9806-006 (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 p Date
6.1"1181 i� � ��� 00 1
Date —iSignature of Contractor f �'�!•��
OWNER -BUILDER DECLARATION
I,.
yI 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 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.
Si)"Kave and will maintain workers' compensation insurance, as required by
CTion 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.
w 0IL,i}ellti FACILE, ITIN 3. 1M1f'�EYd~+3'e fa(200
(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-1=should become
subject to the workers' compensation provisions of ection 3700 of the Labor`
Code! I shall forthwith comply with those prov'isione
Date % c� Applicant /• < lam'
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 is,
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 180days 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<aIP City, and State laws relating to the building
construction, and hereby authorize representatives ofthis City to enter upon
the above-mentioned prope/rty/for inspection purposes 9
/�
Signature (Owner/Agent) t�� 1 / 7 � �� Date•--
BUILDING PER. ■I� PERMIT` CONTROL#
NI
.�s�a��.•tr3y��
AI( A
DATE VALUATION 'Fsi}.4LOT °7 TRACT 67,181316
(� (�
Al SYC
JOB V4f 521-r�%'S.�ANdY�.VIDA HEfi€t��.lUDA
ADDREfs
APN 7734W-5.020
OWNER
CONTRACTORDESIGNER
/ //^^��11v� LL T /+r��1�rt 1' p ��
�..�,✓�\Vt•i t%i,r t✓l.fd�,] i �wyarT�.\,fi'i
,/ENGINEER
/ /
L.r0 ik0i E,1,, S•.ONTIy jT1,Wri-�•ei�aI
51.540 E1Sr3:�.1vH0WEk DR.
?i� u�if .i:15ki�➢� it5i�r �i t)it,
1AQ[S(N'.i'A. C:A. 92253
LA,Q 1INTA CA. 92�5:i
CnIA 111161
USE OF PERMIT
S.i"IJ
it is - i?l;itl+fi f" 1iC3.r"may l�i:`t " .ZaC�.+J1 is' i31.� C1±. "f�l�C: i�ic P00L.
(&fX FV_k 011 RW)UC"ED F -LAN CRE%.K. FIX Air YLIJ Y 1:01d.&11A:rJP1,s
1'a.1ttB..'difl'f','1'iC� 3G �!U si•
f. AT AC#FS CA12k°U1, rV ? 14.00 S
•21(!0;00 T i%
c �i1,i`1�tJr '1C3 3aJ; f�.i- �t� �i1£t-E)!JU 5594.50
ist,AN'(�tQ1tC;K f:1+N.. lt)1,,Lt(tr1.d�t9-3xR '$125:�:f3
N11fCl14i.1AC:AL AX 1.11,3-000421-0,00
W&CF1'diCAL 1' 1V 10440-420.00
P1,fIMI RI'N 0Fi" a 101.000.1.19-€100 *i:t.3.�r;
°1)'r?)1�tC1!4trst'rrfta'i�d.»).F".`i'+i9 3f)l,tif.+(1^;!<t.rl0ti 'i•,y+t
101-000.42.1-000
16ft t: f €>.H .F3 0iN101-OW-441-345
I0I- QD-4,'i4-1tR •,'�?Sf1.t#i0
PLNPir
'OTAL C 1 'r�c,l✓c: -�c r�, n.►�r�PLANcddiEA
♦rry C ��,/�a
JUN 0 3 1998,r.� a PR f�- ,. : �M
I�{�1
!
TOTALVERIMIT FE"EN DUE, NOW
.� Y O
RECEIPT
DATE ��
BY)'DA
F AL
INSPECTOR
3
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
A
Combustion Air
Roof Deck
A.11
Exhaust Fans
O,K to Wrap
/Ilk
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
APPROVA16S
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
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
�l/y 77 40,
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
1
c
Final
Utility Notice (Perm)/��
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 6/3/98
No. 17115
Owner NameCoronel Construction
No. 52-675
City La Quinta
Tract #
Street Avenida Bermudas
Lot #
Type of Development Single Family Residence
Comments
APN # 773-305-020
Jurisdiction La Quinta
zip 92253
Permit #
Log #
Study Area
Square Footage 1,421
No. of Units 1
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 novrb� issued
Fees Paid By Cashier CheckNIB/Coronel Construction ;Ta yephon.e 564=4604
Name on the check -r
B Dr. Doris Wilson
Y
Superintendent
Fee collected /exempted by Juanita Green Payment Received $2;742.53
Check No. 166119
Signature
NOTICE: Pursuant of Assero* 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
S
�' ="" """" "' . q t -r• 'rareu. ;, P.O. BOX 1504 APPLICATION ONLY
Building �'
' ` 78-495 CALLE TAMPICO
Address �Ko ��'"i J�t[J°i� S LA QUINTA, CALIFORNIA 92253
Owner
CORQNEL CONSTRUCTION
Mailing OX 308
Address f!•O►1. _
J -R5,
City f
h�- 4,1
Contractor
CORONEL CONSTRUCTION
Address r3j. BOX 3189
State Lic. Fic.#
ity
& Classif. 3 j/ 246
Arch., Engr.
Designer
Address I Tel.
City Zip State
2 2Z_.L I I Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7oD0) of Division 3 of,the Business and Professions Code, and my license Is �n full__forie;and
effect. - �� /) ��! t/
SIGNATURE / DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness 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).
(J 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 -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
doesnot 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.)
11 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
f7 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.)
1 certify that in the performance of thF 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: 11, after making this Certificate of Exemption you should become
subjectto 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 sof this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant —Date—
Mailing
ateMailing Address
City, State, Zip
BUILDING: TYPE'CONST. OCC. GRP. q
A.P. Number%
Legal Description %� �'"zz g9l
S- r
Project Description
Sq. Ft. No. No. Dw.
Size 140 Stories % Units
New ¢ Add ❑ Alter ❑ y Repair ❑ rDemolition ❑
�!��4?� � ►.QTc
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep. 2.r
Plan Chk. Bal.
Const.
Mech.
Electrical t'!
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
MAY Z 9 1098
TOTAL to 01 11NIA-1
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:
Validation:
WHITE = FINANCE —V LLOW = APPLICANT PINK = BUILDING DIVISION
� r