 191 y? -Ott
(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 sh uld become
subject to the workers' compensation provisions QPSection 3700 of/the .Labor
Code,'I shall forthwith comply with those provisions.
Date:-; r'`r_ r.: tApplicant \ j
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. t
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions sbt forth on his
application.
1. Each person upon whose behalf this application is made &Kofsuch
whose request and for whose benefit work is performed unde
any permit issued as a result of this applicaton agrees to, &
& hold harmless the City of La Quinta, its officers, agents a
2. Any permit issued as a result of this application becomes
work is not commenced within 180 days from date of isspermit, or cessation of work for 180 days will subject permit I certify that I have read this application and state that the abov
correct. I agree to comply with all City, and State laws relating to the building
construction, and herebyrauthorize representatives of this City, tp enter upon
the.above-mentioned, property for inspection purposes.
Si nature (Owner/A ent)4 / H '/ - Date 5 - 1
-_ L BUILDING PERMIT PERMIT”
DATE �+ Y VALUATION LOT 010847-9 TRACT
'�
V-,/ 17/0/ 7 � , 2,32
JOB SITE `-
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
TO BOX 3 '
78.1150 CAUL TA.RMC.0 "OU.M.A230
LAQ�1:KrA ('.•A 92253
L&Q'i NT.A. : VA. 92253
(76f>564 -f 604 M14 x,26 ).
USE OF PERMIT
XeD w PER N3I1' DOESNOT fNC.LUIDE CLOCK 'WA,I.,E,6PUt" 1, OR T3.WVWA.Y
APPROACH, 99'M, , ITER ®T..A03"
..
TRACT CONSMUCT1014 J.6P6,0.fl 11"
LVULAMl'CARPORT 533.60 A
S My. WOOD Mehl 20100
wrzwrm cogs or L'0mmurC'.1 ob
1<N17139 Ai3
plum r *M fl 1JAMIJ&HY
6r`•OMPI'I RUC TION PER . 101.0010-4 IG -000 S07,00
p% field Clit��1C 101-000-439-318
Y h :IJ tCNN� 191mW0-4.21-000 u ,l1fD
101-000 420^000
1, 1"SIF 'tFRE101.000-419000 5122.75
:3T1,I:I*N0 AgOTION "Z • P"300 1040 m000-241.000 $10.412
011 `o"011 FEE 101 •()00.4232,000 VON
1J%°'V7i.1r1PI!'R IMPACT PEP---; $3,907.00
r.:9C 0E PLAN 101-000-441:1345 $160A
s''lRT TN 'PUBLIC- Pt A.C.FZ R F;EGIE 2704J00-443-000 �tfl,rfl
FEii'.. CbUP0,91T 1-000-!39,318 42St1.100
51131.5• -TOTAL a JZ,T&M.'MONOW AN131•'LMY (TEDNX
$3,59:3.66,
7:2001
TOTAL F34AMM FM DVE NOW
lUINTA
E DEPT.
RECEIPT
DATE: / `
BY
DATE FINALED
INSPECTOR
V, i r
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
J!-Ot
Underground Ducts
Ducts
Slab Grade
%
Return Air
Steel
Combustion Air
Roof Deck
O.K. to Wrap
Framing
_10 , of
lg-30..o r
57
•5
Exhaust Fans
F.A.U.
Compressor
Vents
Insulation !/-gyp —Q (
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
-
Final
Final rl- –�� !/'
BLOCKWALL APPROVALS
POOLS -SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test `
Final
I
I
Gas Piping
PLUMBING APPROVALS
_
Waste Lines �Q`$/ �jT`
Gas Test
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
::�jJ _�/d J
$�
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Y
COMMENTS:
/4/400/Utility
Final
Notice (Gas)
a ELECTRICAL APPROVALS
Temp. Power Pole - O
Underground Conduit
Rough Wiring
Law Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final ��
Utility Notice (Perm) %_� O'
!.: •i 7irk,. C:xs►.es+t.. s,. .r x F. {, :_ r:�t--s
Ob4lo
ck�
0 P.O. BOX 1504
Building u C f�
dd78-495 CALLE TAMPICO APPLICATION ONLY
. a.P�S
� 1 F -a..... _ .._ _., _..s LA QUINTA. CALIFORNIA 92253
Owner
U i
Mailing
Address o k�
City Zip Tel.
