9807-111 (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
Date " 'e gnature of Contr �tor
f
Z,
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&RC. 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 & policy no. are:
Carrier Policy No.
' tj v,I Aw3L1"? 11va. r$14WZil i 1w "v?if
(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 they
workers' compensation laws of Calio nla, and agree that if I should become �)
subject to the workers' compensao provisions pf Section 3700 of the Labor/
Code, I Salllf rt with comply with those provisions. �(
Date: ant
Warning: Failure to secure WorkersCompensation 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 ofethis City to enter upon
the above-mentioned property for inspection purposes
Signature (Owner/Agent) 111 a�A,Date P
.L 141111,
t
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
$89.41 Its 1.01 IN] I
JOB SITE
APN
p
ADDRESS .51 -a? -5 A V,FN.lfJ�1li .Itl;��itti.lJ�A694ti
_173-iO4-60
OWNER
CONTRACTOR / DESIGNER / ENGINEER
u`c},ri„i.., L"4✓i�v i1 i,S,.1�::"i ::�r.
roy t
�..�r>��titl r -t �. i, i.1t±�t,,��t'it.tcy�"r+�.-i lV
M-346
51...540 EISENHOWER DR.
LA QLAINTA. C'A. 92253
1:.:A ()1_It'A1'. A. CA 92:153
a 60)5€445**04 C:1d1;(4 2a61
i
USE OF PERMIT
it
SRI
t !;l�tZlwl attt;{'9C}N rlY-i4.lisi), ,N.L(tuii"i UOUS N(Jf'� P34,1,(tDi (1� zC;f VVAf..!}y
Q�t11tC.d#7'i�'i`:tG) 36.00 N111
t:aA.tt1�.�4}J<::d�.fitt'4:;:€t'i' S.t•3.tltt ��#�
6F'1'. WOOL) UNCP . :a1(1t .W ,tvlf
USTIMAIM') (_--DST OF CaNYS"PRUCTIONN
39,413,N)
t"_t ir4` 1rK1 t_1C°T.TC7N F .1,01-000-118-000 54594. 50
IN ACJ'IJFft,.C'KCFIVE $121568
+"T1; ¢0S3._'W
t{1..iX1TitSC J..L WE HH -WO -420 -OW
o.rL UMEONQ FFEE 101-000-449-000
til) 101-11114-241.-0130 3K.94
1.111-1100-42__ .-OC) $2.0140 a
i.?vSr.t1 °l12.Cfi," al2F .eL Z S-000-443.342 Sf,962.IS
RK-FiCX ITIC, " AN 101.-000-441-345 $25.06
101 _{i( -439_3AR 42150.00
31;B"I,"r_ 3'.! :A 1.; ft•.'jl'S'.?'R C,110N ANID P],•,{ N C i'11;G;13..
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LESS IT -11 -RAID ITES
S, 2.50 0 0
".t`OTAL V 4+ RAIST Y)i';!+ S 431)CN01V
$2,7".42
RECEIPT,p 1
-1 .i
DATr r �'
`� - rE l�
By %
1
DATE I Vv
INSPECTOR
(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 /.17
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing A
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
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
Gas Piping
PLUMBING APPROVALS
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
Pool Cover
Sewer Connection 777Z770
Encapsulation
Gas Piping
Gas Test Q
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Allain Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
Notice:
Document Cannot Be Duplicated
Date 8/4/98
No. 17452
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Owner NameCoronel Construction
APN # 773-104-019
Jurisdiction La Quinta
Permit #
No. 51=375 Street Avenida Bermudas Log #
City La Quinta zip 92253 Study Area
Tract #
Lot #
Square Footage 1,421
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
1.93 X 1,421 or $ 2,742.53 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued
Fees Paid By Cash/Coronel Construction TeleIii�one 564-4604
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green Payment Received $2,742.53
Check No. N/A
Signature
NOTICE: Pursuant of As$dmbly 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
ESCROW INSTRUCTIONS
Cindy Burgin
Escrow Officer
Pacific Coast ESCROW Conponation
74920 HIGHWAY 111 INDIAN WELLS, CA 92210
TELEPHONE (760) 568-0344
51-3-7b- AYC f 0L41PDAs
-773 - io,4 - 0i9
Escrow No. 17900
Date: June 16, 1998
This escrow company holds Department of Corporations Escrow License No.
963-0473.
