9601-158 (SFD)LICENSED CONTRACTOR DECLARATION `%
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professiofiaris Code, and my
License is in full force and effect. 634.081 /
13 � / / I V-1119
License #Lic. Class/ !, (p/,D
Date --- nature ofC;,ontractop �' 1
OWNER -BUILDER DECLARATION
I hereby affirm 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'
compensatiori, a4 provided for by Section 3700 of the Labor Code, for the
performance 6f tthe:work for which this permit is issued.
() I have 6n, 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 `>'i'A114'E'UND Policy No. 546545
(This section need not be completed if the permit valuation is for $100.00 or less).
(') I CBftify Met lh me pef10FMdne6 oT Me worK Tor Wnlen INS permh is issued,
I shall not employ any person in any manner so as toA$0ome subject to the
workers' compensation laws of Califgrnia, and agrr that if Ir should become
subject to the workers' compensation provisj'ons of Section 3700 of the Labor
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.
r -
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 application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, 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, andVStilelaws relating to the building
construction, and hereby authorize representatives of this City to enter upon the
above-mentioned property j inspection purposes:
i
Signature (Owner/Agent) I /r' ,(% % -r / J J/ Date'
ALC>t
^{ "'
-BUILDING PERMITPERM'T1_'
DATE "
VALUATION w*y`+ =p7 v.r9 J LOT C° TRACT
08's"ADDRESS � Jif%-7��> :i+t
AIiC)ti ,lit e€t�:.
APN 774-032-016
1.
D OWNER
CONTRACTOR
c OPONR, CONS°I`I?t.TC1710N
7i,`f� f•` {+0 OI IrL
.sY. wF. w �' ,._
Y?�`�J6 A h f�:1�i1bA Xii /A1��-is%iie�A
, S
P.0,
Liv i. uiNrlL CA '92231
I: 0, Qi,.)[N' AC"A 92253
(619Jf,,+4-41604 f'i3Li€ .t�eji
(619).564-4004
DESIGNER/ENGINEER
,j
USE OF PERMI7iliVi.)L,N t'1' Afli, ,. hL...APJ'.j
SM Pel"J1'tlt tkwq not illi) ide b.t mk v !s or prc4, Parthhit, Yndittfes 200 11 prfi' hio, Wow cbnce.
FEE DESCRIPTION
FEES
'A ftrlt,"a l;GN1Iiti.lt: l'Ia,aTv .1,'��I.UU SI;, '
PDX("PATIO 42.00 SF
0ARAC1%C;ARPORT 504,00 Sri i
ti F1. WOOD ''M, "NC1; 20000 1.F i.
1
ht
A.
E'.�7i'lfMA.11''M CM OF d:OiV'STRUd:`IJONPEUMTFEESUAIMARY
MAN CftMe. FRE S480.79
CONSTRUCTION rte' .101-000-418-000 $563.00 '
1t4E?CEf ANLC.A1. Cly 351,50
�.
101-(WO.420.000 $118.734
A UMMING FEE 10:1-000-419-000 �. $140.75
� ?,
^
S9:ONG NIO`.1'iON FEE - R2~SH) 101-000-241-000 SUM
1'
GRA0114C� FL ��1�C1�t}-4�a-0b0
W1CAS"kRUC:TiIIM,13 225-1()0-443-M! S1.79f3.2
i
PitI M1 PLAN t01-000-441-345
FEE DEPOSIT 4 50.00
i
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
T
$3,208.31
LESS, .PRE. -PAID FIE39S
-$250.0()
TOTAL PERI IT 'FEES DUE NOW
$2,952.31
FEB 12 7996
` ;• e c
RECEIPJ. By
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
5All
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
2 'S
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
3 / 9
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
(o
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
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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 3 8
Utility Notice (Perm)
COMMENTS:
Desert Sands Unified School District
Notice: - 82-879 Highway 111
Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
CERTIFICATE OF COMPLIANCE
Date 2/7/96 ApN #
No. 14122 Jurisdiction La Quinta
Owner Name Zeke Coronel
No. 53195 Street Avenida Juarez
City La Quinta. zip 92253
774-032-016
Permit #
Log #
Study Area 111
Tract # Lot # Square Footage 1290
Type of Development Single Family Residence
Comments
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 1.72 x 1,290 or $2,218.80
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. ; 1, n. Ii
Fees Paid By Coronel Construction ;''Telephone 564-4604
Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $2,218.80
Check No. 1122
Signature 6 ,
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
RECORDING REQUESTED BY
ChIe-alac,
AND WHEN RECORDED MAIL THIS DEED AND. UNLESS OTHERWISE
SHOWN BELOW. MAIL TAX STATEMENT TO:
name Esequiel Coronel
Street P.O. Bpx 1238
Address La Quinta, CA. 92253
city 8
State
Zip
585702 15708
Title Order No. Escrow No.