Contractor \ \\
C_civ � �.-:._ ` � � �.a•�
Address
City22
Z�JS J ` Tel._y��
State Lic.tv City
& Classif. G l Cl Lic. #�
Arch., Engr.,
Designer F
Address MTel.
r•
City — Zip State
1 Lic. # *,
LICENSED CONTRACTOR'S DECLARATION
I hereby affirmat I am li9ensethunder p pdns of Chaptei9,(commencing with Seytion
7,gpp)yact of ivis' n 3 of the BOsinessa/"� ro�fgssi ns Cod je, and my license is in full force and
V \ / UAII
OWNER -BUILDER DE RATION
I hereby affi(r�� that I am Lxempt from the Contractor's License Law for the following
reason: (Sec. 703'145. Bust ss and Professions Code: Any city or county which requires a
. permit to construct, a 6'. improve, demolish, or repair any structure, prior to issuance also
repuires,.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 ciW'penalty of not more than five hundred dollars ($500).
I'"., 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_ of
improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. IL 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
does not apply to an owner or property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
17 1 am exempt under Sec. B. d 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 if the permit is for one hundred dollars ($100) valuation
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
—L-aw"s of California.
Date Owner
NOTICE TO APPLICANT: If, 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, CIO 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: TYPE•CONST. OCC. GRP.
A.P. Number `��', ` ` " C1�`t `•
Legal Description���
Project Description � - N1 —\ r c+, cZ, `1
Sq. Ft. `
Size ` 1
New ❑ .Add ❑
No.
Stories
Alter ❑
ko S
rr—W
No. Dw.
Units s•
Repair ❑ Demolition ❑
3timated Valuatn
PERMIT,
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const. :1
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
1 4
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
Issued by:—
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
AUG
Notice:
Document Cannot. Be. Duplicated
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Date 9/17/01 APN# 774-121-014
No. 22509 Jurisdiction La Quinta
Owner NameCoronel Enterprises Permit #0108-179
No, 53-525 Street Avenida Ramirez Log -:4
City La Quinta Zip 92253 Study Area '
Tract # BLK 232. Lot # 2 Square Footage 1696
Type of Development Single Family Residence No. of Units 1
Comments
,ived a cashier's check in the amount of $6,480.05 for (2) SFD
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 foLowing reason:
r
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 , in the amount of
2.05 X 1,696. or $ 3,476.80 the property listed above and that buil6ng
L.
permits'and/or Certificates of Occupancy for this square footage in this proposed project may now,be issued
Fees Paid By. CC / VAlley Independent Bank - Ish Coronel
Telephone 760-564-4604
Name on the check -
4\n
By Dr. Doris Wilson f'1
Superintendent
Fee collected /exempted by Annette Barlow.
Signature
Payment Received $6,480:05
Check No. 253860
OTICE: Pursuant of 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 !ees or other payment identified
bove 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
ollect 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
AS
SALE ESCROW INSTRUCTIONS
THIS DOCUMENT WILL AFFECT YOUR LEGAL RIGHTS - READ IT CAREFULLY!
TO: COMMONWEALTH LAND TITLE COMPANY Escrow No.- 10968KY
72855 Fred Waring Dr. Date: 06/01/01
Suite A5 , Pager 1
Palm Desert, CA 92260 -meq �-����
(760)•836-3726 sm
Escrow Officer: KATHY M. YASI
THE ESCROW HOLDER IS COMMONWEALTH LAND TITLE COMPANY WHICH IS LICENSED
BY THE CALIFORNIA DEPARTMENT OF INSURANCE. {
Buyer will hand you additional funds prior to closing in the amount of .......... $ 26,000.00,
h\
TOTAL CONSIDERATION $ 26,000.00
and any additional funds and instruments required from me to enable you to comply with these
instructions, which you are to use on or before August 20, 2001, and when CHICAGO TITLE COMPANY
can issue a Standard Policy of Title Insurance Owners form, with liability of $26,000.00, on
real property in City of La Quinta, County of Riverside, State of California viz:
Commonly known as: APN# 774-121-014-3 (Ave. Ramirez), La Quinta,.California 92253.