CASH THROUGH ESCROW ...............................................$ 16,500.00
TOTAL CONSIDERATION .......................................... .....$ 16,500.00
Buyer shall deliver to you any instruments and/or funds required from Buyer to enable you
to comply with these instructions, all of which you are authorized to use and/or deliver
on or before 07/16/98, and when you are in a position to obtain a standard Policy of
Title Insurance through CHICAGO TITLE INSURANCE COMPANY, provided that said policy has a
liability of at least the amount of the above total consideration, covering the following
described property in the City of La Quinta, County of Prsi e, f California:
LOT 7 IN BLOCK 134 OF SANTA CARMELITA AT VALE LA QUI A, UNIT NO. 14 AS SHOWN BY MAP
ON FILE IN BOOK 18 PAGES 82- 83 OF MAPS, RECORDS OF RI ALIFORNIA
PROPERTY ADDRESS LOT 7 BLOCK 134,La Quinta,CA 92253
SHOWING TITLE VESTED IN: Esequiel Coronel, a married man as his sole and separate property
41
_ 5
+
FREE FROM ENCUMBRANCES EXCEPT:
General and Special Taxes for current fiscal year, including any special levies, payments.
for which are included therein and collected therewith. Covenants, conditions,
restrictions, reservations, easements, rights of way, of record, if any; also exception_, .
or reservations of oil, gas or mineral rights, if any. Any bonds or assessments of record.
1) . Buyer here int, wi+rl^•pay All Cash for-subjiect, property,,end shall: deposit,siatpraescrow.
prior to the~close-•of escrow, the balance. of --total purchase price..plus buyer.':s..portion of
escrow and recording fees as required in the form of a Cashier's Check or Wire Transfer.:
2). The parties herein agree that the closing of this -escrow is subject to the Buyer' -s
:1
approval of Preliminary Title Report,.CC&R's, if applicable within 3 days of receipt of
same. Buyer's failure to notify Escrow Holder of any disapproval, in writing, within ;.
specified time limit, is deemed to be Buyer's approval of same and this contingency
eliminated. �.;,,:.
3). Covenants, conditions, reservations (including exception of oil, gas, minerals,' +
hydrocarbons; and/or lease without right of surface entry), restrictions, rights of ways•=i(
and easements for public utilities, districts, water. companies, alleys, and streets.
A t
4). Buyer is aware and acknowledges and accepts and holds Seller harmless for said
property in regards to geological, flood hazard, seismic hazard and any special studies,_
zones. Buyer has satisfied himself as to making any further inquiries at appropriate
government agencies, lenders, insurance agents, or other appropriate entities'concerning'�
use of the Property under local building, zoning, fire health and safety codes as may be
applicable under the Special Studies zone act, seismic Hazards mapping act-, and local
geological ordinance(s).
5). Buyer and Seller acknowledge that state laws prohibit this'escrow from closing
(recordation -of Deed) until buyer's funds`, izidluding new loan proceeds, have -been
collected, as defined by law. The undersigned Buyer (Borrower)'understands that,•it is +
their responsibility to determined from lender of their chcice what type of funding
instrument will be used. Also per diem interest will be charged to buyer and seller by
their respective lenders while Pacific Coast Escrow Corporation determines that all funds:
required to close have been legally collected. It is recommended that Buyer have all
•t 1
r , _. ryY V � � • r.
1
157-/ 13 %S P.O. BOX 1504
Building %�_l� 1 78-495 CALLE TAMPICO APPLICATION ONLY
Address �Xl %r°✓/1lU%Fft LAQUINTA, CALIFORNIA 92253
Mailing C
Address v . ��( J
City ZipTel.
,U �,►�.(-� l � X611 11boq
Address
i-- J •
I k air) LIp�Zz5 fel�v�l
State Lic. City
& Classif. �(� , C > Lic. #
Designer
Address Tel.
City IZip I State I
Lic. #
LICENSE I ..ONTRACTOR'S DECLARATION
I herby' affirm thaO am licensed under DrovisioaV_Ehapter 9 commencing with Section
7000) of Division 3%1 the Business and Professto Code, and my Iyegp is in cul fc� e,and
eefiec . / ! t C ( '14 �%�►/ \ �/ / f� 1�� 7 1
SIGNATURE �" GA -4 -
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, after, 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).
1] 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 -budder will have the burden
of proving that he did not build or improve for the purpose of sale.)
1 1 1, 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 contractors) licensed pursuant to the Contractor's License Law.)
17 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. 3800, Labor Code.)
Policy No. Company
(7 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 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 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 a0plicant —Date—
Mailing
ateMailing Address
City, State, Zip
BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number --713 leL(— (� '
Legal Description LZ-(- -1 1>+ e_ • I Z LI
Project Description
REMARKS
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
INSPECTOR
Issued by: Date Permit
Validated by: a !
Validation:
J U L 13 1998
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISIQN_
,1 @ :�
Sq. Ft.
Size Al Z 1
No."7 No. Dw
Stories -7, Units .
New Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.5(J.
GtJ
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 Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by: Date Permit
Validated by: a !
Validation:
J U L 13 1998
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISIQN_
,1 @ :