PAID
Dm. Transfer Tax
FT-ANK K. JOHNSON
r.
Recorder
3(97677
RECEIVED FOR RECORD
AT 2:00 O'CLOCK
NOV 2 0 1995
Recorded In Metal Records
ACaGbmia j
Recorder (�/r,J/
Foos $
T 355 Legal (2.94) -)) Lf SPACE ABOVE THIS LINE FOR RECORDER'S USE
rR-� OAU -C/5 Grant Deed
THE UNDERSIGNED GRANTOR(s) DECLARE(s) 22 00
DOCUMENTARY TRANSFER T�?C IS $
❑ unincoroorated area [_? City of La quinla
Parcel No. 774-032-016-0
91 computed on full value of interest or property conveyed, or
❑ computed on full value less value of liens or encumbrances remaining at time of sale, and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
HENRY C. GRISWOLD, A WIDOWER
hereby GRANT(S) to
ESEQUIEL CORONEL, A SINGLE MAN
the following described real property in the City of La Quinta
county of Riverside , state of California:
LOT 8 OF BLOCK 179 OF SANTA CARMELITA AT VALE LA QUINTA,.UNIT 18 AS PER
MAP RECORDED IN BOOK 19, PAGES 30-31 OF MAPS, RECORDS OF RIVERSIDE
COUNTY, CALIFORNIA
Dated
August 17, 1995
STATE OF CALIFORNIA
COUNTY OF
On
_ f S.S.
before me,
a Notary Public in and AW
-County and ate, personally appeared
personally know me (or pro to me on the basis of satisfactory
evidence)�Zr
e persons hose name(s) is/are subscribed to the
within inswledged to me that helsheAhey executed
the samehorized celpacity(i�), and that by hlsRtedtheir
signaturesens the person(s), or the entity upon behalf
of which thed, executed the instrument.
WITNESSfficial seal
Signature (This area for official notarial goad)
MAIL TAX STATEMENTS TO PARTY SHOWN ON FOLLOWING LINE: EF NO PARTY SHOWN. MAIL. AS DIRECTED ABOVE
Name Street Address city k State
t x'=
OFFICE OF THE
" CALVIN C, KAMINSKAS
AGRICULTURAL COMMISSIONER Assistant Com n*sloner
P.O. BOX 1089
°'+�,,,,, ,�,.•"�� PIVERSIDE'CA 92502-1089 DAN AILEY
JAMES O. WALLACE PHONE (909) 275-3000 Sealer, Welghts & Measures
Agricultural Commissioner FAX (909) 2753012 (904) 276.3030
Director of Welghts & Measures FAX (909) 2764728
83-612 Avenue 45 Suite 7
Indio, CA 92201 =4 `?
(619)863-8291
DATE I — l — 9 6 CASE NO.
j
DEVELOPER'S NAME: � ?
ADDRESS: S/ S/ >�.�.�i+•^�� Ia^ ; ..
TELEPHONE:
Dear Developer:
N
After reviewing "your landscaping plans, all plant material listed his not in
violation of .quarantine laws governing the Coachella Valley. If substitutions
do occur and they differ from plant material listed, this office; must be
notified immediately.
Thank you for protecting and preserving the Coachella Valley's pest -free
environment. j
i
Agricultural Commissioner' 's Office
cc: Indio and Riverside
, ilt~i4b Akg
art
of
OTY'l-k.- •
u
Tip of Ed (Quium
is
This Certificate issued pursuant to the requirements of Section 306 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 53-195 Avenida Juarez
Use Classification Single Family Dwelling Bldg. Permit No. 9601-158
Group R-3 Type Construction VN fire Zone Use Zone SR
Owner of Building Zeke Coronet Address P.O. Box 389
City La Quinta CA., 92253By Daniel P..Crawford Jr.
`••NJj��lil � ;• ~�^'.:
Date March. 27 1996
Building Official
POST IN A CONSTICUOUS PLACE