Lot 2, Block 232, Unit #22, Tract Santa Carmel'ita at Vale La Quinta, as per map recorded in Book
20, Page(s) 24 inclusive of Miscellaneous Maps, in the office of the Coun-y Recorder of said
county.
Except any I reservations of record .of minerals, oil, gas, water, carbons aid hydrocarbons.
Showing title vested in:
Coronel Enterprises, Inc., a California Corporation ,
Free from encumbrance except:
A. Current general and special taxes for the.fiscal year in which this escrow closes, and
taxes for the ensuing year, if any, a lien not yet due or payable..
B. The lien'of supplemental taxes, if any assessed pursuant to the provisions of Chapter
3.5 (commencing with Section 75) of the Revenue and Taxation 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.
A
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 2 -0 -0 -feet of the applicant—and/or-2)-if-there-is-a-need for-the-=3pplic-ant 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 CORONEL CONSTRUCTION
SITE ADDRESS 53-525 Avenida Ramirez
APN 774 121 014 CASE NO.: 2001-538
LEGAL: LOT 2 BLOCK 232 UNIT. 22 S.C.@V.L.Q.
CHECK AND APPROVED BY: Mi rhPl P uamho DATE: !81g -d DI
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..
REQUIRED ITEM
Y
N
COMMENT/CORRECTION
Verify legal and APN. information
X
Consistent with MDG on file (as .V
applicable
MDG filing required (5 filings since`
9/3/98)
FBy p`F�B
0
Architectural variety within 200 feet of
the surrounding area:
Colors
Materials
Architectural design features
F
F!°l
Other Requirements:
.INSTALLATION CERTIFICATE -CF-6R
53-5,5
Site Address Permit Number
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
❑ DUCT LEAKAGE REDUCTION
Pressurization Test Results (CFM @ 25 PA)
Test Leakage (CFM)
Fan Flow
If Fan Flow is Calculated as 400 cfm/ton 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
Leakage. Fraction = Test Leakage/(Measured or Calculated Fan Flow)
Pass if leakage fraction <_ 0.06 ❑ .
Pass Fail
❑ For AEROSOL TYPE SEALANTS ONLY•- The following diagnostic testing was completed:
Duct Fan Pressurization at rough -in measured leakage (CFM)
CHECK AFTER FINISHING WALL:
❑ Yes ❑ No ❑ Pressure pan tesi or House pressurization test
❑ Yes ❑ No, ❑ Visual Inspection of Duct Connections f l/ ❑ ❑
`- Pass Fail
❑ THERMOSTATIC EXPANSION VALVE (TXV)
® Yes ❑ No Thermostatic Expansion Valve (or Commission approved
equivalent) is installed and Access is provided for inspection � ❑
s Yes is a pass Pass ' Fail
❑ DUCT DESIGN ,
1 • ❑ Yes ❑ No ACCA Manual D Design calculations have been completed,
Duct Design is on the plans and duct installation matches
plans: /j) �.
2• 1:1 Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV, / �'- -
verified fan flow matches design from CF -1R.
Measured Fan Flow =
❑ ❑
Yes for both 1 and 2 is a Pass Pass Fail
❑ I, the undersigned, verify that the above diagnostic test results and the work I performed associated with the test(s) is in
conformance with the requirements for compliance credit. [The builder shall provide the HERS provider a copy of the ('-F-6R
signed by the builder employees or sub -contractors certifying that diagnostic testing and installation meet the requirements for
compliance credit.)
Ao)
j/ Tests Signature; Date
Performed
COPY TO: Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
1 +5��
Installing Subcontractor (Co. Name) OR
General Contractor (Co. Name)
Certificate of Occupancy
City of La Quinta
s�
Building and Safety Department OF
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: 53-525 AVENIDA RAMIREZ
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0108-179
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RC
Owner of Building: CORONEL ENTERPRISES
l__&' -t x
Address: P.O. -BOX 389
City: LA QUINTA, CA 92253
By: RICHARD KIRKLAND
Date: JANUARY 16, 2002
Of
Building Official
POST IN A CONSPICUOUS PLACE