0102-225 (SFD)_3
J 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
634981 B j 0WI/V
Date I II 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 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.
( ) 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.
G1�A,�9)r
(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 witli,those provisions.
'rDate: Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application. 1
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this. application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
trabove-mentioned property for inspection purposes. P
Signature (Owner/Agent) Date '
BUILDING PERMIT PERMIT#
DATE / f VALUATION LOT (�i-�;a1S TRACT
JOB SITE
ADDRESS
78•-7.9.0 DC"LE VREIRT.-
APN
I ri a
OWNER
CONTRACTOR/DESIGNER/EN (NEER
f.;`o)12,fy)(��/�.y�T` 0�fl•TXa�fZW-111,1C9�2(ifp�.ryCpORarY�3/�gi},.�G�
C�1yA+1'81''p�?�i�;yff�:^'91'yC'a?ly+l'�
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f�
l'i�- 1 �1i \.a'"Y.C..1GGLr �b"alY;S�i��'+..' f:i'+,'����tiJ4R
L',Q WTA CIA 92253
LAQUWA CA 92253
('760)-1C -4W4 CDU 2261
USE OF PERMIT
S'.iNG1:,E FAMU_Y DMfflLDNG
S'b D - F1$Id.A.t IT I)OF-I 'MOT INC;L.UDLP NL OC r WALL, ,PWI, OR L'3 -.RN' X@y'A"
d5,k''1'Fd.�J.r�.CI�. Ati° .A4�`3`i'L<;F t'•i..rtiZ~i 2�f°.)4�S
TRACT CONSUUC11014 1,485.0101 3F
PORCHIPA` IO 36.00 9i+
0AIiniC4FKARPORT (OF) �,Rn,40
a Ff''. WOODCIE 204.00 LF
E;L Wgm COW, C71+` (110.N'911RTJC."TXUq
FF X 101-000-4418-000. �640.A0
PL.Ax'4 CLIVI( K FEE 101-000-439.318 I'7
MECHANICAL FEE 101-000.421.000
RUXTRIC AL FFR 101-000-420-0.00 8.i 23.56
P1,11MBING F' !3F 101-000-419-000 -000 $I 10.75
;:C►1�Cti ASC ►3 iG3�L - I�.a;7i> i 1 ff 9 -a%0-241-Tfr0 $9.37
Qp_Qlwo B709 101 -000• -4.23 -OW 520.10
OLIVELOPER IMPACT F7I, $1,90=7.40
F&ECISEPy'lu+4rf �J,01^•O:iO b3.34 I.t14.Op
FEZ T)1r:1>t SIT 101-000-4 39-318 •Sa��.4;D
a
L
f_%1y
SUB- t`C' TAL Cop1f'C11:umlCw ANIG, ::7rl�.tlA'A�I(
$3�d,441,21
�Cq`.�7'y�.,Jt
qq� ��
o
1VIAL ho 4 M.T.r FEES DUE NOW
i
e
z
m
RECEIPT t
DATE J
BY
D E F NAALEDO
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
_
Exhaust Fans
O.K.to Wrap
_ _
_
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
/
�J
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
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
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
Final
Utility Notice (Perm)
GI
P.O. BOX 1504 APPLICATION ONLY
Building`�\ 78-495 CALTAMPICO
Address \'4AQUINTA,CALIFORNIA92
253
owner \\
Mailing
Address
City JTel.
Contractor \
Address
� c 1 . Q, _ 72,CA `1
State Lic.
� ( City
8 Classif.,L -1 –1 G� ' Lic. #
Arch., Engr.,
Designer
Address Tel.
City— I Zip _ I State I
Lic. #
LICENSED CONTRACTOR'S7DECLAR�ATTON
that I am licensed'0"rldey pr¢tiisiops of Chapter 9 (commencing with Section
OWNER•BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the following
reason: (Sec. T03 5.Business' and Professions Code: Any city or county which requires a
onsfruc
permit to cf, Iter.,oriTrove, demolish, or repair arty structure, prior to 41s, 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
orimprovement 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.)
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 contractor(s) licensed pursuant to the Contractor's License Law.)
17) 1 am exempt under Sec. B. 8 P.C. for this reason
y
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 #1'
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 (E100) 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' 11, alter 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 aQplicant Date
Mailing Address
City, State,.Zip
BUILDING: TY/PE'C}O%NST. OCC. GRP.
A.P. Number 041, – ,:Z, � r 0'1 V
Legal Description�-
Project Description • \ 1 w.` a.–.
Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.g'
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
No. No. Dw. `
Stories Units `
Alter ❑ Repair ❑ Demolition ❑
k 1
i l F 1 �. •,�,,r,
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 YELLOW = APPLICANT PINK = BUILDING DIVISION
-S"7bo
SALE ESCROW INSTRUCTIONS
THIS DOCUMENT.WILL AFFE CT YOUR LEGAL RIGHTS - READ IT CAREFULLY!
TO: COMMONWEALTH LAND TITLE COMPANY . Escrow No.: 10713KY
72855 Fred Waring Dr. Date: 02/05/01
SuitPalm AS Desert, 9G®
Desert, CA 92260 �� Page: 1
(760) 836-3726��
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.......... $ 32,000.00
TOTAL CONSIDERATION $ 32,000.00
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 March 5, 2001, and when CHICAGO TITLE COMPANY
can issue a Standard Policy of Title Insurance Owners form, with liability of $32,000..00, on
real property in City of La Qunita, County of Riverside, State of California viz:
Commonly known as: APN 646-311-030 Vacant, La Qunita, California 92253
Lot 30, Un.it-No. 1— Tract Desert Club Manor, as per map recorded in Book 22, Page(s) 53
inclusive inclusive of Miscellaneous Maps, in the office of the County Recorder of said
county.Desert Club Manor
Except any reservations of record of minerals, oil, gas, water, carbons and 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.
Notice:
Document Cannot Be Duplicated
Date 3/1/01
No. 21723
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Owner NameCoronel Construction
No. 78-710 Street Bottlebrush
City La Quinta
APN # 646-311-030
Jurisdiction La Quinta
Permit #
Log #
Zip 92253 Study Area
Tract # Lot # Square Footage 1485
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
2.05 X 1,485 or $ 3,044.25 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 y
Fees Paid By CCNalley Independent Bank - Ismael Telep►_ioale 564-4604
Name on the check s
By Dr. Doris Wilson R
Superintendent
Fee collected /exempted by Ellen Patino Payment Received $3,044.25
1_ Check No. 235315
Signature
40TICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment Identified
tbove 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 Distriet('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
Certificate of,Occupancy
City of La Quinta
Building and Safety Department
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:
Use Classification: SFD
Occupancy Group: R 3
78-710 BOTTLEBRUSH
Type of Construction:
Owner of Building: CORONEL CONSTRUCTION
�•f--d'L"t,
Building Official
Bldg. Permit No.: 0102-225
Land Use Zone: RM
Address: 78-150 CALLE TAMPICO #230
City: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 06-27-01
POST IN A CONSPICUOUS PLACE